Author index
A. &Scaron MASCC-0076
G.P. Kurita, C.N.,N.S.,H.F.,U.B.T MASCC-0113
Ş MASCC-0232
&scaron MASCC-0076
A, M. MASCC-0515
A.R. MASCC-0159
Aapro, M. MASCC-0433
Abarca, M. MASCC-0435
Abbasi, S. MASCC-0200
Abbink, F.C.H. MASCC-0455
Abbruzzese, J. MASCC-0742
Abda, N. MASCC-0007
Abdel Kader, Y.S. MASCC-0685
Abdel Khalek, E.R.K. MASCC-0669
Abdel Salam, G.A. MASCC-0685
Abdi, F. MASCC-0105
Abdollahi, A. MASCC-0680
Abdolzade-Bavil, A. MASCC-0712, MASCC-0694
Abdul Majid, A. MASCC-0667, MASCC-0643
Abdul Majid, S. MASCC-0667
Abe, H. MASCC-0779
Abe, K. MASCC-0525
Abella, E. MASCC-0584, MASCC-0438
Abernethy, A. MASCC-0808, MASCC-0410
Abidjonova, N. MASCC-0495
Abimosleh, S.M. MASCC-0043
Abisaid Baker, R. MASCC-0579
Abraham, C. MASCC-0484
Abrahm, J.L. MASCC-0607
Abu, E. MASCC-0074
Abubakar, S. MASCC-0217
Acar, H. MASCC-0627, MASCC-0478, MASCC-0477, MASCC-0286, MASCC-0285, MASCC-0284, MASCC-0283, MASCC-0182, MASCC-0130, MASCC-0119, MASCC-0118, MASCC-0117, MASCC-0116, MASCC-0069, MASCC-0068
Acevedo, A. MASCC-0300
Achkar, S. MASCC-0553
Ackerl, M. MASCC-0063
Acklin, Y. MASCC-0640
Adams, N.B. MASCC-0293
Adamsen, L. MASCC-0443, MASCC-0158
Addington-Hall, J. MASCC-0720
Ademosun, A.O. MASCC-0110, MASCC-0084
Adibi, P. MASCC-0105
Adriana Cristina Nicolussi, A.C.N. MASCC-0273, MASCC-0272
Aertgeerts, B. MASCC-0459
Affonso Fonseca, F.L. MASCC-0107
Affronti, M. MASCC-0805
Affronti, M.L. MASCC-0777
Afshar, M. MASCC-0128
Agarwal, N. MASCC-0059
Aggarwal, G. MASCC-0353
Aghajany-Nasab, M. MASCC-0781
Agulnik, J. MASCC-0793
Ahin", T. MASCC-0232
Ahmad, S.N.A. MASCC-0214
Ahmed, M. MASCC-0193
Ahmed, R. MASCC-0450
Ahmed, S.A. MASCC-0586
Ahn, J.B. MASCC-0511
Ahn, J.S. MASCC-0647
Ahn, M. MASCC-0510
Ai, J.Z. MASCC-0465
Aiba, K. MASCC-0521
Aibar, J. MASCC-0632, MASCC-0056, MASCC-0002
Aieta, M. MASCC-0517
Aihara, Y. MASCC-0757
Aina, O.F. MASCC-0078
Aini, M.N. MASCC-0172
Aitkaci, F. MASCC-0645
Akbari, L. MASCC-0105
Akbayrak, N. MASCC-0303
Aketch, W.A. MASCC-0723
Akhtar, M. MASCC-0326, MASCC-0175
Akhter, T. MASCC-0241
Akkafan, R. MASCC-0761
Akman, T. MASCC-0339
Aktas, A. MASCC-0832, MASCC-0696, MASCC-0536, MASCC-0534, MASCC-0456, MASCC-0453
Akyol, M. MASCC-0031
Akyurek, S. MASCC-0548
Al Duhaiby, E. MASCC-0316
Al Qadire, M. MASCC-0046
Al Rawi, S. MASCC-0643
Al-Azri, A.R. MASCC-0489
Al-Dasooqi, N. MASCC-0853, MASCC-0257
Al-Habib, O. MASCC-0667
Al-Mohaya, M.A. MASCC-0154
Al-Rawi, S. MASCC-0667
Albiges, L. MASCC-0505
Alevizopoulos, N. MASCC-0589
Alevizopoulos., N. MASCC-0349
Alexander, C. MASCC-0480
Alexis, K. MASCC-0454
Alfaro, E. MASCC-0462
Ali, M. MASCC-0219, MASCC-0218, MASCC-0127
Alibay, A. MASCC-0738, MASCC-0527, MASCC-0501
Alibhai, S.M.H. MASCC-0578, MASCC-0577, MASCC-0576, MASCC-0570
Alici, S. MASCC-0339
Alimi, D. MASCC-0371
Alimohammadi, H. MASCC-0178
Alkalay, Y. MASCC-0212
Alkam, T. MASCC-0583
Allan, J.L. MASCC-0180
Allgaier, H. MASCC-0712
Allison, R.R. MASCC-0605
Allo, J.A. MASCC-0552
Alm El-Din, M.A. MASCC-0167
Almeida, A. MASCC-0835
Almeida, A.M. MASCC-0772, MASCC-0764, MASCC-0730
Almond, L. MASCC-0561
Alonzo, R. MASCC-0394, MASCC-0393, MASCC-0392
Alpert, T.E.A. MASCC-0703
Alqudihy, S. MASCC-0162
Alsirafy, S.A. MASCC-0685
Alt-Epping, B. MASCC-0671, MASCC-0670
Alterovitz, G. MASCC-0812
Altinbas, M. MASCC-0802, MASCC-0798
Altino, J. MASCC-0654
Aluma Luis, L. MASCC-0348
Alyasova, A. MASCC-0432
Amaadour, L. MASCC-0007
Amarillo, L. MASCC-0516
Amatya, B. MASCC-0104
Ambrad, A.A. MASCC-0605
Amdur, R. MASCC-0070
Amin, A. MASCC-0075
Amoiridou, S. MASCC-0644
Anagnostopoulos, N. MASCC-0769
Andersen, A. MASCC-0515
Andershed, B. MASCC-0656
Anderson, K.O. MASCC-0838
Anderson, Y. MASCC-0749
Andersson, M. MASCC-0656
Andrade, V. MASCC-0545, MASCC-0544
Andrade, V.A. MASCC-0278, MASCC-0277
Andreasen, A.G. MASCC-0265, MASCC-0264
Andreetta, L. MASCC-0137, MASCC-0327
Andresen, T. MASCC-0112
Andreyev, J. MASCC-0198
Andrikopoulos, E. MASCC-0340
Anees, M. MASCC-0509
Ang, C. MASCC-0749
Ang, N.K.E. MASCC-0014, MASCC-0013, MASCC-0006
Ang, S.F. MASCC-0599, MASCC-0598
Annunziata, M. MASCC-0687, MASCC-0684
Ansari, F. MASCC-0016
Ansari, P. MASCC-0288
Ansari, Z. MASCC-0614
Antoni, G. MASCC-0047
Antonuzzo, A. MASCC-0651
Antoun, J. MASCC-0553
Antoun, S. MASCC-0738, MASCC-0527, MASCC-0505, MASCC-0501
Antunes, H.S. MASCC-0568, MASCC-0565
Aplenc, R. MASCC-0729
Apolinar Martinez, A. MASCC-0309
Appan, P. MASCC-0016
Aprile, G. MASCC-0774, MASCC-0751
Aqil, M. MASCC-0326, MASCC-0175
Aragão Santana, T. MASCC-0608
Aranda Aguilar, E. MASCC-0678
Araneta, M. MASCC-0503
Arata, K. MASCC-0414
Araujo, C. MASCC-0568
Arellano, J. MASCC-0715, MASCC-0713, MASCC-0711, MASCC-0710, MASCC-0641
Argier, P. MASCC-0431
Arifi, S. MASCC-0018, MASCC-0007
Ariza García, A. MASCC-0439
Armer, J.M. MASCC-0027
Armes J. MASCC-0857
Armes, J. MASCC-0039
Aromataris, E. MASCC-0279
Arora, S.A. MASCC-0441
Arranz, C. MASCC-0840
Arroyo Morales, M. MASCC-0442, MASCC-0439
Arshoun, Y.M. MASCC-0605
Ashikaga, T. MASCC-0293
Ashkvari, P. MASCC-0183
Aslan, O. MASCC-0734, MASCC-0031
Assaker, L. MASCC-0247
Ata, O. MASCC-0284, MASCC-0283, MASCC-0119, MASCC-0069, MASCC-0068, MASCC-0066
Ata, O.Y. MASCC-0182, MASCC-0117, MASCC-0116
Athanasiadis, I. MASCC-0778
Athanassiadis, I. MASCC-0181
Atherton, P.J. MASCC-0807
Atia, E. MASCC-0336
Atkins, J.N. MASCC-0829
Atlani, D. MASCC-0376
Auber, M. MASCC-0114
Aubron-Olivier, C. MASCC-0672
Aung, A. MASCC-0162, MASCC-0161
Aung, M.M. MASCC-0319
Auriacombe M, M.A. MASCC-0818
Avgetidou, E. MASCC-0644
Avila, C. MASCC-0586
Avila, J. MASCC-0370
Avisar, N. MASCC-0719
Aydin, O. MASCC-0802
Ayvalioglu, D. MASCC-0770
Azevedo, R.G. MASCC-0856
Azevedo, S.J. MASCC-0654
Azhar, M. MASCC-0326
B. MASCC-0856
Baba, H. MASCC-0521
Baba, S. MASCC-0241
Bablioglu, I. MASCC-0548
Badre, S. MASCC-0541, MASCC-0539
Badros, A.Z. MASCC-0773
Badyal, D.K. MASCC-0201
Bae, D. MASCC-0416
Bafaloukos, D. MASCC-0778, MASCC-0769
Bagcivan, G. MASCC-0303
Bagnato, V.S. MASCC-0106
Bahadur, N. MASCC-0511
Baharvand, M. MASCC-0775, MASCC-0761
Bahiddin yilmaz, B.Y. MASCC-0833
Bairati, I. MASCC-0055, MASCC-0054
Bak, K. MASCC-0431
Bakitas, M. MASCC-0234
Balachandran, D. MASCC-0585
Balakan, O. MASCC-0339
Balakumaran, A. MASCC-0334
Balan, A. MASCC-0806
Ballatori, E. MASCC-0517
Bamberg, M. MASCC-0297
Bandieri, E. MASCC-0706
Banerjee, D. MASCC-0752
Baracos, V.E. MASCC-0505
Barak, F. MASCC-0212, MASCC-0211
Barasch, A. MASCC-0663
Barash, S. MASCC-0719
Barata, P. MASCC-0743, MASCC-0739, MASCC-0659
Barbeau, E. MASCC-0695
Barbosa, P.S. MASCC-0565
Barbosa, Y. MASCC-0835
Barinoff, J. MASCC-0708
Barker, P.N. MASCC-0737, MASCC-0736
Barnes, E. MASCC-0475, MASCC-0238, MASCC-0236, MASCC-0235, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0377, MASCC-0383
Baro, S. MASCC-0344
Barrault M, M.B. MASCC-0818
Barrault, M.B. MASCC-0822
Barret, A. MASCC-0753
Barroso, P.F. MASCC-0315
Barrow, K. MASCC-0390
Barsotti, D. MASCC-0462
Barthelemy V, V.B. MASCC-0822
Barthelemy, V.B. MASCC-0818
Barton, D. MASCC-0562, MASCC-0560
Bascomb, N. MASCC-0621
Bashford, J. MASCC-0469
Basso, F.G. MASCC-0106
Basso, U. MASCC-0653
Bastawisy, A. MASCC-0074
Bastian, S.E.P. MASCC-0044, MASCC-0042
Basu, B. MASCC-0397
Basu, C. MASCC-0397
Basu, S. MASCC-0621
Batarda, L. MASCC-0659
Batarda, M.L. MASCC-0743, MASCC-0739
Bateman, E. MASCC-0677, MASCC-0611, MASCC-0602, MASCC-0600, MASCC-0591
Batist, G. MASCC-0575
Bauchetet, C. MASCC-0531, MASCC-0497
Bauer, J. MASCC-0469
Baumann, S. MASCC-0629, MASCC-0071
Baumann, W. MASCC-0682
Bausa, A. MASCC-0516
Beato, C. MASCC-0632
Beato, C.A.M. MASCC-0654
Beaumont, J.L. MASCC-0011, MASCC-0009
Bechli, A. MASCC-0346, MASCC-0342, MASCC-0341, MASCC-0340, MASCC-0335
Beck, S.L. MASCC-0759
Bedard, A. MASCC-0099
Bedard, G. MASCC-0238, MASCC-0237, MASCC-0236, MASCC-0235, MASCC-0171, MASCC-0170, MASCC-0168, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0009, MASCC-0377, MASCC-0382, MASCC-0383, MASCC-0384
Beddard-Huber, E. MASCC-0099
Beekman, A.T.F. MASCC-0378
Begic, L.J. MASCC-0692
Behera, M.K. MASCC-0016
Behlendorf, T. MASCC-0418
Beijers, T. MASCC-0108
Beirne, G. MASCC-0705, MASCC-0700
Bektas, H. MASCC-0251, MASCC-0250
Bektas-Kayhan, K. MASCC-0770, MASCC-0690
Belderbos, J. MASCC-0224
Belen, F. MASCC-0028
Belka, C. MASCC-0297
Bella, V. MASCC-0134
Bellamy, P. MASCC-0040
Belum, V.R. MASCC-0763
Ben Aharon, I. MASCC-0299
Ben Ami, S. MASCC-0331
Benbrahim, Z. MASCC-0018, MASCC-0007
Bencova, V. MASCC-0134
Benesch, M. MASCC-0129
Bennani-Baiti, N. MASCC-0534, MASCC-0533
Benner, A. MASCC-0808
Bennett, B. MASCC-0715
Bennion, N. MASCC-0199
Bensadoun, R.J. MASCC-0663
Beorchia, A. MASCC-0423, MASCC-0420
Berenbaum, I.L. MASCC-0607
Berg, C. MASCC-0090
Bergamo, F. MASCC-0653
Berger, K. MASCC-0649
Bergman, H. MASCC-0575
Bernardo, M. MASCC-0587
Bernot, M. MASCC-0768
Berraquero, M.L. MASCC-0698
Berry, D.L. MASCC-0607
Bertoncello, M. MASCC-0527
Besen, A. MASCC-0748
Besser, A. MASCC-0049
Bhargava, R. MASCC-0452, MASCC-0447, MASCC-0307, MASCC-0295
Bhaskar, A. MASCC-0705, MASCC-0700
Bhatt, M.L.B. MASCC-0244
Bhattacharyya, G.S. MASCC-0621
Bhattacharyya, M. MASCC-0752
Bhushan, A.A.B. MASCC-0621
Bhushan, M. MASCC-0120
Bianchi, E. MASCC-0795
Bias, P. MASCC-0784, MASCC-0719
Biasotto, M. MASCC-0423, MASCC-0420, MASCC-0033
Bidargaddi, N. MASCC-0847
Bidet, G. MASCC-0461
Bidstrup, P. MASCC-0688
Bilici, M. MASCC-0339
Billard, D. MASCC-0484
Bilushi, Y. MASCC-0345
Bindon, K.A. MASCC-0042
Bingener, J. MASCC-0601
Birgegård, G. MASCC-0486
Birgens, H. MASCC-0158
Biswas, G. MASCC-0621
Bjarnason, G.A. MASCC-0767
Blackhall, L. MASCC-0844, MASCC-0333
Blair, S.C. MASCC-0562
Blais, M.C. MASCC-0289
Blaizac, C. MASCC-0531, MASCC-0497
Blal, K. MASCC-0842
Blazek, N. MASCC-0488
Blazeviciene, A. MASCC-0768
Blijlevens, N.M.A. MASCC-0567, MASCC-0305
Bloise, R. MASCC-0163
Bloom, B.F.B. MASCC-0703
Blum, R. MASCC-0546
Bock de, G.H. MASCC-0523
Body, J. MASCC-0640
Body, J.J. MASCC-0334
Boele, F. MASCC-0424
Boelke, E. MASCC-0297, MASCC-0288
Boers-Doets, C. MASCC-0396
Boespflug, A. MASCC-0753
Boiron, C. MASCC-0718
Boistard, B. MASCC-0718
Boll, D. MASCC-0361
Bolscher, J.G. MASCC-0321
Bomben, F. MASCC-0687
Bommier, C. MASCC-0638
Bonaventura, M. MASCC-0815
Bonfill, T. MASCC-0828
Boniface MASCC-0142
Bonnet, E. MASCC-0753
Bonneterre, J. MASCC-0645
Boot, A.M. MASCC-0419
Bopp, A. MASCC-0060
Borese, B. MASCC-0327
Bornbaum, C.C. MASCC-0790
Borod, M. MASCC-0848
Boronat, L. MASCC-0370
Borroni, M.E. MASCC-0434, MASCC-0433
Boruban, C. MASCC-0339
Bos-den Braber, J. MASCC-0305
Bosnjak, S. MASCC-0458
Bosscha, K. MASCC-0020
Bossi, P. MASCC-0724, MASCC-0668, MASCC-0664, MASCC-0663
Botana Rodriguez, C. MASCC-0462
Bouché, O. MASCC-0350
Boucher, K.M. MASCC-0059
Bouferrache, K. MASCC-0435
Bouillet, T. MASCC-0695
Bowen, J. MASCC-0853, MASCC-0677, MASCC-0611, MASCC-0600, MASCC-0591, MASCC-0502, MASCC-0483, MASCC-0464, MASCC-0257
Bowen, J.M. MASCC-0489, MASCC-0472, MASCC-0471
Bowers, J. MASCC-0199
Boyland, L. MASCC-0720
Bozza, C. MASCC-0633
Bozzetti, F. MASCC-0796
Braccia, D. MASCC-0787, MASCC-0786
Brachet, P.E. MASCC-0753
Brackett, S. MASCC-0522
Bradley, C. MASCC-0727
Braga, F.T.M.M. MASCC-0673, MASCC-0655
Brames, M. MASCC-0310
Brami, C. MASCC-0350, MASCC-0287
Brasnu, D. MASCC-0634
Braun, A. MASCC-0334
Breckons, M. MASCC-0492, MASCC-0271, MASCC-0374
Brinksma, A. MASCC-0523, MASCC-0419, MASCC-0421
Broder, M. MASCC-0756
Bronkhorst, E.M. MASCC-0305
Broto, J. MASCC-0546
Browall, M. MASCC-0095
Brown, J.E. MASCC-0334
Browne, S. MASCC-0180
Bruera, E. MASCC-0585, MASCC-0574, MASCC-0552, MASCC-0542, MASCC-0540, MASCC-0530, MASCC-0504, MASCC-0143, MASCC-0057
Brufsky, A. MASCC-0788
Brugger, W. MASCC-0569
Brundage, W. MASCC-0293
Brunello, A. MASCC-0653
Bruner, D. MASCC-0703
Brunetti, I. MASCC-0651
Buchanan, A. MASCC-0245
Buchner, A. MASCC-0784, MASCC-0719, MASCC-0694
Budach, W. MASCC-0297, MASCC-0288
Buendia, M. MASCC-0300
Buentzel, H. MASCC-0413
Bugat, R. MASCC-0701
Buhren, B.A. MASCC-0288
Büntzel, H. MASCC-0485
Büntzel, J. MASCC-0485, MASCC-0413, MASCC-0049
Buonaccorso, L. MASCC-0706
Burgerhof, J.G.M. MASCC-0419
Burlein-Hall, S. MASCC-0388, MASCC-0387
Burns, A. MASCC-0447
Bury, M.B.J. MASCC-0703
Busam, K.J. MASCC-0763
Busatto, A. MASCC-0327
Busch, S. MASCC-0726
Bussieres E, E.B. MASCC-0818
Bustreo, S. MASCC-0517
Butler, M. MASCC-0353
Butler, R. MASCC-0628
Butow, P. MASCC-0747, MASCC-0744
Buyukberber, S. MASCC-0339
Buyukyoruk, A. MASCC-0116, MASCC-0069
Buzzoni, R. MASCC-0724
Byun, S.W. MASCC-0803, MASCC-0721
C Schimanski, C. MASCC-0649
Cabral, E. MASCC-0568
Cadeddu, F. MASCC-0115
Cakir Gokce, S. MASCC-0548
Calarese, P. MASCC-0607
Caldeira, S. MASCC-0448
Calera, L. MASCC-0678
Calik M. MASCC-0089
Calik, M. MASCC-0067
Calman, L. MASCC-0498, MASCC-0492, MASCC-0271
Calsina, A. MASCC-0804
Calsina-Berna, A. MASCC-0309
Calvo, N. MASCC-0678
Camacho, M. MASCC-0300
Campbell, F. MASCC-0493
Campbell, N.C. MASCC-0180
Campo, R.A. MASCC-0059
Camps, C. MASCC-0678
Cantarero Villanueva, I. MASCC-0442, MASCC-0439
Cantoreggi, S. MASCC-0602
Cao, S. MASCC-0141
Caporusso, F. MASCC-0010
Capovilla, E. MASCC-0653, MASCC-0344
Cappai, E. MASCC-0662
Capparella, V. MASCC-0081, MASCC-0080
Carafizi, N. MASCC-0834
Caraiscos, V.B. MASCC-0467
Carayol, M. MASCC-0532
Cardellino, G.G. MASCC-0774
Cardona, A.F. MASCC-0300
Cardozo, F.M.C.C. MASCC-0278
Carelli MASCC-0856
Carlucci, V.D.S. MASCC-0655
Carmel, D.F. MASCC-0605
Carmona-Bayonas, A. MASCC-0632, MASCC-0626
Carnaby, G. MASCC-0070
Carothers, S. MASCC-0609
Carrara, H.H.A. MASCC-0811
Carvajal Reynaldo, R. MASCC-0348
Carvalho, E.C. MASCC-0675, MASCC-0673
Casagrande, M. MASCC-0774
Casas Fernandez de Tejerina, A. MASCC-0678
Cases, M. MASCC-0017
Cassel, B. MASCC-0615, MASCC-0613
Castaldi, M. MASCC-0454
Castañeda, P. MASCC-0843
Castillo-Carandang, N. MASCC-0516
Castro, A. MASCC-0659
Cattaruzza, M. MASCC-0751
Cau, M.C. MASCC-0047
Cavicchioli, L.T. MASCC-0239
Cazin, J.L. MASCC-0645
Ceccaldi, B. MASCC-0406
Celik, C. MASCC-0116, MASCC-0069
Cella, D. MASCC-0246, MASCC-0011, MASCC-0009, MASCC-0377
Cesas, A. MASCC-0584
Cetin, K. MASCC-0641
Cetingul, N. MASCC-0351
Chachaty, E. MASCC-0501
Chadi, S. MASCC-0603
Chaen, M. MASCC-0487, MASCC-0398
Chahal, K. MASCC-0203
Chair, S.Y. MASCC-0402, MASCC-0400
Chambers, C. MASCC-0572
Chan, A. MASCC-0630, MASCC-0599, MASCC-0598, MASCC-0588, MASCC-0538, MASCC-0479, MASCC-0446, MASCC-0436
Chan, C.en.W.H. MASCC-0537
Chan, C.W.H. MASCC-0606, MASCC-0402, MASCC-0400
Chan, D.N.S. MASCC-0402
Chan, N. MASCC-0014, MASCC-0013, MASCC-0006
Chan, P. MASCC-0030
Chan, R. MASCC-0030, MASCC-0029
Chan, R.J. MASCC-0402
Chan, S. MASCC-0240
Chan, S.L. MASCC-0732
Chan, Y.H. MASCC-0732
Chandía, A. MASCC-0409
Chandra, S. MASCC-0752
Chandrakumaran, K. MASCC-0463
Chang, E. MASCC-0756
Chang, H. MASCC-0510
Chang, H.H. MASCC-0222
Chang, L.-L. MASCC-0153
Chang, S.N. MASCC-0281
Chao, A. MASCC-0352
Chao, H.L. MASCC-0132
Chapman, P.B. MASCC-0763
Charalambous, A. MASCC-0355
Charalambous, M. MASCC-0355
Chargari, C. MASCC-0406
Chasen, M. MASCC-0796, MASCC-0452, MASCC-0447, MASCC-0307, MASCC-0295, MASCC-0252
Chau, N.M. MASCC-0630, MASCC-0479
Chaumard-Billotey, N. MASCC-0571
Chay, W.Y. MASCC-0599, MASCC-0598
Cheah, K.Y. MASCC-0044, MASCC-0042
Chebolu, S. MASCC-0583
Cheetham, T.C. MASCC-0586
Chen, C.H. MASCC-0281
Chen, E. MASCC-0237, MASCC-0010, MASCC-0008
Chen, L. MASCC-0476, MASCC-0474
Chen, P.B. MASCC-0785
Chen, Q. MASCC-0844
Chen, Y. MASCC-0320, MASCC-0282
Chen, Y.M. MASCC-0132
Chen, Z. MASCC-0233
Cheng, K. MASCC-0014, MASCC-0013, MASCC-0012, MASCC-0006, MASCC-0005, MASCC-0004
Cheng, S. MASCC-0681
Cheng, S.F. MASCC-0320, MASCC-0088
Cheng, Y. MASCC-0556
Chermetz, M. MASCC-0033
Cherny, N. MASCC-0164, MASCC-0109
Cheshire, S. MASCC-0805
Cheung, A. MASCC-0431
Cheung, W. MASCC-0476, MASCC-0474
Cheung, Y.T. MASCC-0599, MASCC-0598, MASCC-0588, MASCC-0436
Cheville, A. MASCC-0740
Chey, W.D. MASCC-0737
Chiara, S. MASCC-0517
Chie, W.-C. MASCC-0167
Chisholm, G. MASCC-0542, MASCC-0143
Chisholm, G.B. MASCC-0552
Chiu, K.K. MASCC-0631
Chiu, L. MASCC-0246, MASCC-0242, MASCC-0011, MASCC-0009
Chiu, N. MASCC-0246, MASCC-0242, MASCC-0011, MASCC-0009
Chivers Seymour, K. MASCC-0498
Chmielowska, E. MASCC-0658
Cho, C. MASCC-0416
Cho, I. MASCC-0262, MASCC-0261
Cho, O.H. MASCC-0255
Cho, S. MASCC-0616
Cho, S.J. MASCC-0676
Cho, Y.H. MASCC-0647
Choi, D.R. MASCC-0511
Choi, K.C. MASCC-0402, MASCC-0400
Choi, M.Y. MASCC-0511
Choi, Y.J. MASCC-0511
Chojnicki, M. MASCC-0514
Chong, X.J. MASCC-0479
Choquette, L.C. MASCC-0564
Chou, H.L. MASCC-0132
Choupay-Dessard, G. MASCC-0488
Chow, E. MASCC-0612, MASCC-0475, MASCC-0399, MASCC-0316, MASCC-0246, MASCC-0242, MASCC-0238, MASCC-0237, MASCC-0236, MASCC-0235, MASCC-0171, MASCC-0170, MASCC-0169, MASCC-0168, MASCC-0167, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0011, MASCC-0010, MASCC-0009, MASCC-0008, MASCC-0377, MASCC-0382, MASCC-0383, MASCC-0384
Chow, R. MASCC-0612, MASCC-0399, MASCC-0246, MASCC-0242, MASCC-0171, MASCC-0168, MASCC-0011, MASCC-0009, MASCC-0382
Chrisholm, G. MASCC-0530
Christensen, J. MASCC-0688, MASCC-0158
Christensen, J.C. MASCC-0441
Christensen, L. MASCC-0504
Christrup, L. MASCC-0112, MASCC-0111
Chu, C.Y. MASCC-0709
Chu, D. MASCC-0237, MASCC-0382, MASCC-0383, MASCC-0384
Chu, I. MASCC-0510
Chu, K.M. MASCC-0618
Chue, X.P. MASCC-0630, MASCC-0479
Chui, W.K. MASCC-0599, MASCC-0598, MASCC-0588
Chung, H. MASCC-0316
Chung, I.J. MASCC-0511
Chung, J. MASCC-0586
Chung, K. MASCC-0728
Cinausero, M. MASCC-0633
Cinkir, H. MASCC-0339
Ciorra, A.A. MASCC-0081
Ciriello, F. MASCC-0423, MASCC-0420
Citak, E.A. MASCC-0768
Ciuba, D.F. MASCC-0605
Claret, C. MASCC-0645
Clark, M.M. MASCC-0807
Clavier, J.B. MASCC-0376
Cleeland, C. MASCC-0546, MASCC-0334
Cleijne, W. MASCC-0424
Clerico, M. MASCC-0517
Cnossen, I.C. MASCC-0381
Cobanoglu, G. MASCC-0284, MASCC-0117, MASCC-0116, MASCC-0069
Cohen, E.E.W. MASCC-0708
Cohen, L. MASCC-0395
Colak, D. MASCC-0802, MASCC-0798
Coles, C. MASCC-0810
Colgan, V. MASCC-0620
Coll, J. MASCC-0469
Coller, J. MASCC-0483
Coller, J.K. MASCC-0472
Collini, D. MASCC-0751
Colombani S, S.C. MASCC-0822
Colombat, P. MASCC-0531, MASCC-0497, MASCC-0254
Combariza, J. MASCC-0260, MASCC-0258
Comber, H. MASCC-0428, MASCC-0427
Company, A. MASCC-0768
Cone, C. MASCC-0805
Cong, Z. MASCC-0728
Connolly, E. MASCC-0699, MASCC-0674
Conti, G. MASCC-0033
Coolbrandt, A. MASCC-0459
Cooley, M.E. MASCC-0607
Cooney, M. MASCC-0699, MASCC-0674
Cooper, A.B. MASCC-0800
Copel, L. MASCC-0718
Cordier, J.F. MASCC-0324
Cormier, J.N. MASCC-0027
Corner, J. MASCC-0498, MASCC-0492, MASCC-0271
Corrias, M. MASCC-0653
Cortizo, D.L. MASCC-0801
Cosic, J. MASCC-0692
Costa, F.O. MASCC-0654
Costa, L. MASCC-0743, MASCC-0739
Costa, M.J. MASCC-0587
Cousin, S. MASCC-0425
Cranston, C. MASCC-0452
Crary, M. MASCC-0070
Crawford, J. MASCC-0817, MASCC-0816, MASCC-0765, MASCC-0760, MASCC-0438
Crespel, C. MASCC-0287
Cristino, J. MASCC-0713, MASCC-0711
Croghan, I. MASCC-0740
Crossland, V. MASCC-0713, MASCC-0711
Cruz, F.M. MASCC-0654, MASCC-0581, MASCC-0573
Cruz, J.J. MASCC-0678
Crvenkova, S. MASCC-0038
Cubero, D. MASCC-0654, MASCC-0856
Cubero, D.I.G.C. MASCC-0581
Cucchi, M. MASCC-0645
Cui, J. MASCC-0141
Cuijpers, P. MASCC-0378
Culakova, E. MASCC-0817, MASCC-0816
Cumpston, A. MASCC-0114
Curé, H. MASCC-0287
Curley, K.F. MASCC-0564
Curran, S. MASCC-0665, MASCC-0661
Currow, D. MASCC-0410
Cusano, F. MASCC-0572
Custódio, M.P. MASCC-0743, MASCC-0739
Dabkara, D. MASCC-0850
Daehler, M.A. MASCC-0138
Daghbashyan, S. MASCC-0325
Daher, A. MASCC-0247
Dahham, S. MASCC-0643
Dai, D. MASCC-0729
Dakhil, S.R. MASCC-0560
Dale, D. MASCC-0438
Dale, D.C. MASCC-0817, MASCC-0816
Dale, O. MASCC-0111
Dalmau, E. MASCC-0828
Dalton, J.T. MASCC-0765, MASCC-0760
Dalton, S.O. MASCC-0688
DaLuz, R. MASCC-0659
Dalvad, E. MASCC-0133
Damyanov, D. MASCC-0334
Danilkina, G. MASCC-0485
Danjoux, C. MASCC-0475, MASCC-0238, MASCC-0236, MASCC-0235, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0377, MASCC-0383
Daoud, S. MASCC-0075
Daoudi, K. MASCC-0018
Daoust, L. MASCC-0461, MASCC-0460
Darmani, N. MASCC-0583
DasGupta, T. MASCC-0390
Davidowitz, T. MASCC-0412
Davies, A. MASCC-0245, MASCC-0111, MASCC-0001, MASCC-0359
Davies, M. MASCC-0847, MASCC-0493, MASCC-0391
Davies, W. MASCC-0603
Davis, C. MASCC-0720
Davis, M. MASCC-0196, MASCC-0165, MASCC-0164, MASCC-0163, MASCC-0162, MASCC-0161, MASCC-0109
Davis, R. MASCC-0194
De Angelis, C. MASCC-0475, MASCC-0463
De Botton, S. MASCC-0527
De Bree, R. MASCC-0378, MASCC-0381
De Castro Carpeño, J. MASCC-0678
De Haan, A.F.J. MASCC-0567
De Jesus Cabral, M. MASCC-0638
De La Cruz, M. MASCC-0540, MASCC-0530
De Melker, A. MASCC-0823
De Riu, G. MASCC-0263
De Serres, M. MASCC-0289
De Soet, J.J. MASCC-0321
De Souza Costa, C.A. MASCC-0106
DeAngelis, C. MASCC-0316
Deary, V. MASCC-0582
Debattista, K. MASCC-0322
Debus, J. MASCC-0686, MASCC-0680, MASCC-0496, MASCC-0297
Decaestecker, J. MASCC-0584
Decosterd, S. MASCC-0488
Degardin, M. MASCC-0425
Dégi, C.L. MASCC-0451
DeGore, L. MASCC-0815
Deguzman, C. MASCC-0767
Del Fabbro, E. MASCC-0848, MASCC-0615, MASCC-0613, MASCC-0057
Del Fiol, G. MASCC-0607
Del Giglio, A. MASCC-0581, MASCC-0573, MASCC-0573, MASCC-0239, MASCC-0856
Del Giglio, A.B. MASCC-0856, MASCC-0239
Del Giglio, A.E.R. MASCC-0654
Delaruelle, C. MASCC-0753
Delea, T.E. MASCC-0728
Deledda, A. MASCC-0263
Delgado-Guay, M.O. MASCC-0057
DelGiglio, A. MASCC-0608
Delpierre, C. MASCC-0532
Demir, E.T. MASCC-0102
Demirci, U. MASCC-0339
Den Boer, A.M. MASCC-0455
Denaro, N. MASCC-0664
Deng, J. MASCC-0149, MASCC-0027, MASCC-0558
Denicoff, A. MASCC-0543
DeNittis, A.S.D. MASCC-0703
Dennis, K. MASCC-0475, MASCC-0316, MASCC-0236
Dent, R.A. MASCC-0599, MASCC-0598, MASCC-0538
Dereumaux, N. MASCC-0645
Deryck, T. MASCC-0502
Des Bordes, J.K.A. MASCC-0800
Desbiens, J.F. MASCC-0289
Descotes, J.M. MASCC-0695
Descourt, R. MASCC-0197, MASCC-0098, MASCC-0096
Desilets, O. MASCC-0691
Desjardins, A. MASCC-0805, MASCC-0777
Despierre, E. MASCC-0328
Destro-Borgen, M. MASCC-0722
Dettino, A.A. MASCC-0654
Dev, R. MASCC-0540, MASCC-0057
Di Giovanni, J. MASCC-0237, MASCC-0010, MASCC-0008
Di Lenarda, R. MASCC-0423, MASCC-0420
Di Palma, M. MASCC-0527, MASCC-0501
Dias, B.P. MASCC-0830
Dias, F. MASCC-0568
Diasio, B. MASCC-0845
Díaz Rodríguez, D. MASCC-0698
Díaz Rodriguez, L. MASCC-0442
Dib, L.L. MASCC-0801
Didwaniya, N. MASCC-0540
Dieckmann, K. MASCC-0063
Diel, I. MASCC-0726
Dielenseger, P. MASCC-0707
Diemar, C. MASCC-0418
Dieperink, K. MASCC-0133
Dieperink, K.B. MASCC-0512, MASCC-0265, MASCC-0264
Dierckx de Casterlé, B. MASCC-0459
Dietrich, M.S. MASCC-0149, MASCC-0027, MASCC-0762, MASCC-0558
Dilek Erdem, D.E. MASCC-0833
Dimitrijevic, J. MASCC-0458
Dimitrovska, A. MASCC-0038
Dimov, A. MASCC-0657
