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E. Esposito-Nguyen
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MA 08 - Supportive Care and Communication (ID 669)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Nursing/Palliative Care/Ethics
- Presentations: 12
- Moderators:E. Esposito-Nguyen, John McPhelim
- Coordinates: 10/17/2017, 11:00 - 12:30, Room 511 + 512
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MA 08.01 - Incorporating the Review of Patients on Immunotherapy into an Established Lung CNS Nurse Led Review Clinic (ID 7479)
11:00 - 11:05 | Presenting Author(s): Louise Rae Gilham | Author(s): S. Wakelin, R. Shah
- Abstract
- Presentation
Background:
The Kent Oncology Centre has been instrumental and innovative in the development of nurse-led services since 2005. The Lung CNS’s have been conducting oncology clinics since 2009 reviewing patients on TKI’s and chemotherapy. With Immunotherapy now available to some lung cancer patients, the Lung CNS's needed to incorporate immunotherapy review into their established clinics. The Lung CNS's worked collaboratively to develop a patient-centred electronic assessment tool. The tool would ensure standardised practise, patient safety and assess toxicities whilst on Immunotherapy. The aim is for the Lung CNS’s to utilise the electronic tool and roll out through an educational programme thus increasing knowledge and confidence and empowering nurses to safely review patients on immunotherapy.
Method:
To incorporate immunotherapy patients to an established CNS Nurse-led review clinic: Agreement between Consultant and Senior Nurses. Discussions with Computer Sciences, Lung Cns's, Oncologists, Chemotherapy Lead Nurse. Educational Requirements - Consultation and Physical Examination Skills, Non-Medical Prescribing, Chemotherapy Competence, IRMER. Protocols - Agreed for the Nurse Led Oncology review clinic. Competence - The Lung CNS requires a set of practice and competence in judgement and decision making. How the clinic works Consent by the consultant. Consultant toxicity assessment pre cycle 2. Reviewed thereafter by lung CNS or Chemotherapy Nurse prior to each treatment. Electronic Toxicity assessment completed. Weight/Observations recorded. Bloods FBC, U&E's, LFT's. Thyroid 8 weekly. 9am cortisol LH and FSH Direct access to consultant. Consultant review with CT scan.
Result:
Figure 1 Reported Toxicities. Adisonian Crisis Hypothyroidism Diarrhoea/Colitis Fatigue Hepatitis Skin Reactions Pneumonitis
Conclusion:
The number of patients on Immunotherapy treatment is set to rise. Incorporating the review of Immunotherapy into an established Lung CNS Nurse-led Review clinic enabled standardised practise, enhanced patient safety and provided continuity of care. Through education and training and by using an electronic assessment tool; chemotherapy nurses can be empowered to review patients on Immunotherapy.
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MA 08.02 - Efficacy of Single-Dose NEPA versus 3-Day Aprepitant Regimen for Prevention of CINV: A Phase 3 Lung Cancer Subset Analysis (ID 8460)
11:05 - 11:10 | Presenting Author(s): Shun Lu | Author(s): Li Zhang, A. Dechaphunkul, C. Lanzarotti, K. Jordan, M. Aapro
- Abstract
- Presentation
Background:
Cisplatin, a systemic treatment component for many lung cancer types, is highly emetogenic (HEC). The guideline-recommended antiemetic combination for patients receiving HEC includes a NK~1~ receptor antagonist (NK~1~RA), a 5-HT~3~RA, and dexamethasone (DEX). NEPA is the first oral fixed combination of an NK~1~RA (netupitant) and a 5-HT~3~RA (palonosetron). The approval of oral NEPA was based on studies demonstrating superior prevention of chemotherapy-induced nausea and vomiting (CINV) over oral palonosetron; an intravenous formulation of NEPA is under FDA evaluation. A new Phase 3 study in Asia has reached its primary objective: a single day oral dose of NEPA is non-inferior to a 3-day regimen of aprepitant (APR) and granisetron (GRAN) [both combined with DEX] in preventing CINV in patients receiving cisplatin. This post-hoc analysis explores the efficacy of NEPA vs APR/GRAN within the lung cancer subset of that study.
