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A. Oton
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MINI 28 - Psychological Impact of Lung Cancer and its Treatment (ID 150)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Palliative and Supportive Care
- Presentations: 13
- Moderators:A. Oton
- Coordinates: 9/09/2015, 16:45 - 18:15, 102+104+106
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MINI28.01 - The Impact of Physical Activity on Fatigue and Quality of Life in Lung Cancer Patients: A Randomized Controlled Trial (RCT) (ID 3173)
16:45 - 16:50 | Author(s): J. Vardy, M.L. Bell, H.P. Van Der Ploeg, J. Turner, M. Kabourakis, L. Spencer, C. Lewis, R. Hui, P. Blinman, S. Clarke, M. Boyer, H. Dhillon
- Abstract
- Presentation
Background:
Physical activity (PA) has been shown to improve fatigue and quality of life (QOL) in a range of cancer populations. Little research has been done in the advanced lung cancer setting. This RCT evaluated a 2-month PA intervention in patients with unresectable lung cancer.
Methods:
Participants were stratified (disease stage, performance status [PS] 0-1 vs 2, centre) and randomized (1:1) to usual care (UC) (general nutrition and PA education materials) or UC plus 2-month program of supervised weekly PA and behaviour change sessions and home-based PA. Assessments were completed at baseline, 2, 4 and 6 months. The primary endpoint was fatigue (FACT-F subscale) at 2-months. Secondary endpoints included: QOL, functional abilities, physical fitness, activity (accelerometers), mood, dyspnea, survival and blood results. Intention-to-treat analysis using linear mixed models was done.
Results:
111 patients were randomized: male 55%, median age 62 (35-80); 95% NSCLC, 5% SCLC; 95% Stage IV. At baseline 77% were on active treatment. Baseline characteristics, including PA levels, comorbidities and Glasgow Prognostic Score (GPS) were well balanced between groups. Attrition was 22, 36 and 50% at 2, 4 and 6 months respectively; no difference between groups. Adherence to intervention sessions: behavioral 77%, PA 69%. There were no significant differences in fatigue, QOL, symptoms, mood, distress, sleep, dyspnea, activities of daily living, GPS between the groups at 2, 4 or 6 months. Patients over report PA levels compared to accelerometer data. Using accelerometer data, PA only increased in the PA group from 0 – 2 months, but the difference in PA between groups was not significant. Median survival (months): PA 13.7 vs UC 12.6 (p= 0.76): 38 participants remain alive.PA n=55 UC n=56 p-value FACT-F Fatigue: 0 2 4 6 38.4 37.5 39.6 36.6 36.3 36.3 35.4 34.5 0.61 0.10 0.44 EORTC Global QOL 0 2 4 6 63.8 63.2 64.2 60.8 58.9 64.3 60.2 54.2 0.81 0.45 0.26 Performance Status 0 2 4 6 0.8 0.8 0.8 0.7 0.9 1.0 1.0 1.2 0.30 0.16 0.01
Conclusion:
Adherence to the 8-week intervention was good but did not increase PA levels compared to education materials alone. No difference was seen in fatigue, QOL, symptom control or functional status.
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MINI28.02 - Utilization of Survivorship Care Plans and Analysis of Patient Reported Outcomes in Multinational Lung Cancer Patients (ID 2269)
16:50 - 16:55 | Author(s): A.T. Berman, C. Decesaris, C.B. Simone, C. Vachani, M. Hampsire, J.M. Metz, C. Hill-Kayser
- Abstract
- Presentation
Background:
Lung cancer is the leading cause of cancer death in the United States and is also a significant source of morbidity. Patient-reported outcomes (PROs) are prognostic for survival. Herein we report our analysis of emerging patterns of longitudinal PROs collected in the development of survivorship care plans (SCPs) using an anonymous web-based program.
Methods:
OncoLife and the LIVESTRONG Care Plan are web-based programs that generate unique SCPs and are accessed via OncoLink (www.oncolink.org), the world’s first cancer website. We selected all consecutive patients identifying as primary lung cancer survivors creating SCPs. Patient-reported demographics, treatment and toxicity were examined. For toxicity data, questions with > 10 “yes” responses were included, and were categorized into: cardiovascular; genitourinary; neurocognitive; endocrine; speaking, breathing, swallowing (SBS); thoracic; and musculoskeletal/dermatologic symptoms. Research was conducted under an IRB-approved protocol.
Results:
Overall, 689 plans were created for users self-identifying as primary lung cancer survivors. Average time from diagnosis to reporting was 1.68 years (0-24). Most were Caucasian (85.9%), well-educated (67.3% > “some college”), and lived in a suburban area (45.6%) and the United States (91%). Table 1 shows treatment modalities . Neurocognitive symptoms (e.g. fatigue and cognitive changes) were most common (48.8%), followed by musculoskeletal/dermatologic (14.1%), and thoracic (13.5%). Figure 1 shows symptoms analyzed by treatment. Only 11.2% were initially offered a SCP, and of those, 54.5% were offered by their healthcare provider, most often at a non-university-based cancer center (66.2%).
Figure 1TREATMENT N (689 total) % Any Surgery 375 54.4 Any Chemotherapy 522 75.8 Any Radiation 377 54.7 Surgery Alone 98 14.2 Surgery + Chemotherapy 119 17.3 Surgery + Radiation 15 2.2 Surgery + Chemotherapy + Radiation 143 20.8 Chemotherapy Alone 70 10.2 Chemotherapy + Radiation 190 27.9 Radiation Alone 29 4.2 Not Specified 25 3.6
Conclusion:
For lung cancer patients worldwide, it is feasible to obtain PROs and create SCPs through a web-based program. As lung cancer survivors live longer, further attention should be paid to PROs, and our data indicates that, surprisingly, the most common symptoms to address are neurocognitive. As very few patients were offered SCPs, increased effort should be made to provide SCPs, particularly in urban and university cancer center settings. This study was funded in part by the LIVESTRONG Foundation.
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MINI28.03 - Causes of Death and Hospitalization in Long-Term Lung Cancer Survivors: A Population-Based Appraisal (ID 740)
16:55 - 17:00 | Author(s): G.X. Wu, P.H.G. Ituarte, B. Ferrell, V. Sun, D.J. Raz, J.Y. Kim
- Abstract
- Presentation
Background:
Survivorship care has emerged as an important topic in lung cancer due to advances in screening and treatment that have led to prolonged survival. These survivors may have pre-existing comorbidities or health impairments from their treatments that impact quality of life. A better understanding of the healthcare needs of lung cancer survivors will assist in the development of patient-centered, comprehensive survivorship care. We used a population dataset to assess the most common reasons for hospital admission and causes of death among long term (5-year) survivors of lung cancer.
Methods:
Using linked data from the California Cancer Registry and Office of Statewide Health Planning and Development database, we identified all in-state lung cancer patients diagnosed from 2000-2009. Patients of all stages were included. We used ICD-9 codes to identify causes of death and primary admission diagnoses in survivors after 5 years of lung cancer diagnosis. Annual proportional distribution of reasons for admission and causes of death for survivors were calculated over time.