Ding, S.-A. MASCC-0213
Dintinjana, M. MASCC-0593
DiPalma, M. MASCC-0738, MASCC-0505
Dobrila-Dintinjana, R. MASCC-0597, MASCC-0593
Doherty, G. MASCC-0746
Dolai, T. MASCC-0752
Dolbeault, S. MASCC-0718
Domen, K. MASCC-0256, MASCC-0209
Domingo, E. MASCC-0516
Dominkus, M. MASCC-0546
Donbavand, J. MASCC-0021
Dong, F. MASCC-0292, MASCC-0291
Dong, M. MASCC-0233
Donnely, J.P. MASCC-0567
Donner, C. MASCC-0413
Dorchin, M. MASCC-0174, MASCC-0173
Douw, L. MASCC-0424
Downar, J. MASCC-0603
Dowsett, R.J. MASCC-0564
Doyle, N. MASCC-0270, MASCC-0269
Doyle, P.C. MASCC-0790
Dr. Njimogu MASCC-0142
Drewes, A.M. MASCC-0112
Drobner, I. MASCC-0432
Drummond, F. MASCC-0725, MASCC-0635
Drummond, F.J. MASCC-0428, MASCC-0427
Du, Q. MASCC-0526
Dubinina, V. MASCC-0290
Dubinina, V.G. MASCC-0429
Dubreuil, J. MASCC-0753
Dubroeucq, O. MASCC-0287
Duchnowska, R. MASCC-0658
Duguey-Cachet, O. MASCC-0179
Dumitrescu, C. MASCC-0296
Dunson Jr., W.A. MASCC-0759
Dusza, S. MASCC-0763
Duval, M. MASCC-0461
Dwary, A. MASCC-0850
Dyag?l, I. MASCC-0364
Easson, A. MASCC-0603
Eastman, P. MASCC-0401
Eduardo, B. MASCC-0395
Eeckhout, G.M. MASCC-0378
Eeltink, C. MASCC-0636, MASCC-0375
Eerenstein, S.E. MASCC-0381
Egerdie, B. MASCC-0334
Ehlken, B. MASCC-0649
Einhorn, L.H. MASCC-0310
Ekema, C. MASCC-0142
Ekholm, O. MASCC-0111
El Mesbahi, O. MASCC-0018, MASCC-0007
El Osta, L. MASCC-0553, MASCC-0551
El Osta, N. MASCC-0551
El-hadad, A. MASCC-0336
Elad, S. MASCC-0313
Elangovan, V. MASCC-0704, MASCC-0619
Elayouty, H.L. MASCC-0121
Ellershaw, J.E. MASCC-0343
Elliott, L. MASCC-0857, MASCC-0039
Elmi, S. MASCC-0839
Elrafei, T. MASCC-0454
Elsaesser, R. MASCC-0784
Elsafy, E. MASCC-0336
Elsurer Afsar, R. MASCC-0066
Ely, J. MASCC-0754
Emali, F. MASCC-0723
Emmenegger, U. MASCC-0171, MASCC-0169, MASCC-0168
Engellau, J. MASCC-0546
Engin, H. MASCC-0339
England, D. MASCC-0572
Enright, P. MASCC-0447
Ensslin, C. MASCC-0024
Epstein, J.B. MASCC-0149
Erdemir, U.G.U.R. MASCC-0770
Eremin, V. MASCC-0407
Ermacora, P. MASCC-0774, MASCC-0751
Ersoy, U. MASCC-0802
Escalante, C. MASCC-0395
Escalante, C.P. MASCC-0579
Esh, A. MASCC-0314
Esme, H. MASCC-0089, MASCC-0067
Espejo, J. MASCC-0843
Espie, C.A. MASCC-0437
Espinal, R. MASCC-0194
Estfan, B. MASCC-0832, MASCC-0536, MASCC-0534
Etienne-Mastroianni, B. MASCC-0324
Eurelings, M. MASCC-0636
Evangelista, S. MASCC-0462
Eyll, B.M.V. MASCC-0654
Fabi, A. MASCC-0517
Fache, B. MASCC-0350
Faddoul, S. MASCC-0553
Faerber, J. MASCC-0729
Fairchild, A. MASCC-0167
Faith, K. MASCC-0051
Fakhrul islam, P.R.O.F. MASCC-0275
Fakiha, K. MASCC-0483
Falcone, A. MASCC-0651
Fallowfield, L.J. MASCC-0334
Faltl, L. MASCC-0390
Fan, B. MASCC-0150
Fan, G. MASCC-0599, MASCC-0598
Fansabedian, T. MASCC-0528
Faria, C. MASCC-0766, MASCC-0756
Farley, D. MASCC-0601
Farouk, M. MASCC-0569
Farsi, F. MASCC-0371
Fasola, G. MASCC-0774, MASCC-0751, MASCC-0633
Fatigoni, S. MASCC-0517
Fatigue, . MASCC-0151
Fayette, J. MASCC-0672
Fearon, K. MASCC-0796
Fee-Schroeder, K.C. MASCC-0846
Feinn, R.S. MASCC-0564
Feldman, E. MASCC-0605
Feldstain, A. MASCC-0307, MASCC-0252
Felice, M. MASCC-0462
Fendrychová, J. MASCC-0768
Feng, A. MASCC-0546
Fenlon, D. MASCC-0580, MASCC-0498, MASCC-0492, MASCC-0271
Fennelly, D. MASCC-0746
Fernanda Mara Coelho Cardozo, F.M.C.C. MASCC-0273
Fernanda Mara Coelho, F.M.C. MASCC-0272
Fernández Lao, C. MASCC-0442, MASCC-0439
Fernandez Ortega, P. MASCC-0707
Fernandez Perez, D. MASCC-0707
Fernandez, P. MASCC-0768
Fernandez-Martinez, A. MASCC-0632, MASCC-0626, MASCC-0002
Ferrand, F.R. MASCC-0753
Ferrari, L. MASCC-0774
Ferreira, C. MASCC-0568
Ferreira, E. MASCC-0568
Ferreira, E.M. MASCC-0565
Ferreira, S. MASCC-0835
Ferreira, S.M.A. MASCC-0764
Ferreira, V.T.K. MASCC-0830, MASCC-0811, MASCC-0730
Ferrer, M. MASCC-0828
Festa, A. MASCC-0695
Feudtner, C. MASCC-0729
Feyer, P. MASCC-0726
Fiduccia, P. MASCC-0653
Fieuws, S. MASCC-0023
Fijlstra, M. MASCC-0157
Filho, D.R. MASCC-0654
Fillion, L. MASCC-0289
Findler, M. MASCC-0313, MASCC-0313
Finek, J. MASCC-0640
Finkelstein, D. MASCC-0522
Finkelstein, S.E. MASCC-0605
Finn, K. MASCC-0607
Finnie, J. MASCC-0257
Fiscella, K. MASCC-0556
Fisch, M. MASCC-0559
Fisher, B.T. MASCC-0729
Fishman, M. MASCC-0017
Fitch, M. MASCC-0578, MASCC-0577, MASCC-0576, MASCC-0390, MASCC-0389, MASCC-0388, MASCC-0387, MASCC-0386
Fitch, M.I. MASCC-0449, MASCC-0445
Fitz, A. MASCC-0693, MASCC-0456, MASCC-0453
Fizazi, K. MASCC-0505
Flaiban, C. MASCC-0687, MASCC-0684
Flament, T. MASCC-0753
Flechl, B. MASCC-0063
Fleckenstein, K. MASCC-0520
Fleischmann, C. MASCC-0736
Fleming, L. MASCC-0437
Fletcher, S.W. MASCC-0586
Floquet A, A.F. MASCC-0822
Fogelman, D.R. MASCC-0800, MASCC-0742
Folkins, C. MASCC-0463
Foltran, L. MASCC-0774
Fonseca, O. MASCC-0156
Font, C. MASCC-0678, MASCC-0632, MASCC-0626, MASCC-0056, MASCC-0002
Foo, K.M. MASCC-0538
Foo, Y.L. MASCC-0588
Forges, F. MASCC-0167
Foster, C. MASCC-0720, MASCC-0498, MASCC-0492, MASCC-0271, MASCC-0374
Foster, R. MASCC-0720
Fouladi, N. MASCC-0178
fouquereau, E. MASCC-0254
Fox, A. MASCC-0569
Franklin, J. MASCC-0790
Fraquelli, L. MASCC-0462
Freedman, J.L. MASCC-0729
Freytes, C. MASCC-0392
Freytes, C.O. MASCC-0394, MASCC-0393
Friedman, H. MASCC-0777
Friedman, H.S. MASCC-0805
Friend, J. MASCC-0410
Frisbee-Hume, S. MASCC-0585, MASCC-0574, MASCC-0542, MASCC-0395
Frisbee-Hume, S.E. MASCC-0552
Fritz, G. MASCC-0062, MASCC-0060
Fryer, J. MASCC-0359
Fu, M.R. MASCC-0027
Fu, Q. MASCC-0494
Fujii, H. MASCC-0513, MASCC-0500
Fukutomi, A. MASCC-0369
Fulman, L. MASCC-0493
Fuloria, J. MASCC-0562
Fumis, R.R.L. MASCC-0654
Fundakowski, C. MASCC-0184
Fung, K. MASCC-0790
Furuse, J. MASCC-0521
Gaafar, R. MASCC-0074
Gachot, B. MASCC-0501
Gagne, H. MASCC-0293
Gagnon, P. MASCC-0691
Gaiger, A. MASCC-0063
Galiano Castillo, N. MASCC-0442, MASCC-0439
Galiti, D. MASCC-0769
Galitis, E. MASCC-0769
Gallego Zapata, S. MASCC-0348
Galli, L. MASCC-0651
Galun, D. MASCC-0555
Galvez, K. MASCC-0260, MASCC-0258
Galvin, R. MASCC-0699, MASCC-0674
Gandhavadi, R.B. MASCC-0605
Ganesan, S. MASCC-0704
Gangeri, L. MASCC-0795
Ganguly, B.B. MASCC-0752
Ganjoo, K. MASCC-0546
Ganswindt, U. MASCC-0297
Gao, S. MASCC-0579
Garavello, I. MASCC-0811
Garbin, L.M. MASCC-0655
Garcia, E. MASCC-0828
Garcia, Y. MASCC-0828
Garg, N. MASCC-0742
Garguil V, V.G. MASCC-0818
Garrett, A. MASCC-0408
Garrone, O. MASCC-0517
Garssen, A. MASCC-0563
Gasich, E.L. MASCC-0407
Gaston-Johansson, F. MASCC-0095
Gates, P. MASCC-0365
Gatou, E. MASCC-0778
Gaur, R. MASCC-0829
Gaur, S. MASCC-0215
Gauvin, F. MASCC-0461, MASCC-0460
Gavin, A. MASCC-0725, MASCC-0635
Gaya, S.A. MASCC-0217
Ge, L. MASCC-0004
Geay, J.F. MASCC-0484
George, M. MASCC-0614
Georgieva, S. MASCC-0657
Gerber, P. MASCC-0297
Gerber, P.A. MASCC-0288
Geredeli, C. MASCC-0339
Gerratana, L. MASCC-0633
Ghosh, I. MASCC-0850
Ghosh, K. MASCC-0722
Ghosh, M. MASCC-0752
Ghosh, S. MASCC-0624
Ghosn, M. MASCC-0553, MASCC-0551
Giacchetti, S. MASCC-0767
Gianello, L. MASCC-0664
Giannatempo, P. MASCC-0724
Gibson, R. MASCC-0853, MASCC-0471, MASCC-0257
Gibson, R.J. MASCC-0489, MASCC-0472
Gichini, L. MASCC-0689
Gichini, L.I. MASCC-0148
Giglio, A.D. MASCC-0107
Gijsen, B. MASCC-0323
Gillet, N. MASCC-0254
Gilmore, J. MASCC-0787
Ginocchi, L. MASCC-0651
Giotis, A. MASCC-0463
Gioules, A. MASCC-0297
Giovannini, L. MASCC-0687, MASCC-0684
Giovannoni, M. MASCC-0774
Girard, N. MASCC-0324
Girre, V. MASCC-0575, MASCC-0570
Girvent, F. MASCC-0828
Giscard, S. MASCC-0645
Giuliani, J. MASCC-0137, MASCC-0136, MASCC-0135, MASCC-0327
Given, B. MASCC-0851
Gladkov, O. MASCC-0784, MASCC-0719
Glaus, A. MASCC-0186
Glavic, Z. MASCC-0692
Glaza, I. MASCC-0831
Gleich, L. MASCC-0410
Gloria, K. MASCC-0051, MASCC-0050
Glowacka, I. MASCC-0831, MASCC-0826
Gobbo, M. MASCC-0423, MASCC-0420, MASCC-0033
Goddard, K. MASCC-0797
Godfrey, K.A. MASCC-0749
Gokcen-Röhling, B. MASCC-0770
Gokoz dogu, G. MASCC-0339
Goksel, G. MASCC-0339
Golby, C. MASCC-0322
Goldman, C.S. MASCC-0856
Gomes, A. MASCC-0528
Gomes, F. MASCC-0659
Gonçalves, G. MASCC-0587
Gong, S.J. MASCC-0511
Gonzalez-Barboteo, J. MASCC-0804, MASCC-0309
Gonzalez-Fernandez, R. MASCC-0370
Gooberman-Hill, R. MASCC-0747, MASCC-0744
Good, M. MASCC-0543
Goossens, G.A. MASCC-0328, MASCC-0023
Goswami, D. MASCC-0175
Goto, K. MASCC-0414
Gottumukala, V. MASCC-0800
Gotz, C. MASCC-0204, MASCC-0086
Govindbabu, K. MASCC-0621
Gozzo, T. MASCC-0835
Gozzo, T.O. MASCC-0811, MASCC-0772, MASCC-0764
Gralla, R. MASCC-0737, MASCC-0434, MASCC-0432
Gralla, R.J. MASCC-0765, MASCC-0760, MASCC-0454, MASCC-0312
Grané, M.C. MASCC-0056, MASCC-0002
Granot, T. MASCC-0331, MASCC-0299, MASCC-0298
Gravelle, D. MASCC-0295
Gray, N. MASCC-0180
Gregoracci, G. MASCC-0751
Grendahl, D.C. MASCC-0846
Grimmett, C. MASCC-0492, MASCC-0271
Groot de, M. MASCC-0424
Grothey, A. MASCC-0625
Grunberg, S. MASCC-0433
Grunberg, S.M. MASCC-0293
Grutsch, J. MASCC-0466, MASCC-0465
Grutsch, J.F. MASCC-0138
Guariento, R.T. MASCC-0856
Gucek, M. MASCC-0337
Guerrero, G.P. MASCC-0545
Guest, A. MASCC-0749
Guihard, S. MASCC-0376
Guinigundo, A.S. MASCC-0541, MASCC-0539
Guirro, E.C.O. MASCC-0830, MASCC-0730
Gul, O.V. MASCC-0284, MASCC-0283, MASCC-0119, MASCC-0117
Gunn, K.M. MASCC-0847
Güntsch, F. MASCC-0418
Guo-chenXing, G. MASCC-0065
Gupta, D. MASCC-0138
Gürsel, T. MASCC-0028
Gushiken, F. MASCC-0394, MASCC-0393, MASCC-0392
Guth, D. MASCC-0726
Guy-Coichard, C. MASCC-0753
Guyon F, F.G. MASCC-0822
Güzin demirag, G.D. MASCC-0833
H. MASCC-0182
H. Pedersen, J. MASCC-0716
Haak, H.R. MASCC-0052
Haas-Rassfeld, B. MASCC-0496
Habana, A. MASCC-0516
Habel, L.A. MASCC-0586
Habl, G. MASCC-0680
Hacibekiroglu, I. MASCC-0802
Hack, C. MASCC-0520
Haefner, M. MASCC-0680, MASCC-0496
Hafashimana, V. MASCC-0160
Haga, N. MASCC-0414
Hagag, P. MASCC-0187
Hagiwara, M. MASCC-0728
Hagner, W. MASCC-0831, MASCC-0826
Haid, V. MASCC-0316
Haile, D. MASCC-0394, MASCC-0393, MASCC-0392
Haislip, S. MASCC-0787
Haitz, K. MASCC-0767
Hall, S. MASCC-0329, MASCC-0180, MASCC-0001
Halpenny, B. MASCC-0607
Halpern, A.C. MASCC-0763
Hamad, A.-W.R. MASCC-0072
Hamada, K. MASCC-0757
Hamauchi, S. MASCC-0369
Hamou, A. MASCC-0644
Hancock, M.L. MASCC-0765, MASCC-0760
Handsfield, L. MASCC-0844
Hank, E. MASCC-0481
Hankins, M. MASCC-0374
Hanna, E. MASCC-0838
Hannon, B. MASCC-0820
Hans, S. MASCC-0634
Hansen, D.G. MASCC-0504
Hansen, O. MASCC-0512
Hansen, S. MASCC-0512
Hanucharurnkul, S. MASCC-0015
Haque, R. MASCC-0586
Harder, J. MASCC-0288
Hardt, J. MASCC-0570
Harle, I. MASCC-0431
Harputoglu, H. MASCC-0339
Harrison, J. MASCC-0333
Harsch, J. MASCC-0496
Hartley, B. MASCC-0270, MASCC-0269
Hartmann, I. MASCC-0133
Harvey, R.D. MASCC-0773
Hasan, A. MASCC-0394, MASCC-0393
Hasan, M. MASCC-0742
Hassali, M.A. MASCC-0085
Hassan, B.A.R. MASCC-0085
Hassan, L. MASCC-0643
Hassel, J. MASCC-0680
Hata, T. MASCC-0679
Hatake, K. MASCC-0521
Hauschild, A. MASCC-0709
Hauswald, H. MASCC-0686
Haynes, I. MASCC-0713, MASCC-0711, MASCC-0710
Hebling, J. MASCC-0106
Hechmati, G. MASCC-0715, MASCC-0713, MASCC-0711, MASCC-0710, MASCC-0640
Heckler, C. MASCC-0829, MASCC-0794
Heckler, C.E. MASCC-0810
Hedley, M.L.H. MASCC-0441
Hegarty, J. MASCC-0745, MASCC-0665, MASCC-0661
Hegde, U.P. MASCC-0564
Heike, Y. MASCC-0366
Heilmann, E. MASCC-0780
Heimans, J. MASCC-0424
Hendriksen, C. MASCC-0443
Henke, M. MASCC-0297
Hennequin, M. MASCC-0551
Hennessy, M. MASCC-0428, MASCC-0427
Henninger, C. MASCC-0062, MASCC-0060
Henry, R. MASCC-0269
Hera, M. MASCC-0342, MASCC-0340
Heras, P. MASCC-0346, MASCC-0342, MASCC-0341, MASCC-0340, MASCC-0335
Herbers, A.H.E. MASCC-0567
Herchenhorn, D. MASCC-0568
Hernández, C. MASCC-0056, MASCC-0002
Hernandez, R. MASCC-0641
Herndon II, J.E. MASCC-0805
Heron, D.E. MASCC-0605
Herve, C. MASCC-0638, MASCC-0634
Herzog, M. MASCC-0062
Hesketh, P. MASCC-0432
Hessissen, L. MASCC-0590
Hicks, K. MASCC-0037
Hiegel, C. MASCC-0718
Higa, G. MASCC-0114
Higney, K. MASCC-0727
Hindenburg, H.J. MASCC-0852, MASCC-0726
Hinke, A. MASCC-0496
Hira, N. MASCC-0610
Hirasawa, T. MASCC-0368
Hirata, K. MASCC-0521
Hirsch, B. MASCC-0808
Ho, H.K. MASCC-0630, MASCC-0598, MASCC-0479
Ho, R. MASCC-0003
Ho, S.ne.S.M. MASCC-0537
Ho, S.S.M. MASCC-0639, MASCC-0400
Hobbs, G. MASCC-0114
Hoelzer, K.L. MASCC-0810
Hof, H. MASCC-0686
Hojan, K. MASCC-0785, MASCC-0783
Højsted, J. MASCC-0112
Holcmann, M. MASCC-0288
Holden, L. MASCC-0612, MASCC-0475, MASCC-0238, MASCC-0236, MASCC-0235, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0377, MASCC-0382, MASCC-0383
Hollen, P.J. MASCC-0312
Holliday, L. MASCC-0408
Holm, M. MASCC-0198
Holmes, H. MASCC-0800, MASCC-0742
Homey, B. MASCC-0288
Honaga, K. MASCC-0379, MASCC-0380
Hong, D.S. MASCC-0511
Hong, J. MASCC-0041
Hong, W. MASCC-0405
Hong, Y.S. MASCC-0511, MASCC-0143, MASCC-0041
Honma, Y. MASCC-0414
Hoque, M. MASCC-0481
Horaiya, K. MASCC-0525
Horn, J. MASCC-0493
Horng, C.-F. MASCC-0153
Horsley, P. MASCC-0469
Hoshikawa, Y. MASCC-0508
Hosokawa, R. MASCC-0508, MASCC-0507
Hotko, Y. MASCC-0584
Hou, L. MASCC-0152
Hou, M.-F. MASCC-0167
Houghton, D. MASCC-0493
Howard, A.F. MASCC-0797
Howarth, G.S. MASCC-0044, MASCC-0043, MASCC-0042
Howell, D. MASCC-0578, MASCC-0576
Howell, J. MASCC-0786
Hoy, S. MASCC-0493
Hrushesky, W.J. MASCC-0138
Hsia, T.C. MASCC-0312
Hsiao, J. MASCC-0170
Hsu, L.Y. MASCC-0446
Huang T.-W. MASCC-0221
Huang, D. MASCC-0559
Huang, T.-W. MASCC-0144
Huang, Y.S. MASCC-0729
Hubbard, G. MASCC-0180
Hubbard, J. MASCC-0625
Huelsenbeck, J. MASCC-0062, MASCC-0060
Huelsenbeck, S. MASCC-0060
Hughes, B.G.M. MASCC-0402
Hui, D. MASCC-0552, MASCC-0542, MASCC-0540, MASCC-0143, MASCC-0057
Hulbert Williams, N. MASCC-0374
Humbert, N. MASCC-0461, MASCC-0460
Humphreys, S. MASCC-0648
Hung, C.T. MASCC-0851
Hung, H.C. MASCC-0032
Hung, Y. MASCC-0469
Hunt, J.A.N.E. MASCC-0702
Hussain, R. MASCC-0219, MASCC-0127, MASCC-0083
Hussain, S. MASCC-0275
Hussey, D. MASCC-0464
Husson, O. MASCC-0053, MASCC-0052
Huszno, J. MASCC-0026
Hutchins, R. MASCC-0540
Hutchinson, M.R. MASCC-0472
Huysmans, M.C.D.N.J.M. MASCC-0305
Hwang, J. MASCC-0559, MASCC-0510, MASCC-0262
Hwang, M. MASCC-0101, MASCC-0100
Iacono, D. MASCC-0633
Iacovelli, R. MASCC-0505
Iaiza, E. MASCC-0774
Iannacone, E. MASCC-0664
Ibáñez, B. MASCC-0056, MASCC-0002
Ibrahim, A. MASCC-0815, MASCC-0667
Ichinose, Y. MASCC-0779
Idrees, F. MASCC-0509
Idrees, J. MASCC-0509
Idrees, M. MASCC-0509
Idris yücel, I.Y. MASCC-0833
Iihara, H. MASCC-0513, MASCC-0500
Iire, L. MASCC-0064
Ikeda, M. MASCC-0368
Ikegame, K. MASCC-0256, MASCC-0209
Ikoma, K. MASCC-0524
Imamoglu, G.I. MASCC-0802, MASCC-0798
Imhof, L. MASCC-0186
Immanuel, A.S. MASCC-0702
Inal, A. MASCC-0339
Inamoto, T. MASCC-0779
Indelli, M. MASCC-0517
Innominato, P. MASCC-0791, MASCC-0767
Inocencio Vasques, C. MASCC-0332
Ionta, M.T. MASCC-0517
Iqba, H. MASCC-0127
Iqbal, H. MASCC-0219, MASCC-0218, MASCC-0083
Irfan, N. MASCC-0218
Isenring, E. MASCC-0629, MASCC-0469
Ishida, N. MASCC-0508
Ishida, T. MASCC-0617
Ishiguro, H. MASCC-0779, MASCC-0637
Ishihara, M. MASCC-0513, MASCC-0500
Ishii, S. MASCC-0256, MASCC-0209
Ishikawa, A. MASCC-0379, MASCC-0380
Ishitani, K. MASCC-0308
Isik, M. MASCC-0028
Isikdogan, A. MASCC-0339
Ismail, P. MASCC-0200
Isola, M. MASCC-0751
Israelyan, K. MASCC-0325
Ito, E. MASCC-0507
Ito, Y. MASCC-0521
Itoh, Y. MASCC-0513, MASCC-0500
Itova, Z.Z. MASCC-0076
Ivanova, D. MASCC-0657
Izoe, Y. MASCC-0519, MASCC-0468
J. MASCC-0857
Jaafari, B. MASCC-0159
Jablonka, F. MASCC-0107
Jackson, J. MASCC-0766
Jacob, J. MASCC-0771
Jacobs, I. MASCC-0546
Jacobsen, P. MASCC-0017
Jacquemin, M. MASCC-0023
Jaehde, U. MASCC-0520
Jagannath, S. MASCC-0773
Jagoe, T. MASCC-0793
Jahana, S. MASCC-0757, MASCC-0660
Jair Licio Ferreira Santos, J.L.F.S. MASCC-0273, MASCC-0272
Jakobsen, J. MASCC-0145
Jamal, N. MASCC-0463, MASCC-0244
James MASCC-0857
James, J. MASCC-0039
Jamshed, A. MASCC-0219, MASCC-0218, MASCC-0127, MASCC-0083
Jane, E. MASCC-0843, MASCC-0840
Janelsins, M. MASCC-0794, MASCC-0791, MASCC-0755
Janelsins, M.C. MASCC-0829, MASCC-0810
Jang, J. MASCC-0262
Jang, J.S. MASCC-0647, MASCC-0511
Jang, R.W. MASCC-0467
Jansen, R. MASCC-0422
Jansky, M. MASCC-0670
Janssens, C. MASCC-0023
Jarden, M. MASCC-0158, MASCC-0145
Jarlbaek, L. MASCC-0504
Jarvis, V. MASCC-0431
Jaslowski, A.J. MASCC-0562
Jatoi, A. MASCC-0796, MASCC-0311
Javle, M. MASCC-0742
Jean-Pierre, P. MASCC-0556, MASCC-0184
Jeong, H.J. MASCC-0404
Jérôme, M. MASCC-0023
Jesus-Garcia, R. MASCC-0167
Jhon, M.N. MASCC-0190
Jian, J.-M. MASCC-0153
Jim, H. MASCC-0017
Jiménez, F. MASCC-0362, MASCC-0363
Jin, J. MASCC-0255
Johansen, C. MASCC-0688
Johns, E. MASCC-0607
Johnson, C. MASCC-0620
Johnston, M. MASCC-0180
Johnston, M.A. MASCC-0765, MASCC-0760
Joly, F. MASCC-0836
Jon, F. MASCC-0475, MASCC-0383
Jones, A. MASCC-0648
Jones, P. MASCC-0707
Joo, J. MASCC-0750
Jordan, K. MASCC-0434, MASCC-0418
Jourt Pineau, C. MASCC-0406
Jovenin, N. MASCC-0350, MASCC-0287
Jreige, Y. MASCC-0247
Juhler, M. MASCC-0145
Juliana Maria De Paula, J.M.P. MASCC-0273, MASCC-0272
Julka, P.K. MASCC-0016
Jun, S. MASCC-0666
Jung, H.J. MASCC-0511
Jungberg, P. MASCC-0726
Jungyun, P. MASCC-0415
Jurczak, W. MASCC-0658
Kaasa, S. MASCC-0111
Kadakia, K.C. MASCC-0846
Kaden, B. MASCC-0792
Kahana, B. MASCC-0385, MASCC-0385
Kahana, E. MASCC-0385
Kahangi, L. MASCC-0105
Kaida, K. MASCC-0256, MASCC-0209
Kaina, B. MASCC-0062, MASCC-0060
Kakeji, Y. MASCC-0521
Kalbasi, S. MASCC-0200
Kalinka-Warzocha, E. MASCC-0658
Kalinowski, K. MASCC-0805
Kalyana, H.M. MASCC-0160
Kama, N. MASCC-0314
Kamal, A. MASCC-0314
Kamal, N. MASCC-0336
Kamen, C. MASCC-0829, MASCC-0755
Kamen, C.S. MASCC-0810
Kamizato, M. MASCC-0757, MASCC-0660
Kamps, W.A. MASCC-0419, MASCC-0421
Kamura, T. MASCC-0521
Kan, N. MASCC-0779
Kan-no, H. MASCC-0368
Kanathigoda, S. MASCC-0353, MASCC-0354
Kanda, T. MASCC-0525
Kanemaru, A. MASCC-0229
Kanesvaran, R. MASCC-0630, MASCC-0479
Kang, B.W. MASCC-0511
Kang, J.H. MASCC-0647
Kang, T.I. MASCC-0729
Kantar, M. MASCC-0351
Kaplan, I. MASCC-0412
Karagöz, G. MASCC-0770
Karahan, A. MASCC-0768
Karatsu, F. MASCC-0610
Kasera, C.A. MASCC-0723
Kaspers, G.J.L. MASCC-0455
Kassem, F. MASCC-0074
Kasymjanova, G. MASCC-0793
Kataoka, Y. MASCC-0366
Kathiresan, N. MASCC-0554
Kato, H. MASCC-0779
Katsaragakis, S. MASCC-0644
Kattan, J. MASCC-0247
Katz, M.H.G. MASCC-0800, MASCC-0742
Kaufer, H. MASCC-0212
Kaur P. MASCC-0201
Kav, S. MASCC-0768
Kawamura-Murayama, Y. MASCC-0268
Kaya, Z. MASCC-0028
Kaye, V. MASCC-0021
Kayssi, A. MASCC-0603
Kazanjian, A. MASCC-0797
Kee, Y.C. MASCC-0599, MASCC-0598
Keefe, C. MASCC-0611
Keefe, D. MASCC-0853, MASCC-0677, MASCC-0611, MASCC-0602, MASCC-0600, MASCC-0591, MASCC-0502, MASCC-0464, MASCC-0257
Keefe, D.M.K. MASCC-0489
Keilani, M. MASCC-0063
Kenne Sarenmalm, E. MASCC-0095
Kennedy, J.A. MASCC-0042
Kereena, C. MASCC-0093, MASCC-0092
Kerimoglu, O.S. MASCC-0116
Kerkhof, A.J.F.M. MASCC-0470
Kerkmann, M. MASCC-0782
Kerschaever, I. MASCC-0328
Kersh, R. MASCC-0199
Kersten, M.J. MASCC-0391
Keskin, E.Y. MASCC-0028
Khachatryan, V. MASCC-0325
Khakimova, G.J. MASCC-0249
Khalechelvam, P. MASCC-0006
Khalek, E. MASCC-0314
Khalek, R. MASCC-0336
Khalil, M.A. MASCC-0800, MASCC-0742
Khan, F. MASCC-0104
Khan, R.A. MASCC-0175
Khattab, M. MASCC-0590
Khattak, A.A. MASCC-0509
Khawaja, S. MASCC-0192, MASCC-0191
Khuroo, A.H. MASCC-0175
Kilgour, R.D. MASCC-0848
Kim, B. MASCC-0403
Kim, G.C. MASCC-0404
Kim, H.J. MASCC-0647, MASCC-0647, MASCC-0511
Kim, H.K. MASCC-0312
Kim, H.Y. MASCC-0511
Kim, J. MASCC-0510
Kim, J.S. MASCC-0647
Kim, J.Y. MASCC-0805, MASCC-0666
Kim, K. MASCC-0262
Kim, M.S. MASCC-0403
Kim, S. MASCC-0616, MASCC-0549
Kim, S.H. MASCC-0540
Kim, S.W. MASCC-0647
Kim, S.Y. MASCC-0647, MASCC-0511, MASCC-0511
Kim, Y. MASCC-0416
Kim, Y.S. MASCC-0647
Kingsley, P.A. MASCC-0201
Kinnear, H. MASCC-0725, MASCC-0635
Kinney, A.Y. MASCC-0059
Kinyanjui, D. MASCC-0689
Kirshbaum, M. MASCC-0021
Kirshner, J.J. MASCC-0829
Kirshner, J.K. MASCC-0703
Kitagawa, Y. MASCC-0521
Kitajima, M. MASCC-0521
Kittel, K. MASCC-0726
Kiwada, H. MASCC-0617
Kjeldsen, L. MASCC-0158
Klassen, O. MASCC-0686
Klein, G. MASCC-0557
Klein, M. MASCC-0424
Klepstad, P. MASCC-0111
Kligman, L. MASCC-0139
Knegjens, J. MASCC-0224
Knight, A. MASCC-0431
Knoth, R. MASCC-0766, MASCC-0756
Koç MASCC-0231, MASCC-0230
KO, Y. MASCC-0319, MASCC-0316
Ko, Y.D. MASCC-0520
Ko, Y.H. MASCC-0647
Kobayashi, M. MASCC-0679, MASCC-0487
Kobayashi, T. MASCC-0525
Koç, ". MASCC-0232
Kocak, H. MASCC-0028
Kocak, U. MASCC-0028
Kodama, N. MASCC-0256, MASCC-0209
Koehler, U. MASCC-0133
Koeppen, S. MASCC-0697
Koerber, J. MASCC-0792
Koffka, A. MASCC-0686
Koh, C. MASCC-0005, MASCC-0004
Koh, S. MASCC-0143
Koh, S.J. MASCC-0511
Köhler, J. MASCC-0708
Kohn, N. MASCC-0312
Koike, K. MASCC-0308, MASCC-0367
Kojima T. MASCC-0229
Koldehoff, M.K. MASCC-0697
Kollen, W.J.W. MASCC-0455
Kolnick, L. MASCC-0149
Komatsu, H. MASCC-0398
Kondo, E. MASCC-0268
Konias, M. MASCC-0726
Koo, K. MASCC-0384
Koopman, C. MASCC-0791
Kopecky, J. MASCC-0087
Kose, F. MASCC-0748
Kose, N. MASCC-0802
Koseki, T. MASCC-0508, MASCC-0507
Kostadinova, L. MASCC-0038
Kostanyan, M. MASCC-0253
Kostopoulou, M. MASCC-0346, MASCC-0342, MASCC-0341, MASCC-0340, MASCC-0335
Kotlinska-Lemieszek, A. MASCC-0514
Kotronoulas, G. MASCC-0440
Kottschade, L. MASCC-0562
Kouri, M. MASCC-0769
Kourie, H.R. MASCC-0553, MASCC-0551
Koyama, T. MASCC-0525
Krajcovicova, I. MASCC-0134
Krakauer, E.L. MASCC-0522
Krakowski, I. MASCC-0371, MASCC-0254
Kravchenko, S. MASCC-0364
Krcmery, V. MASCC-0134
Krebber, A.M. MASCC-0378
Kreitler, M.M. MASCC-0211
Kreitler, S. MASCC-0212, MASCC-0211
Kremer, L.C.M. MASCC-0646
Krishnasamy, M. MASCC-0365
Kristaly, K. MASCC-0464
Kroman, N. MASCC-0688
Krug, D. MASCC-0496
Krzyzanowska, M. MASCC-0577, MASCC-0576
Krzyzanowska, M.K. MASCC-0841, MASCC-0820
Kubrak, C. MASCC-0624
Kuchibhatla, R. MASCC-0557
Kucukmetin, A. MASCC-0749
Kuderer, N. MASCC-0816
Kuderer, N.M. MASCC-0817
Kumar, A. MASCC-0167
Kumar, D. MASCC-0244
Kumar, K. MASCC-0316
Kummer, E. MASCC-0187
Kunst, G. MASCC-0636
Kurachi, C. MASCC-0106
Kurahashi, S. MASCC-0513
Kurihara, M. MASCC-0525
Kurita, G.P. MASCC-0112, MASCC-0111
Kuznetsova, O. MASCC-0290
Kuznetsova, O.V. MASCC-0429
Kwan, M.L. MASCC-0586
Kwan, T. MASCC-0003
Kwan, W. MASCC-0813
Kwatra G. MASCC-0201
Kwint, M. MASCC-0223
Kwon, J.H. MASCC-0574, MASCC-0552, MASCC-0540, MASCC-0511, MASCC-0143
Kwong, J. MASCC-0389
Kyrtsonis, M.C. MASCC-0778
Lackner, H. MASCC-0129
Lacouture, M. MASCC-0024
Lacouture, M.E. MASCC-0763, MASCC-0709
Laenen, A. MASCC-0459
Laheij, A. MASCC-0321
Lai J.-H. MASCC-0221
Lai Tiong, F. MASCC-0287
Lai, C.Y. MASCC-0088
Lai, J.-H. MASCC-0144
Lai, Y. MASCC-0243, MASCC-0022
Lai, Y.-H. MASCC-0073
Lai, Y.H. MASCC-0789, MASCC-0317, MASCC-0281
Lakdja F, F.L. MASCC-0818
Lalla, R.V. MASCC-0564, MASCC-0396
Lam", Z. MASCC-0231, MASCC-0230