Method:
Chemotherapy-naïve lung cancer patients in this double-blind, parallel group study received either a single oral dose of NEPA prior to cisplatin-based HEC or a 3-day regimen of APR/GRAN, both with oral DEX on days 1-4. Efficacy endpoints were complete response (CR: no emesis/no rescue medication), no emesis, and no significant nausea (<25 mm on 100 mm visual analog scale) during the acute (0-24h), delayed (25-120h) and overall (0-120h) phases post-chemotherapy. The risk difference for NEPA – APR/GRAN and associated 95% confidence intervals (CIs) were analyzed for each endpoint using the Cochran-Mantel-Haenszel test.
Result:
542 (65%) of the 828 patients had lung cancer. Mean age was 56.1; 73% males. Response rates were comparable for both arms during the acute phase, and favored NEPA in delayed phase (Table). Figure 1
Conclusion:
As a fixed oral combination of an NK~1~RA and 5HT~3~RA in a single capsule/cycle, NEPA offers a convenient and effective prophylactic antiemetic in lung cancer patients receiving cisplatin-based HEC regimens.
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MA 08.03 - Discussing Potential Recurrence after Lung Cancer Surgery: Complexity and Challenges (ID 7436)
11:10 - 11:15 | Presenting Author(s): Matthew Johnson | Author(s): Angela Mary Tod, S.P. Brummell, K. Collins
- Abstract
- Presentation
Background:
Increasing numbers of patients are being treated with potentially curative surgery for lung cancer. Pathological staging gives an indication of 5-year survival and whether further treatment is recommended. Patients undergo a period of post-operative clinical surveillance to monitor for potential recurrence of cancer. The process of discussing potential recurrence and its early warning signs has not been well researched. This study examines how clinical teams and patients manage information disclosure about possible cancer recurrence following lung cancer surgery. The aim is to identify some of the practice implications for lung cancer teams.
Method:
This qualitative project used case study methodology to explore how information regarding possible recurrence was presented to patients. Twelve patients were recruited at two thoracic surgical centres. Observation of the first post-operative surgical and subsequent oncology or follow-up clinic was conducted and consultations audio recorded. In-depth, one-to-one interviews were completed with clinical staff (surgeon, oncologist, physician and/or nurse specialist) who saw the patients to ascertain their perspective and understand rationale for particular information giving. Framework Analysis methods were used to identify key themes.
Result:
Staff varied in the extent and explicitness that long-term surgical outcomes were communicated to patients. Explicit information was presented in terms of recurrence risk or survival and the terms were frequently used interchangeably. Clinicians were often reluctant to give a numerical estimate of risk of recurrence or survival at the post-operative clinic. Information about early warning signs of recurrence was sporadic, with some clinicians preferring to delay such discussions until later on in the follow-up pathway, due to fear of damaging patients’ perceived fragile hope for cure. Information was aimed at supporting hope, aiding treatment understanding, or facilitating decision-making. Choices made by staff regarding information giving were complex and largely tacit, but appeared to be linked to individual professionals’ underlying optimistic or realistic approach. Staff talked about the importance of balancing hope and realism.
