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E. Bernicker
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OA 11 - Reducing Burden: Patient-Centered Care (ID 682)
- Event: WCLC 2017
- Type: Oral
- Track: Nursing/Palliative Care/Ethics
- Presentations: 8
- Moderators:Beth Ivimey, E. Bernicker
- Coordinates: 10/18/2017, 11:00 - 12:30, Room 313 + 314
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OA 11.01 - Impact of Tobacco Smoking on the Humanistic and Financial Burden of Advanced Non-Small Cell Lung Cancer (A-NSCLC) (ID 8662)
11:00 - 11:10 | Presenting Author(s): Oana Chirita | Author(s): R. Wood, G. Taylor-Stokes, M. Lees
- Abstract
- Presentation
Background:
Tobacco smoking has a negative impact on the prognosis of A-NSCLC. It is less well known how smoking impacts the burden of disease. As such, an analysis was conducted to evaluate the impact of a current tobacco smoking habit and/or history of smoking on the burden of A-NSCLC.
Method:
Data were collected between May 2015 and June 2016 from adult patients with Stage IIIB or IV NSCLC via medical chart reviews and patient self-completion forms as part of a multicentre, cross-sectional study conducted in France, Germany and Italy. Health status was measured using the EQ-5D-3L (including the visual analogue scale, EQ-VAS), quality of life (QoL) using the EORTC QLQ-C30 and work/activity impairment using the WPAI:GH questionnaire. Costs of NSCLC-related productivity losses and out-of-pocket expenses were also collected. Outcomes were stratified by smoking status (current/former smoker vs never smoked); no adjustments were made for possible confounding factors. Statistical significance was assessed using Mann–Whitney U tests.
Result:
1030 patients were recruited: mean patient age, 64.5 years; male, 65.9%; Stage IV NSCLC, 88.4%; non-squamous histology, 70.3%; receiving first-line therapy, 70.5%. Patients were largely receiving chemotherapy, regardless of line of therapy. In total, 1010 patients had smoking status recorded; 787 (77.9%) were current/former smokers and 223 (22.1%) had never smoked. Significant differences were observed between current/former smokers and patients who had never smoked for health status, QoL, work- and activity-related impairments, and NSCLC-related costs (TABLE). Figure 1
Conclusion:
A significant deterioration in health status and QoL, along with greater work- and activity-related impairments, was observed in current/former smokers with A-NSCLC. Moreover, costs of NSCLC-related productivity losses and out-of-pocket expenses were also higher versus those who had never smoked. These findings suggest an association between tobacco smoking and the humanistic and financial burden incurred by patients with A-NSCLC.
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OA 11.02 - Exercise Improves Functional Capacity in Patients with Advance Stage Lung Cancer (ID 10024)
11:10 - 11:20 | Presenting Author(s): Morten Quist
- Abstract
- Presentation
Background:
Identifying key issues for patients with lung cancer is central to assessing quality of life (QOL). Gralla el al described in 2014 a five rated issues which were: maintaining independence, ability to perform normal daily activities, ability to sleep, not being a burden for caregivers and not being fatigued. Studies have shown that patients with advanced lung cancer have a decline in functional capacity from diagnosed and during treatment. Studies examining physical exercise in patients with lung cancer have indicated increased physical capacity, functional capacity and muscular capacity, but no unambiguously significant improvements in QOL. The aim of this study is to investigate the effect of an exercise intervention for patients with advanced stage lung cancer.
Method:
Eligible patients >18 years with a WHO performance status 0-2 with stage IIIb-IV NSCLC and SCLC-ED who were undergoing chemotherapy at the Department of Oncology University Hospital Copenhagen were randomized to standard care or a 12 week physical and psycho-social intervention. Aerobic capacity (VO2peak), functional capacity (6MWD) and QOL (FACT-L) were measured at baseline and 12 weeks.