Lam, H. MASCC-0612, MASCC-0246, MASCC-0242, MASCC-0171, MASCC-0170, MASCC-0169, MASCC-0168, MASCC-0011, MASCC-0009, MASCC-0382, MASCC-0384
Lam, Z. MASCC-0232
Lambrinou, E. MASCC-0355
Lamerato, L. MASCC-0766
Landers, M. MASCC-0733
Lane, S.C. MASCC-0605
Langberg, H. MASCC-0716
Langston B. MASCC-0857
Langston, B. MASCC-0039
Lanoy, E. MASCC-0505
Lao, N. MASCC-0612, MASCC-0399, MASCC-0171, MASCC-0169, MASCC-0011, MASCC-0009, MASCC-0382
Lapid, M.I. MASCC-0807
Lappalainen, J. MASCC-0737
Laranjeira, C. MASCC-0735, MASCC-0731
Larkin, D. MASCC-0301, MASCC-0279, MASCC-0259
Larsen, E. MASCC-0030
Larsson, B. MASCC-0079
Larsson, B.K. MASCC-0061
Larue, C. MASCC-0738
Laskarakis, A. MASCC-0589, MASCC-0349
LaStayo, P.C. MASCC-0059
Latour, J.F. MASCC-0571
Lauzon, E. MASCC-0383
Lauzon, N. MASCC-0475, MASCC-0399, MASCC-0238, MASCC-0237, MASCC-0236, MASCC-0235, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0377, MASCC-0382
Lavallière, E. MASCC-0488
Lay, H. MASCC-0805
Le Fel, J. MASCC-0836
Le Moignan, J. MASCC-0691
Le Moulec, S. MASCC-0406
Le, B.H. MASCC-0401
Le, L.W. MASCC-0841, MASCC-0467
Le, Q.H. MASCC-0350
Leal, A.D. MASCC-0846
Leal, I. MASCC-0735, MASCC-0731
Leclercq, E. MASCC-0646, MASCC-0391
Leclercq, V. MASCC-0425
Lee, A.J. MASCC-0180
Lee, C. MASCC-0261
Lee, C.S. MASCC-0746
Lee, D.J. MASCC-0403
Lee, E.M. MASCC-0511
Lee, H.H.-C. MASCC-0132
Lee, H.W. MASCC-0647
Lee, J. MASCC-0681, MASCC-0580, MASCC-0416, MASCC-0262, MASCC-0261
Lee, J.I. MASCC-0511
Lee, K. MASCC-0803, MASCC-0721, MASCC-0202
Lee, K.H. MASCC-0511, MASCC-0143
Lee, K.T. MASCC-0511
Lee, P.H. MASCC-0317
Lee, R. MASCC-0395
Lee, S. MASCC-0616, MASCC-0394, MASCC-0393
Lee, S.C. MASCC-0732
Lee, S.N. MASCC-0647, MASCC-0511
Lee, S.R. MASCC-0647
Lee, T.K. MASCC-0813
Lee, T.Y. MASCC-0222
Lee, Y.H. MASCC-0789
Leemans, C.R. MASCC-0378, MASCC-0381
Lefebvre, G. MASCC-0425
Lefebvre, M. MASCC-0645
Legeren Alvarez, M. MASCC-0439
LeGrand, S. MASCC-0195
Lehmkuhl, M. MASCC-0476
Leighl, N. MASCC-0820, MASCC-0577, MASCC-0576
Leino-Kilpi, H. MASCC-0064
Lemke, M. MASCC-0237, MASCC-0010
Lemmens, V. MASCC-0108, MASCC-0020
Lemonde, M. MASCC-0741
Lemos, L. MASCC-0717
Lennan, E. MASCC-0707
Leppert, W. MASCC-0514, MASCC-0248
Lerner, T.G. MASCC-0573, MASCC-0239, MASCC-0856
Leroy, P. MASCC-0638, MASCC-0634
Lesage, C. MASCC-0350
Lessa, A.E.R. MASCC-0654
Lesser, M. MASCC-0312
Lethan, C. MASCC-0133
Leung, D.Y.P. MASCC-0639, MASCC-0606
Leung, S.Y. MASCC-0732
Levacic, D. MASCC-0805
Levi, F. MASCC-0767
Levin, R.D. MASCC-0138
Lheureux, S. MASCC-0753
Li, D. MASCC-0045
Li, J. MASCC-0228, MASCC-0227
Li, K. MASCC-0169
Li, W.Y. MASCC-0732
Li, X. MASCC-0233
Li, Y. MASCC-0729, MASCC-0228
Li, Y.,P.,X.(. MASCC-0227
Li, Z. MASCC-0234
Liakopoulos, I. MASCC-0644
Lian, C.K. MASCC-0012
Liang, J.-T. MASCC-0073
Liang, S.-Y. MASCC-0213
Liao, W.Y. MASCC-0789
Liao, Y.C. MASCC-0789
Libert, I. MASCC-0417
Lichtenberger, B.M. MASCC-0288
Licitra, L. MASCC-0664
Liedberg, G. MASCC-0061
Liedberg, G.M. MASCC-0079
Liede, A. MASCC-0715, MASCC-0713, MASCC-0711, MASCC-0641
Liem, C. MASCC-0540
Life, q. MASCC-0225
Lifshitz S. MASCC-0212
Light, K.C. MASCC-0059
Lilien, T. MASCC-0388
Lim, G. MASCC-0691
Lim, M.Y. MASCC-0311
Lim, S.R. MASCC-0588
Lim, T. MASCC-0403
Lin, C. MASCC-0318
Lin, E. MASCC-0401
Lin, Y. MASCC-0243
Lindblad, M. MASCC-0079
Lindhorst, S. MASCC-0805
Link, H. MASCC-0782
Liru, M. MASCC-0723
Lis, C.G. MASCC-0138
Lisa, R. MASCC-0162
Liu, B. MASCC-0150
Liu, F. MASCC-0227
Liu, H. MASCC-0560, MASCC-0131
Liu, M. MASCC-0494, MASCC-0379, MASCC-0380
Liu, P. MASCC-0712, MASCC-0694
Liu, P.F. MASCC-0132
Llop, L. MASCC-0056, MASCC-0002
Llorens-Torrome, S. MASCC-0804
Lo, S.K. MASCC-0599, MASCC-0598
Lobach, D.F. MASCC-0607
Loeffen, E.A.H. MASCC-0523
Loeliger, J. MASCC-0491, MASCC-0490
Logan, R. MASCC-0853, MASCC-0483
Logan, R.M. MASCC-0489
Loi, T.T. MASCC-0240
Lok, A. MASCC-0559
Lokar, K. MASCC-0768
Lomas IV, H. MASCC-0199
Lombana, M. MASCC-0300, MASCC-0260, MASCC-0258
Lonardi, S. MASCC-0653
Longo, J.M. MASCC-0605
Lonial, S. MASCC-0773
López López, R. MASCC-0678
López Postigo, M. MASCC-0309
Lopez, G. MASCC-0395
López, J. MASCC-0843, MASCC-0840
Lopez, V. MASCC-0301, MASCC-0279, MASCC-0259
López-Millán, J. MASCC-0698
López-Romboli, E. MASCC-0804
Loprinzi, C.L. MASCC-0846, MASCC-0562, MASCC-0560
Lordick, F. MASCC-0649
Loridan, T. MASCC-0645
Loriot, Y. MASCC-0505
Lossignol, D. MASCC-0417, MASCC-0296
Lotfollahi, Z. MASCC-0044
Loucheux, M.H. MASCC-0645
Lowe, E.S. MASCC-0736
Lozach-Brugirard, M. MASCC-0753
Lu, Y.-Y. MASCC-0213
Lucchesi, M. MASCC-0651
Luci, R. MASCC-0345
Luengo-Gil, G. MASCC-0626
Lugini A. MASCC-0081
Lugini, A. MASCC-0080
Lukkahatai, N. MASCC-0337
Lukkahatai, N.L. MASCC-0503
Lukyanchuk, O.V. MASCC-0429
Lundstöm, S. MASCC-0796
Lundström, S. MASCC-0111
Lunter, S. MASCC-0323
Luo, R. MASCC-0800
Luporsi, E. MASCC-0701
Lustberg, M.B. MASCC-0609
Lutrino, E.S. MASCC-0774
Luz, R. MASCC-0743, MASCC-0739
Lyman, G. MASCC-0817
Lyman, G.H. MASCC-0816, MASCC-0438
Lynn, I. MASCC-0440
Lynnette, J. MASCC-0723
Lyss, A.P. MASCC-0562
Ma, L. MASCC-0252
Ma, Y.M. MASCC-0732
Maamoun, J. MASCC-0449, MASCC-0445
Maccio', A. MASCC-0047
Machado, M.T. MASCC-0107
Machida, N. MASCC-0369
Mack, L.A. MASCC-0603
Mackenzie, C. MASCC-0288
Macleod, U. MASCC-0180
Madeddu, C. MASCC-0047
Madhavan Sasidharan, S. MASCC-0554, MASCC-0550
Madhukumar, P. MASCC-0599, MASCC-0598
Madrid, C. MASCC-0435
Madsen, C.L. MASCC-0265, MASCC-0264
Maeda, Y. MASCC-0268
Maehara, Y. MASCC-0521
Magno, S.M. MASCC-0662
Magrin, M.E. MASCC-0795
Maguire, R. MASCC-0440
Mahadevan, R. MASCC-0214
Maher, J. MASCC-0198
Mahi, L. MASCC-0701
Mai, J.M. MASCC-0703
Mailliez, A. MASCC-0425, MASCC-0645
Mais, K. MASCC-0493
Majeed, S. MASCC-0165
Majorana, A. MASCC-0033
Mak, S.S.S. MASCC-0400
Malhotra, H. MASCC-0621
Mallaev, M. MASCC-0249
Malver, L.P. MASCC-0112
Mamzer, M.F. MASCC-0638
Manceau, F. MASCC-0793
Mandal, S. MASCC-0752
Maniadakis, N. MASCC-0640
Manicom, C. MASCC-0372
Manikowska, F. MASCC-0785
Mank, A. MASCC-0391
Mansikkamaki, P. MASCC-0082
Mantovani, G. MASCC-0047
Manzullo, E. MASCC-0579, MASCC-0395
Marete, J.G. MASCC-0148
Marghoob, A.A. MASCC-0763
Markova, M. MASCC-0768
Marosi, C. MASCC-0063
Marples, G. MASCC-0749
Marquez, M. MASCC-0454
Marshall, K. MASCC-0491, MASCC-0490
Mart?na, Z. MASCC-0364
Martin, A.A. MASCC-0565
Martin, C. MASCC-0527
Martin, T. MASCC-0773
Martin-Vasallo, P. MASCC-0370
Martins, A. MASCC-0448
Maruelli, A. MASCC-0706
Marx, G. MASCC-0334
Marzola, M. MASCC-0135
Mason, H. MASCC-0128
Masood, A. MASCC-0219, MASCC-0218, MASCC-0127, MASCC-0083
Masooma, S. MASCC-0257
Massumi, A. MASCC-0178
Masuoka, K. MASCC-0525
Masutti Sureda, B. MASCC-0678
Maté-Méndez, J. MASCC-0309
Mathias-Duarte, L. MASCC-0801
Matkovic, M. MASCC-0768
Matsui, R. MASCC-0414
Matuschek, C. MASCC-0297
Mauramo, M. MASCC-0566
Mawardi, H.H. MASCC-0154
Maxwell, C. MASCC-0541, MASCC-0539
Mayeur, D. MASCC-0484
Mayo, B. MASCC-0602
Mazanah, M. MASCC-0172
Mazurczak, M.A. MASCC-0562
Mazzaferro, V. MASCC-0795
Mazzer, M. MASCC-0774, MASCC-0751, MASCC-0668
McAllister, W. MASCC-0199
McAndrew, A. MASCC-0390, MASCC-0389, MASCC-0388, MASCC-0386
McBride, L. MASCC-0776
McCabe, R. MASCC-0466
McCabe, R.M. MASCC-0465
McCarthy, A. MASCC-0629, MASCC-0029
McCarthy, G. MASCC-0745, MASCC-0733
McColl, E. MASCC-0582
McCulloch, L. MASCC-0773
McEwen, S. MASCC-0839
McKinley, A. MASCC-0180
McPhelim, J. MASCC-0440
McQuestion, M. MASCC-0528
McVeigh, U. MASCC-0754
McWha, L. MASCC-0847
McWilliams, R. MASCC-0625
Meakin, C.J. MASCC-0605
Megalakaki, K. MASCC-0769
Mehmood, T. MASCC-0219, MASCC-0218, MASCC-0127, MASCC-0083
Meisner, I. MASCC-0299
Meißner, A. MASCC-0823
Mekelenkamp, H. MASCC-0455
Mella, S. MASCC-0687
Mellas, N. MASCC-0018, MASCC-0007
Mellstedt, H. MASCC-0569
Meloni, S.M. MASCC-0263
Meminaj, M. MASCC-0345
Menang, J.N. MASCC-0142
Mendes, M. MASCC-0156
Mendez, C. MASCC-0300
Mensah, K. MASCC-0280
Menzel, L.M. MASCC-0811
Merad, M. MASCC-0527, MASCC-0501
Merad-Taoufik, M. MASCC-0505
Merad-Toufik, M. MASCC-0738
Merani, S. MASCC-0603
Mercier-Vogel, L. MASCC-0488
Merlotti, A. MASCC-0663
Merriman, K.W. MASCC-0838
Mertz, B.G. MASCC-0688
Metcalfe, A. MASCC-0547
Mevlude, I. MASCC-0339
Meyer, F. MASCC-0055, MASCC-0054
Meyer, K. MASCC-0413
Mgren" MASCC-0113
Miao, S.J. MASCC-0132
Miccinesi, G. MASCC-0706
Miceli, R. MASCC-0664
Michel, B. MASCC-0417
Miedema, K.G.E. MASCC-0523
Migliorati, C.A. MASCC-0149
Mikami, M. MASCC-0368
Milani, A. MASCC-0768
Milanti, A. MASCC-0082
Milecki, P. MASCC-0783
Milicevic, M. MASCC-0555
Milisen, K. MASCC-0459
Milito, G. MASCC-0115
Milligan, P. MASCC-0025
Minegishi, S. MASCC-0468
Minn, H. MASCC-0064
Minnema, M. MASCC-0636
Mirabile, A. MASCC-0664
Miriam, W. MASCC-0050
Mirjalili, N. MASCC-0177
Miron, R. MASCC-0527
Mishcheniuk, O. MASCC-0364
Mishima, H. MASCC-0679
Missel, M. MASCC-0716, MASCC-0443
Mitchell, R. MASCC-0754
Mitchell, W. MASCC-0101, MASCC-0100
Miyake, M. MASCC-0679
Miyakoshi, K. MASCC-0524
Miyata, C. MASCC-0379, MASCC-0380
Mizukami, N. MASCC-0367
Mizuma, M. MASCC-0524
Mizuno, M. MASCC-0519
Mizuochi, K. MASCC-0525, MASCC-0524
Mo, M. MASCC-0584
Moattari, M. MASCC-0159
Mohammed M safhi, P.R.O.F. MASCC-0275
Mohan, M.P. MASCC-0806, MASCC-0771
Mohile, S. MASCC-0794
Mok, F. MASCC-0169
Møller, T. MASCC-0158
Mollo V, V.M. MASCC-0822
Molmans, B.H.W. MASCC-0455
Mols, F. MASCC-0108, MASCC-0053, MASCC-0052, MASCC-0020
Monette, J. MASCC-0576, MASCC-0575, MASCC-0575, MASCC-0570
Monhonval, M. MASCC-0738
Monnier, Y. MASCC-0435
Montgomery, P. MASCC-0522
Montserrat, M. MASCC-0768
Mooney, K. MASCC-0759
Moons, P. MASCC-0023
Moore, A.J. MASCC-0558
Moore, D.F. MASCC-0810
Moore, M. MASCC-0820
Morag, A. MASCC-0331
Morais, J.A. MASCC-0848
Morales, M. MASCC-0370
Moreira, M. MASCC-0654
Morere, J.F. MASCC-0701
Morero, J.A.P. MASCC-0544
Moresino, C. MASCC-0071
Morgado Gomes, F. MASCC-0743, MASCC-0739
Morgado, M. MASCC-0717, MASCC-0156
Morgado, S. MASCC-0717, MASCC-0156
Morishita, S. MASCC-0256, MASCC-0209
Morita, N. MASCC-0487
Morita, S. MASCC-0679
Morrison, D. MASCC-0437
Morrow, G. MASCC-0794, MASCC-0791, MASCC-0755
Morrow, G.R. MASCC-0829, MASCC-0810
Morrow, P.K. MASCC-0579, MASCC-0541, MASCC-0539, MASCC-0438
Mortazavi, H. MASCC-0775, MASCC-0761
Mota, A.A. MASCC-0654
Motahhary, P. MASCC-0189, MASCC-0188
Moura, S. MASCC-0390
Movahedian, A. MASCC-0781
Moya, I. MASCC-0828
Mpagiaou, O. MASCC-0644
Msefer Alaoui, F. MASCC-0590
Muallaoglu, S. MASCC-0748
Mueller, U. MASCC-0719, MASCC-0712
Muench, U. MASCC-0058
Muhammad, A. MASCC-0643
Mujeeb, M. MASCC-0326, MASCC-0175
Mukhopadhyay, S. MASCC-0201
Mulcahy, H. MASCC-0746
Mulder, R. MASCC-0391
Munga, E.W. MASCC-0103
Munhoz, B. MASCC-0573
Munier, O. MASCC-0753
Muraoka, K. MASCC-0524
Murchie, P. MASCC-0329, MASCC-0180
Murphy, B. MASCC-0663
Murphy, B.A. MASCC-0149, MASCC-0558
Murphy-Kane, T. MASCC-0431
Muscaritoli, M. MASCC-0796
Mustian, K. MASCC-0794, MASCC-0791, MASCC-0755
Mustian, K.M. MASCC-0829, MASCC-0810
Muzzatti, B. MASCC-0687, MASCC-0684
Myers, J. MASCC-0387
Nabais, I. MASCC-0587
Nacinovic-Duletic, A. MASCC-0593
Naeije, L. MASCC-0646
Nagai, S. MASCC-0366
Nagano, K. MASCC-0757
Nagl, N. MASCC-0756
Naik, R. MASCC-0749
Najib, R. MASCC-0018
Najmi, A.K. MASCC-0326, MASCC-0175
Nakanishi, Y. MASCC-0521
Nakashima, T. MASCC-0617
Nallet, G. MASCC-0531, MASCC-0497
Nam, J. MASCC-0416
Nam, S. MASCC-0403
Nam, S.-H. MASCC-0143
Namie Okino sawada, N.O.S. MASCC-0272
Namura, M. MASCC-0779
Narayama, C. MASCC-0368
Narayama, T. MASCC-0368
Narciso, B. MASCC-0672
Nariana, E. MASCC-0634
Narui, H. MASCC-0610
Nascimento, T.G. MASCC-0772
Nathanel, R. MASCC-0212
Natoli, L. MASCC-0324
Nauck, F. MASCC-0780, MASCC-0671, MASCC-0670
Naumann, P. MASCC-0496
Navari, R. MASCC-0360
Nazar G.A.T. MASCC-0072
Necchi, A. MASCC-0724
Neisi, K. MASCC-0183
Nejjari, C. MASCC-0007
Nemoto, K. MASCC-0366
Neri, E. MASCC-0791
Nestor, K. MASCC-0796
Neuman, T. MASCC-0842
Ng, A. MASCC-0824
Ng, L. MASCC-0104
Ng, Q.S. MASCC-0436
Ng, R. MASCC-0599, MASCC-0598
Ng, T. MASCC-0436
Ngai, M.I. MASCC-0319
Ngan, M.P. MASCC-0618
Nguyen, J. MASCC-0316, MASCC-0010, MASCC-0008, MASCC-0383, MASCC-0384
Ni, X. MASCC-0228, MASCC-0227
Niarou, V. MASCC-0346, MASCC-0342, MASCC-0341, MASCC-0340, MASCC-0335
Nichols, A. MASCC-0790
Nicolatou-Galitis, O. MASCC-0778, MASCC-0769, MASCC-0181
Nicolussi, A.C. MASCC-0545, MASCC-0544
Nicolussi, A.C.N. MASCC-0278, MASCC-0277
Niehoff, P. MASCC-0496
Niesvizky, R. MASCC-0773
Nietsch, J. MASCC-0782
Nieuwlaat, W.A. MASCC-0052
Nik Jaafar, N.R. MASCC-0214
Nikolaidi, A. MASCC-0181
Nilsson, U. MASCC-0656
Ninashvili, N. MASCC-0019
Ninot, G. MASCC-0532
Nirenberg, A. MASCC-0561
Nishigaki, M. MASCC-0513, MASCC-0500
Nishimoto, H. MASCC-0268
Nishioka, K. MASCC-0366
Nissar, S. MASCC-0241
Noel, G. MASCC-0376
Noel-savina, E. MASCC-0197, MASCC-0098, MASCC-0096
Noguera, A. MASCC-0530
Noh, S. MASCC-0510
Noirot, B. MASCC-0645
Nolan, B. MASCC-0746
Nolte, L. MASCC-0491, MASCC-0490
Nooka, A. MASCC-0773
Nooruddin, Z. MASCC-0540
Normal"" MASCC-0208
Novak, S. MASCC-0577, MASCC-0576
Novonty, P.J. MASCC-0562
Novotny, P. MASCC-0311
Nowacka, K. MASCC-0831, MASCC-0826
Nowacki, M. MASCC-0831, MASCC-0826
Nowara, E. MASCC-0026
Nowotnik, D.P. MASCC-0605
Numico, G. MASCC-0668
Nutakki, S. MASCC-0466
O'Brien, D. MASCC-0709, MASCC-0708
O'Brien, K. MASCC-0635
O'Connor, K.J. MASCC-0059
O'Donovan, E. MASCC-0707
O'Driscoll, D. MASCC-0727
O'Mahony, M. MASCC-0745
O'Mara, A. MASCC-0543
O'Neill, M.E. MASCC-0741
O'Sullivan, E. MASCC-0747, MASCC-0744
Oakley, C. MASCC-0529
Obiols-Portis, M. MASCC-0417
Oboh, G. MASCC-0110, MASCC-0084
Ocaña, J. MASCC-0828
ODonnell, R.L. MASCC-0749
Oelmann, J. MASCC-0686
Oerlemans, S. MASCC-0053
Ogawa, H. MASCC-0256, MASCC-0209
Ogawa, T. MASCC-0366
Oguz, A. MASCC-0798
Oh, H.S. MASCC-0511
Oh, S. MASCC-0676, MASCC-0616
Oh, S.Y. MASCC-0511
Ohlsson-Nevo, E. MASCC-0656
Ohmann, C. MASCC-0297
Oikawa, T. MASCC-0229
Oikonomou, H. MASCC-0644
Okamoto, W. MASCC-0414
Olagunju, A.T. MASCC-0078, MASCC-0077
Olcun, U. MASCC-0339
Olimova, Z.A. MASCC-0249
Oliveira, S. MASCC-0743, MASCC-0739, MASCC-0659
Oliveira, S.O. MASCC-0239
Olson, K. MASCC-0624
Olson, R. MASCC-0797
Olver, I. MASCC-0847, MASCC-0408
Omoto, I. MASCC-0047
Öner, N. MASCC-0028
Onoda, H. MASCC-0525
Onoratelli, M. MASCC-0462
Onozawa, Y. MASCC-0369
Onwuteaka-Philipsen, B.D. MASCC-0470
Ooi, W.S. MASCC-0599, MASCC-0598
Oranje, W.A. MASCC-0052
Orgiano, L. MASCC-0047
Orlandi, E. MASCC-0664
Orlando, A. MASCC-0751
Orrevall, Y. MASCC-0796
Orsey, A.D. MASCC-0799
Ortner, P. MASCC-0726
Oshan, G. MASCC-0813
Othman, S. MASCC-0085
Otmani, N. MASCC-0590
Otomo, E. MASCC-0366
Ottaviani, G. MASCC-0423, MASCC-0420, MASCC-0033
Ou, M. MASCC-0222
Ouakinin, S.R. MASCC-0587
Oudard, S. MASCC-0634
Oza, A. MASCC-0820
Ozbay, I. MASCC-0478, MASCC-0477
Özbek, C. MASCC-0690
Ozga-Majchrzak, O. MASCC-0783
Ozkan, I. MASCC-0251
Ozsoy, S. MASCC-0351
Ozturk, S. MASCC-0339
Ozyilkan, O. MASCC-0748
Pace, R. MASCC-0081, MASCC-0080
Padhye, N.S. MASCC-0585
Pais-Ribeiro, J.O.S.E. MASCC-0362, MASCC-0363
Paiva, H. MASCC-0856
Palazzo, F. MASCC-0334
Palesh, O. MASCC-0791, MASCC-0767
Palla, S. MASCC-0574, MASCC-0559, MASCC-0395
Palladino, M.A. MASCC-0517
Palliative Care MASCC-0164
Palliative Medicine MASCC-0109
Palmas, M. MASCC-0434, MASCC-0433, MASCC-0432
Palmeira de Oliveira, R. MASCC-0821
Pampols, M. MASCC-0828
Panda, P. MASCC-0190
Pang, J. MASCC-0316
Pang, K. MASCC-0386
Panjehpour, M. MASCC-0781
Panobianco, M.S. MASCC-0764
Pant, M.C. MASCC-0244
Papadopolou, C. MASCC-0440
Papadopoulos, D. MASCC-0605
Papadopoulou, E. MASCC-0778, MASCC-0769, MASCC-0181
Pappas, L.M. MASCC-0059
Parala, A. MASCC-0165
Parala-Metz, A. MASCC-0196
Pardo, J. MASCC-0828
Park, C. MASCC-0416
Park, J.S. MASCC-0803, MASCC-0721
Park, K. MASCC-0405
Park, K.U. MASCC-0666, MASCC-0647
Park, K.W. MASCC-0143
Park, S. MASCC-0416, MASCC-0416
Park, S.I. MASCC-0404
Park, S.J. MASCC-0676
Park, S.M. MASCC-0202
Park, Y. MASCC-0262, MASCC-0261
Parker, N. MASCC-0800
Parliament, M. MASCC-0624
Parreira, L. MASCC-0743, MASCC-0739
Pascoletti, G. MASCC-0751
Pasetka, M. MASCC-0475, MASCC-0463, MASCC-0316
Paskett, E. MASCC-0556
Pasquin, E. MASCC-0344
Passamonti, S. MASCC-0110, MASCC-0084
Patel, S. MASCC-0337
Patiraki, E. MASCC-0644
Patlan, J.T. MASCC-0579
Patrick, D. MASCC-0334
Patterson, J. MASCC-0582
Paul, J. MASCC-0437
Paula, J.M. MASCC-0545, MASCC-0544
Paula, J.M.P. MASCC-0278, MASCC-0277
Paulus, V. MASCC-0753
Peckham, J. MASCC-0622
Pedersen, J.H. MASCC-0443
Pediatric clients CALMEF MASCC-0142
Peerlinck, K. MASCC-0023
Peetermans, W.E. MASCC-0023
Pelicier, N. MASCC-0634
Pella, N. MASCC-0774
Pellejero, R. MASCC-0828
Pellissier, J. MASCC-0648
Pentikis, H.P. MASCC-0441
Peoples, A. MASCC-0755
Peoples, A.R. MASCC-0829, MASCC-0810
Peppone, L. MASCC-0829, MASCC-0794, MASCC-0755
Peppone, L.J. MASCC-0810
Peralta, E. MASCC-0698
Peralta, L. MASCC-0462
Pereira, J. MASCC-0640
Pereira, R. MASCC-0659
Perelman, M. MASCC-0343
Perez-Cruz, P. MASCC-0522
Peria, F.M. MASCC-0654
Peric, J. MASCC-0597
Pernet A, A.P. MASCC-0822
Pessi, M.A. MASCC-0724, MASCC-0706, MASCC-0652
Peters, K. MASCC-0777
Peters, K.B. MASCC-0805
Peterson, D.E. MASCC-0564
Petit, L. MASCC-0350
Petranovic, D. MASCC-0593, MASCC-0593
Petta, E. MASCC-0644
Pfeffer, K. MASCC-0288
Phillips, S. MASCC-0021
Pianowski, L. MASCC-0856
Pietkun, K. MASCC-0831, MASCC-0826
Pietra, C. MASCC-0602
Piil, K. MASCC-0145
Pilbeam, C.C. MASCC-0564
Pillai, K.K. MASCC-0326
Pimentel, F.L. MASCC-0448
Pimentel, L.E. MASCC-0057
Pino, L. MASCC-0300, MASCC-0260, MASCC-0258
Pinto, M. MASCC-0821
Piper, B. MASCC-0014, MASCC-0006
Pirolli, M. MASCC-0641
Piroozi MASCC-0159
Pisa, F. MASCC-0774
Pisano, M. MASCC-0263
Pishas, K. MASCC-0602
Pizzorni, N. MASCC-0664
Planinsek Rucigaj, T. MASCC-0814
Plews, E. MASCC-0611, MASCC-0602, MASCC-0600
Poillucci, V. MASCC-0805
Pokpalagon, P. MASCC-0015
Poletto, E. MASCC-0774
Polianskis, R. MASCC-0112
Poma, A. MASCC-0441
Pon, D. MASCC-0750
Ponce Leão, P. MASCC-0735, MASCC-0731
Poniedzialek, B. MASCC-0514
Poniewierski, M.S. MASCC-0817, MASCC-0816
Poon, M. MASCC-0399, MASCC-0246, MASCC-0242, MASCC-0171, MASCC-0170, MASCC-0169, MASCC-0168, MASCC-0167, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0011, MASCC-0009
Poortmans, P. MASCC-0053
Pop, M. MASCC-0376
Pope, A. MASCC-0820
Popovic, M. MASCC-0399, MASCC-0246, MASCC-0242, MASCC-0168, MASCC-0011, MASCC-0010, MASCC-0009, MASCC-0008, MASCC-0384
Porta-Sales, J. MASCC-0804
Portilla Carlos, C. MASCC-0348
Posadas Martínez, M. MASCC-0462
Poslins, E. MASCC-0389
Potthoff, K. MASCC-0686, MASCC-0680, MASCC-0496
Potting, C.M.J. MASCC-0305
Poulin, P. MASCC-0252
Poulsen, L.L. MASCC-0515
Power, K. MASCC-0741
Powers, A. MASCC-0766, MASCC-0756
Poyato Gómez, E. MASCC-0309
Prado, C.M.M. MASCC-0765, MASCC-0760
Prado, M.A.E. MASCC-0730
Prado, M.A.S. MASCC-0772
Prasanatikom, W. MASCC-0226
Préaubert, C. MASCC-0531, MASCC-0497
Presseau, J. MASCC-0180
Pritchard, M.J. MASCC-0166
Pritchard, S. MASCC-0797
Probyn, L. MASCC-0399
Pronost, A.M. MASCC-0254
Pruitt, D.E. MASCC-0605
Pruthi, S. MASCC-0740, MASCC-0722
Pugh, S.P. MASCC-0703
Puglisi, F. MASCC-0751, MASCC-0633
Pulitzer, M.P. MASCC-0763
Pulivarthi, K. MASCC-0574
Purcell, B. MASCC-0021
Purfarzi, F. MASCC-0178
Puts, M. MASCC-0578, MASCC-0577, MASCC-0576, MASCC-0575, MASCC-0570
Qian, Y. MASCC-0334
Qin, R. MASCC-0846
Quach, D. MASCC-0641
Quigley, J. MASCC-0641
Quinn, B. MASCC-0493
Quintard, B. MASCC-0179
Rabêlo, P. MASCC-0835
Raber-Durlacher, J. MASCC-0663
Raber-Durlacher, J.E. MASCC-0321
Rabin, M.S. MASCC-0607
Radbruch, L. MASCC-0343
Radina, E. MASCC-0027
Radzuan, M. MASCC-0591
Rafaqat, R. MASCC-0193, MASCC-0192, MASCC-0191, MASCC-0330
Raftopoulos, V. MASCC-0355
Raggi, D. MASCC-0724
Raha cancer center group RCCG MASCC-0174, MASCC-0173
Rahrotaban, S. MASCC-0205
Raimondou, H. MASCC-0644
Rajangam, K. MASCC-0773
Rajapaksa, I. MASCC-0104
Ralph, C. MASCC-0572
Ramadan, M.E. MASCC-0685
Ramadas, L. MASCC-0315
Raman, S.V. MASCC-0609
Ramiandrisoa, F. MASCC-0350
Rampini, M. MASCC-0568
Ranjan, T. MASCC-0805, MASCC-0777
Rao, A. MASCC-0165
Rao, J. MASCC-0494
Raphael, M.F. MASCC-0457, MASCC-0455
Rath, G.K. MASCC-0016
Rauco, A. MASCC-0081, MASCC-0080
Ray, S. MASCC-0377
Raynaud, C. MASCC-0571
Razi, E. MASCC-0778, MASCC-0769
Read, P. MASCC-0844, MASCC-0333
Ream, E. MASCC-0529, MASCC-0857, MASCC-0039
Rebollo Laserna, F.J. MASCC-0678
Rebollo, M. MASCC-0462
Reddy, A. MASCC-0574, MASCC-0395
Redzovic, A. MASCC-0597
Reed, L.J. MASCC-0454
Regan, M. MASCC-0473
Reguart, N. MASCC-0708
Reich, M. MASCC-0425
Reif, M. MASCC-0555
Reifur, L. MASCC-0239
Reijneveld, J. MASCC-0424
Reinbolt, R.E. MASCC-0609
Reiner, M. MASCC-0438
Reis, H.B. MASCC-0801
Reis, P.E.D. MASCC-0655, MASCC-0332
Remondes-Costa, S. MASCC-0362, MASCC-0363
Repousis, P. MASCC-0778
Repping, S. MASCC-0823
Resteghini, C. MASCC-0724
Reverter, J.C. MASCC-0626
Revnic, J. MASCC-0343
Rey, P. MASCC-0571
Reyes-Gibby, C. MASCC-0838
Rezk, J. MASCC-0149
Rha, S. MASCC-0262, MASCC-0261
Rho, S.Y. MASCC-0041
Ribeiro, C. MASCC-0743, MASCC-0739, MASCC-0659
Ribot-Berenguer, T. MASCC-0309
Ricci, S. MASCC-0651
Richard, C. MASCC-0063
Richard, S. MASCC-0634
Richardson, A. MASCC-0720, MASCC-0580, MASCC-0529, MASCC-0498, MASCC-0492, MASCC-0271
Richardson, C. MASCC-0307
Richardson, M. MASCC-0199
Richardson, M.N. MASCC-0579
Richter, K. MASCC-0716
Rider, A. MASCC-0713, MASCC-0711, MASCC-0710
Ridner, S. MASCC-0762, MASCC-0558
Ridner, S.H. MASCC-0027
Riese, C. MASCC-0682
Rigal, O. MASCC-0836
Riklikiene, O. MASCC-0768
Riley, E. MASCC-0493
Rings, E.H.H.M. MASCC-0157
Ripamonti, C. MASCC-0724, MASCC-0706, MASCC-0652
Ristevski, E. MASCC-0473
Rizel, S. MASCC-0299
Rizzi, G. MASCC-0434, MASCC-0433, MASCC-0432
Rj, E. MASCC-0749
Robert, G. MASCC-0529
Roberts, J. MASCC-0506, MASCC-0186, MASCC-0025
Roberts, K. MASCC-0749
Robinson, E. MASCC-0522
Robitaille, M.A. MASCC-0289
Rocha, M. MASCC-0362, MASCC-0363
Rock, H. MASCC-0780
Rodin, G. MASCC-0841, MASCC-0820
Rodrigues, M. MASCC-0371
Rodrigues, P. MASCC-0568
Rodriguez, R. MASCC-0840
Roeland, E. MASCC-0101, MASCC-0100
Rogowski, W. MASCC-0584
Rohde, L. MASCC-0566
Roila, F. MASCC-0517
Roma, A. MASCC-0653
Roman, M. MASCC-0056, MASCC-0002
Rondelli, P. MASCC-0706, MASCC-0652
Roodbol, P.F. MASCC-0419, MASCC-0421
Root, C. MASCC-0431
Ros, C. MASCC-0840
Roscoe, J.A. MASCC-0810
Rose, M. MASCC-0017
Rosello, A. MASCC-0843
Rosello, J. MASCC-0843, MASCC-0840
Rosen, A. MASCC-0024
Rosen, A.C. MASCC-0763
Rosenthal, M.A. MASCC-0401
Rossi R. MASCC-0081
Rossi, G. MASCC-0432
Rossi, R. MASCC-0080
Rotsaert, L. MASCC-0645
Rousseau, C. MASCC-0417
Rovira, K. MASCC-0836
Rovo, A. MASCC-0566
Row, M.B. MASCC-0579
Roy, V. MASCC-0836
Rubenstein, E. MASCC-0812
Ruberg, K. MASCC-0520
Rudd, J.A. MASCC-0618