Conclusion:
These findings give unique insight and reveal how challenging and complex it is for clinicians to discuss recurrence following lung cancer surgery. The next stage of the project will examine the patient’s perspective of this process. These data will then be combined to identify ways to improve communication of recurrence
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MA 08.04 - Discussant - MA 08.01, MA 08.02, MA 08.03 (ID 10859)
11:15 - 11:30 | Presenting Author(s): Jeffrey Crawford
- Abstract
- Presentation
Abstract not provided
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MA 08.05 - Surviving Lung Cancer, an Analysis of the Patient Concerns Identified in a Nurse-Led Follow-Up Clinic after Thoracic Surgery (ID 8079)
11:30 - 11:35 | Presenting Author(s): Jenny Mitchell
- Abstract
- Presentation
Background:
Using evidence based follow up guidelines, our nurse led follow-up clinic was established in December 2012. All post-operative thoracic surgery patients are seen, including patients with primary lung cancer. We evaluated problems and issues patients identified related to their post-operative recovery and follow-up period
Method:
Data was collected prospectively from December 2012 to March 2017. This included information for each patient on surgery, pathology, TNM stage, follow-up plan and smoking status. We recorded additional issues raised by patients. Data was analysed to generate descriptive statistics of post-operative problems. There were 546 patient episodes in 189 clinics for 285 patients with primary lung cancer
Result:
Of the 285 patients 70 (25%) were smokers in the 6 weeks prior to surgery. 171 (60%) were ex-smokers and 44 (15%) had never smoked. 32 (11%) patients smoked after surgery, all except one were pre-operative smokers. Smoking cessation was a concern after surgery with 44% of the pre-operative smokers restarting smoking post-operatively. The number of patients seen at each follow-up interval and the issues identified are shown in the table below. The most frequent issues reported by patients after thoracic surgery are pain, respiratory issues and anxiety. 80% of patients report problems at their first follow-up appointment after surgery, decreasing to 59% at five years. Respiratory issues are common in this group of patients who often have co-existing lung disease. Anxiety, most commonly associated with fears about recurrence of disease, remains a problem throughout the follow-up period. 31% of patients had abnormal imaging at one or more appointments.Issues identified in the nurse led thoracic surgery follow-up clinic
Number of patients % of the total patients seen in each survillance period Time since surgery Total Pain Respiratory issues Anxiety Imaging issues Other issues No issues 1st follow-up 120 33 27.5% 23 19% 24 20% 18 15% 16 13% 24 20% 6 months 118 21 18% 20 17% 11 9% 33 28% 14 12% 31 26% 12 months 79 10 13% 20 25% 8 10% 19 24% 8 10% 14 18% 18 months 66 9 14% 15 23% 8 12% 14 21% 7 11% 22 33% 2 years 65 9 14% 12 18% 7 11% 10 15% 10 15% 19 29% 3 years 48 7 15% 7 15% 7 15% 11 23% 8 17% 13 27% 4 years 28 0 7 25% 5 18% 5 18% 8 29% 7 25% 5 years 22 0 6 27% 2 9% 4 18% 2 9% 9 41% Totals 546 89 16% 110 20% 72 13% 114 21% 71 13% 139 25%
Conclusion:
The findings indicate the extent of physical, psychological and lifestyle (e.g. smoking) concerns in post-operative follow-up. A new telephone follow-up clinic has recently been introduced to address these needs. Further investigation with objective assessment and scoring of symptoms would improve the quality of the data collected.
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MA 08.06 - Assessment to Programming: Responding to the Needs of the US Lung Cancer Community (ID 9394)
11:35 - 11:40 | Presenting Author(s): Maureen Rigney | Author(s): Jennifer C King
- Abstract
- Presentation
Background:
Research shows people diagnosed with lung cancer have greater unmet supportive care, physical and emotional needs compared to those diagnosed with other cancers. Much of this research is older and primarily focused on small numbers of newly diagnosed patients. Other research has focused on the relative lack of treatment options and does not address practical and psychosocial needs.
Method:
To more fully understand the current unmet needs of lung cancer survivors, an online survey was distributed between 11/9/2015 and 2/8/2016. Of 820 respondents, 471 were lung cancer patients/survivors with 349 loved ones. Queried on treatment histories, respondents were asked to identify the most prevalent and problematic symptoms and side effects experienced during treatment, shortly after treatment ended and at 5+ years post-diagnosis. They were also asked which were most problematic during each time period.