Results:
Among 157,236 lung cancer patients, 80.6% (n=126,775) died within 5 years of diagnosis. Although lung cancer accounted for the majority of hospital admissions in the initial years post-diagnosis, nonmalignant pulmonary disease, (n=7,102, 23.3%) replaced lung cancer progression (n=2,047, 6.7%) as the most common principal diagnosis in 30,461 admissions among 9,166 survivors who were admitted after 5 years from initial lung cancer diagnosis (Figure 1A). Cardiovascular (n=5,712, 18.8%), gastrointestinal (n=2,901, 9.5%), and infectious diseases (n=2,819, 9.3%) also surpassed lung cancer progression as reasons for admission after 5 years of survival. However, lung cancer progression remained the leading cause of death in long-term lung cancer survivors (Figure 1B). Among 5-year survivors, 46.2% (n= 2,855) eventually died from lung cancer progression. The next most common causes of death were cardiovascular disease (n=947, 15.3%), nonmalignant pulmonary disease (n=776, 12.6%), and secondary malignancy (n=605, 9.8%). Figure 1
Conclusion:
Most lung cancer patients died within 5 years of diagnosis. Among remaining survivors, cardiovascular, pulmonary, and gastrointestinal diseases rather than lung cancer were the primary reasons for hospital admission 5 years after diagnosis. However, lung cancer progression remained the dominant cause of patient death even beyond 5 years of survival. Cardiopulmonary disease and other malignancies were secondary competitors for mortality. Active control of chronic cardiopulmonary disease in addition to lung cancer surveillance should be priorities in long-term lung cancer survivors.
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MINI28.04 - Discussant for MINI28.01, MINI28.02, MINI28.03 (ID 3382)
17:00 - 17:10 | Author(s): B. Slotman
- Abstract
- Presentation
Abstract not provided
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MINI28.05 - Depression and Anxiety in Lung Cancer Patients: The Unmet Need for Recognition and Early Detection (ID 2407)
17:10 - 17:15 | Author(s): T. Kovacevic, B. Zaric, J. Stanic, B. Perin, D. Bokan
- Abstract
- Presentation
Background:
Anxiety and depression are present in significant number of patients with lung cancer. Aims of this trial were to examine the frequency of depression and anxiety in lung cancer (LC) patients and to investigate relations between clinico-pathological characteristics (CPC) and depression and anxiety disorders.
Methods:
This prospective observational trial was conducted at Institute for Pulmonary Diseases of Vojvodina, Serbia. Two hundred and eight LC patients at various stages of disease and treatment rated themselves on the Hospital Anxiety and Depression Scale (HADS). Investigated CPC among other were Eastern Cooperative Oncology Group Performance Status (ECOG PS), tumor type and tobacco abuse. In order to correlate the data univariate and multivariate analysis was performed.
Results:
Of total 208 enrolled patients 76% (158) were males and 24% (50) females. Majority of patients were with ECOG PS 1 75% (156), smokers (58.7%), in stage III and IV (42.3% each) LC. Most frequent LC type was adenocarcinoma 46.6% (97) while squamous, small-cell and other types were confirmed in 38% (79), 13.5% (28) and 1.9% (4) respectively. Patients with brain metastasis and known depression and/or anxiety disorder before LC diagnosis were excluded from the trial. HADS-defined depression and/or anxiety were identified in 39.5% (82) patients. Frequency of anxiety was 22.6% (47) and of depression 36.1% (75). Both depression and anxiety severity were ranged from mild to severe. Combined depression with anxiety was identified in 19.2% (40) patients. We identified significant relation (p=0.003) between ECOG PS and anxiety. There is positive correlation between depression and ECOG PS (p=0.007). When depression and anxiety are present as combined disorders severity of each anxiety and depression are significantly higher (p<0.0001).MALE FEMALE N (%) 158(76%) 50(24%) ECOG PS 0 32(20.3%) 7(14%) 1 115(72.8%) 41(82%) 2 10(6.3%) 1(2%) 3 1(0.6%) 1(2%) SMOKING Never 16(10.1%) 11(22%) Ex smoker 46(29.1%) 13(26%) Smoker 96(60.8%) 26(52%) PCKY Ex smoker 50,7 37,7 (mean) Smoker 40,9 37,2 TUMOR TYPE Adenocarcinoma 68(43%) 29(58%) Squamouse carcinoma 65(41.1%) 14(28%) Small-cell carcinoma 22(13.9%) 6(12%) Other 3(1.9%) 1(2%) STAGE I 14(8.9%) 2(4%) II 14(8.9) 2(4%) III 63(39.9%) 25(50%) IV 67(42.4%) 21(42%) DEPRESSION 59(37.3%) 16(32%) ANXIETY 37(23.4%) 10(20%) SEVERITY OF DEPRESSION Mild 34(21.5%) 8(16%) Moderate 20(12.7%) 8(16%) Severe 5(3.2%) - SEVERITY OF ANXIETY Mild 22(13.9%) 5(10%) Moderate 10(6.3%) 3(6%) Severe 5(3.2%) 2(4%)
Conclusion:
Anxiety and depression are diagnosed in significant number of lung cancer patients. Presence of these disorders can significantly influence quality of life of lung cancer patients. The results of this trial suggest that screening on depression and anxiety should be performed at any stage of disease course. Early recognition, detection and therapy can help in better control of depression and anxiety with aim to increase patients quality of life.
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MINI28.06 - Patterns of Palliative and Psychosocial Care in Stage IV NSCLC in South Western Sydney (ID 118)
17:15 - 17:20 | Author(s): K.J. Duggan, J. Wiltshire, R. Strutt, M. Boxer, A. Berthelsen, J. Descallar, S.K. Vinod
- Abstract
- Presentation
Background:
South West Sydney (SWS) is a region of greater ethnic diversity and poorer socioeconomic status than the Australian average. Over half of all patients with Non-Small Cell Lung Cancer (NSCLC) in SWS present with metastatic disease. The primary goals of management are palliation of symptoms and maintenance of quality of life. Patients need adequate access to specialist palliative care (PC) and psychosocial care (PSC) in order to achieve these goals. The aims of this study were to evaluate referrals to PC and PSC services in SWS residents with Stage IV NSCLC and identify factors associated with utilisation of these services.
Methods:
SWS residents diagnosed with Stage IV NSCLC between January 2006 and December 2012 were identified from the SWS Local Health District Clinical Cancer Registry. Supplementary information was sourced from oncology and hospital electronic medical records and palliative care databases. Modified Poisson regression was used to analyse significant factors associated with referrals to PC and PSC. Cox regression was used for multivariate survival analysis.