Ruggeri, B. MASCC-0517
Ruijs, C.D.M. MASCC-0470
Ruiz BS, T.L. MASCC-0799
Rummans, T.A. MASCC-0807
Ruppert, A.S. MASCC-0609
Rüssel, J. MASCC-0418
Russi, E. MASCC-0668, MASCC-0664, MASCC-0663
Russo, S. MASCC-0633
Ryan, E. MASCC-0746
Ryan, N. MASCC-0572
Rybicki, L. MASCC-0536, MASCC-0456, MASCC-0453, MASCC-0165
Rybin, A. MASCC-0290
Rybin, A.I. MASCC-0429
Ryoo, H.M. MASCC-0511
Rzymski, P. MASCC-0514
S. MASCC-0159
S. Sommer, M. MASCC-0716
S., R. MASCC-0216
Sağ MASCC-0232, MASCC-0231, MASCC-0230
Sa, T.H. MASCC-0654
Saada, Y. MASCC-0179
Sadhu, C. MASCC-0694
Saeed, K. MASCC-0083
Saeki, K. MASCC-0757
Saeki, T. MASCC-0521
Sahani, M.K. MASCC-0160
Sahgal, A. MASCC-0475, MASCC-0238, MASCC-0236, MASCC-0235, MASCC-0167, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0377
Saibene, G. MASCC-0668
Sakamoto, J. MASCC-0679
Sakhri, S. MASCC-0206
Sakli, I. MASCC-0645
Sakurai, K. MASCC-0617
Salameh, O. MASCC-0553
Saligan, L. MASCC-0337, MASCC-0151
Saligan, L.S. MASCC-0503
Salman, S. MASCC-0509
Salmon, H. MASCC-0565
Salner, A.L. MASCC-0564
Samadova, G. MASCC-0495
Samala, M. MASCC-0194
Samala, R. MASCC-0196, MASCC-0195
Samanta, B. MASCC-0201
Sameer, A.S. MASCC-0241
Samiee, S. MASCC-0781
Samuel, C.O. MASCC-0776
Samuel, L. MASCC-0180
San Miguel-Arregui, M. MASCC-0530
San-Miguel, M.T. MASCC-0552
Sanad, R. MASCC-0336
Sanatani, M. MASCC-0140
Sánchez Blanco, C. MASCC-0698
Sánchez Salado, C. MASCC-0442
Sani, F. MASCC-0795
Sano, M. MASCC-0414
Sant'Anna, G.R. MASCC-0565
Santacruz, J. MASCC-0300
Santak, G. MASCC-0692
Santi, P.X. MASCC-0654, MASCC-0581
Santos, A.C.F. MASCC-0675
Santos, B. MASCC-0570
Santos, J.L.F.S. MASCC-0278, MASCC-0277
Sapsford, M. MASCC-0390
Saraiva, D.A. MASCC-0545
Sargi, Z. MASCC-0184
Sargon, M.F. MASCC-0089, MASCC-0067
Sari, E. MASCC-0802
Sarimiye, F.O. MASCC-0077
Sarri, T. MASCC-0778
Sasaki, E. MASCC-0525
Satheeshkumar, P.S. MASCC-0806, MASCC-0771
Sato, M. MASCC-0617
Sato, T. MASCC-0508
Saunders, D. MASCC-0431
Saunders, T.A. MASCC-0607
Saura, R. MASCC-0524
Sauvajot, C. MASCC-0634
Savage, E. MASCC-0733
Savage-Larose, L. MASCC-0295
Sawada, N. MASCC-0545, MASCC-0544, MASCC-0278, MASCC-0273
Sawada, N.O. MASCC-0837
Sawada, N.O.S. MASCC-0277
Sax, C. MASCC-0063
Schadendorf, D. MASCC-0709
Schaller, A.K.C. MASCC-0079, MASCC-0061
Scheckermann, C. MASCC-0712
Schiller, D. MASCC-0603
Schilling, J. MASCC-0852, MASCC-0726
Schindler, A. MASCC-0664
Schindler, F. MASCC-0856
Schipper, J. MASCC-0297
Schluckebier, L. MASCC-0568
Schlundt, S. MASCC-0805
Schmidt, K. MASCC-0712, MASCC-0624
Schmidt, M. MASCC-0686
Schmoll, H.J. MASCC-0418
Schneider, D. MASCC-0394, MASCC-0393
Schneider, S.M. MASCC-0805
Schneider-Stock, R. MASCC-0075
Schorr, A. MASCC-0060
Schottinger, J. MASCC-0586
Schroeder, J.M. MASCC-0288
Schrumpf, H. MASCC-0288
Schumacher, C. MASCC-0376
Schumacher, R.F. MASCC-0033
Schumann, A. MASCC-0555
Schwartzberg, L. MASCC-0812
Schwinger, W. MASCC-0129
Sciacca, V. MASCC-0081
Scotte, F. MASCC-0638, MASCC-0701, MASCC-0634
Scrignaro, M. MASCC-0795
Secilmis Kerimoglu, O. MASCC-0069
Seckin, G. MASCC-0827
Sedano, A. MASCC-0768
Seganfredo, H.C. MASCC-0332
Seidel, M. MASCC-0129
Seijas, N. MASCC-0056, MASCC-0002
Seisler, D. MASCC-0601
Seisler, D.K. MASCC-0846
Seki, N. MASCC-0414
Selamat Din, S.H. MASCC-0214
Selvi, M. MASCC-0632, MASCC-0626, MASCC-0056
Seonghoon, S. MASCC-0552
Serna, J. MASCC-0522
Serpe, R. MASCC-0047
Serpentini, S. MASCC-0344
Seymour, J.F. MASCC-0365
Shaker, B. MASCC-0454
Shanaz M.G. MASCC-0072
Shao, C. MASCC-0556
Shapiro, C.L. MASCC-0609
Sharma, A. MASCC-0016, MASCC-0356, MASCC-0357
Sharma, D.N. MASCC-0016
Sharma, M. MASCC-0356, MASCC-0357, MASCC-0358
Sharp, L. MASCC-0747, MASCC-0744, MASCC-0727, MASCC-0725, MASCC-0635, MASCC-0428, MASCC-0427
Sharp, S. MASCC-0707
Shavdia, M. MASCC-0019
Shavdia, N. MASCC-0019
Shaw, A. MASCC-0557
Shebl, A. MASCC-0336
Sheehan, J. MASCC-0199
Shen, W. MASCC-0712
Sheng, J. MASCC-0227
Sherief, L. MASCC-0336, MASCC-0314
Sheu, J.C. MASCC-0281
Shi, G. MASCC-0131
Shi, J. MASCC-0586
Shi, Q. MASCC-0845
Shi, Y. MASCC-0152
Shibamori, M. MASCC-0617
Shibata, K. MASCC-0414
Shida, M. MASCC-0368
Shih, V. MASCC-0538
Shimizu, K. MASCC-0757
Shimoni, M. MASCC-0331
Shin, K. MASCC-0518
Shin, S. MASCC-0616
Shin, S.-W. MASCC-0143
Shin, S.W. MASCC-0647, MASCC-0511
Shindo, E. MASCC-0487, MASCC-0482, MASCC-0398
Shinkura, N. MASCC-0779
Shishkin, E.A. MASCC-0407
Shklovskiy-Kordi, N. MASCC-0499
Shokaier, F. MASCC-0842
Showalter, T. MASCC-0844
Shrotiya, S. MASCC-0832, MASCC-0693
Shrotriya, S. MASCC-0536, MASCC-0535, MASCC-0534, MASCC-0533
Shun, S.-C. MASCC-0073
Shun, S.C. MASCC-0789, MASCC-0317, MASCC-0281
Shunmugam, C. MASCC-0619
Shwe, M. MASCC-0599, MASCC-0598
Sibilia, M. MASCC-0288
Sidhu, K.S. MASCC-0703
Siegel, D. MASCC-0773
Siegelmann, N. MASCC-0212
Sigaard, L. MASCC-0265, MASCC-0264, MASCC-0133
Silva Melo Cruz, F. MASCC-0608
Silva, T. MASCC-0568
Silveira, R.C.C.P. MASCC-0675, MASCC-0673, MASCC-0655
Sim, A. MASCC-0844
Sim, J. MASCC-0683
Sim, Y.J. MASCC-0404
Sima, L. MASCC-0150
Simanek, R. MASCC-0796
Simino, G.P.R. MASCC-0332
Siminska, J. MASCC-0831, MASCC-0826
Simlesa, D. MASCC-0692
Simmons, C. MASCC-0168
Simpson, M. MASCC-0269
Simpson, M.F. MASCC-0440
Simson, L. MASCC-0044
Singh, S. MASCC-0244
Singh-Carlson, S. MASCC-0086, MASCC-0813, MASCC-0622, MASCC-0480, MASCC-0204, MASCC-0203
Sit, J.W.H. MASCC-0639
Sjøgren, P. MASCC-0112, MASCC-0111
Skerman, H. MASCC-0629
Skubitz, K. MASCC-0546
Sleeboom, H. MASCC-0640
Sloan, J. MASCC-0845, MASCC-0625, MASCC-0601, MASCC-0560
Sloan, J.A. MASCC-0807, MASCC-0562
Slovacek, L. MASCC-0147, MASCC-0087
Slovackova, B. MASCC-0147, MASCC-0087
Small, I. MASCC-0568
Small, W.J.S. MASCC-0703
Smeets, R.E.H. MASCC-0053
Smillie, K. MASCC-0797
Smit, H.F.E. MASCC-0378
Smith, K. MASCC-0359
Smith, L. MASCC-0464
Smith, P. MASCC-0498, MASCC-0492, MASCC-0271
Smith, S. MASCC-0086, MASCC-0480, MASCC-0204
Smith, S.M. MASCC-0059
Smolle, V. MASCC-0288
Snelgrove, R. MASCC-0603
So, W.K.W. MASCC-0606, MASCC-0402, MASCC-0400
Soares, L.E. MASCC-0565
Soares, L.R. MASCC-0581
Soerensen, B. MASCC-0265, MASCC-0264
Soga, Y. MASCC-0268
Soibinet, P. MASCC-0287
Soler, J. MASCC-0828
Soliman, A. MASCC-0314
Song, E.K. MASCC-0647, MASCC-0511
Song, H.S. MASCC-0511
Song, S. MASCC-0261
Sonis, S. MASCC-0181
Sonis, S.T. MASCC-0812, MASCC-0605, MASCC-0564
Sonmez, O. MASCC-0339
Sonobe, H.M. MASCC-0544
Soon Haeng, L. MASCC-0415
Soran, A. MASCC-0815
Sørbye, L.W. MASCC-0306, MASCC-0304
Sørensen, V.-A. MASCC-0158
Sorgatz, K.M. MASCC-0846
Soriano, M.L. MASCC-0370
Sostek, M. MASCC-0737, MASCC-0736
Sota, K. MASCC-0256, MASCC-0209
Sottile, R. MASCC-0633
Soumoudronga, R.F. MASCC-0672
Sousa, M. MASCC-0743, MASCC-0739
Southerland, C. MASCC-0805
Sovinz, P. MASCC-0129
Spanjaard, L. MASCC-0457
Spano, I. MASCC-0344
Spence, L. MASCC-0851
Spencer, K. MASCC-0199
Spiegel, D. MASCC-0791, MASCC-0767
Spinelli, T. MASCC-0071
Springall, E. MASCC-0578, MASCC-0576, MASCC-0570
Sprod, L. MASCC-0794
Srinivasan, V. MASCC-0554, MASCC-0550
St-Hilaire, A. MASCC-0289
St. Germain, D. MASCC-0543
Staddon, A. MASCC-0546
Stadelmaier, N. MASCC-0179
Stammberger, U. MASCC-0709, MASCC-0708
Stan, D. MASCC-0740, MASCC-0722
Stanise, B. MASCC-0454
Stankovic, N. MASCC-0555
Stas, M. MASCC-0328, MASCC-0023
Stegmaier, P. MASCC-0297
Steigerwald, S. MASCC-0603
Steinbrenner, L.M. MASCC-0605
Steindal, S. MASCC-0306, MASCC-0304
Steindorf, K. MASCC-0686
Steiner, M.S. MASCC-0765, MASCC-0760
Stella, K. MASCC-0048
Stella, R. MASCC-0051, MASCC-0050, MASCC-0048
Stella, W. MASCC-0051
Stemmer, S. MASCC-0412
Stemmer, S.M. MASCC-0331, MASCC-0299, MASCC-0298
Stensen, M. MASCC-0158
Stephens, E.K. MASCC-0311
Stewart, E. MASCC-0437
Stilos, K. MASCC-0390
Stitt, L. MASCC-0140
Stojanovic, S. MASCC-0460
Stokes, E. MASCC-0699, MASCC-0674, MASCC-0389
Stolz Baskett, P. MASCC-0025
Stolz-Baskett, P. MASCC-0186
Stone, L. MASCC-0855, MASCC-0854
Stopeck, A. MASCC-0334
Strakhan, M. MASCC-0454
Strasser, F. MASCC-0796, MASCC-0164, MASCC-0109
Strenger, V. MASCC-0129
Strik, H. MASCC-0780
Stringer, A. MASCC-0853, MASCC-0628, MASCC-0602, MASCC-0591, MASCC-0483
Stringer, A.M. MASCC-0489
Stukenborg, G. MASCC-0333
Sturt, J. MASCC-0547
Su, C. MASCC-0338, MASCC-0302
Su, C.C. MASCC-0091
Su, W. MASCC-0243, MASCC-0022
Suarez-Almazor, M. MASCC-0559
Sugie, T. MASCC-0637
Sugimori, N. MASCC-0525
Sugiura, Y. MASCC-0268
Sugiyama, T. MASCC-0521
Sulkers, E. MASCC-0419, MASCC-0421
Sulkes, A. MASCC-0331, MASCC-0299
Sung, L. MASCC-0841
Surbone, A. MASCC-0687, MASCC-0684
Surendran, V. MASCC-0554, MASCC-0550
Susnjar, S. MASCC-0458
Suwa, H. MASCC-0779
Suzuki, A. MASCC-0500
Suzuki, K. MASCC-0414
Svanberg, A. MASCC-0486
Svec, J. MASCC-0134
Swami, N. MASCC-0841, MASCC-0820
Swinton, N. MASCC-0793
Swistel, A. MASCC-0561
Sym, S.J. MASCC-0511
Symons, J. MASCC-0720
Szwarc, M. MASCC-0107
Tack, J. MASCC-0737, MASCC-0736
Tada, K. MASCC-0366
Tagbarha, M. MASCC-0155
Tahmasebi, S. MASCC-0159
Taira, M. MASCC-0757
Tajima, T. MASCC-0368
Takahashi, K. MASCC-0268
Takahashi, M. MASCC-0513
Takahashi, N. MASCC-0508
Takahashi, T. MASCC-0513
Takakura, Y. MASCC-0525
Takamiya, R. MASCC-0757
Takase, K. MASCC-0679
Takase, M. MASCC-0414
Talei MASCC-0159
Tamahara, T. MASCC-0507
Tamai, N. MASCC-0757
Tamaki, K. MASCC-0757
Tamashiro, A.S. MASCC-0581
Tamminga, R.Y.J. MASCC-0419
Tamozlu, T. MASCC-0339
Tamparon, R. MASCC-0294
Tamura, K. MASCC-0521
Tan de Bibiana, J. MASCC-0797
Tan, A. MASCC-0560
Tan, C. MASCC-0294
Tan, J. MASCC-0294
Tan, L. MASCC-0012
Tan, M.H. MASCC-0630, MASCC-0479
Tan, W. MASCC-0225
Tan, X.Y. MASCC-0319
Tan, Y.P. MASCC-0588
Tanaka, I. MASCC-0610
Tanay, M. MASCC-0506
Tanda, N. MASCC-0508, MASCC-0507
Tang, C.L. MASCC-0240
Tang, J.L. MASCC-0317
Tang, W.ie.P.Y. MASCC-0537
Tannir, N. MASCC-0395
Tanuma, A. MASCC-0524, MASCC-0379, MASCC-0380
Taphoorn, M. MASCC-0424
Tarcea, V. MASCC-0496
Tardif, F. MASCC-0691
Tarrant, R. MASCC-0580
Tasaka, A. MASCC-0549
Tasar, A. MASCC-0520
Tàssies, D. MASCC-0626
Taylor, D. MASCC-0343
Taylor, M.A. MASCC-0605
Teich, N. MASCC-0568
Teich, V. MASCC-0568
Teillet, A. MASCC-0484
Tejani, M. MASCC-0755
Temel, J.S. MASCC-0410
Teo, Y.L. MASCC-0630, MASCC-0479
Teresa, C. MASCC-0409
Terpos, E. MASCC-0640
Terstriep, S.A. MASCC-0562
Terui, T. MASCC-0308
Tetelin, F. MASCC-0634
Tetterton, J. MASCC-0805
Tewes, M. MASCC-0443
Tez, T. MASCC-0301
Thamm, C. MASCC-0849
Thavarajah, N. MASCC-0238, MASCC-0237, MASCC-0236, MASCC-0235, MASCC-0010
Thiadens, S.R.J. MASCC-0027
Thirugnanasambanthan, A.T. MASCC-0697
Thomas, R. MASCC-0198, MASCC-0040
Thomas, S. MASCC-0832, MASCC-0696, MASCC-0693, MASCC-0535, MASCC-0533
Thompson, J.O. MASCC-0001
Thompson, S. MASCC-0464
Thomson, D. MASCC-0629
Thomson, M. MASCC-0493
Thong, M.S.Y. MASCC-0020
Thongprasert, S. MASCC-0312
Thorpe, D. MASCC-0628
Thuijl van, H. MASCC-0424
Tierney, S. MASCC-0431
Timmer, W. MASCC-0071
Timmons, A. MASCC-0747, MASCC-0744
Tissing, W.J.E. MASCC-0523, MASCC-0455, MASCC-0419, MASCC-0157, MASCC-0421
Titareli Merizio Martins Braga, F. MASCC-0675
Tlaker Zunter, V. MASCC-0814
Todaka, A. MASCC-0369
Toi, M. MASCC-0779, MASCC-0637
Tokashiki, S. MASCC-0229
Tokunaga, Y. MASCC-0679
Toledano, A. MASCC-0701
Tolver, A. MASCC-0158
Toral, J. MASCC-0516
Toro, J. MASCC-0393, MASCC-0392
Toro, J.J. MASCC-0394
Torp, K. MASCC-0729
Torres, A. MASCC-0300
Torres, H. MASCC-0559
Torres, L.M. MASCC-0343
Tosker, V. MASCC-0187
Tosteson, T. MASCC-0234
Tourangeau, A. MASCC-0578, MASCC-0577
Tournigand, C. MASCC-0753
Tovstohan, A. MASCC-0364
Toy MASCC-0182
Toy, H. MASCC-0089, MASCC-0068, MASCC-0067
Toyokawa, A. MASCC-0679
Trager, S. MASCC-0531, MASCC-0497, MASCC-0371
Tramer, F. MASCC-0110, MASCC-0084
Tran, B.T. MASCC-0703
Tran, C.D. MASCC-0043
Tran, T. MASCC-0793
Treister, N.S. MASCC-0154
Treleaven, J. MASCC-0493
Tremblay, A. MASCC-0289
Trentin, L. MASCC-0653
Trier, K. MASCC-0716
Trimmer, R. MASCC-0535
Trindade, A.C. MASCC-0659
Tröger, W. MASCC-0555
Trufelli, D. MASCC-0608
Truntzer, P. MASCC-0376
Truty, M. MASCC-0601
Tsai, Y.-C. MASCC-0153
Tsao, M. MASCC-0475, MASCC-0238, MASCC-0236, MASCC-0235, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0377, MASCC-0383
Tsauo, J.-Y. MASCC-0073
Tsauo, J.Y. MASCC-0317
Tsay, S.-L. MASCC-0213
Tsay, S.L. MASCC-0032
Tseng, H. MASCC-0595, MASCC-0594, MASCC-0592
Tseng, L.-M. MASCC-0167
Tserkezoglou, A. MASCC-0644
Tsianakas, V. MASCC-0529
Tsotakos, S. MASCC-0644
Tsuda, M. MASCC-0679, MASCC-0637
Tsuji, E. MASCC-0366
Tsuji, T. MASCC-0525, MASCC-0524, MASCC-0379, MASCC-0380
Tsurukawa, T. MASCC-0524
Tsushima, T. MASCC-0369
Tsuyuki, S. MASCC-0779
Tu, H.A. MASCC-0578
Tual, V. MASCC-0531, MASCC-0497
Tubert-Jeannin, S. MASCC-0551
Tullio, A. MASCC-0263
Tuppo, C.M. MASCC-0027
Turcotte, S. MASCC-0054
Turnbull, D. MASCC-0847
Turrioni, A.P.S. MASCC-0106
Ueda, Y. MASCC-0229
Uematsu, N. MASCC-0617
Uemura, S.T. MASCC-0565
Uesugi, M. MASCC-0468
Ulas, M. MASCC-0748
Ulrich, C. MASCC-0686
Ünür, M. MASCC-0770, MASCC-0690
Urban, C. MASCC-0129
Urrego Marcela, M. MASCC-0348
Urvay, S. MASCC-0802
Uttenreuther-Fischer, M. MASCC-0709, MASCC-0708
Uwland, N.F. MASCC-0563
Uyterlinde, W. MASCC-0224, MASCC-0223
Vaartio-Rajalin, H. MASCC-0064
Vaezi, M. MASCC-0583
Vaiman, M. MASCC-0187
Vales, D. MASCC-0793
Valieva, R.M. MASCC-0249
Valls, S. MASCC-0056, MASCC-0002
Van Achterberg, T. MASCC-0459
Van Dalen, E. MASCC-0391
Van de Poll-Franse, L. MASCC-0108
Van de Poll-Franse, L.V. MASCC-0053, MASCC-0052
VAN de Velden, W.J.F.M. MASCC-0567
Van de Wetering, M. MASCC-0391
Van de Wetering, M.D. MASCC-0823, MASCC-0646, MASCC-0457
Van de Wiele, T. MASCC-0502
Van den Broek, W. MASCC-0020
Van den Heuvel, M. MASCC-0224, MASCC-0223
Van den Hurk, C. MASCC-0108
Van der Elst, E. MASCC-0459
Van der Pol, M. MASCC-0323
Van der Veen, F. MASCC-0823
Van der Venn, I. MASCC-0580
Van der Wal, G. MASCC-0470
Van Loveren, C. MASCC-0321
Van Oorschot, B. MASCC-0430
Van Pelt, A.M.M. MASCC-0823
Van Straten, A. MASCC-0378
Van Teijlingen, E. MASCC-0702
Van Uden-Kraan, C.F. MASCC-0381
Van-der Molen, L. MASCC-0663
Vandenbussche, K. MASCC-0389
Vanhoecke, B. MASCC-0502
Vanlemmens, L. MASCC-0645
Vanni, L. MASCC-0541, MASCC-0539
Vardas, E. MASCC-0778, MASCC-0769
Varenova, L. MASCC-0094
Vargas, A. MASCC-0632, MASCC-0626
Vasconcelos, T. MASCC-0821
Vasile, E. MASCC-0651
Vaskelyte, A. MASCC-0768
Vaslamatzis, M.M. MASCC-0589, MASCC-0349
Vassiliou, V. MASCC-0167
Vasumathy, N. MASCC-0550
Vazquez, D. MASCC-0604
Vazquez-Quintana, E. MASCC-0604
Védrine, L. MASCC-0406
Veeraiah, S. MASCC-0704, MASCC-0619
Veerman, E.C.I. MASCC-0321
Velthuis, M. MASCC-0323
Verdonck- de Leeuw, I. MASCC-0636
Verdonck-de Leeuw, I. MASCC-0378, MASCC-0381
Verdonck-de Leeuw, I.M. MASCC-0663
Vergeichik, G.I. MASCC-0407
Vergis, A. MASCC-0603
Verity, R. MASCC-0547, MASCC-0529
Verkade, H.J. MASCC-0157
Verschakelen, J. MASCC-0023
Viallard, M.L. MASCC-0638
Viaux, P. MASCC-0350
Vibe-Petersen, J. MASCC-0716
Viel, E. MASCC-0753
Vigano, A. MASCC-0848
Vij, R. MASCC-0773
Vilallonga, J.S. MASCC-0409
Villeneuve, E. MASCC-0460
Vinther, A. MASCC-0515
Vishnuvardhan, Z. MASCC-0093, MASCC-0092
Visser, A. MASCC-0563
Visser, O. MASCC-0375
Vithala, M. MASCC-0293
Vitori, W. MASCC-0107
Viviane Andrade, V.A. MASCC-0273, MASCC-0272
Vizzard, M.A. MASCC-0293
Vlahovic, G. MASCC-0777
Vogl, F.D. MASCC-0541, MASCC-0539
Vogt., T. MASCC-0792
Volet, J. MASCC-0350
Volovat, C. MASCC-0719
Von Dincklage, J. MASCC-0408
Von Moos, R. MASCC-0640, MASCC-0334
Von Roenn, J.H. MASCC-0736
Vredenburgh, J.J. MASCC-0805
Vreugdenhil, G. MASCC-0108
Vrouchou, P. MASCC-0713, MASCC-0711
Vujovic, A. MASCC-0458
Vuletich, C. MASCC-0408
Vulser, C. MASCC-0634
Vvedenskaia, E. MASCC-0094
Wadhawan, G.S. MASCC-0120
Wagland, R. MASCC-0720, MASCC-0580
Wagner, L. MASCC-0512
Wagner, L.I.W. MASCC-0703
Wahner-Roedler, D. MASCC-0722
Wai, M.K. MASCC-0618
Wakabayashi, G. MASCC-0521
Wakeda, T. MASCC-0366
Wakefield MS, D.B. MASCC-0799
Wales Arnold, S. MASCC-0431
Walker, H. MASCC-0620
Walpole, E. MASCC-0629
Walsh, D. MASCC-0832, MASCC-0696, MASCC-0693, MASCC-0536, MASCC-0535, MASCC-0534, MASCC-0533, MASCC-0456, MASCC-0453
Waltimo, T. MASCC-0566
Wan Mohamad Zain, W.N.I. MASCC-0677
Wan, R.W.M. MASCC-0400
Wan-Chow-Wah, D. MASCC-0576
Wang, J. MASCC-0228, MASCC-0227
Wang, X. MASCC-0579, MASCC-0574
Wang, X.S. MASCC-0579
Wardill, H.R. MASCC-0471
Wartlick, F. MASCC-0060
Wass, M. MASCC-0418
Watanabe, A. MASCC-0367
Watson, D. MASCC-0464
Watzke, H. MASCC-0796
Weaver, E.W. MASCC-0557
Webster, L. MASCC-0737
Wee, H.L. MASCC-0630, MASCC-0630, MASCC-0479
Weidner, S.M. MASCC-0812
Wein, S. MASCC-0034
Weiss, J. MASCC-0027
Weiss, M. MASCC-0187
Welz, S. MASCC-0297
Wendt, T. MASCC-0297
Wentlandt, K. MASCC-0841
Were, P. MASCC-0723
Weru, K.J. MASCC-0426
Wessels, S. MASCC-0686
Westerhof, G.J. MASCC-0563
Whang, S. MASCC-0616
Whelton, R. MASCC-0450
White, I. MASCC-0464
Whiteford, A. MASCC-0707
Wiegel, T. MASCC-0496, MASCC-0297
Wieruszewska, K. MASCC-0658
Wignall, A. MASCC-0611, MASCC-0600, MASCC-0591
Wiktorowicz, K. MASCC-0514
Wildiers, H. MASCC-0459
Wiles, L. MASCC-0707
Wilkinson, A. MASCC-0623
Wilkinson, A.M. MASCC-0620
Williams, J. MASCC-0530, MASCC-0395
Williams, J.L. MASCC-0585
Williams, J.P. MASCC-0810
Williams, M. MASCC-0040
Wilmer, A. MASCC-0520
Wilson, C. MASCC-0611
Wilson, D. MASCC-0844
Wilson, H. MASCC-0749
Winter, J. MASCC-0498
Wisbeck, W.M. MASCC-0605
Wiseman, T. MASCC-0270
Wiskemann, J. MASCC-0686
Witte, B.I. MASCC-0378
Wogu, A.F. MASCC-0817, MASCC-0816
Wojciechowska-Lampka, E. MASCC-0658
Wolf, J. MASCC-0708
Wolfson, C. MASCC-0575
Wollenberg, A. MASCC-0288
Won, J.Y. MASCC-0143
Wong, B. MASCC-0759
Wong, E. MASCC-0238, MASCC-0236, MASCC-0235, MASCC-0171, MASCC-0170, MASCC-0169, MASCC-0167, MASCC-0377, MASCC-0383, MASCC-0384
Wong, E.M.L. MASCC-0639, MASCC-0606
Wong, F. MASCC-0086, MASCC-0204
Wong, H.L. MASCC-0005
Wong, K. MASCC-0238, MASCC-0236, MASCC-0235
Wong, K.S. MASCC-0606
Wong, M. MASCC-0446
Wong, M.C. MASCC-0631
Wong, Q.X. MASCC-0446
Wong, R. MASCC-0631, MASCC-0240
Wong, S. MASCC-0715
Wong, S.M. MASCC-0732
Wong, W.H. MASCC-0004
Woo, I.S. MASCC-0511
Wood, P.A. MASCC-0138
Woodring, S. MASCC-0777
Woody, N. MASCC-0195
Worsfold, A. MASCC-0713, MASCC-0711, MASCC-0710
Wroclawski, M.L. MASCC-0107
Wu, P. MASCC-0185
Wu, S. MASCC-0024
Wu, S.-F. MASCC-0213
Wu, W. MASCC-0681
Wu, W.W. MASCC-0088
Wu, X. MASCC-0233
Wujcik, D. MASCC-0759
Wyke, S. MASCC-0180
Xie, F. MASCC-0319
Xu, A. MASCC-0542
Xu, H.-Y. MASCC-0126, MASCC-0125, MASCC-0124, MASCC-0123, MASCC-0122
Xu, L. MASCC-0152
Xu, X.L. MASCC-0526
Yacouben, K. MASCC-0738
Yakasai, I.A. MASCC-0217
Yamada, M. MASCC-0513
Yamada, N. MASCC-0268
Yamagami, K. MASCC-0779
Yamagishi, N. MASCC-0487, MASCC-0398
Yamakage, M. MASCC-0367
Yamamoto, K. MASCC-0549
Yamamoto, N. MASCC-0521, MASCC-0414
Yaman, S. MASCC-0339
Yamanaka, T. MASCC-0414
Yamatodani, A. MASCC-0549
Yamauchi, A. MASCC-0779
Yamauchi, M. MASCC-0367
Yamauchi, S. MASCC-0256, MASCC-0209
Yamazaki, K. MASCC-0369
Yanai, T. MASCC-0414
Yang, H. MASCC-0045
Yang, J.C.H. MASCC-0708
Yang, P. MASCC-0845
Yang, P.C. MASCC-0789
Yao, C.T. MASCC-0132
Yap, K. MASCC-0642, MASCC-0322
Yap, Y.S. MASCC-0599, MASCC-0598, MASCC-0538
Yardley, L. MASCC-0492, MASCC-0271
Yasaka, M. MASCC-0368
Yasoda, A. MASCC-0637
Yasui, H. MASCC-0369
Yasumori, N. MASCC-0414
Yates, P. MASCC-0629, MASCC-0029
Yavas, C. MASCC-0627, MASCC-0478, MASCC-0477, MASCC-0286, MASCC-0285, MASCC-0284, MASCC-0283, MASCC-0182, MASCC-0130, MASCC-0119, MASCC-0118, MASCC-0117, MASCC-0116, MASCC-0089, MASCC-0069, MASCC-0068, MASCC-0067, MASCC-0066
Yavas, G. MASCC-0627, MASCC-0478, MASCC-0477, MASCC-0286, MASCC-0285, MASCC-0284, MASCC-0283, MASCC-0182, MASCC-0130, MASCC-0119, MASCC-0118, MASCC-0117, MASCC-0116, MASCC-0089, MASCC-0069, MASCC-0068, MASCC-0067, MASCC-0066
Yazilitas, D. MASCC-0798
Yeh, K.-H. MASCC-0073
Yenicesu, I. MASCC-0028
Yennu, S. MASCC-0585, MASCC-0395
Yennurajalingam, S. MASCC-0574, MASCC-0552
Yerushalmi, R. MASCC-0299
Yeung, C.K. MASCC-0618
Yeung, S.J. MASCC-0579
Yigit, G. MASCC-0250
Yildirim Sari, H. MASCC-0351
Yilmaz, M. MASCC-0351
Yin, P. MASCC-0152
Yokota, T. MASCC-0369
Yong, W.S. MASCC-0599, MASCC-0598
Yoo, J. MASCC-0790
Yoo, S. MASCC-0416
Yoo, Y.S. MASCC-0255
Yoon, K.S. MASCC-0403
Yoon, S.Y. MASCC-0143
Yoon, T. MASCC-0510
Yoshibayashi, H. MASCC-0779
Yoshida, E. MASCC-0507
Yoshida, K. MASCC-0521, MASCC-0513
Yoshimi, C. MASCC-0513
Yoshizawa, R. MASCC-0757
Young, A. MASCC-0707, MASCC-0128
Younus, J. MASCC-0140, MASCC-0139
Yu, B. MASCC-0526
Yu, C.J. MASCC-0789
Yu, I. MASCC-0474
Yu, S. MASCC-0494
Yuankai, S. MASCC-0312
Yuh, G.E. MASCC-0605
Yuh, Y.J. MASCC-0511
Yuksel, S. MASCC-0548
Yun, H.J. MASCC-0647
Yun, Y. MASCC-0416
Yun, Y.H. MASCC-0683
Yunjung, Y. MASCC-0415
Yusoff, Z.M. MASCC-0085
Zacchigna, S. MASCC-0423, MASCC-0420, MASCC-0033
Zachariah, B. MASCC-0017
Zadik, Y. MASCC-0842
Zafferri, V. MASCC-0653
Zagonel, V. MASCC-0653
Zakeri, Z. MASCC-0159
Zakin, L. MASCC-0701, MASCC-0527
Zamora, I. MASCC-0300
Zanardi, O. MASCC-0327
Zandonai, A.P. MASCC-0837
Zanellato, R.M. MASCC-0239
Zaner, K. MASCC-0607
Zegarski, W. MASCC-0831, MASCC-0826
Zelek, L. MASCC-0695
Zeltser, R. MASCC-0842
Zeng, L. MASCC-0612, MASCC-0246, MASCC-0242, MASCC-0237, MASCC-0171, MASCC-0170, MASCC-0168, MASCC-0167, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0011, MASCC-0010, MASCC-0009, MASCC-0008, MASCC-0377, MASCC-0382, MASCC-0384
Zeppetella, G. MASCC-0245
Zhang, H. MASCC-0045
Zhang, L. MASCC-0246, MASCC-0242, MASCC-0238, MASCC-0236, MASCC-0235, MASCC-0171, MASCC-0170, MASCC-0169, MASCC-0168, MASCC-0167, MASCC-0037, MASCC-0036, MASCC-0035, MASCC-0011, MASCC-0009, MASCC-0377
Zhang, R. MASCC-0045
Zhao, G. MASCC-0141
Zhen, P. MASCC-0012
Zheng, L. MASCC-0228
Zheng, R. MASCC-0292, MASCC-0291
Zhong, W. MASCC-0583
Zhong, X. MASCC-0233
Zhou, K. MASCC-0732, MASCC-0631
Zhou, M. MASCC-0612, MASCC-0237, MASCC-0169, MASCC-0382
Zhou, Y. MASCC-0334
Zhu, B. MASCC-0526
Zhu, L. MASCC-0045
Zilembo, N. MASCC-0724
Zimmermann, C. MASCC-0841, MASCC-0820, MASCC-0467
Zingerman, B.V. MASCC-0499
Zirko, R. MASCC-0087
Zomer-Kooijker, K. MASCC-0455
Zou, L. MASCC-0694
MASCC-0001
An evaluation of the activity of a 7-day per week, nurse-led, face-to-face specialist palliative care service in an acute district general hospital
A. Davies 1, J.O. Thompson1, S. Hall1
1Palliative Care, St. Luke’s Cancer Centre, Guildford, United Kingdom
Introduction: UK guidelines recommend that hospital-based specialist palliative care teams should provide a 9 am to 5 pm, 7-day per week, face-to-face service.
Objectives: This report describes the activity of a new, 9 am to 5 pm, 7-day per week, nurse-led, face-to-face service in an acute district general hospital in the United Kingdom.