Result:
The survey had an overall 72% completion rate with 21% of survivor-respondents indicating a diagnosis 5+ years prior. Patients/survivors rated anxiety, fatigue and shortness of breath as most challenging in the immediate, post-treatment, and long-term. During treatment, gastrointestinal issues including constipation, diarrhea and nausea were also highly problematic. All groups reported physical effects were significantly more problematic during treatment but deemed emotional effects more difficult to manage post-treatment and in the long-term. In open-ended questions, nearly 25% of respondents indicated they received inadequate information/assistance to manage physical and emotional reactions, both during and after treatment. Only 27% of respondents had a discussion about palliative care with just over 20% having received it. The survey affirmed that assistance to manage lung cancer’s symptoms and treatment side effects is an unmet need in the lung cancer community. In response, a four-part educational series, including webinars and accompanying print materials, was developed. The series is the only to focus specifically on lung cancer and helps participants understand the causes of the top four reported symptoms and side effects, including potential medical interventions and holistic, practical tips that can used immediately.
Conclusion:
Those diagnosed with lung cancer are the experts and we can only understand their unmet needs by asking them. This large, extensive survey provided insight into their needs during, immediately after and long after treatment. Our initial four-part webinar series is only the beginning--through our results and querying webinar participants, we are developing additional educational programming to help those diagnosed with lung cancer and their loved ones understand and manage their specific disease and treatment-related challenges.
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MA 08.07 - Can the Early Intervention of the Lung Cancer CNS Reduce the Length of Stay for Patients Admitted via the Emergency Route on First Presentation? (ID 7458)
11:40 - 11:45 | Presenting Author(s): Jeanette Draffen | Author(s): K.J. Clayton, P. Shepherd, S. Bolton, V. Beattie, P. Rees, J. Roberts, John McPhelim, S. Kefyalew, Y. Jeffs, D. Denby
- Abstract
- Presentation
Background:
The National Lung Cancer Audit 2015 reported 40% of patients with Lung cancer are diagnosed following an emergency admission. The National Lung Cancer Forum for Nurses Workshop 2016 undertook a review of how the Lung Cancer CNS’s (LCNS) early intervention can have a positive impact on the reduction in the length of stay for those patients admitted via the emergency route at their first presentation.
Method:
A prospective and a retrospective review of a cohort of patients admitted by the emergency route was undertaken, n=51 in both cohorts, across 13 UK sites over a 2 month period. A standardised Data Collection Tool was developed to ensure consistency and avoid bias. In the prospective cohort the LCNS actively identified patients at an early stage following their admission, whereas the retrospective cohort was a random sample of patients admitted and diagnosed via the emergency route irrespective of the LCNS involvement.
Result:
Demographics and baseline characteristics were found to be similar in both cohorts. 31% of patients were never seen by the LCNS in the retrospective cohort whereas all patients were seen in the prospective cohort 76% of patients in the prospective cohort were seen within 0-5 days following admission by a LCNS compared with 43% in the retrospective cohort Average length of stay in the prospective cohort was 9.7 days V 17.6 days in the retrospective cohort.
Conclusion:
This review suggests the early intervention of a LCNS is associated with a reduced length of stay following an emergency admission when Lung Cancer/Mesothelioma is diagnosed.
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MA 08.08 - Discussant - MA 08.05, MA 08.06, MA 08.07 (ID 10860)
11:45 - 12:00 | Presenting Author(s): Beth Ivimey
- Abstract
- Presentation
Abstract not provided
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MA 08.09 - Postoperative Mobilisation and Rehabilitation Requirements for Lung Cancer Patients Undergoing Minimally Invasive Surgery (ID 10064)
12:00 - 12:05 | Presenting Author(s): Paula Jane Agostini | Author(s): S.T. Lugg, K. Adams, T. Smith, M. Kalkat, P. Rajesh, R. Steyn, B. Naidu, A. Rushton, E. Bishay
- Abstract
- Presentation
Background:
Video-assisted thoracoscopic surgery (VATS) is now increasingly performed and recommended in early-stage NSCLC resection. Early postoperative mobilisation, rehabilitation and physiotherapy can improve subsequent reduction in lung volumes, aid clearance of secretions and independent mobility, although there is much variation in how lung cancer patients are currently managed in this respect. The objective of this study was to observe capability for early mobility and frequency of issues potentially amenable to physiotherapy rehabilitation following VATS lobectomy for lung cancer. Any preoperative factors associated with increased rehabilitation needs were also identified, thus enabling early recognition of lung cancer patients needing rehabilitation.