Result:
A total of 218 patients met the inclusion criteria and were randomized. There were no significant differences in baseline characteristics between the groups. There was a significant improvement in 6MWD in both groups, improvement in intervention was 41.1 m and improvement in control was 16.5 m. There were no significant differences between-groups in overal QOL (FACT-L) although there was a significant improvement in groups in overall QOL (FACT-L), Physical wellbeing, Emotrional wellbeing,Trial Outcome Index for the intervention group. There was a significant difference between groups in the subscale Social Wellbeing (FACT-L) P=<0.04.
Conclusion:
Conclusion: The results of this study demonstrate that functional capacity (6MWD) improves during a 12 week period for patients with advanced stage lung cancer. The improvements in both groups indicate an effect of chemotherapy on functional capacity however the significantly higher improvement in the intervention group indicate a further effect of the exercise intervention. The in-group improvement in QOL in the intervention group indicate a link between an incline in functional capacity and the QOL.
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OA 11.03 - Reducing Lung Cancer Mortality in Disparate Populations through Cancer-Community Awareness Access Research and Education (C-CARE) (ID 7444)
11:20 - 11:30 | Presenting Author(s): Lovoria B Williams | Author(s): T.V. Joshua, S. Looney, A. McCall, M. Tingen
- Abstract
- Presentation
Background:
Lung cancer is the leading cause of cancer death in the US. Only 15% are diagnosed at early stage, resulting in a 5-year survival of 17%. Disparities exist among racial/ethnic minorities and the medically underserved and regionally. High mortality is in part due to the prior absence of a lung cancer screening guideline. c-CARE aims to improve cancer health literacy and outcomes in disparate populations. The purpose of c-CARE project is to increase community awareness of lung cancer risk factors and screening criteria, and to connect high-risk individuals to lung cancer screening and tobacco cessation services.
Method:
The study approach was Community-engaged Research. Formative development involved vetting the study design with the Community Advisory Board (CAB) to ensure community priorities and concerns were addressed. Curriculum development and intervention evaluation were guided by the Health Belief Model. Community members and Community Health Workers unassociated with the current project were recruited to participate in focus groups and semi-structured interviews to review the curriculum and guide refinement of the survey instruments. Thirteen community sites were enrolled: 9 African- American churches; 3 community clinics that serve the medically underserved, and a community recreation center. Researchers trained four Community Health Workers from within each community site to deliver four education sessions. High-risk individuals were connected to lung cancer screening programs and tobacco cessation. Pre- and post-intervention outcome measures were collected on enrolled participants (n=481) to assess changes in participant knowledge, attitudes and beliefs regarding cancer, perceived barriers and self-efficacy to obtain lung cancer screening and tobacco cessation services.
Result:
Participants were majority African American, (n= 481);mean age 58.3 years; 16% were tobacco users. Post intervention knowledge, attitudes and beliefs regarding cancer had significant change (p= 001). Health Belief Model constructs post intervention were significant for Perceived Benefits and Self Efficacy subscales. Spearman correlations were significant between smoking status and Perceived Susceptibility, Perceived Barriers post intervention, Self Efficacy at baseline, Attitude post intervention and Belief at baseline.
Conclusion:
Community engaged methods engendered community buy-in of the project, enhanced the study design and development of a culturally acceptable curriculum. The data derived from the focus groups and interviews facilitated the refinement of the curriculum and data collection instruments. Training Community Health Workers to recruit participants and deliver the curriculum facilitates access to a hard-to-reach population, builds community capacity,and ensures curriculum delivery within the social context of the setting.Brief community interventions can increase cancer knowledge and sreening self-efficacy.