Methods: The service is based in a district general hospital, with an integral cancer centre. On the weekends, one clinical nurse specialist (CNS) is present within the hospital, with a consultant in palliative medicine providing telephone support. The data for this report was obtained by reviewing the clinical databases used by the specialist palliative care team.
Results: During the first year, the CNS’s undertook 651 face-to-face consultations on the weekends; the median number of consultations was 12, with the median number of “new” patient consultations being 1.5. Overall, 25 % total consultations, and 18 % “new” patient consultations, were undertaken on the weekends.
The primary reasons for reviewing patients on the weekends were pain (46 %), other symptoms (27.5 %), psychological support (2 %), deterioration in condition (3 %), discharge planning (4 %), patient on the Liverpool Care Pathway (17 %), and patient with malignant spinal cord compression (0.5 %). In 60 % of cases, the CNS’s identified another problem during the consultation. Overall, 23 % “new” patients died over the weekend.
Conclusions: Our data provides evidence of the value of having a 9 am to 5 pm, 7-day per week, face-to-face service in an acute district general hospital.
References: National Institute for Clinical Excellence. Improving Supportive and Palliative Care for Adults with Cancer. London: NICE; 2004.
MASCC-0002
Hospital at home in cancer patients
J. Aibar 1, A. Fernández-Martínez2, N. Seijas1, C. Font2, B. Ibáñez1, L. Llop1, S. Valls1, M. Roman1, M.C. Grané1, C. Hernández1
1Integrated Care Unit. Medical and Nursing Direction, Hospital Clinic de Barcelona, Barcelona, Spain, 2Department of oncology, Hospital Clinic de Barcelona, Barcelona, Spain
Introduction: Cancer patients often have acute complications associated or not with malignancy that require hospitalization. An approach to avoiding hospitalization even for acutely ill patients is the ‘hospital at home (HaH)’ model.
Objectives: To compare the characteristics and outcome of cancer patients with acute medical complications admitted to a HaH program with a hospitalized control group.
Methods: Three hundred sixty-six cancer patients with acute complications requiring complex medical care were included, 247 of whom were attended in HaH program and 119 received conventional hospitalization (CH).
Results: No differences were found in the proportion of tumor types, being lung cancer the most common malignancy in both groups, followed by gastrointestinal tract tumors, breast cancer and genitourinary malignancies. The most common reasons for admission were respiratory infection/pneumonia, febrile neutropenia and fever without a clear clinical focus. Patients in the CH group had higher Charlson index (p < 0.001). Patients admitted to HaH had a lower total stay than those admitted to the hospital (p = 0.04). During HaH admission 5 patients consulted the emergency room for medical complications, 11 patients required hospitalization, and 3 patients died. CH patients had a significantly higher in-hospital mortality (p < 0.05).
Conclusions: HaH for patients with cancer who require hospitalization is an acceptable alternative to hospital based treatment in selected patients with good results in terms of mortality, total stay and hospital readmissions.
References: 1. Shepperd S, Doll H, Angus RM, et al. Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data. CMAJ. 2009 Jan 20;180(2):175–82.
MASCC-0003
Complementary therapy usage in Hong Kong Chinese women with early stage breast cancer awaiting adjuvant radiotherapy
T. Kwan 1, R. Ho1
1Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong China
Introduction: In Hong Kong, it is common for patients to use complementary therapy (CMT) on their own initiative while receiving Western medical treatment.
Objectives: To assess the prevalence of CMT usage and its associations with demographic and clinical factors in Chinese women with early stage breast cancer during cancer treatment.
Methods: Ethnic Chinese breast cancer patients awaiting adjuvant radiotherapy (n = 133) were recruited from two public hospitals and three community patient support centres in Hong Kong from December 2010 onward. Self-administered questionnaires were used to collect data on demographics, clinical status and the use of these types of CMT since diagnosis: Chinese herbal medicine, dietary therapy, physical therapy and/or mental therapy
Results: Of all women (median age 49 years), 78 % had received both breast surgery and adjuvant chemotherapy. The rate of using any type of CMT was 62 %. Chinese herbal medicine was the type most commonly taken. The use of CMT was significantly associated with age (r = −0.24, p = 0.006), and education (X2 trend = 11.26, p = 0.001), but not with household income, marital status, cancer stage, breast surgery type or chemotherapy. Qualitative data showed that women had little knowledge of the herbal products they took. Women’s classifications of dietary supplements and herbal medicine varied widely, leading to misreporting or under-reporting.
Conclusions: In this study, majority of the women had used CMT. Younger age and higher education were associated with using CMT. The consumption of Chinese herbs during Western cancer treatment raised concerns for potential interactions, and disclosure of its use may be hampered by women’s limited understanding.
MASCC-0004
Perceived symptoms and unmet needs in breast cancer survivors: a comparison study between 2 and 5 years post-treatment cohorts
K. Cheng 1, W.H. Wong2, L. Ge1, C. Koh2
1Nursing, National University of Singapore, Singapore, Singapore, 2Nursing, National University Hospital, Singapore, Singapore
Introduction: Symptoms would be one of the most important aspects impeding the transition and can give rise to unmet needs for breast cancer survivors (BCS).
Objectives: To compare the range and levels of perceived symptoms and unmet needs reported by BCS between 2 and 5 years post- cancer treatment.
Methods: Two hundred BCS (mean age: 54 years) within 2 years following cancer treatment (n = 108) and at 2–5 years post-treatment period (n = 92) were enrolled for analysis. The Memorial Symptom Assessment Scale (MSAS) and the Supportive Care Needs Survey (SCNS-34) were used to assess symptom burden and unmet needs
Results: Eighty-eight percent of the survivors reported having at least one symptom, while 49 % reported at least one unmet need. Lack of energy was the most prevalent symptom (50 %) in 2 years post-treatment group, while numbness/tingling in hands/feet was the most prevalent symptom (46 %) in 5 years post-treatment group. There was a trend in 2 years group to have higher MSAS Psychological (PSYCH), Physical (PHY), Global Distress Index (GDI) scores than the 5 years group, however, the difference was not significant (p > 0.05). Most of the survivors had unmet needs in the Health care system/Information domain; with 33 % and 38 % reported at least one unmet need for help in 2 years and 5 years groups, respectively. The mean score for the Psychological needs was significantly higher in the 2 years group compared with the 5 years group (p = 0.01).
Conclusions: Survivors in the 2 to 5 years post-cancer treatment reported more perceived needs in Psychological domain than those in less than 2 years.
MASCC-0005
Factors associated with unmet supportive care needs of breast cancer survivors during the 5 years post-cancer treatment
K. Cheng 1, H.L. Wong2, C. Koh2
1Nursing, National University of Singapore, Singapore, Singapore, 2Nursing, National University Hospital, Singapore, Singapore
Introduction: There is limited study with respect to the factors that may influence the breast cancer patients’ needs in the phase of rehabilitation and survivorship.
Objectives: To examine factors associated with unmet supportive care needs of breast cancer survivors (BCS) in the half-year to 5 year post-treatment period.
Methods: Two hundred BCS (mean age: 54 ± 8 years) at the half-year to 5 year post-treatment period were enrolled for analysis. Measuring instruments included the Supportive Care Needs Survey (SCNS-34) and the Memorial Symptom Assessment Scale.
Results: About half (49 %) of the BCS reported at least one unmet need and 36 % reported having at least one moderate or high unmet need. Of these, 65 %, 16 % and 19 % of the survivors reported 1–5, 6–10, >10 unmet needs, respectively. In the multivariable model, BCS reported high symptom burden (adjusted OR = 10.29; 95 % CI = 2.25–47.12; p = 0.003), and received adjuvant chemotherapy (adjusted OR = 5.13; 95 % CI = 1.68–15.67; p = 0.004) were significantly associated with a higher probability of at least one unmet need. As for the probability of having at least one moderate or high unmet need, the adjusted OR of high symptom burden and adjuvant chemotherapy were 12.46 (95 % CI = 3.36–46.18, p < 0.001) and 3.45 (95 % CI = 1.13–10.52, p = 0.03), respectively.
Conclusions: Adjuvant chemotherapy and residual and/or late emerging symptoms long after the completion of the treatment can give rise to unmet needs for breast cancer survivors.
MASCC-0006
A longitudinal study of the effects of multimodal symptom management program on reducing symptom burden for patients with breast and colorectal cancer
K. Cheng 1, N. Chan2, N.K.E. Ang3, P. Khalechelvam1, B. Piper4
1Nursing, National University of Singapore, Singapore, Singapore, 2Oncology, National University Hospital, Singapore, Singapore, 3Nursing, National University Hospital, Singapore, Singapore, 4Nursing, University of Arizona, Singapore, Singapore
Introduction: The consequences that cancer and its treatment-related symptoms exert have negative effects on many aspects of patients.
Objectives: To determine the effects of a RCT of a multimodal program on reducing symptom occurrence and severity.
Methods: Fifty-two patients (mean age 56.7) were randomized either to an experimental or a control group. The experimental group received a multimodal structured symptom management program for 20 weeks, and standard treatment and care (n = 27). The control group received standard treatment and care (n = 25). The Memorial Symptom Assessment Scale (MSAS) was completed weekly at baseline (before adjuvant cancer therapy, time 1), at 6 weeks from time 1 (time 2), at 12 weeks from time 1 (time 3), and at 24 weeks from time 1 (time 4).
Results: Most were aged 50 or older (81 %) and had a diagnosis with breast cancer (62 %). The longitudinal pattern of symptom median intensity was very similar for both groups. There was a trend in the experimental group to have lower severity at 6 week from time point 1 than the control group, however, the difference was not significant (p > 0.05). The median scores for MSAS Physical, Global Distress Index, and total scores were lower in the experimental group at 6- and 24-week from time 1 (median 0.24 to 0.73) compared with the control group (median 0.15 to 0.93), but the differences were not significant (p > 0.05).
Conclusions: The symptom management program may reduce symptom severity at 6- and 24-week. Nevertheless, the evaluable subjects were relatively small in this analysis that would limit the statistical power of demonstrating the differences.
MASCC-0007
Albuminemia is a prognostic factor for overall and disease free survivals in metastatic non small cell lung cancer : experience of Hassan II university hospital
Z. Benbrahim 1, S. Arifi1, L. Amaadour1, N. Abda2, C. Nejjari2, N. Mellas1, O. El Mesbahi1
1Medical Oncology, Hassan II University Hospital, Fez, Morocco, 2Epidemiology, Faculty of Medicine and Pharmacy of Fez, Fez, Morocco
Introduction: Hypoalbuminemia is a frequent manifestation of advanced NSCLC which is often related with a poor survival.
Objectives: The aim of our study was to establish the correlation between hypoalbuminemia and survival (disease-free survival (DFS) and overall survival (OS)) in Moroccan patients with metastatic NSCLC.
Methods: We reviewed 115 cases of metastatic non small cell lung carcinomas diagnosed between January 2007 and June 2011 at the Medical Oncology Department of Hassan II University Hospital. Albumin level was performed at the time of diagnosis and prior to treatment. Survival curves were plotted by the Kaplan-Meier method and compared using the log-rank test.
Results: Median age was 57 ± 10 years. Forty eight per cent had albuminemia ≤35 mg/mL with a mean level of 28 mg/L. Hypoalbuminemia was more frequently associated with body mass index <18.5 kg/m2 (p = 0,008). However, it was not correlated to age, performance status, histologic type, number of metastatic sites involved, pleural effusion, liver metastasis, hypercalcemia and anemia. The median duration of follow-up was 7.4 months (range: 1–99 months). In the univariate analysis, hypoalbuminemia was significantly correlated to lower OS (mean: 15 vs 4 months, p = 0,0023) and lower DFS (mean :10,8 versus 3,8 months, p = 0,033). The response rate was shorter (10 % vs 43 %) but not significantly different (p = 0,09). In multivariate analysis, hyoalbuminemia was significantly associated with shorter OS and DFS.
Conclusions: This study suggests that hypoalbuminemia could be an independent prognostic marker to predict unfavorable OS and PFS in patients with metastatic NSCLC.
MASCC-0008
Comparison of the EORTC QLQ-BM22 and the FACT-BP for assessment of quality of life in cancer patients with bone metastases
M. Popovic 1, J. Nguyen1, E. Chen1, J. Di Giovanni1, L. Zeng1, E. Chow1
1Rapid Response Radiotherapy Program, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: Currently, the EORTC QLQ-BM22 and the FACT-BP are the two most widely used and validated quality of life (QOL) tools for bone metastases patients.
Objectives: The purpose of this study is to compare the development and characteristics of these two modules, as well as their current use in palliative research.
Methods: Studies detailing the development process for the QLQ-BM22 and the FACT-BP were identified and consulted. A comparison between the development, characteristics, validation and use of both questionnaires was conducted.
Results: The QLQ-BM22 was developed with collaboration from patients, health care professionals and consultation from the literature whereas the FACT-BP was created strictly through interviews with patients. The two tools have identical approaches to the types of QOL they assess, generally concerning themselves with the four fields of physical well-being, emotional well-being, social well-being and functional well-being. Scoring, organization, response options and item format are different; however, recall period is the same. Both tools serve as bone metastases supplements to core items relevant to all patients with cancer.
Conclusions: Both the QLQ-BM22 and FACT-BP are designed for assessment of QOL issues specific to cancer patients with bone metastases. Each instrument has unique strengths and weaknesses and choice between these tools is dependent on the needs of the investigators and of the study.
MASCC-0009
Quality of life in patients with advanced cancers using the functional assessment of cancer therapy-general assessment tool: a literature review
M. Popovic 1, N. Lao1, G. Bedard1, L. Zeng1, L. Zhang1, D. Cella2, J.L. Beaumont2, N. Chiu1, L. Chiu1, H. Lam1, M. Poon1, R. Chow1, E. Chow1
1Rapid Response Radiotherapy Program, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada, 2Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
Introduction: Clinicians assess quality of life (QOL) in advanced cancer patients in order to select appropriate treatment regimens.
Objectives: The present review aims to compare QOL scores of the Functional Assessment of Cancer Therapy-General (FACT-G) assessment tool in relation to clinical and socio-demographic features in patients with advanced cancers.
Methods: A literature search was conducted using EMBASE (1994 to 2012) and MEDLINE (1994 to 2012) in the OvidSP platform. Weighted analysis of variance was conducted by using the number of patients from each study arm as a weighting variable.
Results: Thirty-three relevant studies encompassing 39 study arms were identified. Education, national per capita healthcare expenditure, admission status and previous radiation therapy were found to be statistically significant with respect to certain domains of the FACT-G. A greater percentage of patients completing post-secondary education correlated to significantly better emotional well-being and global QOL. Cohorts from countries with higher national per capita healthcare expenditures had better physical well-being, social/family well-being and improved relationships with their doctors. Patient samples comprised of purely outpatients had better levels of emotional well-being and global QOL when compared to mixed cohorts. A greater percentage of patients previously receiving radiation therapy correlated to a better relationship with doctor score.
Conclusions: Although limitations of the present review exist, clear differences in QOL scores based on socio-demographic and clinical factors are observed. Future work aimed at determining confounding parameters or cause and effect relationships is recommended.
MASCC-0010
Comparing prognostic factors in patients with spinal metastases: a literature review
M. Popovic 1, M. Lemke1, L. Zeng1, E. Chen1, J. Nguyen1, N. Thavarajah1, J. Di Giovanni1, F. Caporusso1, E. Chow1
1Rapid Response Radiotherapy Program, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: The expected prognosis of spinal metastases patients plays a large role in guiding treatment decisions, the outcome of which influences quality of life.
Objectives: The current study aims to review the reported factors and prognostic scoring systems that accurately predict survival of patients with spinal metastases.
Methods: A literature search was conducted to identify studies which elucidated prognostic factors in spinal metastases patients. PubMed (1966 to 2011), MEDLINE (1948 to July 2011) and EMBASE (1947 to 2011) were consulted. Articles were included if they conducted retrospective or prospective analyses on predictors of survival for patients with spinal metastases; articles validating or examining the accuracy of existing prognostic scoring systems were also included.
Results: A total of 29 studies were identified. A consensus of the literature was found with respect to three prognostic parameters: primary cancer site, extent of metastases and general condition or performance score. Further research is recommended to determine the prognostic value of age, neurological deficit, and previous treatment. The Bauer scoring system was found to be the superior prognostic model for heterogeneous populations. The Tokuhashi scoring system performed well for breast and prostate cancer patients, but poorly for renal and lung cancer patients.
Conclusions: No current prognostic scoring method was shown to be robust enough to accommodate all spinal metastases patients. Future studies are encouraged to develop.
Methods for determination of the appropriate prognostic factors and scoring systems for specific patient populations.
MASCC-0012
A longitudinal study of the prevalence and impact of symptoms in children and adolescents with cancer
K. Cheng 1, C.K. Lian2, P. Zhen2, L. Tan2
1Nursing, National University of Singapore, Singapore, Singapore, 2Paediatric Oncology, National University Hospital, Singapore, Singapore
Introduction: The consequences that cancer and its treatment-related symptoms exert have negative effects on many aspects of paediatric patients.
Objectives: To describe the symptoms reported by cancer patients who were between 10 and 18 years of age, and to explore the relationships between symptom scores and quality of life (QoL) scores.
Methods: Twenty-four patients (mean age, 14 ± 2.7 years; 63 %, was boys) diagnosed with hematological malignancy (67 %) and solid tumor (33 %) were enrolled for analysis. Data were collected before commencement of chemotherapy (time 1), at 2 months from time 1 (T2), and at 4 months from time 1 (T3). Measuring instruments included the Memorial Symptom Assessment Scale Pediatric 10–18 (MSAS) and the PedsQL4.
Results: All of the patients reported at least one symptom; with 21 %, 42 % and 37 % of them reported 1–5, 6–10, >10 symptoms, respectively, at baseline. The most common reported symptoms (>50 %) were lack of energy, weight loss, lack of appetite and feeling of sadness, and they decreased to 21 %, 25 %, 38 % and 8 %, respectively, at T3. The MSAS Psychological (PSYCH) (p = 0.08), PHY (p = 0.03), Global Distress Index (GDI) (p = 0.01), and total scores (p = 0.05) decreased over time (T1-T3). Significant strong correlations were noted between MSAS PSYCH, GDI and Total scores, and Emotional (−0.445 to −0.836, p < 0.01), Psychosocial Health (−0.522 to −0.746, p < 0.01) and Total PedsQL scores (−0.463 to −0.645, p < 0.05) at T1 and T2.
Conclusions: Symptoms are prevalent to children and adolescents after diagnosis with cancer but are in a descending pattern over time, and can cause impairments of QoL.
MASCC-0013
Trajectory of psychological morbidity and quality of life for patients receiving adjuvant cancer therapy
K. Cheng 1, N. Chan2, N.K.E. Ang2
1Nursing, National University of Singapore, Singapore, Singapore, 2Oncology, National University Hospital, Singapore, Singapore
Introduction: Cancer diagnosis and cancer therapy can give rise to psychological morbidity.
Objectives: To determine the psychological symptoms and quality of life (QoL) status reported by patients during the first three cycles of adjuvant chemotherapy until 3 months.
Methods: Seventy patients (mean age, 56.3 ± 8.1 years) diagnosed with breast (70 %) and colorectal (30 %) cancers completed the Hospital and Depression Scale (HADS) and the EORTC QLQ-C30 before commencement of chemotherapy (time 1), weekly thereafter during the chemotherapy (cycles 1–3), and at 1.5 (time 2) and 3 months (time 3) from time 1.
Results: At baseline, 7.1 % and 8.6 % of patients were probable cases (score >10) of anxiety and depression respectively, while 5.7 % and 7.1 % were possible cases (score 8–10) of anxiety and depression respectively. The probable cases of anxiety and depression increased to 11.4 % and 15.7 % at cycle 3, separately. The possible cases of anxiety went up to 17.1 % at time 3, while depression increased to 18.6 % at cycle 3. The mean anxiety score was 4.3 at baseline and in an ascending pattern at cycles 1, 3 and time 2 (p < 0.01), while the mean depression score was 3.8 at baseline and in an ascending pattern at cycle 1, times 2 and 3 (p < 0.01). All the subscale and overall QoL scores were in the descending patterns at cycles 1 and 3 (p < 0.01). The social (mean 65.1–73.6) and role functioning (median 64–73.6) spheres were those mostly compromised across time.
Conclusions: Chemotherapy may impact anxiety and depression, and thus patients’ QoL.
MASCC-0014
The effects of home-based symptom management programme to fatigue, sleep disturbance, and mood disturbance in patients with cancer undergoing adjuvant chemotherapy
K. Cheng 1, N.K.E. Ang2, N. Chan2, B. Piper3
1Nursing, National University of Singapore, Singapore, Singapore, 2Oncology, National University Hospital, Singapore, Singapore, 3Nursing, University of Arizona, Arizona, USA
Introduction: Fatigue, sleep disturbance and mood disturbance are the common symptoms reported by patients undergoing chemotherapy.
Objectives: To determine the effects of a home-based symptom management programme on reducing fatigue, sleep disturbance and mood disturbance.
Methods: Fifty-two patients (mean, 56.7; range, 37–76 years) with a diagnosis of breast (n = 32) and colorectal (n = 20) cancers were randomized either to an experimental or a control group. The experimental group received a home-based symptom management program for 20 weeks, and standard care (n = 27). The control group received standard care (n = 25). The memorial symptom assessment scale was completed weekly at baseline (before chemotherapy) and weekly thereafter during the chemotherapy (cycles 1–4).
Results: Fatigue, sleep disturbance and mood disturbance reported at baseline were 27 %, 39 % and 58 % by experimental group, and 20 %, 28 % and 56 % by control group (p > 0.05). Subjects in control group (90 %) reported a higher prevalence of fatigue than the experimental group (63 %) in cycle 4 (p = 0.045). The patterns of median frequency, intensity and distress of these three symptoms were very similar for both groups; peaked on cycle 3 for fatigue while peaked on cycle 1 for sleep disturbance and mood disturbance. There was a trend in experimental group to have lower symptom scores across the four cycles of chemotherapy than the control group, however, the difference was not significant (p = 0.05).
Conclusions: Home-based symptom management programme directed at managing fatigue, sleep disturbance and mood disturbance would be useful in reducing the symptom prevalence and severity. Nevertheless, larger population group is required to confirm our findings.
MASCC-0015
Religious organization supporting palliative care in advanced cancer in Thailand
P. Pokpalagon 1, S. Hanucharurnkul1
1Ramathibodi School of Nursing Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Introduction: The religious organizations in Thailand play an important role in palliative care for helping advanced cancer patients accepted the reality of life and meet the bio-psycho-social-spiritual needs.
Objectives: To describe the structure, process, and outcome of palliative care from a religious organization based.
Methods: This qualitative study was conducted in a religious organization in Northeastern Thailand which focusing on palliative care for cancer patients. Forty-four advanced cancer patients and five key professional carers were interviewed. Participant observation and field note were also recorded.
Results: The religious organization is a non-profit organization, provided 60 beds for cancer patients and families in natural and peaceful environment. The aims of this organization based on Buddhism is to help cancer patients accepted reality of life and enhanced physical, psychosocial, and spiritual comfort. The abbot managed the total care system and took care patients with receiving help from volunteers, patients, and families in the community with the atmosphere of mutual assistance. The organization combined Thai traditional and Western medications, natural herbal, herbal sauna, breathing practice, diet, music, sense of humor, and healing touch to help patients. Family support and spiritual wisdom from the abbot (e.g., naming individual patient, a ritual of chanting with herbal preparation, or patients/families boiling herbal preparation together) was integrated to help cancer patients. The outcomes revealed that the patients can accept the reality of life with peaceful death.
Conclusions: Religious organization was found to be helpful to the patients and their families, and should be supported by the healthcare policy makers.
MASCC-0016
Role of supportive care in the management of radiation therapy toxicities in elderly head & neck cancer patients
M.K. Behera 1, A. Sharma1, F. Ansari1, P. Appan2, D.N. Sharma2, P.K. Julka2, G.K. Rath1
1Clinical Oncology, ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS), New Delhi, India, 2Surgical Oncology, ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS), New Delhi, India
Introduction: Toxicities of combined-modality treatment of head and neck cancers usually associated with significant morbidity and decreased quality of life. It is necessary to provide patients with adequate supportive measures in order to decrease suffering while maintaining the ability to deliver full treatment.
Objectives: To evaluate the radiation therapy toxicities & role of supportive care and treatment compliance of elderly patients in head and neck squamous cell carcinoma.
Methods: A total of 164 elderly patients were studied. Sixty percent of the patients were subjected to either radical radiation ± chemotherapy or surgery followed by post-op RT, rest 40 % were treated with palliative radiation and/or best supportive care.
Results: Acute toxicities encountered were anemia-gr III-10 %, gr II-40 %, neutropenia-gr II-40 %, gr III-14 %, radiation dermatitis gr III-22 %, gr II-40 %, mucositis—gr III-30 %, gr II-50 %, and dysphagia- gr III-22 % and II-40 %. Gr I-II radiation dermatitis managed with topical emollients, multiagent ointments ± topical steroid ointments. Patients having gr II dysphagia or more and patients with surgery advised for ryle’s tube insertion to maintain oral feeds. Mucositis managed with regular mouth rinse with povidone iodine ± local anaesthetic solution and dispersible paracetamol/diclofenac gargles. Thirty percent of the patients were not able to complete the stipulated treatment.
Conclusions: Even after careful selection of patients in a multidisciplinary clinic more than one third of the elderly HNSCC failed to comply for the stipulated treatment. Best supportive care remains the most important aspect in the management of radiation toxicities.
References: 1.Murphy et al, Clinical Advances in Hematology & Oncology Volume 5, Issue 10 October 2007, 807–22.
MASCC-0017
Effects of androgen deprivation therapy (ADT) for prostate cancer (PC) on muscle strength and physical functioning
H. Jim 1, M. Cases1, M. Rose1, B. Zachariah2, M. Fishman3, P. Jacobsen1
1Dept. of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, USA, 2Dept. of Radiation Oncology, James A. Haley Veterans Medical Center, Tampa, USA, 3Dept. of Genitourinary Oncology, Moffitt Cancer Center, Tampa, USA
Introduction: Loss of skeletal muscle mass is a known adverse effect of ADT used in treatment of PC.
Objectives: Although ADT-related loss of muscle mass is also likely to result in loss of muscle strength and declines in physical functioning, this possibility has not been systematically evaluated.
Methods: To address this issue, we assessed physical functioning (using the SF-12), upper body muscle strength (using a hand dynamometer), and lower body muscle strength (using the Chair Stand Test) in PC patients undergoing ADT (n = 32; M = 65 years) and PC patients previously treated with surgery but not ADT (n = 64; M = 67 years). Assessments were conducted before the start of ADT and 6 and 12 months later and at corresponding intervals in the non-ADT sample.
Results: Group (ADT, no ADT) × time (baseline, 6 months, 12 months) interactions (p < .05) were found for grip strength (dominant and non-dominant hands), chair rise, and physical functioning. In each instance, there was growing divergence between groups over time, with muscle strength and physical functioning at 12 months worse in the ADT group than in the non-ADT group.
Conclusions: Results confirm that adverse effects of ADT on muscle mass are accompanied by loss of muscle strength. Additionally, they suggest that ADT-related loss of muscle strength results in markedly poorer physical functioning within 12 months of treatment onset. Taken together, findings point to the importance of identifying interventions effective in preventing or reversing loss of muscle strength in this patient population.
MASCC-0018
Safety and efficacy of 5FU bolus in association with cisplatin: a retrospective study about 40 patients
Z. Benbrahim 1, R. Najib1, K. Daoudi1, S. Arifi1, N. Mellas1, O. El Mesbahi1
1Medical Oncology, Hassan II University Hospital, Fez, Morocco
Introduction: Combination of 5-fluorouracil in continuous infusion and cisplatin is an effective regimen for the treatment of a wide range of carcinomas. This chemotherapy often requires a long period of hospitalization and limitation of daily activity of these patients.
Objectives: The aim of this study is to evaluate safety and efficacy of cisplatin associated with 5FU bolus.
Methods: We retrospectively reviewed 40 patients treated with cisplatin and 5FU bolus between January 2009 to April 2012 at Hassan II University Hospital. Toxicities were evaluated according to the NCI-CTC version 3.0.
Results: Median age of patients was: 54.2 ± 10.2 years. 70 % were men. All patients had not receive prior chemotherapy. A total of 128 cycles of chemotherapy were administered. 51 cycles (40 %) of cisplatin-5FU bolus were received for the treatment of gastric cancers, 46 cycles (36 %) for Head and neck cancers, 16 cycles (12.5 %) for biliary tract cancers. Doses of 300 mg/m2 d1-d3 (95 cycles), 300 mg/m2 d1-d5 (17 cycles), 400 mg/m2 d1-d5 (12 cycles) were used. Toxicity was mainly hematological: overall incidence of toxicity grade 3 and 4 per cycle were: anemia 14 %, neutropenia 12 %. Non hematological toxicity was mild to moderate: overall incidence of toxicity grade 1–2 per cycle were: vomiting: 25 %, mucositis: 13 %, diarrhea: 7 %. The median duration of follow-up was 3.4 months (range: 1–9). Overall response rate was 57 %.
Conclusions: Our experience indicated the safety and some efficacy of cisplatin associated with 5FU bolus. Further studies are required to elucidate the clinical role of 5FU bolus in these cancers.
MASCC-0020
Living with the physical and mental consequences of an ostomy; a study among 1–10 year rectal cancer survivors from the population-based profiles registry
F. Mols 1, V. Lemmens2, K. Bosscha3, W. van den Broek4, M.S.Y. Thong1
1Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands, 2Department of Research, Comprehensive Cancer Centre South, Eindhoven, Netherlands, 3Department of Surgery, Jeroen Bosch Hospital, Den Bosch, Netherlands, 4Department of Surgery, Sint Anna Hospital, Geldrop, Netherlands
Introduction: Having an ostomy can have a major impact on the lives of rectal cancer patients.
Objectives: To examine the physical and mental consequences of an ostomy among 1–10 year rectal cancer survivors.
Methods: Rectal cancer patients diagnosed between 2000 and 2009, as registered in the population-based Eindhoven Cancer Registry, received a questionnaire on quality of life (QOL; EORTC QLQ-C30), disease-specific health status (EORTC QLQ-CR38), depression and anxiety (HADS), illness perceptions (B-IPQ), and health care utilization; 76 % (n = 1017) responded.
Results: Four hundred seven (43 %) rectal cancer survivors had an ostomy at time of survey. They reported a statistically significant and clinically relevant lower physical, role and social functioning, and global health status/QOL but fewer symptoms of constipation and diarrhea compared to those without an ostomy. Also they had a statistically significantly but not clinically relevant worse body image, more male sexual and fewer gastrointestinal problems. No differences regarding the prevalence of symptoms of anxiety and depression were found. Those without an ostomy believed that their illness had less serious consequences, will last shorter, they experienced less illness symptoms, and are less concerned about their illness compared to those with a permanent or those who had a temporary ostomy. Only the subscale Consequences showed clinical relevance. Patients with an ostomy visited their medical specialist, but not their general practitioner, significantly more often.
Conclusions: Rectal cancer survivors with an ostomy have a lower QOL, worse illness perceptions and a higher health care consumption compared to those without an ostomy 1–10 years after diagnosis.
MASCC-0021
Making the most out of life: the contribution of attention restorative theory as a non-pharmacological approach to manage cancer fatigue
M. Kirshbaum 1, J. Donbavand1, S. Phillips1, V. Kaye1, B. Purcell1
1Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
Introduction: This study investigates a unique approach based on Attention Restorative Theory (ART) (Kaplan 2001) to develop a non-pharmacological intervention to help individuals manage the distressing effects of cancer fatigue.
Objectives: To: identify activities and situations identified as being enjoyable by individuals who have moderate to severe fatigue; analyze reported ‘enjoyable experiences’ by mapping emergent themes to core components of attention restoration; develop a self-management intervention tool.
Methods: A purposive sample of 25 individuals who experienced moderate to severe fatigue was selected from the local hospice and community. Focused semi-structured interviews probed the question: What do you enjoying doing? Framework analysis was used to manage responses.
Results: Seventy-five ‘enjoyable experiences’ were identified, including artistic pursuits, voluntary work, socialising and learning. These activities were organised into five conceptual themes: Belonging, Expansion, Nurturing, Purposeful and Fascination. When mapped against attributes of restorative activities specified in ART, there was some congruence and variation. It was clear that the participants expressed a great need to be safe and in a nurturing environment. Some participants placed a high value in and received great joy from contributing to the community; this was not noted in previous ART literature.
Conclusions: A self-management intervention tool was developed and due to be piloted comprising a short interview, an analysis of activities and a co-planning section. The guide is intended to be used to address fatigue through exploring, discovering and promoting experiences which engage interest, excite, nurture and challenge the person.
References: Kaplan, S. (2001) Mediation, Restoration and the Management of Mental Fatigue. Environment and Behavior, 33:480–506.
MASCC-0022
An analysis of the usage of strong opioids in the palliative care unit of a medical center-a three-year review
Y. Lai 1, W. Su1
1Hospice Palliative Care Center, Mackay Memorial Hospital, Taipei city, Taiwan
Introduction: Pain management is integral to palliative care to effectively improve patients’ quality of life.
Objectives: The aim of this study was to collect valuable data on the use of strong opioid analgesics in the management of pain in terminally ill cancer patients receiving palliative care in a Taiwanese medical center. This detailed analysis of drug usage should help in making decisions on opioid treatment in palliative care.
Methods: A retrospectively reviewed was used. Information regarding medications for pain management in the last 2 weeks before death was analyzed.
Results: In the second-last week of life, 97 (64.6 %) patients were prescribed morphine only and 43 (28.7 %) of them received two or more different opioids. In the last week, patients tended to prefer morphine to other opioids. The mean daily morphine dosage was significantly higher in the last week (96.79 mg) than in the second-last week (88.08 mg). Subcutaneous injection (76 %) was the most frequent route of opioid administration. In the second-last week before death, patients had taken a significantly higher dose of opioids to improve the breakthrough pain.
Conclusions: Generally, most intractable cancer pain could be controlled by strong opioids through appropriate dose adjustments and routes. However, breakthrough pain could not be effectively relieved immediately by morphine, the mainly opium-based drug for the sudden severe pain.
Prospectively, we initiate more research effort into breakthrough pain in Taiwan. The development of an appropriate drug with immediate-release effects is on -going. The clinical management quality with regard to BTP can then be improved gradually.
MASCC-0023
Heparin versus normal saline as locking solution in totally implantable venous ports: a randomized controlled trial in cancer patients
G.A. Goossens 1, M. Jérôme1, C. Janssens1, W.E. Peetermans2, S. Fieuws3, P. Moons4, J. Verschakelen5, K. Peerlinck6, M. Jacquemin6, M. Stas7
1Nursing Centre of Excellence, University Hospitals Leuven, Leuven, Belgium, 2Internal Medicine, University Hospitals Leuven, Leuven, Belgium, 3Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium, 4Public Health an Primary Care, KU Leuven, Leuven, Belgium, 5Radiology, University Hospitals Leuven, Leuven, Belgium, 6Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium, 7Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
Introduction: Heparin is commonly used as locking solution in implantable venous access ports. However, evidence that normal saline is not inferior to heparin is lacking.
Objectives: We tested the hypothesis that locking ports with normal saline is not inferior to heparin regarding functional problems and catheter-related bacteraemia.
Methods: We conducted an open-label, parallel-group, randomized, non-inferiority trial. Eight hundred and two cancer patients with a newly inserted port were randomised either to lock their port with heparin (300U/3 ml) or with normal saline. Ports, inserted by dedicated surgeons, were accessed by specially trained nurses, according to strict protocols. The number of functional complications was the primary outcome and defined as “easy injection, impossible aspiration” at port access. Secondary outcomes comprised all functional problems and catheter-related bacteraemia.
Results: From January 2009, to December 2010, 404 patients received a normal saline lock and 398 a heparin lock. Of these patients, 382 from the normal saline group and 383 from the heparin lock group were included in the analysis. The incidence rate of “easy injection, impossible aspiration” was 3.70 % (95 % CI 2.91–4.69) of accesses in the normal saline group and 3.92 % (95 % CI 3.09–4.96) in the heparin group with a relative risk of 0.94 (95 % CI 0.67–1.32). Catheter-related bloodstream infection rate per 1,000 catheter days was 0.03 in the normal saline and 0.10 in the heparin group.
Conclusions: A normal saline lock, prior to Huber needle removal, is safe if combined with a strict protocol for port insertion and maintenance.
MASCC-0024
Pruritus in patients treated with targeted cancer therapies: systematic review and meta-analysis
C. Ensslin 1, A. Rosen1, S. Wu2, M. Lacouture1
1Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, USA, 2Division of Medical Oncology Department of Medicine, Stony Brook University, Stony Brook, USA
Introduction: Pruritus is a disabling symptom that has been anecdotally described in patients treated with targeted cancer therapies, and reports on its incidence vary. The overall risk to develop pruritus in these patients has not been systematically ascertained.