Results:
A total of 923 patients were identified. The median age was 69 years, 63% were male and 54% were born overseas. Active treatment was received by 65% of patients with 34% receiving chemotherapy and 65% receiving radiotherapy. Eighty-three percent of patients were referred to PC, with 67% occurring within 8 weeks of diagnosis. Eighty-two percent of patients were referred to PSC, with referrals to social workers being most frequent (76%) followed by specialist nursing (26%) and psychology/psychiatry (16%). On multivariate analysis, radiotherapy treatment, M1b disease and residential location were associated with PC referrals, and radiotherapy treatment, PC referral and residential location were associated with PSC referrals. Age, language spoken, country of birth, socioeconomic status, year of diagnosis and multidisciplinary team discussion were not significant factors in referral to either service. The median overall survival was 4.3 months and one year survival was 19%. On multivariate analysis, factors associated with improved survival were active treatment, chemotherapy and multidisciplinary team discussion.
Conclusion:
Rates of referral to PC and PSC services were high in this cohort suggesting good access to care. Greater referrals were particularly associated with patients undergoing radiotherapy. There were no sociodemographic barriers to referral. Some geographic differences were noted in referrals to both services. Further investigation into referral gaps will guide service delivery to improve quality of life and care for future patients.
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MINI28.07 - Interdisciplinary Palliative Care for Lung Cancer Patients and Family Caregivers (ID 379)
17:20 - 17:25 | Author(s): M. Koczywas, V. Sun, A. Hurria, M. Cristea, D.J. Raz, J.Y. Kim, K. Reckamp, F. Zachariah, A.C. Williams, T. Borneman, R. Fujinami, C. Del Ferraro, G. Uman, B. Ferrell
- Abstract
- Presentation
Background:
Palliative care is focused on supporting the best possible quality of life (QOL) for patients and family caregivers (FCGs) coping with serious and complex illnesses such as lung cancer. Although the accepted definition of palliative care encompasses the entire trajectory of the cancer continuum from diagnosis to the end of life, the majority of published palliative care trials focused primarily on patients with metastatic disease. The purpose of this National Cancer Institute-supported Program Project (P01) was to test the effect of a concurrent, interdisciplinary palliative care intervention in patients with Stage I-IV non-small cell lung cancer (NSCLC) and FCGs in an ambulatory care setting, comparing the usual care and intervention groups.
Methods:
Patients undergoing treatments for NSCLC and their FCGs were enrolled in a prospective, sequential design whereby the usual care group was accrued first followed by the intervention group. Patients and FCGs in the intervention group completed a comprehensive QOL assessment at baseline, and were presented by nurses at weekly interdisciplinary care meetings. They also received four educational sessions that addressed physical, psychological, social, and spiritual well-being needs. Patients and FCGs in the usual care group received disease-focused therapies and procedures and were referred by their treating oncologist to palliative care services as needed per standard of care. Patients’ QOL, symptoms, and psychological distress were assessed at baseline and 12 weeks using validated measures which included the FACT-L, FACIT-Sp-12, LCS, and the Distress Thermometer. FCG outcomes included QOL, psychological distress, perceived burden, and caregiving preparedness, with validated measures that included the COH-QOL-FCG, Distress Thermometer, Caregiver Burden Scale, and Caregiver Skills Preparedness Tool. Outcomes were tested using factorial ANOVAs controlling for baseline scores, with disease stage as a blocking variable and group (usual care versus intervention) as the factor.
Results:
A total of 491 patients (219 = usual care; 272 = intervention) and 354 FCGs (157 = usual care; 197 = intervention) who completed baseline assessments were included in the primary analysis. Patients who received the intervention had significantly better scores for QOL (109.1 vs. 101.4; p<.001), symptoms (25.8 vs. 23.9; p<.001) spiritual well-being (38.1 vs. 36.2; p=.001), lower psychological distress (2.2 vs. 3.3; p<.001), and more advance care planning (44% versus 9%; p<.001) at 12 weeks compared to patients in the usual care group. FCGs in the intervention group had significantly better scores for social well-being (5.84 vs. 6.86; p<.001) and lower psychological distress (4.61 vs. 4.20; p=.010) at 12 weeks compared to FCGs in the usual care group. Survival analysis for stage IV patients using the Kaplan-Meier approach did not achieve statistical significance but showed a 6 month difference in favor of the intervention group. t included the COH-QOL-FCG, Distress Thermometer, Caregiver Burden Scale, and Caregiver Skills Preparedness Tool. Outcomes were tested using factorial ANOVAs controlling for baseline scores, with disease stage as a blocking variable and group (usual care versus intervention) as the factor.
Conclusion:
Interdisciplinary palliative care in the ambulatory care setting resulted in significant improvements in QOL, symptoms, and psychological distress for NSCLC patients and FCGs.
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MINI28.08 - Discussant for MINI28.05, MINI28.06, MINI28.07 (ID 3551)
17:25 - 17:35 | Author(s): J. Youngwerth
- Abstract
- Presentation
Abstract not provided
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MINI28.09 - Can WBRT Be Omitted in NSCLC Patients with Inoperable Brain Metastases? Results from the UK MRC QUARTZ Randomised Clinical Trial (ID 2914)
17:35 - 17:40 | Author(s): P. Mulvenna, M. Nankivell, C. Faivre-Finn, R. Barton, P. Wilson, D. Ardron, E. McColl, B. Moore, I. Brisbane, B. Sydes, R. Stephens, M. Parmar, R. Langley
- Abstract
- Presentation
Background:
Brain metastases affect up to 40% of patients with non-small cell lung cancer (NSCLC), and for patients not suitable for surgical resection or stereotactic radiosurgery, whole brain radiotherapy (WBRT) and dexamethasone is standard treatment. However there are no randomised clinical trials showing whether WBRT improves either quality of life (QoL) or survival.
Methods:
A phase III randomised non-inferiority trial with a primary outcome measure of quality adjusted life years (QALYs). Patients with brain metastases from NSCLC who were not suitable for resection or stereotactic radiotherapy, irrespective of any other clinical characteristics, were randomly allocated to either optimal supportive care, including dexamethasone, plus WBRT 20 Gy/5f (OSC+WBRT) or OSC alone. QALYs were generated from overall survival and patients’ weekly completion of the EQ-5D questionnaire. OSC alone was considered non-inferior if not greater than 7 QALY days worse than OSC+WBRT (80% power and a one sided significance level of 5% requiring 534 patients). Secondary outcome measures include sub-group analyses to identify/validate predictive classifications.