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OA 11.04 - Effect of Early Palliative Care on Aggressiveness of Cancer Care near End of Life in Lung Cancer Patient (ID 8294)
11:30 - 11:40 | Presenting Author(s): Wandee Chanprasertpinyo | Author(s): S. Semsarn, V. Tangsujaritvijit, N. Ngamphaiboon, Thanyanan Reungwetwattana, S. Chaiviboontham, J. Konmun, V. Sachdev, P. Chansriwong
- Abstract
- Presentation
Background:
Aggressive care and chemotherapy worsens quality of life (QoL) of dying cancer patients. Early palliative care (EPC) in patients with metastatic non small cell lung cancer (NSCLC) is associated with improvements in QoL. Thus, we aimed to explore an impact of EPC on the aggressiveness of care at the end of life (EOL).
Method:
An observational cohort enrolled newly diagnosed metastasis NSCLC at Ramathibodi hospital from 31[st] August 2015 to 1[st] September 2016. In EPC group, the consultation of specialized palliative team was performed ≤ 4 weeks of diagnosis and before start chemotherapy treatment, then monthly visits until death and the last visit for bereavement. The palliative consultation in standard of care (SOC) patients performed as their routine practices. The cutoff date for survival analysis was on 31[st] December 2016. The aggressiveness of care in EOL was defined as the composite outcome as any of the followings: last dose of chemotherapy received < 14 days of death, a new chemotherapy regimen starting < 30 days before death, ≥ 1 hospital admissions or emergency room visits or hospitalizations > 14 days in 30 days of death, or an ICU admission in 30 days of death.
Result:
105 patients were enrolled, 38 out of 70 patients (54%) in SOC group and 17 out of 35 patients (48%) in EPC group died. More aggressiveness of care at the EOL (97.3% vs 64.7%, p=0.003), more in-patient death (89.5% vs 58.8%; p=0.009) and longer hospitalization before death were observed in the SOC group (12 days vs 4 days, p=0.028). The cost analysis of patients who died at the hospital showed higher hospitalized cost in the SOC group (p=0.005). The EPC group received less aggressive treatments such as using less than 3 regimens of chemotherapy (77.1% vs 94.3%; p=0.028), but the survival rate was not different (11.3 months vs 6.6 months; p=0.08).
Conclusion:
Early palliative care reduced the aggressiveness of care at the end of life, shortened hospitalization and covered less cost of treatment.
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OA 11.05 - Discussant - OA 11.01, OA 11.02, OA 11.03, OA 11.04 (ID 10857)
11:40 - 11:55 | Presenting Author(s): J.S. Lee
- Abstract
- Presentation
Abstract not provided
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OA 11.06 - Lung Cancer Diagnosis and Assessment as a System Design Problem: Creating an Award Winning Program with Patient Advocates as Co-Designers (ID 10203)
11:55 - 12:05 | Presenting Author(s): Jason Pantarotto | Author(s): M. Fung-Kee-Fung, D. Maziak, J. Smylie, L. Taylor, T. Timlin, T. Cacciotti, Patrick James Villeneuve, C. Dennie, C. Bornais, J. Aquino, P. Wheatley-Price, R. Ozer, David James Stewart
- Abstract
- Presentation
Background:
Lung cancer continues to have a high mortality in Canada, with many patients presenting with advanced stage disease. The Ottawa Hospital (TOH) used a learning health systems (LHS) approach to redesign regional diagnostic processes to reduce the overall time from presentation with a suspicious lung mass to diagnosis and treatment. As previously published by our group, an LHS approach is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. TOH is the only provider of cancer services for a population of 1.3 million people in eastern Ontario and hence the need for an integrated patient journey from regional health facility to tertiary care centre was identified. Patient advocates have been incorporated as key members of the LHS from inception to implementation to post-implementation review.
Method:
The Ottawa Health Transformation model (OHTM) was developed as a means of operationalizing a LHS. A kick off meeting brought together cancer patients and their families to map out existing processes and document the patient experience. A regional lung cancer Community of Practice (CoP) of clinical and non-clinical stakeholders was then established to guide and approve the work of a core transformation team. The team had patient and family advocates as key members and they were tasked with identifying appropriate wait time targets and vetting proposed processes. A consensus approach was used to address process barriers, resistance to change and conflicting priorities in regular meetings spanning over two years. Commercially available software was used to track patient progress through the diagnostic process and to report real time metrics to the transformation team.