Method:
A prospective observational study was performed including all consecutive cancer patients undergoing VATS lobectomy in a regional centre over 4 years (2012-2016). Standard postoperative care included early mobilisation where patients were sat out by nursing staff from postoperative day 1 (POD1) and assisted to mobilise as able. Physiotherapy assessment of all patients on POD1 determined presence of issues potentially amenable to rehabilitation, and this was commenced as deemed necessary. Outcome measures included development of postoperative pulmonary complication (PPC), hospital and high dependency unit (HDU) length of stay (LOS) and intensive therapy unit admission (ITU).
Result:
285 lung cancer patients were observed; 76 (27%) patients did not requiring specialised rehabilitation or physiotherapy, and engaged with nursing staff successfully in early mobility and becoming independently mobile. These patients had a significantly lower hospital and HDU length of stay (p<0.001), reflecting uncomplicated recovery. The remaining 209 patients (73%) received physiotherapy rehabilitation to assist/improve reduced mobility. Of these patients 23 (8%) also received chest physiotherapy for sputum clearance and 65 (23%) for lung volume loss. amongst those requiring this therapy were all patients who developed PPC, and all those admitted to the ITU. Despite surgery being non-invasive the frequency of development of PPC was higher than that for other VATS surgery at 7%, and this was associated with poorer outcomes. Logistic regression identified that COPD, BMI, preoperative mobility and age were associated with increased postoperative rehabilitation needs for mobility or respiratory issues (p=0.013).
Conclusion:
We recommend that all lung cancer patients receive early mobilisation and routine postoperative rehabilitation following this surgery ensuring issues amenable to physiotherapy and the need for rehabilitation is detected early. Associated preoperative baseline factors included COPD, poor preoperative mobility, and increasing BMI and age; such patients may benefit from preoperative rehabilitation as well as routine physiotherapy for better postoperative outcome.
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MA 08.10 - Favorable Clinical Status Predicts Benefit From Early-Palliative Cares & OS Improvement in NSCLC: A Randomized Clinical Study (ID 10348)
12:05 - 12:10 | Presenting Author(s): Oscar Arrieta | Author(s): L. Ramirez-Tirado, D. Michel-Tello, J. Turcott, J. Martinez-Hernandez, A. Beck-Magaña, E. Montes-Servin, E. Verastegui, S. Allende-Perez
- Abstract
- Presentation
Background:
Early-palliative care (EPC) after lung cancer diagnosis is essential for a better quality-of-life (QoL), and even offers a substantial improvement in survival outcomes. We prospectively assessed the effect of EPC in overall survival (OS) and patient-reported outcomes in non-small cell lung cancer (NSCLC) patients.
Method:
Newly-diagnosed and treatment-naïve NSCLC patients were included and randomly assigned (1:1) to receive either EPC with oncologic, nutritional, and psychological care, or standard oncologic care alone. Assessments were performed at baseline, second, fourth and sixth cycle of chemotherapy, with evaluations including: QoL, evaluated by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, depression and anxiety which were evaluated using the Hospital Anxiety and Depression Scale, and oncologic symptomatology, which was evaluated with the Edmonton System Assessment Scale. NCT01631565 [013/020ICI(CV773/13)].