Results:
From 2007-2014 538 patients were recruited from 69 UK and 3 Australian centres. Summary trial information is presented in table 1, with baseline characteristics well balanced between trial arms. Median survival was 65 days (OSC+WBRT) vs 57 days (OSC), hazard ratio 1.05 (95% CI 0.89 – 1.26). The mean QALY was 43.3 days (OSC+WBRT) vs 41.4 days (OSC), difference -1.9 days (90% CI -9.1 – +6.6). More OSC patients received additional anti-cancer treatment (39% vs 25%, p-value=0.0004), particularly radiotherapy (22% vs 13%, p-value=0.0067), with palliative thoracic irradiation in the two weeks following randomisation accounting for most of the difference. At 4 weeks post-randomisation, 36% of patients in each arm were alive with maintained or improved QoL compared to baseline. This fell to 17% in each arm at 8 weeks. The most commonly reported problems at 4 weeks concerned mobility (73% WBRT vs 79% OSC) and the ability to perform usual activities (68% vs 67%). Table 1. Summary of main trial dataOSC+WBRT (N=269) OSC (N=269) Sex Male 157 (58%) 157 (58%) Age Median 66 67 IQR 60 – 72 62 – 72 Range 38 – 84 45 – 85 KPS <70 101 (38%) 102 (38%) ≥70 168 (62%) 167 (62%) Extra-cranial mets No 122 (45%) 124 (46%) Number of brain mets Solitary 80 (30%) 82 (30%) Time since brain mets diagnosis <= 4 weeks 165 (61%) 153 (57%) > 4 weeks 104 (39%) 116 (43%) Median (days) 23 26 Range (days) 2 – 235 0 – 196 Survival (weeks) Deaths 260 262 One-year (95% CI) 2.6% (1.1%, 5.1%) 2.7% (1.2%, 5.3%)
Conclusion:
This is the only large randomised trial evaluating the utility of WBRT in this disease. Although the results include the pre-specified non-inferiority margin, the estimate of the difference in QALYs suggests WBRT provides no additional clinically significant benefit for this group of patients. Additionally there were no significant differences in overall survival or quality of life. .
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MINI28.10 - C-Type Natriuretic Peptide Attenuates Bleomycin-Induced Fibrosis and Inflammation in Murine Lung (ID 471)
17:40 - 17:45 | Author(s): T. Kimura, T. Nojiri, H. Hosoda, Y. Shintani, M. Inoue, M. Miyazato, M. Okumura, K. Kangawa
- Abstract
- Presentation
Background:
Interstitial lung diseases (ILDs) are sometimes seen in patients with primary lung cancer. Therapeutic interventions for lung cancer patients with ILDs occasionally induce acute exacerbation (AE), which is a potentially fatal complication. However, no prophylactic treatments have been established. Although the etiology of ILD-related AE is unknown, management of the ILD disease process, including fibrotic changes and inflammatory reactions, is thought to lead to the prophylaxis of AE. C-type natriuretic peptide (CNP) is a member of the natriuretic peptide family, which includes atrial and brain natriuretic peptides. CNP has cardioprotective effects, such as anti-fibrotic and anti-inflammatory effects, in animal models of myocarditis and myocardial infarction. The objective of the present study was to investigate the anti-fibrotic and anti-inflammatory effects of CNP on bleomycin (BLM)-induced lung injury.
Methods:
C57BL/6 mice were divided into two groups, vehicle- and CNP-treated groups, for evaluation of pulmonary fibrosis and inflammation induced by BLM. CNP (2.5 µg/kg/min) or vehicle were subcutaneously infused using an osmotic mini-pump from 24 h before BLM administration until the mice were euthanized. On 14 days after intratracheal administration of BLM (1 mg/kg), histological changes, collagen content, and mRNA expression of inflammatory cytokines in lungs and bronchoalveolar lavage fluid (BALF) were assessed.
Results:
Continuous infusion of CNP attenuated BLM-induced fibrotic changes. Quantitative histological analysis showed that BLM-induced fibrotic lesions were significantly smaller in CNP treated mice compared to vehicle mice. The collagen content, determined with the hydroxyproline assay, increased in BLM-administered lung and CNP treatment reduced BLM-induced collagen production. CNP treatment tended to improve body weight loss after BLM administration. In BALF, BLM administration augmented the number of inflammatory cells in the vehicle group, which was significantly lower in CNP treated mice. The expression of IL-1β, IL-6, and bFGF mRNA were significantly elevated by BLM administration, and CNP treatment significantly attenuated these increases. Figure 1
Conclusion:
These results indicate that CNP attenuates fibrotic changes, namely the accumulation of inflammatory cells, and the increased expression of inflammatory cytokines in BLM-induced pulmonary fibrosis. CNP may have therapeutic potential in patients with ILD and lead to prophylaxis for AE.
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MINI28.11 - Randomised Study of Acupuncture, Morphine and Combination in NSCLC/Mesothelioma (ID 108)
17:45 - 17:50 | Author(s): M.E.R. O'Brien, A.R. Minchom, R. Punwani, J. Bhosle, K. Nimako, R. Gunapala, S. Popat, J. Filshie
- Abstract
- Presentation
Background:
Dyspnoea is a common symptom of lung cancer. Morphine is widely used to control dyspnoea.
Methods:
We randomised 173 patients with advanced non-small cell lung cancer or mesothelioma with a dyspnoea score ≥ 4 on visual analogue scale (VAS) to one of three arms (acupuncture [A], morphine [M] or combination [AM]). A was delivered to upper sternal, paravertebral, hand and trapezius trigger points. Patients on arm A were given rescue morphine if needed. We recorded VAS dyspnoea and relaxation, lung function tests, respiratory rate, and EORTC QLQ-30/ QLQ-LC13 questionnaires at baseline, 30mins, 90mins, 4 hours, day 2, 7 and 14. Primary endpoint was proportion of patients achieving ≥1.5 improvement in VAS dyspnoea at 4 hours.
Results:
The median age of the study population was 73. 53% were performance status 2-3. The baseline median VAS dyspnoea score was 6.5. All patients scored >7 on HAD depression score. 44.3% scored >10 on HAD anxiety. Dyspnoea improved by ≥1.5 points on the VAS in 74% of patients in arm A, 60% in arm M and 66% in arm AM (A versus M p-value 0.12, AM versus M p-value 0.50). On VAS scales there was improved anxiety, relaxation and tiredness of A over M. Analysis of EORTC questionnaire data showed a mean change from baseline global health % score for arm A of 7.08 compared to -2.08 for arm M (p-value = 0.009). There was a mean change from baseline in dyspnoea % score for arm A of -7.89 compared to -1.05 for arm M (p=0.029, not significant at 1% level). There was no improvement in lung function or respiratory rate. 21% of patients in arm A, 87% in arm M and 87% in arm AM took one of more doses of morphine (p<0.001). 123 patients had toxicity data. All toxicities were CTCAE grade 1/2 and in line with morphine’s toxicity profile, with 8% of patients in arm A, 35% in arm M and 39% of patients in arm AM reporting toxicities. Two patients stopped morphine because of side effects. There were two cases of skin irritation attributable to acupuncture site dressings. Score Changes from BaselineA M AM Mean VAS relaxation (SD) -1.06 (±2.60) 0.19 (±2.43) -1.48 (±2.05) p<0.001 Day 7 median LAR relaxation (range) -1 (-6.7–4.5) 0 (-3.5–4.4) -0.9 (-5.6–4) p=0.006 Day 7 median LAR anxiety (range) 1.5 (-2.5–8) 0 (-4–6.2) 1.2 (-5.4–6.3) p=0.003 Mean LAR tiredness (SD) -0.82 (±2.61) 0.02 (±2.20) -0.94 (±2.37) p=0.002 Mean EORTC global health % (SD) 7.08 (±25.54) -2.08 (±17.70) 2.72 (±16.96) p=0.009 Mean EORTC dyspnoea % (SD) -7.89 (±17.382) -1.05 (±17.704) -6.37 (±17.797) p=0.029 Median dose morphine (range) 32mg (1-60) 53mg (13-163) 40.63mg (3-154) p=0.007
Conclusion:
This study population was of poor performance status. A is as effective as M in the treatment of dyspnoea and has additive value for anxiety, relaxation and global health. Acupuncture is morphine sparing. Acupuncture should be a treatment available to lung cancer patients with dyspnoea and as a morphine adjunct.