Objectives: We conducted a systematic review and meta-analysis of the literature to determine the incidence and risk of developing pruritus among patients treated with targeted therapies.
Methods: Databases from PubMed and Web of Science from January 1998 until July 2012 and abstracts presented at the American Society of Clinical Oncology annual meetings from 2004 to 2012 were searched to identify relevant studies. The incidence and relative risk (RR) of pruritus were calculated using random-effects or fixed-effects model depending on the heterogeneity of included studies
Results: Of 5,065 studies initially identified, a total of 20,532 patients from 144 studies were included for analysis. The summary incidences of all-grade and high-grade pruritus were 17.4 % (95 % confidence interval (CI): 16.0–19.0 %) and 1.4 % (95 % CI: 1.2–1.6 %). From randomized controlled trials, patients treated with targeted therapies had a significantly increased risk of developing all-grade pruritus, with an overall RR of 2.59 (95 % CI: 2.03–3.30, p < 0.001); there was a significant variation among different classes of drugs (P < 0.001)
Conclusions: There is a significant risk of developing pruritus in cancer patients receiving targeted therapies. In order to prevent suboptimal dosing and reductions in quality of life, these patients should be counseled and treated against this disabling event.
References: Balagula Y, Lacouture ME, Cotliar JA. Dermatologic toxicities of targeted anticancer therapies. The journal of supportive oncology 2010;8:149–61.
MASCC-0025
Needs assessment in caregivers of older cancer patients using the German version of the supportive care needs survey for partners and caregivers (SCNS-P&C44)
P. Stolz Baskett 1, J. Roberts2, P. Milligan2
1School of Health Professions, Institute of Nursing, Winterthur, Switzerland, 2King’s College, Florence Nightingale School of Nursing & Midwivery, London, United Kingdom
Introduction: Only few tested needs assessment instruments for informal caregivers are available in other languages than English.
Objectives: To present data on the translation, discriminatory potential, psychometric properties and none-response issues related to the SCNS-P&C44 (German version).
Methods: A consecutive sample of informal caregivers (n = 86; aged 37–85), of older chemotherapy patients were recruited from three ambulatory cancer clinics in north-eastern Switzerland. The SCNS-P&C44 was translated from its original English version into German following common procedures for cultural adaptation of research instruments, i.e. multiple forward translation, translator agreement and piloting. None response was assessed and internal consistency measured using Cronbach’s alpha for the proposed subscales.
Results: Respondents reported up to 41 moderate to high needs, with 24 participants (28 %) reporting no moderate to high needs at all. Cronbach’s alpha for the proposed underlying factors ranged from 0.91 to 0.97, indicating good reliability. Caregivers with depressed mood (p = .001) had significantly more often one or more moderate to high needs with an additional gender difference approaching significance (p = 0.55). Non-response to single items appeared at random apart from the item ‘Fertility problems in patient’, which was missing for six of the cases (7 %).
Conclusions: The German version of the SCNS-P&C44 appears to be a reliable tool to assess informal caregivers of older cancer patients’ needs indicated by high Cronbach’s alpha values. Associations of gender and mood state with need level add evidence to construct validity. Items assessing needs around fertility may be culturally or population specific and warrant further exploration in a larger study.
MASCC-0026
Cardiac side effects of trastuzumab in her 2 positive breast cancer patients – single centere experiences
J. Huszno 1, E. Nowara1
1Clinical and Experimental Oncology Department, Maria Sklodowska Curie Memorial Cancer Centere and Institut of Oncology Gliwice, Gliwice, Poland
Introduction: The expression of steroid receptors and HER2 over expression in breast cancer cells are predictive and prognostic factors. Over expression of HER2 allows to use immunotherapy which most serious side effect is cardiotoxicity.
Objectives: The aim of this study was to present our own experiences concerning well known cardiac risk factors and evaluate the influence of steroid receptor status profile on cardiotoxicity risk in HER2 breast cancer patients.
Methods: The study was performed in 166 breast cancer patients who received immunotherapy in the Clinical and Experimental Oncology Department, between 2006 and 2012.
Results: LVEF reduction >10 % of the baseline fraction was observed in 12 (8 %) patients. Due to persistent cardiotoxicity 10 patients (6 %) had to discontinue therapy prematurely. There was observed the predisposition to cardiac side effects (13 % vs 5 %) in patients with negative steroid receptor status p = 0.08. The decrease of LVEF (12 % vs 0) and cardiac adverse side effects (2 % vs 0) were detected only in ER-/PR- patients but without statistical significance. Discontinuation of therapy because of cardiotoxicity was associated with negative receptor status (33 % vs 7 %) p = 0,019. Irrespective of steroid receptor status, older age of patients (p = 0,009), higher BMI (p = 0,05), low baseline LVEF (p < 0.001), previous anthracycline based chemotherapy (p = 0.01) and radiotherapy to the left side of the chest (p = 0,02) were associated with the occurrence of cardiotoxicity and decrease of LVEF.
Conclusions: Breast cancer type containing Erb-B2 overexpresson (ER-/PR-/HER2+) was associated with predisposition to cardiac side effects. The signification of cardiac risk factors were confirmed.
MASCC-0027
Factors associated with symptoms and infection occurrence among individuals with secondary extremity lymphedema
J. Deng 1, M.R. Fu2, J.M. Armer3, J.N. Cormier4, E. Radina5, S.R.J. Thiadens6, J. Weiss7, C.M. Tuppo8, M.S. Dietrich1, S.H. Ridner1
1School of Nursing, Vanderbilt University, Nashville, USA, 2College of Nursing, New York University, New York, USA, 3Sinclair School of Nursing, University of Missouri, Columbia, USA, 4UT MD Anderson Cancer Center, The University of Texas, Houston, USA, 5Department of Family Studies & Social Work, Miami University, Oxford, USA, 6National Lymphedema Network, National Lymphedema Network, San Francisco, USA, 7CoxHealth Outpatient Rehabilitation, CoxHealth Outpatient Rehabilitation, Springfield, USA, 8Bariatric and Metabolic Weight Loss Center, Stony Brook Medicine, Stony Brook, USA
Introduction: Secondary extremity lymphedema is the most common type of lymphedema in the United States, which largely results from cancer and its treatment. Currently, a limited number of studies have been available to examine risk factors related to symptoms and infections in individuals with extremity lymphedema.
Objectives: The objective of this study was to examine factors associated with symptoms and infections among individuals with secondary extremity lymphedema.
Methods: Data were collected from a web-based survey supported by the National Lymphedema Network (NLN) from March 2006 through January 2010. A total of 1206 participants reported having secondary upper or lower extremity lymphedema. Multivariate and logistic regression analysis was used to examine the factors associated with symptoms and infection among individuals with extremity lymphedema.
Results: Distressing symptoms were more likely reported by individuals with lower income (p = .005), no insurance coverage (p = .030), history of surgery (p = .024), history of infection in the affected extremity (p = .020), no self-care (p = .011), and lower extremity lymphedema (p = .037). Individuals with a history of surgery (p < .001), radiation therapy (p = .043), reporting the symptom of heaviness of the affected extremity (p = .016), and with lower extremity lymphedema (p = .004) had an increased likelihood of episodes of infection.
Conclusions: Select factors of level of income, insurance coverage status, surgery treatment history, self-care status, and anatomical site of lymphedema were associated with symptom burden among individuals with secondary extremity lymphedema. Symptoms and infection were significantly correlated. Longitudinal studies are needed to identify causative risk factors for symptoms and infection in individuals with secondary extremity lymphedema.
MASCC-0028
Usage of low dose oral midazolam during invasive procedures of pediatric hematology patients
F. Belen 1, H. Kocak2, U. Kocak1, M. Isik1, N. Öner1, E.Y. Keskin1, Z. Kaya1, I. Yenicesu1, T. Gürsel1
1Department of Pediatric Hematology, Gazi University, Ankara, Turkey, 2Department of Pediatrics, Gazi University, Ankara, Turkey
Introduction: Children with hematological diseases (especially with leukemias) often undergo painful procedures that add more stress to their underlying illness.
Objectives: The aim of the study was to investigate whether oral midazolam can decrease fear, pain and distress when given together with usual intravenous sedoanalgesia.
Methods: A total of 47 patients 1–18 years of age who were followed at hematology inpatient setting were included at the study. The study group consisted of patients undergoing bone marrow aspiration or lumbar puncture for Acute Leukemia, Immune Thrombocytopenia, Thrombocytosis, Chronic Myleogeneous Leukemia and Aplastic Anemia. Patients were divided into placebo (n = 23) and oral midazolam (n = 24) groups in this double blind randomized study. Midazolam group received 0.1 mg/kg(maximum 10 mg) orally 30 min before the procedure. Both groups were administered 0.5 mg/kg ketamine intravenously before the procedure. Parents and children >7 years reported their fear, distress and pain with visual analogous scale (VAS) and Wong-Baker Fascies Scale. CHEOPS score was filled by the blinded pediatric hematologist performing the procedures.
Results: There was no difference of fear, pain and distress levels of placebo and midazolam groups according to VAS, Wong Baker Fascies and CHEOPS scores(p > 0.05). We found no additional effect in decreasing pain and stress of oral midazolam versus placebo when administered together with intravenous ketamine analgesia. Nausea according to analgesia was found less in the midazolam group (p < 0.05).
Conclusions: Low dose oral midazolam does not have an additional effect in decreasing pain and stress in pediatric hematology patients when administered together with intravenous ketamine analgesia. More studies to evaluate its effect when used without intravenous analgesia is warrented.
MASCC-0029
A prospective longitudinal survey of fatigue self-management behaviors in patients with advanced cancer
R. Chan 1, P. Yates2, A. McCarthy3
1Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston, Australia, 2Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia, 3School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
Introduction: Fatigue is a distressing symptom frequently experienced by patients with advanced cancer. Although there have been advances in managing fatigue with the use of a range of pharmacologic and non-pharmacologic strategies, fatigue is not well-managed in this population.
Objectives: For patients with advanced cancer, the aims of the study were to examine the self-management behaviors associated with fatigue, the perceived effectiveness of these behaviors, and the medical/socio-demographic factors influencing the perceived effectiveness of these behaviors.
Methods: A prospective longitudinal study was undertaken with a 152 patients with metastatic breast, lung, colorectal and prostate cancer experiencing fatigue (>3/10) recruited from oncology outpatients department at a tertiary referral cancer center. Patients were interviewed on three occasions over a two-month period. Self-management behaviors associated with fatigue, medical/socio-demographic characteristics, social support, depression, anxiety, self-efficacy and other symptoms were assessed.
Results: Findings indicate that most of the fatigue severity measures increased slightly over time. On average, participants used nine fatigue self-management behaviors at each time-point. Participants reported that the most effective self-management behaviors were ‘pacing their activities’, ‘planning activities to make the most of energy’, and ‘taking short sleeps’. General Estimating Equations were used to examine the factors associated with the increased perceived effectiveness of fatigue self-management behaviors over time. These were higher self-efficacy, higher education level, lower levels of depressive symptoms, and lower functional status.
Conclusions: Interventions which assist individuals to use selected fatigue self-management behaviors have the potential to alleviate fatigue. Further investigation of these behaviors and the factors influencing their uptake is required.
MASCC-0030
An overview of level I evidence for the management of radiation dermatitis literature
R. Chan 1, E. Larsen1, P. Chan1
1Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston, Australia
Introduction: Despite the technologic advances, radiation dermatitis is still a prevalent and distressing symptom in patients with cancer undergoing radiotherapy. Systematic reviews (SRs) are regarded as level I evidence providing direction for clinical practice and guidelines.
Objectives: This overview aims to provide a critical appraisal of SRs published on interventions for the prevention/management of radiation dermatitis.
Methods: We searched the following electronic databases: MEDLINE, CINAHL, EMBASE, and the Cochrane Library (up to Feb 2012). We also hand-searched reference lists of potentially eligible articles and a number of key journals in the area. Two authors screened all potential articles and included eligible SRs. Two authors critically appraised and extracted key findings from the included reviews using the “A Measurement Tool to Assess Systematic Reviews” (AMSTAR).
Results: Of 1,837 potential titles, six SRs were included. A number of interventions have been reported to be potentially beneficial for managing radiation dermatitis. Interventions evaluated in these reviews included skin care advice, steroidal/non-steroidal topical agents, systematic therapies, modes of radiation delivery, and dressings. However, all the included SRs reported that there is insufficient evidence supporting any single effective intervention. The methodological quality of the included studies varied, and methodological shortfalls in these reviews may create biases to the overall results or recommendations for clinical practice.
Conclusions: An up-to-date high quality SR in preventing/managing radiation dermatitis is needed to guide practice and direction for future research. Clinicians or guideline developers are recommended to critically evaluate the information of SRs in their decision making.
MASCC-0031
Conflict management styles among oncology nurses
O. Aslan 1, M. Akyol2
1Department of Fundamentals of Nursing, Gülhane Military Medical Academy, Ankara, Turkey, 2Department of Biostatistics, Yildirim Beyazit University, Ankara, Turkey
Introduction: Suitable conflict management in the oncology setting contributes to lead the effective decision making process during cancer care.
Objectives: The aim of this research was to determine the conflict management styles of oncology nurses with their peers.
Methods: It was planned as a descriptive study. Ninety-nine oncology nurses working at an oncology research and education hospital in Ankara were included in the study in June-July 2009. Rahim Organizational Conflict Inventory-II C (ROCI-II) and a demographic data form were used to collect data. Data were analyzed in SPSS 15.00 program.
Results: The highest mean subscale score in ROCI-II was 29.13 ± 2.90(Integrating). The lowest mean subscale score was 16.88 ± 1.67(Compromising). Mean “Integrating” and “Obliging” subscale scores of nurses in high school level were significantly higher than those of nurses with associate degree and bachelor’s degree(Z = 2.717, P = 0.007). Mean “Dominating” and “Avoiding” subscale scores didn’t differ with demographic characteristics of nurses(P > 0.05). Mean “Comprimising” subscale scores differed with duration in oncology significantly(X 2 = 8.421, P = 0.016).
Conclusions: This research revealed that mostly used conflict management style of oncology nurses was “Integrating.” Some sociodemographic factors affected conflict management styles of nurses. Educational activities may be benefical for nurses on conflict management styles according to various conditions. Because using suitable conflict management styles will provide oncology nurses with peaceful working environments during high quality supportive cancer care process.
References:
1.Vivar CG. Putting conflict management into practice: a nursing case study. J Nurs Manage 2006; Apr; 14(3):201–206.
2.Walczak MB, Absolon PL. Essentials for Effective Communication in Oncology Nursing: Assertiveness, Conflict Management, Resolution, Delegation and Motivation. J Nurses Staff Dev 2001; Mar-Apr;17(2):67–70.
MASCC-0032
Patient and clinical determinants predict treatment outcomes of health-related quality of life, pain and symptoms in colorectal cancer: a follow-up study
S.L. Tsay 1, H.C. Hung2
1School of Nursing, National Taipei University of Nursing & Health Sciences, Taipei, Taiwan, 2School of Nursing, Hung Kuang University, Taichung, Taiwan
Introduction: None
Objectives: The aim of the current study was to evaluate the changes in outcomes of health-related quality of life (HRQoL), pain and symptoms and its relationship to the demographic and clinical characteristics from diagnosis, 1 month, 3 months, and 6 months after the initial diagnosis in patients with colorectal cancer using a repeated measures framework.
Methods: A cohort study was performed in 134 colorectal cancer patients in Central Taiwan. HRQoL, pain, and symptoms were assessed at 4 points. The Functional Assessment of Cancer Therapy-colon (FACT-C) questionnaire, VAS pain, and the Memorial Symptom Assessment Scale (MSAS) were used for data collection. A generalized estimating equation (GEE) was applied for statistical analysis.
Results: The majority of the patients were male (55 %) and married (91.5 %). The mean of age was 60.39 years (SD = 11.71). 55 % of patients were diagnosed at the third and fourth stage of colorectal cancer (54.5 %). The results of GEE showed that patients’ HRQoL, pain, and symptoms significantly improved over time. Female, had comorbidity, and stage IV patients had higher pain scores overtime. Female and stage IV patients had worse physical symptoms, stage IV and II patients had worse psychological symptoms overtime. Patients with stage IV who received surgery and CCRT had the worst health-related quality of life overtime.
Conclusions: Patients’ demographic and clinical characteristics affect treatment outcomes of pain, symptoms, and health-related quality of life overtime.
MASCC-0033
High-level laser therapy in the treatment of chemotherapy-induced oral mucositis in paediatric patients
G. Ottaviani 1, M. Gobbo1, M. Chermetz1, S. Zacchigna1, R.F. Schumacher2, G. Conti3, M. Biasotto1, A. Majorana4
1Oral Medicine, University of Trieste, Trieste, Italy, 2Pediatrics, University of Brescia, Brescia, Italy, 3Oral Surgery, University of Milan, Brescia, Italy, 4Oral Medicine, University of Brescia, Brescia, Italy
Introduction: Oral mucositis is one of the most debilitating side effects of chemotherapy.
Laser Therapy has recently proven successful in the management of such affection, through a safe, non-invasive and free-of-side-effect procedure.
Objectives: To verify the success of High-Level Laser Therapy in the management of oral mucositis in children.
Methods: Eighteen paediatric oncologic patients receiving chemotherapy and/or hematopoietic stem-cell transplantation affected by oral mucositis were enrolled. Assessment of oral mucositis was performed through Common Toxicity Criteria objective scale, and through VAS. Patients were asked to fill in a validated questionnaire and photos of lesions were taken in each session.
Patients were treated through HLL Therapy through 4-minute applications twice a day over a period of 4 consecutive days. A follow up recall was performed 7 days after the last laser application.
Results: All patients referred an improvement in pain, and an objective amelioration of lesions was registered since Day 4 up to a complete regression of oral mucositis on Day 11, with no apparent side effects.
Conclusions: HLL therapy was well tolerated and may be effective in the treatment of chemotherapy-induced oral mucositis in pediatric patients, accelerating wound healing and reducing symptoms.
Being non-invasive, easy to use and free of side effects, we feel confident to affirm that HLL Therapy may become a standard protocol in the treatment of chemotherapy-induced oral mucositis in paediatric patients.
References: Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients. Migliorati C,et al; Mucositis Study Group of the MASCC/ISOO. Support Care Cancer. 2013 Jan;21(1):333–41.
MASCC-0034
The nature of hope and why it cannot be false
S. Wein 1
1Pain and Palliative Care Service, Institute of Oncology Davidoff Center, Petach-Tikva, Israel
Introduction: Hope is a two-edged sword. It makes one feel good and provides a stimulus to reach a goal. At the same time however, it can trap one into pursuing futile dreams.
Objectives: The Ancient Greeks thought that hope was evil and expressed this in the myth of Pandora. Later, Judeo-Christian doctrine categorized hope as good.
Methods: Hope is a hard-wired psychological process guided by beliefs, culture, and character. Medical-nursing decisions in cancer care, such as further chemotherapy, truth-telling and resuscitation are partly determined by hope.
Results: Hope has three essential characteristics: it exists only in the future; it helps to create goals, and it invariably generates good feelings for the subject. Hope is a subjective commitment to the uncertain future. Hence a 5 % chance of response to chemotherapy may be hope-generating to some, but appear ‘false’ and futile to others. Some people hope for miracles, and for them this is realistic. Thus the concept ‘false hope’ is an oxymoron since by definition hope is subjectively true.
The ‘good feeling’ associated with hoping is inherent to the process of hoping and is not part of the content of the hope. The emotional and spiritual aspects of hope commonly cited in the literature, are epiphenomena, not integral to hope itself.
Conclusions: Hope can only be considered ‘false’ if staff or family provide false information to the patient. Since hope intrinsically makes us feel good and helps create goals, people can be manipulated with hope-generating scenarios. Hope as a medicant must be used cautiously.
MASCC-0035
Minimal clinically important differences in the Edmonton symptom assessment system in patients with advanced cancer
G. Bedard 1, L. Zeng1, L. Zhang1, N. Lauzon1, L. Holden1, M. Tsao1, C. Danjoux1, E. Barnes1, A. Sahgal1, M. Poon1, E. Chow1
1Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: Longitudinal symptom monitoring is important in the advanced cancer patient setting. Scores over time may naturally fluctuate, though a patient may feel the same
Objectives: The purpose of this study was to determine the minimal levels of change required to be clinically relevant (the minimal clinically important difference; MCID) using the Edmonton Symptom Assessment System (ESAS)
Methods: Patients completed the ESAS prior to palliative radiotherapy and at follow-up. MCIDs were calculated using both anchor and distribution-based Methods for improvement and deterioration. Ninety-five percent confidence intervals (CI) for the differences in mean change scores between adjacent categories (i.e. ‘improved’ versus ‘no change’ and ‘no change’ versus ‘deteriorated’) were calculated.
Results: A total of 276 patients completed the ESAS at baseline and during at least one follow-up visit. MCIDs were seen at the 4 week follow-up: decreases of 1.2 units and 1.1 units in pain and depression scales, respectively, constituted clinically relevant improvement. Deterioration in the pain, tiredness, depression, anxiety, and appetite loss symptom scales showed meaningful change if increases of at least 1.4, 1.8, 1.1, 1.1 and 1.4 units were observed, respectively. Eight and twelve week follow-ups values were similar. The distribution-based method produced results that tended to be closest to the 0.5 SD estimates.
Conclusions: MCIDs can help to determine whether treatment is successful in maintaining and improving patient quality of life, and may be useful in determining whether changes in pain and other symptoms are clinically relevant. Future studies should confirm our findings with a variety of anchors.
MASCC-0036
Minimal important differences in the EORTC QLQ-C30 to determine meaningful change for patients with advanced cancer
G. Bedard 1, L. Zeng1, L. Zhang1, N. Lauzon1, L. Holden1, M. Tsao1, C. Danjoux1, E. Barnes1, A. Sahgal1, M. Poon1, E. Chow1
1Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: Quality of life (QOL) is an important consideration for patients with advanced cancer. The EORTC QLQ-C30 is a general QOL tool used in the cancer population. Often, with a large enough sample, statistical significance can be reached, however the clinical significance is often unknown.
Objectives: The purpose of this study was to determine the magnitude of change that is meaningful to patients in the EORTC QLQ-C30 for advanced cancer patients.
Methods: Patients completed the EORTC QLQ-C30 at baseline and 1 month later. Minimal important differences (MID) were calculated through anchor and distribution based Methods for improvement and deterioration. The two anchors of overall health and overall QOL were used to determine meaningful change.
Results: All functional scales and some symptom scales correlated at least moderately (r > 0.30) with both anchors. The overall health anchor produced a greater number of scales and symptoms that reached statistically significant meaningful change. Meaningful change for improvement with these two anchors ranged from 9.1 units (cognitive functioning) to 23.5 units (pain), and for deterioration ranged from 7.2 units (physical functioning) to 13.5 units (role functioning).
Conclusions: Knowledge of meaningful change on the EORTC QLQ-C30 allows physicians to assess patient change over time, along with evaluating the impact of treatment (or no treatment) on a patient’s quality of life. This knowledge gives insight into whether or not the treatment is effective and ultimately if it should be continued. Knowledge of MIDs may assist in sample size determination and interpretation for future trials.
MASCC-0037
Minimal important differences in the EORTC QLQ-C15-Pal to determine meaningful change in palliative advanced cancer patients
G. Bedard 1, L. Zeng1, L. Zhang1, N. Lauzon1, L. Holden1, M. Tsao1, C. Danjoux1, E. Barnes1, A. Sahgal1, M. Poon1, K. Hicks1, E. Chow1
1Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: Quality of life (QOL) is an important consideration for advanced cancer patients. Brief questionnaires are advantageous to reduce patient burden. In large clinical trials, statistical significance of small changes can be achieved; however whether such change is clinically relevant is unknown.
Objectives: The purpose of this study was to determine the minimal important differences (MID) of the EORTC QLQ-C15-Pal.
Methods: Patients undergoing palliative radiotherapy completed the EORTC QLQ-C15-Pal at baseline and 1 month later. Anchor and distribution-based assessments were employed to determine the MID associated with this instrument. The anchor of overall QOL (question 15) was used to determine meaningful change.
Results: Two hundred seventy-six patients were included in the calculation of MID. Mean age was 65 years and the majority of patients had primary lung, breast or prostate cancers. Statistically significant MID for improvement was seen in emotional functioning and pain (20.9 and 15.6 respectively). MID for deterioration required a change 20.4, 24.5, 17.1 and 23.0 in physical functioning, fatigue, pain, and appetite loss, respectively to constitute meaningful change. Distribution-based estimates of MID were closest to the SEM. MID for brain and bone metastases patients yielded MIDs larger than previously determined in the incorporation of all patients.
Conclusions: Meaningful change of the EORTC QLQ-C15-Pal is important for clinicians to determine the impact of treatment on QOL of patients and can also aid in determination of the sample size required for clinical trials. Future studies should investigate MID in subpopulations using symptom specific modules.
MASCC-0038
Supportive care during adjuvant interferon (IFN) alpha treatment in patients (PTS) with high-risk melanoma
A. Dimitrovska 1, S. Crvenkova1, L. Kostadinova2
1Sarcoma, Institute of Radiotherapy and Oncology, Skopje, Macedonia
2Melanoma, Institute of Radiotherapy and Oncology, Skopje, Macedonia
Introduction: The treatment with IFN is associated with side-effects and poor tolerance by pts.
Objectives: To determine IFN-induced toxicity in the adjuvant treatment of high-risk for recurrence melanoma pts.
Methods: Histories of 182 stage IIb-c and III melanoma pts were reviewed. One hundred twelve pts received intermediate dose IFN (IDI) after excisional biopsy: 9 MU/day/5 days per week for 4 weeks, followed by 48 weeks of the same dose, 3 times a week, s.c., and 70 pts received high-dose IFN (HDI): 20 MU/m2/5 days per week for 4 weeks followed by 10 MU/m2 s.c., 3 times a week, for 48 weeks maintenance therapy.
Results: The adverse effects were more prominent in the HDI group. Flu-like syndrome was the most common in the induction phase (72 % in the IDI and 82 % in the HDI group), while fatigue (53 % vs 68 %), weight loss (20 % vs 36 %), nausea (2 % vs 17 %)-in the maintenance phase. Of neuropsychiatric symptoms the most frequent were depression with apathy (18 %), insomnia (11 %), irritability (6 %). Pts were receiving concomitant supportive therapy: paracetampl before administration of IFN, increased fluid intake, antidepressants if necessary, antiemetics and were advised for proper nutrition. While hematological toxicity could be successfully managed by colono-stimulating factors and platelet transfusions, liver abnormalities seen in 57 % in the HDI group were the main reason for treatment discontinuation (31 %).
Conclusions: Successful management of adverse events of IFN alpha is very important in the adjuvant therapy of melanoma pts. Proper supportive care can ensure more pts to complete the planned therapy.
MASCC-0039
The effectiveness of a brief telephone based intervention to reduce fatigue in prostate cancer: a feasibility study
B. Langston 1, J. Armes1, L. Elliott2, J. James2, E. Ream1
1Florence Nightingale School of Nursing & Midwifery, King’s College London, London, United Kingdom, 2Services, Prostate Cancer UK, London, United Kingdom
Introduction: Cancer-related fatigue is a significant clinical symptom commonly experienced by men during and following treatment for prostate cancer. It is distressing, interferes with functioning, and is often under-acknowledged by healthcare professionals.
Objectives: To evaluate the effectiveness of a brief telephone-based intervention for fatigue delivered by Specialist Nurses at Prostate Cancer UK.
Methods: A randomised control trial design was adopted. Men experiencing fatigue during or following treatment for prostate cancer were eligible to participate and were randomly allocated between waiting list control group receiving usual care or the intervention. The intervention comprised psychological support, self-care education and goal setting for behaviour change. It was delivered using motivational interviewing via 4 telephone calls over 10 weeks. Outcomes were assessed at baseline and at trial completion using the BFI, FDS, HADS, NRS (fatigue management) and EORTC-QLQ-C30. Analysis consisted of Mann–Whitney Tests for between group comparisons.
Results: Seventy-six men were recruited. Fatigue in study groups was equivalent at baseline. Post-trial between group analysis showed the intervention group reported improved global fatigue (p = .005), fatigue severity (p = .001), fatigue management (coping with fatigue in daily life) (p = .031), social functioning (p = .028) and fatigue symptoms (p = .018).
Conclusions: The findings show the effectiveness of brief a telephone intervention at improving fatigue, fatigue management and social functioning. This represents a sustainable model of intervention delivery which is acceptable to men with prostate cancer and is effective in producing positive outcomes.
References: E Ream, A Richardson, C exander-Dann (2006) ‘Supportive intervention for fatigue in patients undergoing chemotherapy: A randomized controlled trial’ Journal of Pain and Symptom Management, 31 (2), pp. 148–161.
MASCC-0040
A polyphenol rich whole food supplement reduces PSA progression in men with prostate cancer in a double blind placebo controlled RCT—the UK national Pomi-T study
R. Thomas 1, M. Williams2, P. Bellamy3
1Oncology, Bedford and Addenbrooke’s Cambridge University Hospital trusts, Bedford, United Kingdom, 2Oncology and Lifestyle Research Unit, Bedford Hospital trusts, Bedford, United Kingdom, 3Statistics, Cranfield University, Bedford, United Kingdom
Introduction: Polyphenol rich foods, particularly pomegranate, green tea, broccoli and turmeric have demonstrated anti-neoplastic effects in laboratory models. Although, some have been investigated in small phase II studies this combination had never been evaluated within an adequately powered nationally certified RCT.
Objectives: Does a 2/day oral capsule containing a specific blend of pomegranate seed, green tea, broccoli and turmeric (Pomi-T) alter the rate of PSA progression compared to placebo?
Methods: Two hundred three men, average age 74 years, had localised prostate cancer, 59 % managed with active surveillance and 41 % with watchful waiting (progressive PSA relapse following previous radical interventions) received Pomi-T or placebo for 6 months.
Results: The median rise in PSA in the supplement group (SG) was 14.7 % (95 % CI 3.4–36.7 %) versus 78.5 % in the placebo group (PG) (95 % CI 48.1–115.5 %) (63.8 % difference, analysis of covariance, p = 0.0008). 46 % of men had stable or lower PSA at trial completion in the SG versus 14 % in the PG (32 % difference, chi2, p = 0.00001). 24 % men recorded events in the SG and 34 % in the PG (non significant). Mild gastro-intestinal effects were (17 %) in the SG but 8 % of these reported an improvement in stool quality.
Conclusions: This specific well tolerated food supplement (Pomi-T) statistically slowed PSA progression in these men managed with observation compared to placebo. Many men would see this as useful addition to their self help strategies. Future trials are planned addressing the longer term clinical benefits and its combination with hormone therapies.
MASCC-0041
Trends in the aggressiveness of end-of-life care for advanced stomach cancer patients
J. Hong 1, Y.S. Hong1, S.Y. Rho1
1Division of Medical Oncology Department of Internal Medicine, College of Medicine The Catholic University of Korea, Seoul, Korea
Introduction: It is important to balance the appropriateness of active cancer treatments and end-of-life care to improve the quality of life for terminally ill cancer patients.
Objectives: This study was performed to describe the treatment pattern and end-of-life care in terminal gastric cancer patients.
Methods: We retrospectively analyzed the records of 137 patients with advanced gastric cancer receiving chemotherapy and dying between June 1, 2006 and May 31, 2011. We recorded: 1) interval between last chemotherapy dose and death; 2) frequency of emergency room visits or admission to the intensive care unit in the last month before death; 3) rate of hospice referral and agreement with written do-not-resuscitate orders; and 4) change in laboratory values in the last 3 months before death.
Results: During the last 6 months of life, 130 (94.9 %) patients received palliative chemotherapy; 86 (62.7 %) during the final 2 months; 41 (29.9 %) during the final month. During the final month, 53 (38.7 %) patients visited an ER more than once; 21 (15.3 %) were admitted to the ICU. Hospice referral occurred in 54 % (74) of the patients; 93.4 % (128 patients) gave written do-not-resuscitate orders. Platelets, aspartate aminotransferase and creatinine changed significantly 2 weeks before death; total bilirubin, 1 month before; and C-reactive protein, between 1 month and 2 weeks before death.
Conclusions: Significant proportions of gastric cancer patients still received palliative chemotherapy to the end of life. Large prospective studies are needed to validate these results and provide guidelines for discontinuing chemotherapy in terminal gastric cancer patients.
MASCC-0042
Grape seed procyanidin fractions enhance the impact of 5-fluorouracil chemotherapy on colon cancer cells
K.Y. Cheah 1, G.S. Howarth2, K.A. Bindon3, J.A. Kennedy4, S.E.P. Bastian1
1School of Agriculture Food and Wine, The University of Adelaide, Adelaide, Australia, 2School of Animal and Veterinary Sciences, The University of Adelaide, Adelaide, Australia, 3The Australian Wine Research Institute, The Australian Wine Research Institute, Adelaide, Australia, 4Department of Viticulture and Enology, California State University, Fresno, USA
Introduction: Grape seed procyanidins (PCs) have been reported to reduce intestinal injury in rat models of intestinal mucositis and ulcerative colitis.
Objectives: We investigated the effects of purified PC fractions differing in mean degree of polymerization (mDP) combined with 5-Fluorouracil (5-FU) chemotherapy, on the viability of Caco-2 colon cancer cells
Methods: Six PC fractions were isolated from Cabernet Sauvignon seeds at two ripeness stages: pre-veraison unripe (immature) and ripe (mature). Fractions were characterized by phloroglucinolysis and gel permeation chromatography (GPC). Fractions were tested on Caco-2 cells, alone and in combination with 5-FU. Cell viability was determined by 3-(4,5-Dimethylthiazol-2yl)-2,5-diphenyl-tetrazolium bromide) (MTT) assay. p < 0.05 was considered significant
Results: All isolated fractions significantly reduced Caco-2 cell viability compared to control (p < 0.05), but F2 and F3 were the most active fractions (immature F2 = 32 %, F3 = 35 % and mature F2 = 13 % and F3 = 17 %; percentage of viable cells remaining) on Caco-2 cells. When combined with 5-FU, immature seed fractions F1-F3 and mature seed fractions F1-F4 enhanced the growth-inhibitory effects of 5-FU by 27–73 % and 60–83 % (p < 0.05; compared to 5-FU control), respectively. Moreover, some fractions alone were more potent at decreasing viability of Caco-2 cells (p < 0.05; immature = 65–68 %; mature = 83–87 %) compared to 5-FU alone (37 %)
Conclusions: PCs of mDP 2–6 (immature F1-F3 and mature F1 and F4) exhibited synergistic effects on viability of Caco-2 cells when tested in combination with 5-FU. Concomitant use of grape seed PCs and 5-FU chemotherapy could represent a promising new approach for colon cancer chemoprevention.
MASCC-0043
Emu oil expedites small intestinal repair following 5-fluorouracil-induced mucositis in rats
S.M. Abimosleh 1, C.D. Tran1, G.S. Howarth2
1Women’s and Children’s Hospital North Adelaide, Department of Gastroenterology, Adelaide, Australia, 2School of Animal and Veterinary Sciences, The University of Adelaide, Adelaide, Australia
Introduction: Mucositis resulting from cancer chemotherapy is characterized by intestinal inflammation and ulceration. Previously, Emu Oil (EO) improved intestinal architecture in a rat model of chemotherapy-induced mucositis.
Objectives: We investigated EO for its further potential to promote intestinal repair in this mucositis model.
Methods: Female Dark Agouti rats (n = 8/group) were gavaged with water, Olive Oil (OO) or EO once daily (1 ml), injected with 5-Fluorouracil (5-FU) or saline, on day 5 and euthanized on day 8, 9, 10 or 11. Intestinal villus height (VH) and crypt depth (CD), neutral mucin-secreting goblet cell [GC] count, myeloperoxidase (MPO) activity and selected cytokines were quantified. p < 0.05 was considered significant.
Results: In 5-FU-injected rats, only EO administration increased VH in the ileum (day 8), jejunum and JI (days 8 and 9) compared to 5-FU controls (p < 0.05). GC count was reduced by 5-FU (jejunum: days 8 and 9; ileum: day 8; p < 0.05) and EO increased ileal GC on days 10 and 11 compared to 5-FU controls. MPO activity was increased in jejunum (days 8 and 9) and ileum (day 8) following 5-FU injection, compared to normal controls (p < 0.05). Both EO and OO reduced jejunal MPO on days 8 and 9, however, only EO decreased ileal MPO on day 8. Cytokine levels were not significantly affected by either oil or 5-FU administration at the day 8 time point.
Conclusions: Promotion of repair from injury could represent a new mechanism of action for Emu Oil, suggesting potential as an adjunct to conventional treatment approaches for cancer management.