Result:
The project operationalized lung cancer diagnostic pathway guidance and optimized patient flow from referral to initiation of treatment. Twelve major processes in referral, review, diagnostics, assessment, triage and consult were redesigned. TOH now provides a diagnosis to 80% of referrals within the provincial target of 28 days and leads all other jurisdictions in Ontario in this metric by a wide margin. The median patient journey from referral to initial treatment decreased 48% from 92 to 47 days. In 2016 this work was recognized by a provincial cancer agency with a quality award.
Conclusion:
A learning health system has significantly reduced the time from referral with suspicion of lung cancer to diagnosis to treatment. Achievements require a multi-disciplinary approach with a regional perspective. Patient and family advocates have an important voice in re-designing health care systems.
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OA 11.07 - Enhancing Lung Cancer (LC) Care in the Community Setting Through a Patient Advocacy 'Centers of Excellence' (COE) Program (ID 10423)
12:05 - 12:15 | Presenting Author(s): Raymond U. Osarogiagbon | Author(s): Luis E Raez, L. Fine
- Abstract
- Presentation
Background:
The Addario Lung Cancer Foundation’s community hospital COE Program seeks to improve LC outcomes by catalyzing the dissemination of coordinated, evidence-based multidisciplinary care incorporating institutional performance benchmarks across the LC care continuum. The COE program is a network of community-level institutions committed to objectively-measured quality improvement through annual cycles of data collection, comparative analysis and feedback. We analyzed 2016 benchmarks, comparing COE and non-COE programs.
Method:
The annual COE Impact Survey instrument includes an 81-item questionnaire administered by ZoomRx, an independent survey company. Respondents were key institutional representatives of COE- and community-level non-COE institutions. The survey measured the care continuum from screening to end-of-life care. Patient- and institutional-level data for 2016 were analyzed.
Result:
Cohort- 15 COE v 15 non-COE, mean number of annual patients per site 264 v 279; % stage III/IV patients 62 v 74; Medicare-enrolled patients, 54% v 40%; patients 61-80 years 61% v 46%; % patients who encountered financial difficulty in 2016, 42% v 34%. Institutional screening/nodule management programs: 71% of COE v 60% of non-COE programs had a low-dose CT (LDCT) screening program; 86% v 80% used a standard protocol to follow patients with suspicious nodules; 35% v 28% LDCT patients were requested to follow up on suspicious findings; 76% v 67% patients actually followed up. Diagnostic biopsy of LC was by minimally invasive endobronchial approaches in 47% v 15%. Programmatic management of patients with stage III/IV disease: 75% v 49% of patients with stage III/IV disease were reviewed at a Tumor Board and 74% v 62% had a palliative care discussion. Molecular testing was used in 51% v 81%. In patients undergoing molecular testing, institutional use of blood-based ‘liquid biopsies’ was 86% v 18% and next generation sequencing of tissue 67% v 58%. Clinical trials enrollment rates were 20% v 13%, but 18% v 31% of patients were not screened for clinical trials. In weighting factors driving treatment selection on a 100-point relative scale, COE programs weighted ‘quality of life’ (39% v 26%) and ‘patient expense’ (22% v 11%) more than non-COE programs. Non-COE programs weighted ‘product attributes’ (efficacy and safety) 48% (v 14% in COE) more.
Conclusion:
Differences exist in the approach to LC care between COE and non-COE programs. Future iterations of the COE Impact Survey will enable a data-driven approach to disseminating high quality LC care at community-level institutions, where the majority of patients seek care for lung cancer.
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OA 11.08 - Discussant - OA 11.06, OA 11.07 (ID 10858)
12:15 - 12:30 | Presenting Author(s): Kazuo Hasegawa
- Abstract
- Presentation
Abstract not provided
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