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MINI28.12 - A Meta-Analysis of Clinical Trials on the Risk of Hyponatraemia in Cancer Patients Treated with Targeted Therapies (ID 2994)
17:50 - 17:55 | Author(s): R. Berardi, S. Rinaldi, M. Santoni, E. Nunzi, A. Smerilli, M. Caramanti, F. Morgese, M. Torniai, A. Onofri, M. Pistelli, A. Taccaliti, S. Cascinu
- Abstract
- Presentation
Background:
The incidence of hyponatremia in non-small cell lung cancer (NSCLC) varies from 1% to 50%. Early recognition and a prompt treatment of this electrolytic imbalance could prevent clinical complications and improve survival. Hyponatraemia has recently been reported with targeted therapies in cancer patients. Aim of the study was to perform an up-to-date meta-analysis in order to determine the incidence and relative risk (RR) in cancer patients treated with these agents.
Methods:
The published scientific literature regarding hyponatremia in peer-review journals was extensively reviewed using the MEDLINE and Pubmed databases till January 2015. Eligible studies were selected according to PRISMA statement. Summary incidence, RR, and 95% Confidence Intervals were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies.
Results:
A total of 4803 potentially relevant trials were identified: of them, 13 randomized phase III studies were included in this meta-analysis. A total number of 6670 patients treated with 8 distinct targeted agents were available for this analysis: 648 patients had NSCLC and were treated with afatinib or gefitinib (vs. placebo) and vorinostat + chemotherapy (vs. placebo + chemotherapy). The highest incidences of all-grade hyponatraemia were observed with the combination of brivanib and cetuximab (63.4) and pazopanib (31.7), while the lowest incidence was reported by afatinib (1.7). The highest incidence of high-grade hyponatraemia was reported by cetuximab (34.8), whilst the lowest incidences were reported by gefitinib (1.0). Summary RR of developing all-grade and high-grade hyponatraemia with targeted agents was 1.36 and 1.52, respectively. The highest RRs of all-grade and high-grade hyponatraemia were associated with brivanib (6.5 and 5.2, respectively). Grouping by drug category, the RR of high-grade hyponatraemia with angiogenesis inhibitors was 2.69 compared to anti-Epidermal Growth Factor Receptors Tirosine Kinase Inhibitors or monoclonal Antibodies (1.12).
Conclusion:
Treatment with biological therapy in cancer patients is associated with a significant increased risk of hyponatraemia, therefore frequent clinical monitoring should be emphasized when managing these and newer targeted agents.
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MINI28.13 - Discussant for MINI28.09, MINI28.10, MINI28.11, MINI28.12 (ID 3384)
17:55 - 18:05 | Author(s): E. Santos
- Abstract
- Presentation
Abstract not provided
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MS 09 - Worldwide Perspective/Review of Limitations, Resources, Programs and Accomplishments of Supportive Care and Palliative Care Multidisciplinary Teams, by Continent (ID 27)
- Event: WCLC 2015
- Type: Mini Symposium
- Track: Palliative and Supportive Care
- Presentations: 8
- Moderators:R.I. Lopez, A. Oton
- Coordinates: 9/07/2015, 14:15 - 15:45, 108+110+112
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MS09.01 - Nurse's Perspective (ID 1881)
14:20 - 14:30 | Author(s): T. Trabert
- Abstract
- Presentation
Abstract not provided
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MS09.02 - Doctor's Perspective (ID 1882)
14:30 - 14:40 | Author(s): A. Vigano, H. Bhanabhai
- Abstract
- Presentation
Abstract:
Lung cancer is the leading cause of cancer death in Canada, and is associated with the highest levels of distress among all cancers (Canadian Cancer Statistics 2012, Zabora J et al 2001). Over two-thirds of newly diagnosed lung cancer patients are over 65 years of age and have advanced-stage disease. Many of these patients experience malnutrition comprising a combination of starvation (inadequate nutrient intake), sarcopenia (loss of muscle mass associated with loss of strength and or function), and cachexia (presence of systemic inflammation/altered metabolism). These factors are also major determinants of frailty in elderly lung cancer patients (ELCP), and are associated with reduced cancer treatment tolerance and response (Vigano and Morais, 2015). The addition of palliative care consultation initiated in parallel to treatment for lung cancer has been shown to improve both overall lung cancer mortality and patient symptom burden during cancer treatments (Greer et al, 2013). However, there is a paucity of information regarding the peri-diagnostic, pre-treatment phase. Most often, the pre-treatment phase of lung cancer care is defined as a prolonged period (mean = 6 weeks) of fragmented care that is associated with high levels of symptom burden and psychological distress (Dekhuijzen et al, 2014; Iyer et al 2013). The supportive care needs of patients during this period are often inadequately addressed. Thus, the potential for personalized interventions to reduce frailty in ELCP by targeting malnutrition and symptom burden have been largely unexplored during this critical phase. The Rapid Investigation Clinic (RIC) at the McGill University Health Centre (MUHC) currently investigates and stages patients with suspected lung cancer. The clinic operates on a bi-weekly basis and includes dedicated pulmonologists with a particular expertise in lung cancer, a dedicated nurse clinician, and a palliative care consultant. Once staged, patients’findings are discussed at tumor board meetings and are evaluated at the multidisciplinary lung cancer clinic. The mean time from referral to lung cancer treatment is approximately 6 weeks. When patients are identified at the RIC as requiring supportive care they are referred to one of seven interdisciplinary clinic/programs available at the Cancer Care Mission of the MUHC (see figure below). Figure 1 For instance, if a patient presents primarily with signs and symptoms of cachexia or deconditioning, he/she is referred to the Cancer Rehabilitation Program (CRP) and Cachexia Clinic (CC) at the MUHC, which are fully integrated with the MUHC Nutrition and Performance Laboratory (MNUPAL, www.mnupal.mcgill.ca) . MNUPAL is a state-of-the-art facility devoted to nutritional and functional assessment for patients with advanced cancer.. The primary goals of these assessments are: a) to identify presence and severity of cachexia and/or sarcopenia, b) to address reversible causes for these syndromes, such as inadequate symptom control, nutritional and hormonal deficits (i.e. hypogonadism, hypothyroidism etc), and c) to identify personalized interventions (pharmacological, nutritional, and functional) that will be appropriate for patients’ conditions and wishes. The current research at MNUPAL is driving some of the future directions of specific and personalized care, especially in terms of the Cachexia Clinic and the stages of cancer cachexia that will ultimately provide more specific and personalized care for those who are in the various stages of cancer cachexia (Vigano et al, 2012). The CRP and CC teams include a palliative care physician, a nurse clinician, a physiotherapist, an occupational therapist and a nutritionist. If patients present primarily with cancer related pain, they are referred to the Cancer Pain Clinic, whereas patients who have advanced disease and are no longer receiving treatment with a curative intent may be referred to the Palliative Care Clinic. Access to physiotherapy, occupational and nutritional services is available for all clinics which do not include these specialties in their teams.Patients assessed with psychosocial distress from all clinics are referred to the psychosocial oncology program and/or social services. CanSupport services (i.e. reimbursements for parking, transportation etc.) are also available upon request. Screening assessments for both malnutrition and symptom distress are available at the RIC. At the present time, there is ongoing research for using these screening to systematically identify frail elderly cancer patients prior to cancer treatment initiation. There is also a need to objectively determine if interventions targeted to decrease malnutrition and symptom burden will diminish frailty, may improve patient psychological and physiologic “readiness” for what are often aggressive treatments (chemotherapy, radiotherapy or surgery). There is a convincing body of research evidence including case reports (Carli et al., 2012, Carli et al., 2014), pilot studies (Li et al., 2013), and randomized clinical trials (Gillis et al., 2014) that supports geriatric patient engagement in multi-modal, cancer pre-habilitation programs designed to improve physical (physiological) and psychological (anxiety and depression) outcomes during a perioperative time period. We are therefore investigating ways to enhance access to supportive care services for elderly lung cancer patients, which include: Standardized screening for malnutrition and symptom burden. Standardized approaches to symptom control, psychological distress, as well as nutritional and functional problems Identification of specific therapeutic targets and interventions to reduce frailty Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2012. Toronto, ON: Canadian Cancer Society; 2012. Carli F, Brown R, Kennepohl S. Prehabilitation to enhance postoperative recovery for an octogenarian following robotic-assisted hysterectomy with endometrial cancer. Can J Anaesth. 