MASCC-0044
Comparative effects of mistletoe extracts and 5-fluorouracil chemotherapy on viability of Caco-2 and IEC-6 intestinal epithelial cells
Z. Lotfollahi 1, G.S. Howarth2, L. Simson3, K.Y. Cheah4, S.E.P. Bastian4
1School of Medical Sciences, The University of Adelaide, Adelaide, Australia, 2School of Animal and Veterinary Sciences, The University of Adelaide, Adelaide, Australia, 3Faculty of Applied Sciences, University of Canberra, Canberra, Australia, 4School of Agriculture Food and Wine, The University of Adelaide, Adelaide, Australia
Introduction: Mistletoe Extract (ME) (Viscum album) is predominantly composed of lectins and viscotoxins with purported claims of toxicity to tumour cells. 5-Fluorouracil (5-FU) chemotherapy for cancer treatment is often accompanied by severe intestinal injury (mucositis).
Objectives: MEs from different host trees (Quercus: Oak, Fraxini: Ash and Mali: Apple) in the presence or absence of 5-FU chemotherapy, were examined for their effects on viability of colon cancer and normal intestinal cells in vitro.
Methods: MTT assay was used to determine Caco-2 (colonic cancer) and IEC-6 (non-transformed) cell viability after 48 h incubation with MEs (1–100 μg/mL) or MEs (1–100 μg/mL) combined with 5-FU (100 μM for Caco-2 and 5 μM for IEC-6). Statistical significance was assumed at p < 0.05.
Results: Fraxini; with highest levels of lectin and viscotoxin, was the most potent ME followed by Quercus and Mali with IC50 values of 42.7, 65.5 and 84.4 μg/mL, respectively, on Caco-2 cells. Fraxini (50 μg/mL) when combined with 5-FU (5 μM), significantly increased the toxicity of 5-FU on IEC-6 cells compared to Fraxini (50 μg/mL) alone (p < 0.05). None of the MEs, when combined with 5-FU, significantly increased 5-FU toxicity on Caco-2 cells compared to ME alone. Quercus and Mali did not alter the degree of 5-FU toxicity on IEC-6 cells, compared to the same concentrations of Quercus and Fraxini alone.
Conclusions: Future studies could investigate ME effects in vivo models of colon cancer to determine whether ME (particularly Quercus) inhibits the development of colonic neoplasia without exacerbating the undesirable impact of 5-FU on the normal healthy intestine.
MASCC-0045
In-depth bioinformatic analysis of lung cancer-related microRNA targets
D. Li 1, H. Yang1, R. Zhang1, H. Zhang1, L. Zhu2
1School of Life Sciences, Nanjing University, Nanjing, China, 2Institute of Discovery Biology, Jiangsu Simcere Pharmaceutical R&D Co. Ltd, Nanjing, China
Introduction: Lung cancer (LC) is the leading cause of cancer deaths worldwide, yet few studies of its specific mechanisms useful for diagnosis or treatment exist. MicroRNAs (miRNAs) present one mechanism by which genes with diverse functions on multiple pathways can be simultaneously regulated on the post-transcriptional level, and they are closely integrated with lung cancer [1,2].
Objectives: Lung cancer related pathways through which lung cancer associated miRNAs (LC-miRNAs) regulate these processes were investigated.
Methods: Gene targets of miRNAs were predicted using TargetScan. The web-based functional annotation tool DAVID was applied for disease analysis, gene ontology analysis and pathway analysis. The signaling pathways and processes were explored using the systems biology tool KEGG Mapper.
Results: The results showed that LC-miRNAs might function in the post-transcriptional level mainly through manipulating the expression of transcription factors and protein kinases, and target genes for the LC-miRNAs were most prominently predicted to function in regulation of transcription. Our analysis also highlighted the potential of these LC-miRNAs to regulate the cell differentiation, proliferation, endocytosis and migration signaling logically required to cause a lung cancer cell mainly through five canonical pathways (PI3K-Akt signaling pathway, Pathways in cancer, MAPK signaling pathway, HTLV-I infection, Focal adhesion).
Conclusions: This study may improve the understanding the regulatory role of miRNAs in lung cancer. These findings should form a useful knowledge base for potential future development of novel therapeutic treatments.
References:
1.International Journal Oncology. 2012, 41(6):2213–26.
2.International Journal Oncology. 2012, 40(6):1763–9.
MASCC-0046
Jordanian nurses’ views on adequacy of cancer pain management: a qualitative study
M. Al Qadire 1
1Faculty of Nursing, Al Albyat University, Mafraq, Jordan
Introduction: Cancer patients currently live longer than previously because of earlier diagnosis and developments in treatment medications and techniques. Although guidelines and pharmacological interventions exist to manage cancer pain, poor assessment and under-medication is well-documented. Cancer pain is a cultural-sensitive phenomenon and many barriers may hinder patients from receiving adequate pain management. No previous study explored barriers to optimal cancer pain management within the Islamic-Arabic culture communities such as Jordan.
Objectives: This study aims to exploring nurses’ views on the factors contributing to the inadequacy of pain management in Jordan.
Methods: Qualitative research method and semi-structured interviews were used to interview 20 oncology nurses who working in two referral hospitals in Jordan
Results: Nurses’ mean age was 29 years (SD 1.9) and 12 were males. They had on average 4.8 (SD 2.0) years of working experience. Thematic analysis of nurses’ interviews identified many factors that may result in ineffective cancer pain management, including the following: belief in God’s Will, doctor verses nurse tension, institutional characteristics (e.g. difficult access to pain medication, low priority to cancer pain management, absence of pain policy, healthcare providers characteristics (e.g. negative attitudes toward cancer pain, lack of knowledge and training), fear of addiction and misconceptions complex, and devaluing patients pain report.
Conclusions: Barriers to cancer pain management and misconceptions were abundant. These barriers, in general, were similar to barriers within the other cultures with some of them are related to country culture. Education, training, more financial resources, and public awareness might be possible interventions to reduce patients suffering.
MASCC-0047
Efficacy and safety of a two drug-combination regimen for cancer-related cachexia in the clinical practice
G. Mantovani 1, C. Madeddu1, L. Orgiano1, G. Antoni1, R. Serpe1, I. Omoto2, M.C. Cau1, A. Maccio’1
1Department of Internal Medical Sciences Medical Oncology, University of Cagliari, Cagliari, Italy, 2Department of Surgery, Tanoue Hospital, Kagoshima, Japan
Introduction: To test the safety and efficacy of a combination treatment (including nutraceuticals) with carnitine + celecoxib for cancer-related anorexia/cachexia syndrome (CACS) in the clinical practice.
Objectives: Primary: safety, increase of lean body mass (LBM) and improvement of quality of life.CACS) in the clinical practice. Secondary: increase of physical performance (grip strength and 6-min walk test, 6MWT) and decrease of inflammation (serum levels of IL-6 and Glasgow prognostic score, GPS)
Methods: Outpatients with CACS (i.e. loss of body weight >5 % of the pre-illness or ideal weight in the previous 3 months) were eligible. Treatment: L-carnitine 4 g/day + Celecoxib 300 mg/day. Basic treatment polyphenols 300 mg/day, lipoic acid 300 mg/day, carbocysteine 2.7 g/day, Vitamin E, A, C, all orally. Treatment duration 4 months.
Results: From 06/2011 to 04/2012, 75 patients all stage IV were enrolled: 40 completed the treatment and were evaluable (mean age 65 ± 9.6, range 32–82 years)
Results showed a significant increase of LBM (dual-energy X-ray absorptiometry and L3 computed tomography) from baseline as well as physical performance by 6MWT. Quality of life (EORTC-QLQ-C30) as well as fatigue (MFSI-SF) also improved significantly. ECOG PS and GPS decreased significantly. The treatment was safe, no grade 3–4 toxicities occurred and no patient had to discontinue the treatment due to severe adverse events.
Conclusions: Results of the present study confirm the efficacy and safety of the two-drug combination regimen1. Therefore, this simple, feasible, effective, safe, with favorable cost-benefit profile, two-drug approach could be suggested in the clinical practice as a treatment for CACS.
References: 1. Madeddu et al, Clinical Nutrition 31:176–182,2012
MASCC-0048
Are there benefits of palliative care services at home than hospice for critically ill HIV/aids patients?
K. stella1, R. Stella 2
1Palliative section-nursing, Meru palliative care unit, Meru, Kenya, 2School of Nursing, Kenya Medical Training College, Nairobi, Kenya
Introduction: Home palliative care service is becoming the choice of many patients with life limiting illness in Kenya especially in rural areas where clinics/hospitals are far away.
The care under the relative is more preferred by patients but lack professional palliative care to manage symptoms like pain.
Objectives: To assess the benefit of palliative care service at home visas hospice. The survey was done at Ongata –Ngong area about 40 km from capital city.
Methods: Six care givers and 10 patients with HIV/AIDS were invited to participate, the survey purpose was explained to the patients and caregivers.
Results: Seventy-five percent patients preferred home care with specialised palliative care 25 % hospice. 60 % referred for Hospice pain management but declined due to long distance and expenses involved, 35 % bought pain killer locally, 40 % received palliative care at the Hospice, 25 % traditional medicine 80 % had several symptoms requiring a specialist. 90 % referred the care with a specialist palliative care as a special care and human, 10 % preferred a health worker from different area. 40 % of caregiver referred home care as burden, 60 % fulfilling. They all thought they could share their problems better at home than at the Hospice.
Conclusions: There is need for incorporating home based care and palliative care for better symptom approach and involvement of other health providers, private clinics and the community at large. Training of local area health providers on palliative care hence ensuring all who need the service receives with less strain.
References: HIV/AIDS, Cancer, life limiting illness, community based, training and palliative care.
MASCC-0049
Aquafitness rehabilitation for patients with tracheostomy
J. Büntzel 1, A. Besser1
1Otolaryngology, Südharz Klinikum, Nordhausen, Germany
Introduction: Swimming and aquafitness are normally prohibited for each patient suffering from tracheostomy. The individual physical rehabilitation program is limited.
Objectives: We have introduced a combined system of tracheostomy tube and snorkel in our rehabilitation system after laryngectomy/tracheostomy in order to open aquafitness courses for these patients too.
Methods: Between 10–2011 and 1–2013 we have included 12 patients to our pilot program. We used a commercial available snorkelling system (“Lorchel”, Heimomed Frechen, Germany). 10/12 patients had got a laryngectomy, and further two patients had had a tracheostomy and partial laryngectomy because of their cancer. The aquafitness program was introduced by a specialized instructor, and the swim training was supervised by professional trainers. The launching process included 10 weekly sessions about 90 min.
Results: 10/12 patients were satisfied in using the new combined system. Two patients rejected the system after first session. All 10 positive patients were able to perform the aquafitnes program. 8/10 patients were able to swim in deep water. 2/12 patients have already used the snorkelling system during their individual holidays. We have not seen any complication of the used technique. The supervising system seems to be necessary in order to ensure the correct usage of the snorkel by the patients.
Conclusions: The usage of snorkelling systems offers new possibilities in the physical are habilitation for individuals with tracheostomy. Aquafitness as well as swimming should be included to avoid muscular late side effects due to surgery and radiotherapy of the treated body region.
MASCC-0050
Young women in Kenya are on a rough journey with breast and cervical cancers causing emotional and fears among the community
R. Stella 1, K. Gloria2, W. Miriam3
1School of Nursing, Kenya Medical Training College, Nairobi, Kenya, 2Research, University of Manitoba, Nairobi, Kenya, 3School of Nursing, KMTC, Nairobi, Kenya
Introduction: The word breast or cervical cancer is becoming common in most families in Kenya, in almost 40 % household there is a young patient diagnosed or on treatment. Young children are more affected being left without mothers.
Objectives: To find out the average age of patients admitted with breast/cervical cancer at the Hospice due to high number of orphan children.
Methods: The survey was conducted at Nairobi Hospice between March 2010–August 2010, which serves an average of 600 patients a year with 6 medical staffs and volunteers.
Results: There were 106 patients with breast cancer and 142 patients with cervical cancer a total of 248 admissions. Forty-three percent were diagnosed with breast cancer and 57 % with cervical cancer. Forty-nine percent breast cancers, 63 % cervical cancer below 50 years of age. Fifty-five percent diagnosed in late stage, 40.5 % HIV+. Forty-five percent referred for palliative care without surgery, chemotherapy or radiation, 55 % had some form of curative treatment, 20 % had recurrent and 15 % had not given birth. 65 % were from rural homes while 35 % urban towns. Forty-five percent not disclosed to children, 60 % received support from partners, 35 % abandoned by partners, 70 % had financial constrain hence stopping treatment midway.
Conclusions: There is need for health promotion programs to reduce the incidence and mortality of the two most common cancers among women. Ministry of Health and other stake holders need to avail more school and community health education. Good mechanism is needed in counseling the affected especially children and early screening of young ladies.
References: Breast cancer, cervical cervical, children, support
MASCC-0051
Does deaf community receive equal palliative care services as others? Challenges of health care providers offering the service
R. Stella 1, K. Faith2, K. Gloria3, W. stella4
1School of Nursing, Kenya Medical Training College, Nairobi, Kenya, 2Nursing, Ministry of Medical Services, Nairobi, Kenya, 3Research, University of Manitoba, Nairobi, Kenya, 4Palliative, Cancer Care Kenya, Nairobi, Kenya
Introduction: Deaf community can’t hear either speak, In Kenya they are isolated members of our society who suffers in silence when sick due to few signing health workers in our hospitals, and hence a Deaf has to bring in a relative/friend to interpret for them.
Objectives: Find out the challenges experienced by palliative care provider and the patients during care/management.
Methods: A survey was carried out at 6 hospices in Kenya in different counties, 10 palliative care providers and 5 deaf patients with life limiting illness. The survey purposes were explained and consent obtained.
Results: None of the palliative care providers trained in signing language. Only 45 nurses in the whole country trained on Kenya sign language, No record of palliative care awareness, 90 % of the patients brought in a relative to interpret, 60 % cannot read, 90 % feels they are not understood by health providers, 80 % feels their pain not well managed, 60 % their relationship with providers a challenge, 80 % feels below deal than others patients, 100 % wished for communication directly, 60 % felt went with untreated symptoms, 40 % felt health providers avoided them, 50 % health providers disinterested in learning, 60 % willing, 80 % communication a challenge and 40 % basic sign language.
Conclusions: There is a need for sign language training in ensuring quality palliative care delivery to all. Importance of on job training by already trained nurses and workshops on palliative care to the deaf community. Ministry of health fully participation and filling gaps in palliative care services.
References: Palliative, deaf, communication, nurses
MASCC-0052
Fatigue among (long-term) thyroid cancer survivors: results from the population-based profiles registry
O. Husson 1, W.A. Nieuwlaat2, W.A. Oranje3, H.R. Haak4, L.V. van de Poll-Franse1, F. Mols1
1Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands, 2Internal Medicine, Elisabeth Hospital, Tilburg, Netherlands, 3Internal Medicine, Tweesteden Hospital, Tilburg, Netherlands, 4Internal Medicine, Maxima Medical Centre, Eindhoven, Netherlands
Introduction: Fatigue is a common problem among different groups of cancer survivors. Research focusing on the levels of fatigue among thyroid cancer (TC) survivors is lacking.
Objectives: The aims of this study were 1) to obtain insight into the prevalence of fatigue among short-term and long-term TC survivors, by comparing a sample of TC survivors with an age- and sex-matched normative population; 2) to investigate which demographic, clinical, and thyroid cancer specific characteristics were associated with fatigue.
Methods: All patients diagnosed with TC between 1990 and 2008, as registered in the Eindhoven Cancer Registry, received a cross-sectional survey on fatigue (FAS) and disease-specific symptoms (THYCA-QoL). The fatigue scores were compared with those of an age- and sex-matched normative population (n = 530). Multiple linear regression analyses were conducted to investigate the independent associations between clinical and demographic variables and (TC specific) HRQoL.
Results: Eighty-six percent (n = 306) responded. TC survivors were more often classified as fatigued or very fatigued (short-term <5 years: 43 %; long-term 5–10 years: 44 %; long-term 10–15 years: 47 %; long-term >15 years: 39 %) compared to the normative population (25 %; p < 0.001). Anxiety (OR: 1.15, 95 % CI: 1.03–1.28) and depression in general (OR: 1.43, 95 % CI: 1.22–1.68) were associated with fatigue, as was also the case for TC specific neuromuscular (OR: 1.03, 95 %CI: 1.01–1.06), concentration (OR: 1.03, 95 %CI: 1.01–1.06) and psychological problems (OR: 1.06, 95 %CI: 1.02–1.10).
Conclusions: Short-term and long-term TC survivors report higher levels of fatigue compared to an age- and sex-matched normative population. Both TC specific and mental health problems were strongly associated with fatigue.
MASCC-0053
Satisfaction with information is associated with baseline and follow-up quality of life among lymphoma and multiple myeloma survivors: results from the profiles registry
O. Husson 1, S. Oerlemans1, F. Mols1, R.E.H. Smeets2, P. Poortmans3, L.V. van de Poll-Franse4
1Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands, 2Internal Medicine, St. Anna Hospital, Geldrop, Netherlands, 3Radiation Oncology, Verbeeten Institute, Tilburg, Netherlands, 4Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
Introduction: Providing information that is congruent with patients’ needs is an important determinant for patient satisfaction.
Objectives: The aim was to insight into the relationship between information provision and HRQoL, anxiety and depression levels among lymphoma and Multiple Myeloma (MM) survivors.
Methods: All patients diagnosed with lymphoma or MM between 1999 and 2009, registered in the Eindhoven Cancer Registry, received a questionnaire including the EORTC QLQ-INFO25, EORTC QLQ-C30 and HADS on two time points. Paired sample t-tests were used to assess changes over time and multivariate linear regression analyses were used to determine independent associations of information provision with HRQoL, levels of anxiety and depression.
Results: The perceived receipt of information about medical tests, treatment and helpfulness of the received information were significantly higher at baseline compared to 2-year follow-up. The perceived level of information about the disease and other services and the HRQoL and levels of anxiety and depression did not change over time.
Higher satisfaction with the received information at T1 was associated with better physical, role, emotional and social functioning and global quality of life at T2 (ß ranging from 0.15 to 0.25; all p < 0.05). After correction for baseline functioning levels, this relationships remained only significant for role functioning (ß = 0.17, p < 0.05) and global quality of life (ß = 0.14, p < 0.05). Survivors who were satisfied at both time points (56 %) reported highest levels of mental HRQoL.
Conclusions: Satisfaction with the received information is associated with better HRQoL and lower levels of anxiety and depression. Future studies should explore strategies to optimize patient satisfaction with received information.
MASCC-0054
Mortality among cancer free survivors 3 to 7 years after treatment for early stage head and neck cancer (HNC): comparison with the general population
F. Meyer 1, S. Turcotte1, I. Bairati1
1Clinical Epidemiology, Cancer Research Center, Quebec City, Canada
Introduction: Guidelines for follow-up for HNC patients recommend fewer visits after 3 years. Overall survival is considerably better among long term cancer free survivors than among those living with cancer. Yet, there is no evidence that long term cancer free survivors have a mortality rate similar to that in the general population.
Objectives: We compared the mortality rate of HNC patients free of cancer, 3 to 7 years after therapy ended, to that in the general population.
Methods: Patients (n = 540) with early stage HNC treated with radiation therapy (RT) were recruited in all regions of the province of Quebec to participate in a randomized trial (1994–2000). We formed five cohorts with all cancer free survivors (without HNC relapse or second primary cancer) respectively three (n = 350), four (n = 279), five (n = 199), six (n = 125) and seven (n = 49) years after RT ended. Patients’ follow-up was partitioned according to age, sex and calendar year. Age and sex specific mortality rates in the Quebec population were obtained for each calendar year (1994–2009). Standardized mortality ratios (SMR) were used to compare survivors’ mortality rate to that in the general population.
Results: The SMR were 1.68, 1.65, 1.80, 1.41 and 1.86 for cancer free survivors respectively at 3, 4, 5, 6 and 7 years. The mortality rate among cancer free survivors was always higher (p < 0.05) than in the general population.
Conclusions: Despite the excellent outcome of their early stage HNC, long term cancer free survivors have a higher mortality rate than the general population presumably because of smoking and socioeconomic conditions.
MASCC-0055
Quality of life as survival predictor among survivors, cancer free or not, 3 years after radiation therapy for early stage head and neck cancer (HNC)
I. Bairati 1, F. Meyer1
1Clinical Epidemiology, Cancer Research Center, Quebec City, Canada
Introduction: Health-related quality of life (HRQOL) at the time of cancer diagnosis is a predictor of overall survival (OS). The prognostic significance of HRQOL assessed at later times is less documented.
Objectives: We assessed whether HRQOL 3 years after initial therapy was associated with OS among cancer free survivors and among those living with cancer (after relapse or second primary cancer).
Methods: In a randomized trial conducted among 540 patients treated with radiation therapy (RT) for early stage HNC, we assessed HRQOL with the EORTC QLQ-C30 3 years after RT ended. Multivariate Cox regression was used to assess, separately for cancer free survivors and for survivors living with cancer, whether HRQOL was an independent predictor of OS.
Results: Among the 340 cancer free survivors with HRQOL data, 126 deaths were observed in the follow-up (median 8.1 years). After controlling for age, nine of the 15 HRQOL variables were associated with OS (p < 0.05). When all variables were considered, age, sex, smoking, comorbidity, physical functioning (hazard ratio (HR) for a 10 point increment: 0.85) and appetite loss (HR: 1.10) were independent OS predictors (p < 0.05). Among the 76 survivors living with cancer, 39 deaths were observed in the follow-up (median 7.2 years). After controlling for age, 12 of the 15 HRQOL variables were associated with OS (p < 0.05). When all variables were considered, age, appetite loss (HR: 1.28) and pain (HR: 1.21) were independent OS predictors (p < 0.05).
Conclusions: HRQOL after initial therapy remains a survival predictor both for cancer free survivors and for survivors living with cancer.
MASCC-0056
Hospital at home in patients with febrile neutropenia
J. Aibar 1, M. Selvi2, N. Seijas1, C. Font2, B. Ibáñez1, S. Valls1, L. Llop1, M. Roman1, M.C. Grané1, C. Hernández1
1Integrated Care Unit. Medical and Nursing Direction, Hospital Clinic de Barcelona, Barcelona, Spain, 2Department of oncology, Hospital Clinic de Barcelona, Barcelona, Spain
Introduction: Patients with febrile neutropenia traditionally require in-hospital treatment because of the risk of serious complications and associated mortality. In a subgroup of these patients who are considered ‘low risk’, however, treatment in the outpatient setting may be considered. One of such alternatives to hospital admission is the hospital-at-home program (HaH).
Objectives: To evaluate the efficacy and safety of HaH program in patients with febrile neutropenia.
Methods: Sixty cases of patients with febrile neutropenia included in our HaH program were revised.
Results: Twenty patients had lung cancer, 22 had breast cancer, 9 had cancer of the urogenital aparatus, 3 had lymphoma and 6 had others. At admission median C-reactive protein (CRP) level was 6.5 mg/dl and mean absolute neutrophil count (ANC) was 581.3 cells/μL; at discharge these values were 2.7 mg/dl and 5011,9 cells/μL respectively. 91.7 % of the patients received intravenous antibiotic. Microbiological evidence of infection was found in 11 cases. Median length of HaH stay was 6 days. Fourteen patients had to consult again at the ED and/or needed hospitalization within 30 days after HaH discharge, one of whom died during hospital stay. By logistic regression analysis we found that a higher CRP level at HaH admission is a factor independently associated to this clinical course.
Conclusions: Hospital-at-home is a good alternative to hospitalizatión in the management of patients with low-risk febrile neutropenia.
References: Beguin Y, Benoit Y, Crokaert F, et al. Outpatient and home parenteral antibiotic therapy (OHPAT) in low-risk febrile neutropenia: consensus statement of a Belgian panel. Acta Clin Belg 2002;57(6):309–16
MASCC-0057
The association between hypogonadism, symptom burden, and survival in male patients with advanced cancer
R. Dev 1, D. Hui1, E. Del Fabbro2, M.O. Delgado-Guay1, L.E. Pimentel1, E. Bruera1
1Supportive Care and Palliative Medicine, University of Texas MD Anderson Cancer Center, Houston, USA, 2Palliative Medicine, Virginia Commonwealth University, Richmond, USA
Introduction: Our group has previously reported the high frequency of hypogonadism in advanced cancer patients compared to the general population. Low testosterone is associated with opioid use and cachexia.
Objectives: To evaluate the association between the hypogonadism, symptom burden, and survival in advanced cancer patients.
Methods: 119/131 (91 %) consecutive male cancer patients had an endocrine evaluation (total/free testosterone, c-reactive protein, thyroid stimulating hormone, and morning cortisol level) when presenting with symptoms of fatigue or anorexia-cachexia. Symptoms were evaluated by the Edmonton Symptom Assessment Scale. We examined the correlation with Spearman test and survival with log rank test and Cox-regression analysis.
Results: The median age was 64; majority were white 85 (71 %). Median total testosterone was 209 ng/dL (normal ≥240 ng/dL) and free testosterone 4 ng/dL (normal ≥9 ng/dL). Decreased total testosterone was associated with elevated CRP (r = 0.40; p < 0.001), increase white blood cell count (r = 0.20; p = 0.03), worse Eastern Cooperative Oncology Group (ECOG) performance status (r = 0.20; p = 0.03), >5 % weight loss (r = 0.27; p = 0.003), and opioid use (r = 0.36; p < 0.001). Low total and free testosterone were significantly associated with worse fatigue (p ≤ 0.02), increased anxiety (p ≤ 0.04), decreased feeling of well-being (p ≤ 0.04), and increased dyspnea (p ≤ 0.05). On multivariate analysis, decreased survival was associated with low total testosterone (HR 1.7; p = 0.03), worsening ECOG status (HR 1.6; p < 0.01), high c-reactive protein (HR 3.3; p < 0.001), and decreased albumin (HR 2.6; p < 0.001)
Conclusions: Systemic inflammation, weight loss, and opioid use were associated with decreased testosterone in cancer patients. Low testosterone is associated with a symptom burden and may have prognostic value independent of c-reactive protein, albumin, and performance status.
MASCC-0058
The status and importance of communication in physiotherapy – do physiotherapists need skills in professional communication?
U. Muench 1
1Klinik für Allgemein- und Viszeralchirurgie Darmzentrum Westend, DRK Kliniken Berlin | Westend, Berlin, Germany
Introduction: Patients have significantly less inhibitions towards physiotherapists compared to physicians and/or psycho-oncologists in terms of telling them about experiences, questions, fears and troubles in their everyday language. In addition, physiotherapists are regularly faced with the challenge of having to motivate fatigued cancer patients to do exercises to reduce their symptoms of weakness.
Objectives: As part of a ‘Sport for cancer patients’ curriculum organized by the ‘Cancer and Sports’ team from the Tumor Center Berlin eV module on ‘Communication with cancer patients’ was developed and carried out first time 2011, repeated 2012 at a level of 15 h. 2011 the module was planned with a length of 1 h. Feedback from the evaluation showed a strong desire to gain more knowledge about communication and psychosocial oncology. In 2012, the module planned with 2 h time.
Methods: The evaluation itself contained five questions/statements concerning the module itself and importance of communication skills.
Two measurement points were planned. First point immediately after taking part at the module itself, the second one two months later by mail.
Results: Participation: about 50 %.
Feedback showed a very strong need to gain knowledge about communication and communication skills, and deepen this, also more and better knowledge about self-care and keeping up mental health.
Conclusions: This small sample shows a need for training in communication from the perspective of physiotherapists. It may require a study to review the evaluation results scientifically.
References: Hermann, A., Rosenbaum, M., Hoppe, S., Hohenberger, P. (2002), Physiotherapeutische und psychoonkologische Betreuung von Patienten mit Sarkomen, Der Onkologe 4/2002, 366–377
MASCC-0059
An eccentrically-biased qigong intervention in prostate cancer survivors: effects on fatigue and psychological distress
A.Y. Kinney 1, R.A. Campo2, L.M. Pappas2, K.J. O’Connor2, P.C. LaStayo3, S.M. Smith2, K.M. Boucher4, K.C. Light5, N. Agarwal6
1Department of Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, USA, 2Huntsman Cancer Institute, University of Utah, Salt Lake City, USA, 3Physical Therapy, University of Utah, Salt Lake City, USA, 4Oncologic Sciences, University of Utah, Salt Lake City, USA, 5Department of Anesthesiology, University of Utah, Salt Lake City, USA, 6Department of Medicine, University of Utah, Salt Lake City, USA
Introduction: Fatigue is one of the most commonly reported and least understood cancer-related symptoms among prostate cancer survivors. It has been associated with psychological distress and a sedentary lifestyle.
Objectives: To determine the feasibility and preliminary efficacy of an eccentrically-biased Qigong intervention in fatigued prostate cancer survivors.
Methods: We conducted a single-blind, randomized feasibility trial of an eccentrically-biased Qigong intervention as compared with a control intervention consisting of non-aerobic stretching among 41 men (mean age = 72.8, sd = 9.4). Sessions lasted 60 min each and took place twice a week for 12 weeks for each of the study groups. The primary end point was a change in the FACIT-Fatigue. The secondary endpoints included changes in BSI-18 global severity index and subscale scores at the end of 12 weeks. The study groups were compared on their changes (post-baseline) with Wilcoxon tests. The analysis includes 29 men who completed the post-intervention measures.
Results: The study groups did not differ significantly with regard to baseline FACIT-Fatigue and the BSI-18 scores. Men in the Qigong condition, compared with the stretching condition, demonstrated clinically and statistically significant improvements in FACIT fatigue (p = 0.016), global severity index (p = 0.002), somatization (p = 0.048) and anxiety (p = 0.003) scores. 69 % of the qigong group had improved depression scores, but there was not a significant difference in change between groups (0.092). No adverse events were observed.
Conclusions: Qigong that is eccentrically biased may be a useful treatment for fatigued prostate cancer survivors and merits implementation of a larger definitive trial.
MASCC-0060
Multiple beneficial effects of statins and Rac1-inhibitors on cardio- and hepatotoxicity induced by the anthracycline derivative doxorubicin
G. Fritz 1, C. Henninger1, A. Schorr1, A. Bopp1, F. Wartlick1, J. Huelsenbeck2, S. Huelsenbeck2, B. Kaina2
1Toxicology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany, 2Toxicology, Johannes Gutenberg University, Mainz, Germany
Introduction: The lipid lowering drug lovastatin (Lova) exhibits pleiotropic effects, which mainly rest on the inhibition of Ras-homologous (Rho) GTPases. Pharmacological inhibition of Rho GTPases potentiates the antitumor efficacy of various anticancer drugs. The influence of statins on normal tissue damage provoked by anticancer drugs is hitherto only poorly investigated.
Objectives: We aim to elucidate the consequences of pharmacological inhibition of Rac1 signaling on stress responses and cell death of non-malignant cells treated with the anthracycline derivative doxorubicin (Doxo).
Methods: Human endothelial cells (HUVEC) and rat cardiomyoblasts (H9c2) were pretreated with Lova or a Rac1-specific small-molecule inhibitor. Following Doxo exposure, DNA damage response (DDR) and cytotoxicity were monitored. Besides these in vitro studies, the influence of Lova was analyzed on Doxo-induced acute and subacute cardio- and hepatotoxicity in vivo (Balb/c mice).
Results: Lovastatin blocked the DDR and promoted survival of HUVEC and H9c2 cells following Doxo treatment1. Protection by Lova rests on inhibition of Rac1 signaling, which is required for DNA double-strand break formation resulting from inhibition of topoisomerases by Doxo. Moreover, Lova protected Balb/c mice against acute and subacute cardio- and hepatotoxic effects of Doxo1,2. Taken together we suggest that the cytoprotective effect of Lova against Doxo-induced injury is due to a reduced DNA damage induction, attenuated DDR and reduction of cell death.
Conclusions: Lova attenuates dose-limiting adverse effects of Doxo-based anticancer therapy, thereby widening its therapeutic window.
References: 1Huelsenbeck et al (2011) Cell Death Dis 2:e190; 2Henninger et al (2012) Tox Appl Pharm 261, 66–73.
MASCC-0061
Relatives’ perception of head and neck cancer patients’ pain
A.K.C. Schaller 1, G. Liedberg2, B.K. Larsson1
1Department of Medical and Health Sciences Faculty of Health Sciences Linköping University, Rehabilitation Medicine, Linköping, Sweden, 2Faculty of Health Sciences Linköping University, Department of Social and Welfare studies, Linköping, Sweden
Introduction: When a family member suffers from cancer, there is a risk that their family members’ quality of life and everyday life will be negatively affected.
Objectives: The aim was to describe how family members experience their ill relative’s situation especially with respect to various dimensions of pain due to head and neck cancer (HNC) and radiotherapy. Furthermore, this study aims to describe the family members’ own experiences.
Methods: This qualitative interview study involved 21 relatives of HNC patients.
Results: Relatives reported that patients suffered from severe pain in their oral cavity region and frequently saw that the patient’s pain relief was insufficient. Nevertheless, relatives noted that the patients were long-suffering and were experienced at coping with the difficult situation. It was hard for the relatives to see their loved ones in such a difficult situation, which included treatment-related side effects such as fatigue, obstipation, nausea, and weight loss. Both relatives and patients experienced anxiety and fear about the prognosis.
Family members experienced difficulties managing household chores, providing care, and accompanying their sick relative to medical visits. Moreover, many relatives were employed and were expected to work. This demanding situation resulted in feelings of loneliness and abandonment that sometimes led to sleeping difficulties. More information was desired regarding treatment and prognosis and the relatives thought a nurse could help facilitate contact with healthcare would be helpful. In all, a dark picture was reported.
Conclusions: Caregiving relatives to HNC patients need extensive psychological and practical support to optimize mutual wellbeing during the disease period.
MASCC-0062
Statins protect against ionizing radiation-induced adverse normal tissue responses
G. Fritz 1, C. Henninger1, J. Huelsenbeck2, M. Herzog2, B. Kaina2
1Toxicology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany, 2Toxicology, Johannes Gutenberg University Mainz, Mainz, Germany
Introduction: Radiotherapy plays a key role in anticancer therapy. However, ionizing radiation (IR) also damages normal tissue. HMG-CoA-reductase inhibitors (statins) block the function of Ras and Ras-homologous (Rho) GTPases, which are involved in the regulation of IR-induced stress responses and apoptosis.
Objectives: We aim to examine the usefulness of statins to protect normal tissue from the side effects of IR.
Methods: Early IR-induced DNA damage response (DDR) and cell death were comparatively analyzed in human endothelial cells (HUVEC; EA.hy926) pretreated or not with lovastatin (Lova). Moreover, we investigated the effect of Lova on acute and subacute normal tissue damage induced by total body irradiation (TBI) of Balb/c mice.
Results: Lovastatin inhibited the IR-stimulated activation of the DDR (i.e p53) in endothelial cells1 without affecting the level of DNA strand breaks. The statin also increased the survival of irradiated endothelial cells in vitro. TBI of Balb/c mice (1 × 6 Gy) revealed that Lova reduces acute proinflammatory and profibrotic stress responses of liver and intestine2. Lova also attenuated the mRNA expression of proinflammatory and profibrotic cytokines observed 3 weeks after TBI (2 × 2.5 Gy) in the lung. TBI promoted the extravasation of circulating tumor cells and subsequent formation of lung metastases. Again, this pro-metastatic IR effect was blocked by Lova3.
Conclusions: Lova counteracts multiple adverse normal tissue responses caused by irradiation, pointing to a radioprophylactic potency of statins.
References: 1Nübel et al. (2006) Clin Cancer Res 12, 933–39; 2Ostrau et al (2009) Radiotherapy Oncology 9, 492–99; 3Hamalukic et al (2011) PLOSone 6(19)e26413.
MASCC-0063
The prognostic value of cognition in patients with glioblastoma multiforme
B. Flechl 1, M. Ackerl1, C. Sax1, C. Richard2, M. Keilani2, A. Gaiger1, K. Dieckmann3, C. Marosi1
1Internal Medicine, Medical University, Vienna, Austria, 2Physical Medicine and Rehabilitation, Medical University, Vienna, Austria, 3Radiotherapy, Medical University, Vienna, Austria
Introduction: In patients with Glioblastoma multiforme (GBM) progressive disease leads sooner or later to cognitive decline
Objectives: In this study we evaluated if two cognitive assessments performed early in the treatment course have a prognostic significance for predicting progression free survival (PFS).
Methods: We assessed the cognition of 35 patients with GBM using the program NeuroCogFX with four subscales (working memory, attention, verbal and figural memory, verbal fluency) and summary scale. Baseline evaluation was done at initiation of radiotherapy (11–57 days after diagnosis) and second evaluation 3 months later (82–117 days after baseline).