Result:
Ninety-six NSCLC patients were enrolled; 42 patients were allocated to EPC while 54 patients were allocated to standard-care. Overall, patients receiving EPC have lower self-reported symptoms, depression and anxiety. Median OS of patients with EPC was 11.1 months (95% CI: 8.4–13.9), while in patients with standard-care was 5.9 months (95% CI: 4.8 – 7.1); p=0.049. In the multivariate analysis, factors associated with worse OS were: patients in standard-care arm (HR, 95% CI 1.6 (0.9 – 2.7); p=0.05), male patients (HR, 95% CI 1.8 (1.1 – 3.0); p=0.028) and worse ECOG performance status (≥2) (HR, 95% CI 1.9 (1.0 – 3.5); p=0.039).In a subgroup analysis, patients who reaped the most benefit from EPC included those with better ECOG performance status (<2) (8.9 vs. 5.7 months; p=0.05); those without depression at baseline (14.8 vs. 6.5 months; p=0.05) and those Corroborar que si sea mayor ansiedad basal-mayor beneficio Figure 1
Conclusion:
EPC might provide benefit in the clinical symptomatic burden and OS of NSCLC patients. Benefits from EPC in OS might be associated to favorable global clinical status.
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MA 08.11 - Do Patients Treated with Chemotherapy for Advanced NSCLC Regret Having Received Treatment? A Prospective Evaluation in 164 Patients (ID 10241)
12:10 - 12:15 | Presenting Author(s): Patricia J. Hollen | Author(s): Richard J Gralla, B. Coyne, R. Hall, R. Genzler, Haiying Cheng, G. Weiss, J. Gildersleeve, I. Hinton, Jeffrey Crawford, L. Rosen, M. Lesser
- Abstract
- Presentation
Background:
While many thousands of patients per year receive chemotherapy for advanced NSCLC with first-line or subsequent chemotherapy, little is known about patients’ views on their decision to receive that treatment. In that median survival results generally do not exceed one year, there are many potential risks for regret. Given the highly symptomatic nature of NSCLC coupled with patient, family and oncologist desires to decide rapidly on treatment, many challenges exist affecting quality decision making for patients and their supporters facing treatment. Among 59 studies dealing with regret in a recent systematic review (Becerra Perez 2016), none analyzed patients with lung cancer (66% of studies were in oncology). A clinical profile of the extent of regret, and factors contributing to that regret is lacking in those undergoing chemotherapy for lung cancer.
Method:
All patients were entered into a phase III, two-arm, prospective, randomized trial in patients receiving chemotherapy for lung cancer. Patients were randomly assigned to either usual care (UC), or enhanced care (EC) using the DecisionKEYS decision aid coupled with every 3 week PRO assessment using the electronic LCSS measure. All patients were offered the Decision Regret Scale (“DRS,” O’Connor 1999), at 11 weeks (+/- 2 weeks) after starting treatment. The DRS is a categorical scale with 5-items in 5 categories (ranging from “strongly disagree” to “strongly agree”). Patients completed assessment for decisional conflict; the patients’ supporters completed similar measures.
Result:
164 patients were entered, 160 received chemotherapy. Characteristics: 43% women; 92% Stage IV; 73% first-line therapy. Means: age 63; KPS 81. ECOG 1 = 56%; ECOG 2 = 42%. 46% represented minority groups. 22 different chemotherapy regimens were used. First-line patients received combination regimens with the majority being platinum-based with 2 or 3 drugs. 128 patients (80%) completed the DRS. Results combined the two top categories indicating the greatest extent of regret. Only 9 patients (7%) expressed regret as the maximum of the 5 DRS questions. 94% expressed that the decision for chemotherapy was a wise one. This low degree of regret did not differ by first-line or subsequent chemo or by EC versus UC groups.
Conclusion:
Patients receiving chemotherapy for advanced NSCLC, at 3 months after starting treatment, rarely (7%) have regret, and 98% expressed that they made the right decision. Other factors associated with the few patients with regret, such as decisional conflict or reduced quality of life, will also be presented. Support: NIH/NCI R01 CA-157409
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MA 08.12 - Discussant - MA 08.09, MA 08.10, MA 08.11 (ID 10861)
12:15 - 12:30 | Presenting Author(s): Bonnie Leung
- Abstract
- Presentation
Abstract not provided
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