2012 Aug;59(8):779-84. doi: 10.1007/s12630-012-9734-4. Epub 2012 May 26. Carli F, Awasthi R, Gillis C, Kassouf W Optimizing a frail elderly patient for radical cystectomy with a prehabilitation program. Can Urol Assoc J. 2014 Nov;8(11-12):E884-7. doi: 10.5489/cuaj.2025. Dahele, M., R. J. Skipworth, L. Wall, A. Voss, T. Preston and K. C. Fearon (2007). "Objective physical activity and self-reported quality of life in patients receiving palliative chemotherapy." J Pain Symptom Manage 33(6): 676-685. Dekhuijzen PN, Prins JB. Distress in suspected lung cancer patients following rapid and standard diagnostic programs: a prospective observational study. Psycho-oncology. 2014 Sep 9. doi: 10.1002/pon.3660. [Epub ahead of print] Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, Liberman AS, Stein B, Charlebois P, Feldman LS, Carli F. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014 Nov;121(5):937-47. doi: 10.1097/ALN.0000000000000393. Greer JA, Jackson VA, Meier DE, Temel JS. Early integration of palliative care services with standard oncology care for patients with advanced cancer.CA Cancer J Clin. 2013 Sep;63(5):349-63. doi: 10.3322/caac.21192. Epub 2013 Jul 15. Iyer S, Roughley A, Rider A, Taylor-Stokes G. The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study Support Care Cancer. 2014 Jan;22(1):181-7. doi: 10.1007/s00520-013-1959-4. Epub 2013 Sep 12. Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, Kaneva P, Augustin B, Wongyingsinn M, Gamsa A, Kim do J, Vassiliou MC, Feldman LS. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc. 2013 Apr;27(4):1072-82. doi: 10.1007/s00464-012-2560-5. Epub 2012 Oct 9. Vigano A, Morais JA. The elderly patient with cancer: a holistic view. Nutrition. Published on line January 8, 2015. http://dx.doi.org/10.1016/j.nut.2015.01.001 Vigano A, Del Fabbro E, Bruera E, Borod M. The cachexia clinic: from staging to managing nutritional and functional problems in advancer cancer patients. Critical Reviews in Oncogenesis 2012 17(3), 293–304 Zabora J, Brintzenhofeszoc K, Curbow B, Hooker C and Piantadosi S. The prevalence of psychological distress by cancer site. Psycho-oncology 10 : 19–28 (2001)
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MS09.03 - Radiation Oncologist's Perspective (ID 1883)
14:40 - 14:50 | Author(s): J.D. Bradley
- Abstract
- Presentation
Abstract not provided
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MS09.04 - Patient and Caregiver's Perspective (ID 1884)
14:50 - 15:00 | Author(s): R.M. Fink
- Abstract
- Presentation
Abstract:
Palliative care has been shown to improve outcomes for patients with life threatening illness and patients at the end of life, including decreasing symptom burden, improving quality of life, and working with patients and families to help ensure that the medical and nursing care provided is congruent with goals and preferences. Palliative care, focusing on assistance with advance care planning, decision-making, pain and symptom management, psycho-social support, and patient navigation, has the potential to improve care quality and reduce medical service utilization.[1] In a randomized controlled trial (RCT) of a palliative care intervention, Temel and colleagues demonstrated that patients with advanced lung cancer who received early palliative care had better quality of life, less depression, and lived longer.[2] The American Society of Clinical Oncology[3] and other organizations have published position statements supporting the need for oncologists, nurses, and other clinicians to participate in difficult conversations with patients regarding prognosis, preferences, and palliative care options earlier in the course of illness. Patients and their caregivers (family and/or significant others) need to be part of the discussion about care goals at the time of diagnosis, during treatment, and at the time of recurrence. Shared decision-making about end-of-life care must be based on patient/family caregiver beliefs, values, and preferences.[4] Developing rapport with patients and starting the conversation about care goals is often difficult and time-consuming. Often, patients do not understand the difference between palliative care and hospice and may not want to participate in a palliative care program because of their concern that health care providers are “giving up” on them. In a survey of health care professionals, barriers to goals of care discussions with seriously ill hospitalized patients and families include: patients’ and family members’ difficulty accepting a poor prognosis and understanding limitations/complications of life-sustaining treatments, family member disagreement about care goals, and patient incapacity to make care decisions.[5 ] Interventions to improve communication and shared decision making about plans and goals of care are key and must take into account cultural and spiritual preferences. Cultural and linguistic barriers increase disparities in providing palliative care for ethnic minorities. Patient and family cultural values have a major impact on care preferences at the end of life for some ethnic minorities and should be considered by the health care professional. Cultural, spiritual, and religious values often influence how palliative care and pain/symptom management are perceived and accepted. While nationwide averages of completed advance directives are low for all groups, patients of ethnic minority are less likely to have a living will, durable power of attorney, or a Do Not Resuscitate (DNR) order, are more likely to choose very aggressive care in the face of serious or incurable illness, and less likely to acknowledge their terminally ill status.[6] Palliative care and hospice services are rarely accessed by non-Caucasians. In addition, expanding evidence suggests that adequate pain and symptom assessment and management is not achieved for many persons with late stage disease; pain occurs in approximately 80% of patients with life-threatening illness.[7] Solano et al. found breathlessness and fatigue were present in >50% of patients with cancer and COPD.[8] All of these barriers suggest that improving palliative care access may have benefit for patients and their family caregivers. However, tertiary palliative care cannot grow fast enough to meet the demand. Models of care that promote primary palliative care are required in outpatient, community, homecare, and rural settings to maintain the capacity for the ever-growing needs of patients and their family caregivers. Primary care physicians and nurses play important roles in delivering palliative care, and may in fact not have the knowledge and skills to do so effectively. Significant barriers to integrating palliative care include lack of access to palliative care resources to implement change, personnel constraints, inadequate basic knowledge about palliative care strategies and communication, and little training, skills, or certification in palliative care.[11] It is imperative for health care professionals to improve their knowledge about palliative care, support the provision of early palliative care, and establish relationships with patients to understand values and preferences. Dr. Atul Gawande, in his recent book Being Mortal, suggests that patients be asked five key questions to open discussion about care goals.[12] These questions include the following: 1. What is the understanding of your current health and condition? 2. If your condition worsens, what are your goals? 3. What are your fears? 4. Are there any tradeoffs you are willing to make or not? 5. What would a good day be like? Additional suggestions and strategies to improve communication with patients and their family caregivers in the palliative care setting will be discussed in this presentation. 1. Ferris FD, Bruera E, Cherny N, et al. Palliative cancer care a decade later: accomplishments, the need, next steps -- from the American Society of Clinical Oncology. J Clin Oncol 2009;27:3052-8. 2. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733-42. 3. Peppercorn JM, Smith TJ, Helft PR, et al. American society of clinical oncology statement: toward individualized care for patients with advanced cancer. J Clin Oncol 2011;29:755-60. 4. Curtis JR, White DB. Practical guidance for evidence-based ICU family conferences. Chest. 2008;134:835-43. 5. You JJ, Downar J, Fowler RA, et al. Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians. JAMA Intern Med February 2, 2015;epub E1-8. 6. Smith AK, McCarthy EP, Paulk E, et al. Racial and ethnic differences in advance care planning among patients with cancer: impact of terminal illness acknowledgment, religiousness, and treatment preferences. J Clin Oncol 2008;26:4131-7. 7. Kutner JS, Bryant LL, Beaty BL, Fairclough DL. Time course and characteristics of symptom distress and quality of life at the end of life. JPain Symptom Manage 2007;34:227-36. 8. Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Sympt Manage 2006;31:58-69. 9. Fink RM, Oman KS, Youngwerth J, Bryant L. A palliative care needs assessment of rural hospitals. J Pall Med 2013;16(6):638-644. 10. Gawande A. Being Mortal: medicine and what matter in the end. New York: Metropolitan Books, Henry Holt and Company, 2014.
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MS09.05 - Latin America (ID 1885)
15:00 - 15:10 | Author(s): E.A. Richardet
- Abstract
- Presentation
Abstract not provided
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MS09.06 - Africa (ID 1886)
15:10 - 15:20 | Author(s): M.M.A. Elhassan
- Abstract
- Presentation
Abstract:
Cancer has emerged as a major health problem in Africa.[1]Healthcare in Africa differ widely, countries in North Africa and the republic of South Africa have better health care services than those in sub Saharan Africa. In Africa particularly in sub-Saharan region, due to the limited access to cancer screening and early diagnosis, an estimated 80% of cancer patients are present with advanced stage. [2]Additionally, inadequate access to standard cancer therapies result in difficulty to achieve cure even for patients with early stage cancer. Despite the clear public health needs for multidisciplinary palliative care for millions of cancer patients, access to this option is limited in most African countries. Information regards palliative care in Africa is lacking.[3]It was estimated that only 5% of patients in need to palliative care receive it.[4]This is especially true in sub-Saharan Africa, where about 80% of cancer patients are likely to experience suffering in the course of their advanced illnesses.[2] Palliative care is a relatively new discipline in Africa, Initiatives in South Africa and Zimbabwe dated back to 1970s. There has been significant progress over the last ten years. From being significantly present in only five countries in 2004, palliative care services was established in nearly half of African countries in before the World Health Assembly in 2005.[4]These services usually confined to large cities, most of which are pain clinics driven by nongovernmental sector. The majority of health care professionals at palliative care clinics lack the appropriate training for pain assessment and management and they are relying on their own personal experience while practicing palliative care. Clark et al. [3]have conducted a multi-method survey to review services and experiences of palliative care development in 47 African countries. The 47 countries studied could be grouped into four categories of palliative care development: No identified hospice or palliative care activity (21 countries); Capacity-building activity underway to promote hospices and palliative care delivery (11countries); localized provision of hospices and palliative care in place, often supported by external donors (11countries); and Hospices and palliative care services achieving some measure of integration with mainstream service providers and gaining wider policy recognition (4 countries) The Limitations to the development of multidisciplinary palliative care programs in Africa are that: high burden of HIV and cancer, extreme shortage of trained health care professionals in palliative care, insufficient facilities, weak referral systems and lack of access to opioid or the restriction of their use in many African countries.[5, 6]Moreover, there is still a general lack of government policies that recognize palliative care as an essential component of health care along with great challenge to acquire funding for palliative care programs.[5] Despite these limitations, there has been some success so far. Uganda, Kenya, South Africa, and Zimbabwe developed successful models for the development of affordable, sustainable community- based hospices and palliative care services. [3]Kenya, South Africa, Uganda and Tanzania have integrated palliative care into healthcare policy. Uganda has mad oral morphine freely available to its patient’s population and it has passed law to allow prescription of morphine by nurses.[7]The Ministry of Health in Malawi acknowledged palliative care as part of a minimum standard of care for all tertiary institutions.[8] The importance of palliative care in the African setting have been recognized by the World Health Organization (WHO). There are several palliative care initiative in Africa that have provided good quality palliative care in limited recourse setting.[3]The majority of successful palliative care initiatives are supported by international organizations in collaboration with governments and non-governmental organization (NGOs) e.g. the WHO 5-country palliative care project. The Foundation for Hospices in Sub-Saharan Africa, has a grant support program operating in several African countries. The African Palliative Care Association (APCA) has a fast developing program of activities to promote development across the continent and supports governments and other local service providers to ensure the provision of opioids and other palliative care medications. The role of education and training has been essential in strengthening capacities to develop multidisciplinary palliative care programs. Efforts to develop in country training are underway in few African countries. The University of Cape Town offers Post Graduate Diploma/MPhil, in Palliative Medicine. Makerere University through its affiliated institution Hospice Africa Uganda in partnership with APCA offers a Bachelor’s Degree in Palliative Care. Nairobi Hospice in collaboration with Oxford Brookes University offers diploma in palliative care. The National Cancer Institute, Cairo offers Master degrees in pain management and palliative care has been incorporated in the curriculum of the oncology nursing program in the same institute. Palliative care in Africa is still at an early stage of development and faces many obstacles. A lot of progress has been made already, however much still remains to be done, particularly across sub-Saharan Africa. Many challenges cannot be corrected without governments and NGOs willing to effect changes and commit funds to research and training. References 1. Basu, A., B.N. Mittag-Leffler, and K. Miller, Palliative care in low- and medium-resource countries. Cancer J, 2013. 19(5): p. 410-3. 2. Spence, D., A. Merriman, and A. Binagwaho, Palliative care in Africa and the Caribbean. PLoS Med, 2004. 1(1): p. e5. 3. Clark, D., et al., Hospice and palliative care development in Africa: a multi-method review of services and experiences. J Pain Symptom Manage, 2007. 33(6): p. 698-710. 4. Grant, L., et al., Palliative care in Africa since 2005: good progress, but much further to go. BMJ Support Palliat Care, 2011. 1(2): p. 118-22. 5. Ddungu, H., Palliative care: what approaches are suitable in developing countries? Br J Haematol, 2011. 154(6): p. 728-35. 6. Harding, R. and I.J. Higginson, Palliative care in sub-Saharan Africa. Lancet, 2005. 365(9475): p. 1971-7. 7. Ramsay, S., Leading the way in African home-based palliative care. Free oral morphine has allowed expansion of model home-based palliative care in Uganda. Lancet, 2003. 362(9398): p. 1812-3. 8. Tapsfield, J.B. and M. Jane Bates, Hospital based palliative care in sub-Saharan Africa; a six month review from Malawi. BMC Palliat Care, 2011. 10: p. 12.
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MS09.07 - Asia/Oceania (ID 1887)
15:20 - 15:30 | Author(s): C.R. Underhill
- Abstract
- Presentation
Abstract not provided
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MS09.08 - Supportive Care and Palliative Care in Europe (ID 1888)
15:30 - 15:40 | Author(s): J. Herrstedt
- Abstract
- Presentation
Abstract:
The major societies of Supportive and Palliative Care in Europe are the Multinational Association of Supportive Care in Cancer (MASCC), the European Society for Medical Oncology (ESMO) and the European Association for Palliative Care (EAPC). Supportive Care is defined by MASCC as: “Supportive Care in Cancer is the prevention and management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer experience from diagnosis through anticancer treatment to post-treatment care. Enhancing rehabilitation, secondary cancer prevention, survivorship and end of life care are integral to Supportive Care [1].” Palliative Care is defined by EAPC as: “Palliative Care is the active, total care of the patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of social, psychological and spiritual problems is paramount. Palliative Care is interdisciplinary in its approach and encompasses the patient, the family and the community in its scope. In a sense, palliative care is to offer the most basic concept of care – that of providing for the needs of the patient wherever he or she is cared for, either at home or in the hospital. Palliative care affirms life and regards dying as a normal process; it neither hastens nor postpones death. It sets out to preserve the best possible quality of life until death [2].” ESMO took a stand on Supportive and Palliative Care in 2003 as follows: “Supportive Care’ is defined as care that aims to optimize the comfort, function and social support of the patients and their family at all stages of the illness. This dimension of care emphasizes the oncologist’s role in optimizing quality of life for all patients, including those with potentially curative illness.” “Palliative Care’ is defined as care that aims to optimize the comfort, function and social support of the patients and their family when cure is not possible. This dimension of care emphasizes the special needs of patients whose illness is either unlikely to be cured or that is incurable. These needs include physical and psychological symptom control, education and optimization of community supports [3].” These definitions are summarized in the Figure. The definitions all respect the recent trend of early integration of Palliative Care in patients with advanced cancer. Two randomized studies showed a survival benefit [4] or an improvement in some quality of life parameters [5], whereas a recent randomized study was unable to demonstrate any benefit of early integration of Palliative Care [6]. Recently MASCC, ESMO and EAPC joint forces and completed two surveys to disclose the use of existing palliative care programs in Europe. The result of these surveys will be summarized [7, 8]. Figure 1 References 1. MASCC homepage accessed July 7, 2015 - http://www.mascc.org/about-mascc 2. EAPC homepage accessed July 7, 2015 - http://www.eapcnet.eu/Corporate/AbouttheEAPC/Definitionandaims.aspx 3. Cherny NI, Catane R, Kosmidis P et al. ESMO takes a stand on supportive and palliative care. Ann Oncol 2003;14:1335-1337. 4. Temel N, Greer JA, Muzikansky A et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733-42. 5. Zimmerman C, Swami N, Krzyzanowska M et al. Eraly palliative care for patients with advanced cancer: a cluster randomised controlled trial. Lancet 2014;383:1721-30. 6. Groenvold M, Petersen MA, Damkier A et al. The Danish palliative care trial (DanPaCT), a randomised trial of early palliative care in cancer: results of the primary analysis. EAPC 14th World Congress May 8-10, 2015: abstract PL7. 7. Davis MP, Strasser, F, Cherny N. How well is palliative care integrated into cancer care? A MASCC, ESMO and EAPC project. Support Care Cancer DOI 10.1007/s00520-015-2630-z 8. Davis MP, Strasser F, Cherny N, Levan N. MASCC/ESMO/EAPC survey of palliative care programs. Support Care Cancer 2015;23:1951-1968.
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ED 08 - Talking with Patients (ID 8)
- Event: WCLC 2015
- Type: Education Session
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:L.A. Mas Lopez, N. Pilnik
- Coordinates: 9/08/2015, 14:15 - 15:45, 108+110+112
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ED08.02 - The Art of Taking Care of Patients, The Art of Giving Bad News (ID 1803)
14:40 - 15:00 | Author(s): A. Oton
- Abstract
- Presentation
Abstract:
For some health professionals, communicating bad news is one of the most frequent tasks of their daily work. Conversations on new diagnosis of a dismal disease, discontinuation of therapy due to disease progression or end-of-life care goals are some examples of discussions that oncologists and other health professionals are responsible for everyday with patients and caregivers. However, despite the frequency of these conversations, few health professionals are properly trained in how to conduct difficult conversations in an effective and yet compassionate manner. Navigating through these difficult conversations with thoughtfulness are crucial moments on the patient-physician relationship. The way in how these conversations are delivered have a direct impact on how the patient will perceive and react to the situation and it might make the difference between failure and success of this relationship. Communicating bad news demonstrates personal courage and integrity and when conducted in the right way, increases patient’s confidence and trust on the oncologist and his ability to make the right decisions during the patient’s journey. In addition, empathic communication can influence patient’s satisfaction with care, quality of life and ultimately patient’s outcome. Some studies have reported that the most valued qualities in nurses and doctors communicating bad news –from the patient’s perspective, are: recognition (how the oncologist respond to the gravity of the news), guiding (what patient would like to get after news are delivered) and responsiveness (oncologist’s ability to sense patient’s need). Learning how to communicate bad news effectively with patients and family members is an essential requirement on becoming a successful and contemporary health professional. During this lecture we will review some communication strategies on how to efficiently lead these conversations with our patients. References: Baile WF, et al. Curr Opin Oncol 2005, Jul;17(4):331-5 Fujmori M, et al. J Clin Oncol 2014 jul 10;32(20):2166-72 Back AL, et al. Oncologist 2011;16(3):342-50 Baile WF, et al. Oncologist 2000; 5(4):302-11 Girgis A, at al. Aust N Z J Surg 1997 Nov;67(11):775-80
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