Results in subscales were categorized in ‘declined’, ‘stable’ and ‘improved’. Tumor progression was based on MRI scans
Results: The patients (12 women, 23 men) were in median 54 years old (21–75 years). The majority (61 %) showed stable cognitive results, 22 % improved and 14 % decreased in the summary scale of cognition. The median PFS was 11 months (2.6–27.4 months). An improvement of attention correlated significantly with longer PFS (p = 0.015, see Fig 1) whereas the other three cognitive subscales were not associated with PFS.
Conclusions: The present study shows evidence, that an increase or decrease of attention scales measured within the first 5 months of disease has prognostic value for PFS.
MASCC-0064
Empowering patient education—model development
H. Vaartio-Rajalin 1, H. Leino-Kilpi1, H. Minn2, L. Iire2
1Nursing Science, University of Turku, Turku, Finland, 2Oncologic, Turku University Hospital, Turku, Finland
Introduction: Oncologic patients are a heterogeneous group of individuals with a vast range of cognitive needs and informational expectations during their illness trajectory. The cognitive resources of these patients may be affected due to illness and its care, and should be continuously analyzed in order to coordinate well-targeted patient counseling in inter-professional collaboration.
Objectives: The goal of this international multicenter study is to develop a model of empowering counseling praxis for cancer patients during illness trajectory. This model will contain a diagnostic instrument for self-identification of adult cancer patients’ cognitive needs and a collaborative counseling checklist for health care professionals at clinical specialties during cancer management.
Methods: The process of establishing the model will be presented at conference. There will be altogether six datasets to be obtained in Finland, Sweden, Norway and Spain from oncological clinics. At the first phase of study the focus is in identification of the cognitive needs of adult oncologic patients during the whole illness trajectory, and identification of the significant factors affecting these cognitive needs. From the base of this phase, a diagnostic instrument for self- identification of one’s cognitive needs will be developed and validated. At second phase there will be an exploration of the cancer nurses’ and physicians’ Methods to identify, analyze and response to the cognitive needs of their patients, and nurses’ activities as counseling patient advocates. Finally, the third phase focuses on validation of a collaborative counseling checklist for health care professionals during cancer management.
Results: Not available yet.
Conclusions: Not available yet.
MASCC-0065
The prediction of the TS?ERCC1 mRNA levels to the clinical outcome of patients with esophageal squamous cell carcinoma treated with CDDP/5-FU chemotherapy
G. Guo-chenXing 1
1Cancer, Zhengzhou University Affiliated Zhengzhou Central Hospital, Zhengzhou, China
Introduction: Oesophageal cancer is the eight most frequent malignancy and the fourth highest cause of cancer-related mortality, with almost 500,000 new patients diagnosed annually worldwide.
Objectives: The aim of this study was to determine whether the expressions of excision repair cross-complementation group 1 (ERCC1) and thymidylate synthase (TS) predict the clinical outcome of patients with esophageal squamous cell carcinoma treated with CDDP/5-FU chemotherapy.
Methods: The mRNA levels of TS/β-actin and ERCC1/β-actin in esophageal cancer tissue were determined by semi-quantitative reverse-transcription polymerase chain reaction(RT-PCR) and their correlations to the chemotherapy results were studied.
Results: Twenty esophageal cancer patients were divided into two groups by the mean TS mRNA level, and all 8 patients in low level group were responsers to chemotherapy, whereas only 3 in12 patients in high level group responded to chemotherapy. There was a significant difference between the two groups(Fisher’s exact test, P = 0.001)?7 patients with TS and ERCC1 mRNA level lower than or equal to their respective means were all responsers to chemotherapy, however only 4 in 13 patients with TS and ERCC1 mRNA level higher than their respective means responded to chemotherapy. The difference between the two groups for response has a statistical significance (Fisher’s exact test, P = 0.005).
Conclusions: This study indicates that TS?ERCC1 mRNA levels may be predictive markers for response in patients with oesophageal squamous cell cancer receiving CDDP/5-FU chemotherapy.
MASCC-0066
Renal function analyses in patients with stomach cancer who underwent adjuvant chemoradiotherapy
G. Yavas 1, R. Elsurer Afsar2, C. Yavas3, O. Ata4
1Radiation Oncology, Selcuk University, Konya, Turkey, 2Nephrology, Selcuk University, Konya, Turkey, 3R, Konya Training and Research Hospital, Konya, Turkey, 4Medical Oncology, Selcuk University, Konya, Turkey
Introduction: Chemoradiotherapy is an important part of stomach cancer treatment.
Objectives: We aimed to evaluate renal functions in patients with stomach cancer who underwent adjuvant chemoradiotherapy.
Methods: Fifty-nine stomach cancer patients who underwent total gastrectomy and lymph node dissection and adjuvant chemoradiotherapy were included. Demographic parameters (age, gender), and basal and 12th month biochemical parameters were recorded. Mean kidney dose (MKD) administered during radiotherapy (RT) was determined. Basal and 12th month estimated glomerular filtration rate (eGFR) was calculated by MDRD formula.
Results: There were 25 female (42,4 %) and 34 male (57,6 %) patients. The mean age of the patients was 60,8 ± 11,9 years. Mean follow-up period was 15,6 ± 9,8 months. Twenty-three (39 %) patients were ≥65 years of age and 21 patients (%35.6) had basal eGFR <90 ml/min/1.73 m2. When the basal and 12th month eGFR was compared, eGFR decreased in 27 patients (45,8 %), whereas eGFR remained stable in 32 (54,2 %) patients. We performed cox regression analyses in order to define the relationship between a decreased eGFR and age, gender, MKD, basal MKD and albumin. Cox regression analyses revealed that a MKD >1,500 cGy and basal eGFR <90 ml/min/1.73 m2 significantly increased the risk of a decreased eGFR at 12th month (HR = 2,288, 95 % CI (1,009–5,188), p = 0,048 and HR = 2,854, 95 % CI (1,121–7,262), p = 0,028, respectively).
Conclusions: Our results suggested that a basal eGFR <90 ml/min/1.73 m2 and MKD >1,500 cGy significantly increased the risk of a decreased 12th month eGFR.
References: 1. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001;345:725–30.
MASCC-0067
The effect of halofuginone on radiation induced cardiovascular damage
C. Yavas 1, M. Calik2, G. Yavas3, H. Toy4, H. Esme2, M.F. Sargon5
1Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey, 2Thoracic Surgery, Konya Training and Research Hospital, Konya, Turkey, 3Radiation Oncology, Selcuk University, Konya, Turkey, 4Pathology, Necmettin Erbakan University, Konya, Turkey, 5Anatomy, Hacettepe University, Ankara, Turkey
Introduction: Cardiovascular toxicity is a major dose limiting factor during mediastinal irradiation.
Objectives: To evaluate the effects of two different doses of Halofuginone (H) on radiation induced cardiovascular damage.
Methods: Sixty rats were divided into 6 groups. Group (G) 1 was defined as control group. G2 was radiotherapy (RT) only group. Group 3 and 4 were 2.5 and 5 μg H groups respectively. Group 5 and 6 were RT plus 2.5 and 5 μg H groups respectively. A single dose of 12 Gy RT was given with 6 MV photon beams. H was applied intraperitoneally with daily doses, started immediately after administration radiotherapy and continued until the animals were sacrificed.
Results: The endocardial thickness of all study groups was significantly differed at 6th and 16th week of RT (p < 0.001 for each). The maximum thickness was observed in G2. There were significant differences between G2 and G5 (p < 0.001); G2 and G6 (p < 0.001) and; G5 and G6 (p = 0.001) regarding to endocardial thickness at 16th week of RT. There were significant differences within the study groups in terms of thoracic aorta fibrosis scores (p = 0.002). When the RT groups were compared there were significant differences between G2-G5, G2-G6 (p = 0,007 and =0,002 respectively). There weren’t any difference between the control and H groups.
Conclusions: Our results suggested that H may improve radiation induced cardiovascular damage. The most prominent improvement was observed in 5 μg H + RT group at 16th week of RT.
References: 1. Adams MJ, Hardenbergh PH, Constine SL, Liphultz SE. Radiation-associated cardiovascular disease, Critical reviews in oncology/Hematology2003;45: 55–75.
MASCC-0068
The morphological effects of tamoxifen, letrozole, anastrozole and radiotherapy in cardiac tissue of rats
O. Ata 1, G. Yavas2, C. Yavas3, H. Acar2, H. Toy4
1Medical Oncology, Selcuk University, Konya, Turkey, 2Radiation Oncology, Selcuk University, Konya, Turkey, 3Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey, 4Pathology, Necmettin Erbakan University, Konya, Turkey
Introduction: There is limited data regarding the cardiac toxicity profile of hormonal therapy when used alone and concurrent with radiotherapy.
Objectives: We aimed to evaluate the morphological effects of Anastrozole (A), Letrozole (L) and Tamoxifen (T) on cardiac tissue, when used alone or combination with radiotherapy in rats.
Methods: Eighty rats were divided into 8 groups. Group (G) 1 was defined as control group. G2 was RT only group. Group 3, 4 and 6 were T, A and L control groups respectively. Group 6, 7 and 8 were RT plus T, A and L groups respectively. A single dose of 12 Gy RT was given. The drugs were started 1 week before the RT and continued until the animals were sacrificed 16 weeks after the RT. As an end point the extent of cardiac toxicity for each rat was quantified with image analysis of histological sections of the heart.
Results: RT increased both endocardial thickness (p < 0.001) and cardiac fibrosis scores (p < 0.001), whereas A and L did not. As for T, only significant change was observed in endocardial thickness (p < 0.001). RT combined with T or A or L did not increase endocardial thickness (p: 0.739, p:<0.99, p: 0.280, respectively) and cardiac fibrosis scores (p:0.089, p: 0.796, p: 0.796:, respectively) when compared with RT alone.
Conclusions: Our results suggested that unlike A and L, RT and T may be cardiotoxic in rats, as measured by increased endocardial thickness and cardiac fibrosis score. However, concurrent T with RT did not further increase carditoxicity.
MASCC-0069
Dosimetric comparison of 3-dimensional conformal and field in field radiotherapy techniques for the adjuvant treatment of early stage endometrial cancer
G. Yavas 1, C. Yavas2, H. Acar1, A. Buyukyoruk1, G. Cobanoglu1, O. Secilmis Kerimoglu3, O. Ata4, C. Celik3
1Radiation Oncology, Selcuk University, Konya, Turkey, 2Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey, 3Obstetrics and Gynecology, Selcuk University, Konya, Turkey, 4Medical Oncology, Selcuk University, Konya, Turkey
Introduction: Adjuvant radiotherapy has been shown to improve loco-regional control rates in endometrial cancer patients.
Objectives: To compare field-in-field radiotherapy (FIF) with conformal radiotherapy (CRT) in terms of dosimetric benefits for early stage endometrial cancer patients.
Methods: Ten consecutive early stage endometrial cancer patients who underwent adjuvant external beam radiotherapy were included to the study. For each patient, two different treatment plans were created. FIF and CRT plans were compared for doses in the planning target volume (PTV), the organ at risk (OAR) volume including rectum, bladder, bowel, bilateral femurs and bone marrow, the dose homogeneity index, and the monitor unit counts required for the treatment.
Results: The FIF technique significantly reduced the maximum dose of the PTV, rectum, bladder, bowel, left femur, right femur and bone marrow (p values were: <0.001, 0.031, 0.003, <0.001, 0.001, 0.001 and <0.001 respectively). When the OAR volumes irradiated with 30 and 45 Gy were compared, the results were in favor of the FIF technique. The volumes of rectum, bladder, bowel, left femur, right femur and bone marrow receiving more than the prescription dose of 45 Gy were significantly reduced with FIF technique (p values were 0.016, 0.039, 0.01, 0.04, 0.037 and 0.01 respectively). The dose homogeneity index (DHI) was significantly improved with FIF technique (p < 0.001)
Conclusions: FIF technique seems to be more advantageous than CRT during adjuvant radiotherapy for early stage endometrial cancer patients.
References: Chan P, Yeo I, Perkins G, Fyles A, Milosevic M. Dosimetric comparison of intensity modulated, conformal, and fourfield pelvic radiotherapy boost plans for gynecologic cancer: a retrospective planning study. Radiat Oncol 2006;4:13–21.
MASCC-0070
Role of fear and pain avoidance on adherence to prophylactic swallowing exercises in head and neck cancer patients
G. Carnaby 1, R. Amdur2, M. Crary3
1Behavioral Science & Community Health, University of Florida, Gainesville, USA, 2Radiation Oncology, University of Florida, Gainesville, USA, 3Speech Hearing & Language Science, University of Florida, Gainesville, USA
Introduction: Participation in preventative swallowing exercise during HNC treatment improves functional swallowing and maintains muscle structure. Despite these benefits, patient adherence to exercise programs is not always optimal. One possible factor associated with lower exercise adherence is pain-related fear.
Objectives: This study sought to identify behavioral reactions to pain during HNC treatment and the impact of Pain-fear avoidance on swallowing exercise adherence.
Methods: One hundred thirty HNC subjects enrolled in a trial of swallowing intervention, completed Pain Disability Index (PDI), Pain-Interference visual analogue (VAS) and pain related-swallowing quality of life scales(SWALQOL) at baseline, post radiotherapy, 3-months following treatment. Repeated measures ANOVA explored relationships between psychosocial pain/avoidance factors and swallowing exercise adherence.
Results: Data was available on 127 subjects. Swallowing function was normal across subjects at baseline. No difference between group baseline scores for PDI, VAS or SWALQOL scores was observed. A strong relationship between pain intensity (VAS) and deterioration in swallowing ability at 6 weeks (post treatment) and 3 months (p < .0008) was identified. Withdrawal from dysphagia intervention was significantly associated with higher pain intensity across time points (p < .002). Fear of choking reported at baseline was linearly related to amount of swallowing exercise performed during CRT (F (4, 83) = 3.26, p < .016), and to pain/disability ratings post treatment F (4,105) =4.69, P < .002) and 3 months following CRT (F (4, 74) = 3.03, P < .023).
Conclusions: Findings suggest the pain experience and psychologic factors (emotional reaction to pain) interact to influence and maintain swallowing avoidant behavior, reducing adherence to prophylactic swallowing exercise.
MASCC-0071
A randomized, controlled, thorough ECG trial to investigate the effects of netupitant and palonosetron (NEPA) combinations on ECG of healthy volunteers
T. Spinelli 1, C. Moresino1, S. Baumann2, W. Timmer2
1Research and Development, Helsinn Healthcare SA, Lugano, Switzerland, 2CRS, Clinical Research Services Mannheim GmbH, Mannheim, Germany
Introduction: Chemotherapy-induced nausea and vomiting is ranked among the worst side effects of chemotherapy. NEPA, a new antiemetic under development, is a fixed-dose combination of the highly selective NK1 receptor antagonist (RA) netupitant (300 mg), and the pharmacologically distinct 5-HT3 RA palonosetron (0.5 mg). NEPA targets 2 important emetic pathways with a single oral dose.
Objectives: This randomized, double-blind, placebo- and positive-controlled study aimed to determine the individually heart rate (HR)-corrected QT interval (QTcI) after different doses of NEPA treatments.
Methods: The study included 197 volunteers in 4 treatment groups: placebo, 200 mg netupitant + 0.5 mg palonosetron (NEPA200/0.5), 600 mg netupitant + 1.5 mg palonosetron (NEPA600/1.5), and 400 mg moxifloxacin. Treatment involved a 24-h baseline ECG, a single dose of treatment, followed by ECG measurements for 2 days. Cardiovascular safety and tolerability were assessed.
Results: Mean placebo-corrected QTcI change from baseline for NEPA200/0.5 and NEPA600/1.5 was +5 and +4 ms, respectively. Moxifloxacin showed an expected 8/9 ms increase in QTcI vs placebo. Mean placebo-corrected change from baseline for HR was -3 bpm for both NEPA groups. Placebo-corrected changes in pulse rate (PR) and QRS durations were comparable in both NEPA groups (0–1 ms). The frequency of treatment-related AEs (TRAEs) in the NEPA200/0.5 was similar to the placebo and moxifloxacin groups but slightly higher in the NEPA600/1.5. Constipation, upper abdominal pain, and headache were commonly reported TRAEs after different NEPA doses administration.
Conclusions: No significant effects on QTcI, HR, PR, or QRS duration were observed after different NEPA doses administration.
MASCC-0072
Serum and salivary levels of polyamines as potential biomarkers in the diagnosis of oral squamous cell carcinoma
S.G.Al-Talabani A.-W.R. Hamad 1,2
1Medical Allied Sciences, Al-Balqa Applied University, Salt, 2Al-Balqa Applied University, Amman, Jordan
Background: Oral cancer is one of the prevalent cancers of the body and is one of the 10 most common causes of death. Oral squamous cell carcinoma (OSCC) accounts for over 90 % of these tumors. The aim of this study was designed to detect biochemical markers in serum and saliva of oral squamous cell carcinoma patients and to evaluate their validity in monitoring and diagnosis.
Patients and Methods: The level of polyamines in the serum and saliva of (30) patients with OSCC and (20) healthy individuals as control group was measured. Polyamines (spermidine and spermine)were determined by high performance liquid chromatography (HPLC) in both serum and saliva of patients with OSCC and control group.
Results and Discussion: The total serum and salivary polyamines level of OSCC were significantly higher than the control group (P < 0.001). Both salivary and serum polyamines level were reliably accurate test in separating between OSCC patients and control group since the area under the ROC curve for both serum and salivary polyamines was one which is significantly higher (different) from that of an equivocal test of 0.5. There was significant difference in salivary spermine level among OSCC patients in relation to lesion status. Spermine levels were reduced in recurrent lesion especially with metastases. There were significant differences in serum polyamines level among OSCC patients in relation to duration of the disease (P < 0.05).
MASCC-0073
Fatigue characteristics and physical fitness in colorectal cancer survivors
Y.-H.L.,K.-H.Y.,J.-Y.T.,J.-T. S.-C. Shun 1
1Department of nursing, College of Medicine/National Taiwan University, 2National Taiwan University, 3Depatment of medicine, 4Department of Physical Therapy, 5Department of Medicine, National Taiwan University, Taipei, Taiwan R.O.C.
Introduction: Enhancing activity has been proved as the best strategy to improve cancer-related fatigue. Exercise behavior should be understood before conducting exercise program. Fatigue is current measured by self-report but objective reporting method should be explored to measure the exactly change of fatigue.
Objective: To (1) explore exercise behavior and level of physical fitness and domains of fatigue, and (2) identify associations between physical fitness and domains of fatigue in colorectal cancer survivors.
Methods: A cross-sectional design was used, with participants recruited from the outpatient clinics in Northern Taiwan. A set of structured questionnaires was used to assess participants’ exercise behavior, fatigue characteristics (intensity, duration and its interference), anxiety, and depression. Physical fitness was measured by 6-minutes walking test (6MWT), 30-second sit and up (30-SU), hand grip strength, and low leg muscle strength.
Results: One hundred and sixty-one patients were included in this study. About 72.7 % (n = 117) patients reported taking regular exercise, but the level of loving to take exercise was 6.5 points based on a 0 to 10 scale. Around 59.6 % of survivors reported experiencing fatigue. Duration of fatigue and the level of interference in daily life caused fatigue and overall fatigue were associated with hand grip strength.
Conclusions: Healthcare providers should understand the cancer survivors’ exercise preferences before conducting exercise program to improve their fatigue. Hand grip strength may be the good objective indicator for fatigue in colorectal cancer survivors. Larger sample size is suggested to confirm the results for the future studies.
MASCC-0074
Mistletoe preparation (Viscum Fraxini2) as palliative treatment of malignant pleural effusion
R. Gaafar1, F.A. Kassem1, A.E. Bastawisy 1
1Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
Background: Malignant pleural effusion is a common finding in patients with solid tumors with significant impact on quality of life hence there is a strong need to investigate new agents in this entity.
Patients and Methods: This is a prospective randomized controlled study including patients with symptomatic recurrent malignant pleural effusion of different primaries. Patients were randomized into 2 groups : the 1stgroup received 5 ampoules of Mistletoe preparation with defined lectin content(Viscum Fraxini2) diluted in 10 cc glucose 5 % solution. Re-instillation was repeated every week till complete dryness of the pleural fluid (maximum duration of therapy 8 weeks). 2nd group received 60 units of Bleomycin once intrapleurally. The primary aim of this study was to evaluate the efficacy of Mistletoe preparation as a palliative treatment of malignant pleural effusions in comparison to Bleomycin. Secondary aim was to evaluate the tolerability of the Mistletoe preparation.
Results: A total of 23 patients were included and followed up during the study from Dec.2007 till Jan.2012.13 patients received Mistletoe preparation and 10 patients received Bleomycin. Overall clinical response (drytap) was reported in 61.5 % of Mistletoe preparation arm versus 30 % in Bleomycinarm (p = 0.2138), 95 % CI = (-0.1203, 0.6325). Toxicity of both arms was mild admanageable and included in Mistletoe preparation arm: fever, chills, headache, malaise and in 2 cases allergic reaction which was controlled by discontinuation of the drug and steroid injection.
Conclusions: Mistletoe preparation is an efficient and well tolerated sclerosant agent and needs further investigations.
MASCC-0075
Preventive effect of saffron’s bioactive ingredient “crocin” against liver cancer: a preclinical study
R.S.-S.,S.D. A. Amin 1,2
1Biology, UAE University, Al-Ain, United Arab Emirates, 2Zoology, Cairo University, Cairo, Egypt, 3Institute of Pathology, University of Erlangen, Erlangen, Germany, 4Histopathology, Tawam Hospital, Al-Ain, United Arab Emirates
Introduction: This is a follow up of our study published in September issue of Hepatology and featured in October issue of Science News that documented the antic-cancer potential of saffron.
Objectives: To investigate both chemopreventive actions and mechanisms of saffron-based bioactive ingredient; crocin, against diethylnitrosamine (DEN)-induced liver cancer in rats.
Methods: Administration of crocin at two doses of 100 and 200 mg/kg body wt per day was started 2 weeks prior to the DEN injection and was continued for 22 weeks.
Results: Crocin decreased the placental glutathione-S-transferase positive foci in livers of DEN-treated rats. Furthermore, crocin counteracted DEN-induced oxidative stress in rats as assessed by restoration of superoxide dismutase, catalase, and glutathione-S-transferase levels and diminishing of myeloperoxidase activity, malondialdehyde and protein carbonyl formation in liver. The results of immunohistochemical staining of rat liver showed that crocin inhibited the DEN-mediated elevations in numbers of cells positive for Ki-67, cyclooxygenase 2, inducible nitric oxide synthase, nuclear factor-kappa Bp-65 and the phosphorylated tumor necrosis factor receptor. Crocin also blocked the depletion in the number of cells positive for TUNEL and M30 CytoDeath in liver tissues of DEN-treated rats. In vitro experiments also confirmed these findings and showed inhibition of NFkB activation, increased cleavage of caspase-3, as well as DNA damage upon saffron treatment.
Conclusions: The present study provides evidence that crocin protects against liver cancer through inhibition of cell proliferation and induction of apoptosis and that crocin’s anti-cancer effect is manifested via modulating oxidative damage and suppressing inflammatory response.
MASCC-0076
Food sources of vitamin d and its deficiency in Latvian males
1The sanatorium ‘Jantarnij Bereg’, Riga Stradins University, 2Riga Stradins University, Faculty of Rehabilitation Sports, Nutrition and Education Department, Riga, Latvia
Background and objectives: Over50 % of population is found to suffer from vitamin D deficiency. Vitamin D deficiency in Europe, Northern Europe, Asia and Africa, especially in elderly people was revealed by many epidemiological researches.
Methods: There were included 134 males aged 45–80. None of the research participants have taken any vitamin D supplements or supplements containing vitamin D. Serum vitamin D level was detected in all the participants((25 hydroxyl vitamin D: 25(OH)D) and the amount of the consumed vitamin D was determined. The survey was conducted to acquire information about the amount of vitamin D consumed with food.
Results: Insufficient Vitamin D intake was detected in 78,4 %, vitamin D deficiency with consequent low vitamin D serum level in 94,1 %. Mean data: vitamin Din food—6,9 μg, 25(OH)D—16,9 ng/mL, BMI—28,1 kg/m2, age–59,4 years. The amount of vitamin D in food statistically reliably directly correlate with serum vitamin D level (r = 0,961; p = 0,01), and there is an inverse correlation with age (r = 0,226; p = 0,009). No statistical reliable correlation was found between serum 25 (OH) Dlevels and BMI. Major food sources of Vitamin D are fat-rich seafish, eggs, dairy product.
Conclusions: Insufficient intake of vitamin D with food and low serum level is marked in males of advancing age. Vitamin D levels directly correlate with vitamin D intake. Not found statistically significant correlation between vitamin D levels, vitamin D diet and BMI, but indirectly correlates with age.
MASCC-0077
The burden of unidentified depression in breast cancer patients in a Nigerian oncological clinic: evidence for scaling up services to bridge mental health gap
F.O.S. A.T. Olagunju 1
1Department of Neuropsychiatry (psychooncology), Lagos University Teaching Hospital/College of Medicine, University of Lagos, Lagos, 2Department of Oncology/Radiotherapy, University College Hospital, Ibadan, Ibadan, Nigeria
Introduction: The diagnosis, course and treatment of breast cancer are frequently not without emotional distress in the affected people. Common emotional related problems include fear, anger, shock, low self esteem, anxiety, impaired social functioning and depression (perhaps the commonest). Unfortunately, emotional disorders, especially depression in people with breast cancer are poorly dealt with, despite the linkage of their co-morbidity with poor treatment compliance; worsen disease progression and poorer quality of life.
Objectives: This abstract aims at illustrating the burden of unidentified depressive illness in people with breast cancer in a treatment facility in Lagos.
Methods: A total of 96 consenting adults with histological diagnosis of breast cancer recruited using systematic random sampling were interviewed with sociodemographic/clinical profile questionnaire and Centre for Epidemiological Studies Depression Scale Revised (CES-DR) by the researchers. Data obtained were analysed using SPSS-15.
Results: In this study, a significant proportion of individuals with breast cancer had depressive symptomatology (CES-DR score of 16 and above) made up of 46(47.9 %) of the total participants. In addition, none of these depressed participants have been identified or treated previously for depression.
Conclusions: Overall, the finding in this study exemplifies the existing mental health gap among people with breast cancer, thus underscores the need to either develop or scale up comprehensive mental health services targeted towards prompt identification and treatment of emotional disorders using a holistic approach. Furthermore, key stakeholders in the management of breast cancer need to be engaged in order to translate research evidence to policy formulation and development of treatment programmes.
MASCC-0078
Assessment of prevalence, psychosocial correlates and psychometrics of a screening instrument of depression among oncology outpatients in Sub-Saharan Africa
A.T. Olagunju 1, O.F. Aina1
1Department of Neuropsychiatry, Lagos University Teaching Hospital/College of Medicine, University of Lagos, Lagos, Nigeria
Introduction: Depression in cancer subjects has been linked with grave consequences if unattended, however, poorly diagnosed due to paucity of information and absence of screening modalities.
Objectives: This study aims to determine the prevalence with correlates of depression and evaluate the diagnostic validity of Centre for Epidemiological Studies Depression Scale Revised (CES-DR) for screening in cancer subjects.
Methods: The participants were recruited using systematic random sampling, made up of 200 cancer patients and 200 age and sex matched controls that consented and met the inclusion criteria. A designed socio-demographic, clinical profile questionnaire, CES-DR and the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were used to interview participants.
Results: One-half of all cancer patients presented with advanced stage cancer and 98 (49.0 %) of them compared with 40 (20.0 %) controls had significant depressive symptomatology using CES-DR scores of ≥16. The prevalence of depression based on SCAN in cancer subjects was 27.5 % with 9.5 % in controls and the difference was statistically significant (p = < 0.001). A substantial proportion of cancer patients with depression 36(65.5 %, n = 55) had moderate depression, while 7.2 % (n = 55) had severe depression. Unemployment status, being unmarried and duration of cancer were predictive of depression in cancer participants (p = ≤0.005). The sensitivity and specificity of CES-DR was 96.4 % and 68.7 % respectively
Conclusions: Prompt identification and treatment of cancer, mental disorders like depression should be integrated into cancer care in this part of the world. Furthermore, availability of screening tools like CES-DR for cancer patients in local languages in primary care settings is warranted.
MASCC-0079
Experiences of pain—a longitudinal qualitative study of patients with head and neck cancer recently treated with radiotherapy
B.L.,2.,M.L.,G.M.L. A.K.C. Schaller 1,2
1“Rehabilitation Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 2Pain and Rehabilitation Centre, County Council of Östergötland, 3Department of Social and Welfare studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden”
It is not unusual for Patients with Head and Neck Cancer (HNC) often suffer from both tumour and treatment-related pain that is difficult to alleviate. This longitudinal, qualitative study aims to describe how HNC patients experience existential, psychological, physical and social pain and how these dimensions of pain influence the well-being of HNC patients treated with radiotherapy (RT).
Twenty-six patients were invited to participate in two interviews after RT had been completed. These interviews were analysed using content analysis. The effects of pain on the well-being of HNC patients emerged as a main category within the results. Besides, five additional categories were found: the preoccupied mind, the altered mood, overwhelming fatigue, bodily pain and decreased participation and changed relations. For the first time, this study demonstrated that a patient group in the treatment phase suffers from existential pain in the form of fear of death, meaninglessness and guilt. Psychological, physical and social pain were also prominent. In all likelihood, the different dimensions of pain influence one another. Health care staff should consider a patient’s overall pain situation from the time cancer treatment begins, so that the depression, anxiety, fatigue, pain, nutritional difficulties and social withdrawal experienced by patients will decrease.
MASCC-0080
Phase II clinical trial using aminotrofic in the prevention of anorexia and cachexia in cancer patients receiving chemotherapy: evaluation of the efficacy and safety
R.P.,A.R.,V.C.,R.R. A. Lugini 1
1Medical Oncology, Hospital ‘San Camillo de Lellis’, 2medical Oncology, Hospital ‘San Camillo de Lellis’, Rieti, 3medical Oncology, Hospital ‘Santa Maria Goretti’, Latina, Italy
Introduction: Food shortage in cancer patients is associated with poor prognosis. Treatments and disease have a major impact on nutritional status. An improvement of the nutritional status of patients with cancer can change the prognosis, quality of life and functional status, facilitating improved tolerance to treatment. Aminotrofic is a supplement of amino acids with vitamins B6 and B1, shown to provide useful nutrients for muscle trophism.
Methods: From November 2011 to April 2012, 30 cancer patients received Aminotrofic at a dose of 2 sachet/day. All patients included in the study performed chemotherapy: 70 % of the patients performed a treatment for metastatic disease. The treatment duration was at least 4 months. The following variables were evaluated: 1) nutritional status; 2) clinical status; 3) quality of life; 4) adherence to the chemotherapy.
Results: Of 30 patients, 28 completed the treatment and were assessable. All evaluable patients did not show a significant reduction in body weight, appetite and quality of life. The 28 evaluable patients also completed the chemotherapy program.
Conclusions: Aminotrofic found to be safe and effective in this setting of the study. The relevant data is represented by adherence of patients to chemotherapy treatment in relation to the maintenance of an adequate performance status. A randomized phase III study is warranted.
MASCC-0081
Quality of life of elderly patients receiving weekly carboplatin and paclitaxel chemotherapy plus cetuximab first line for metastatic squamous carcinoma of the head and neck
R.R.,R.P.,V.S.,A.R. A. Lugini 1
1medical Oncology, San Camillo de Lellis, General Hospital, Rieti, 2Medical Oncology, Santa Maria Goretti, General Hospital, Latina, Italy
Background: A phase III trial demonstrated that Cetuximab is the first agent to improve survival when added tho platinum-based chemotherapy for metastatic squamous cell carcinoma of the head and neck. The safety and tolerability of a combination of weekly Paclitaxel and Carboplatin and Cetuximab for the first line treatment for metastatic squamous cell carcinoma of the head and neck in elderly population were investigated.
Patients and Methods: Patients >70 years of age with histologically confirmed metastatic squamous cell carcinoma were enrolled. Other eligibility criteria included: measurable disease, Karnofsky performance status >60 % and adequate hematologic, hepatic and renal functions. Patients receiving Paclitaxel (80 mg/mq), Carboplatin AUC 2 and Cetuximab (400/250 mg/mq) weekly. Treatment was continued for a maximum of six cycles of chemotherapy. After six cycles, patients in the who had at least stable disease received cetuximab monotherapy until disease progression or unacceptable toxicity. The European Organisation for Research and Treatment of Cancer QoL Questionnaire-Core 30 and QLQ-Head and Neck 35 module were used to assess QoL.
Results: From September 2010 to September 2012 were evaluated 40 patients with metastatic squamous carcinoma of the head and neck. Patients were scheduled to complete the questionnaires on day 1 of every cycle. The analysis of the responses to the questionnaires from patients shows that the pattern of chemotherapy used provides excellent control of symptoms related to the disease.
Conclusion: This analysis shows an important clinical benefit of chemotherapy regimen proposed in the population included in the study.
MASCC-0082
The quality improvement of palliative care in the intensive care unit
P.M. A. Milanti 1
1Maternity and women’s health nursing, University of Indonesia, Depok, Indonesia, 2Faculty of Health Care and Nursing, Helsinki Metropolia University, Helsinki, Finland
Introduction: There are evidences of failure and challenges to incorporate a holistic palliative care into the nursing care plan in the critical care setting.
Objectives: The objective of this study was to assess the interventions to improve the quality of palliative care in the intensive care unit.
Methods: Online search of electronic nursing databases were conducted. Five studies met the inclusion criteria. The data were then extracted and analyzed by using content analysis
Results: The thematic analysis revealed some interventions aimed for quality improvement of palliative care in the ICU are integrating palliative care into the intensive care, promoting palliative care consultation and enhancing collaboration between the palliative care by the ICU team and the palliative team.
Conclusions: Quality improvement of the palliative care in the intensive care unit is a collaborative work that can be implemented in several approaches. A strong nursing leadership and managerial ability is needed to address the common challenges of the group change process in the quality improvement.
MASCC-0083
Outcome of intravenous methotrexate in recurrent or persistent squamous cell carcinoma of head and neck
1Radiation Oncology, 2Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
Introduction: Recurrent or progressive disease in head and neck cancers is considered to have poor prognosis. Although various chemotherapeutic agents have been tried in palliative setting but there is a lack of definitive standard protocol.
Objectives: The aim of this retrospective study is to evaluate the outcome of intravenous methotrexate in recurrent or persistent squamous cell carcinoma of head and neck in our institution.
Methods: Between January 2006 and December 2009, 103 patients with recurrent or persistent head and neck cancers were identified from Head and Neck Database at Shaukat Khanum Memorial Cancer Hospital and Research Center. All the patients had good performance status (ECOG 0–1) prior to the start of palliative chemotherapy and received intravenous methotrexate 40 mg/m2 weekly. Response, toxicity and mean time to progression were determined.
Results: Response to methotrexate; complete response (CR) in 10 %, partial response (PR) in 11 11 %, stable disease (SD) in 60 % and progressive disease (PD) in 19 % of patients respectively. Chemotherapy related toxicities includes; grade 4 neutropenia and mucositis in 6 (5 %) and 8 (7 %) respectively and deranged liver functions in 17 (16 %) patients. Mean time to progression was 7.5 months (range 1–39 months).
Conclusions: The disease control in our study is comparable with already published literature. Although various drug regimens have been employed in the past very little has been gained in slowing the progression of the disease.
MASCC-0084
Inhibition of proteasome and metalloproteinase activities in CACO2 cells by phenolic-rich extracts from some citrus peels
G.O.,S.p.,F.T. A.O. Ademosun 1
1Biochemistry Department, Federal University of Technology, 2Department of Biochemistry, Federal University of Technology, Akure, Nigeria, 3Department of Life Sciences, University of Trieste, Trieste, Italy
This study sought to investigate the effect of free and bound phenolic extracts from some citrus[grapefruit (Citrus paradisii), orange(Citrus sinensis) and shaddock (Citrus maxima)] peels on the proteasome and matrix metalloproteinase (MMP) activities in primary colon cancer cells(Caco-2). The free phenolics were extracted with 80 % acetone, while the bound phenolics were extracted from the alkaline and acid hydrolyzed residues withethyl acetate. The results revealed that free and bound phenolic extracts from orange peels had significantly (P < 0.05) higher inhibition of proteasome activity in extract-treated cell lysates, while free and bound phenolics from shaddock peels had the least inhibition. Both phenolic extracts from orange peels and bound phenolics from grapefruit peels had significantly (P < 0.05)higher inhibition of proteasome activity in intact cells after 24 h treatment with the extracts. Furthermore, the dose-dependent inhibition of MMP activity in Caco-2 cells by the extracts showed that free phenolic extracts had significantly (P < 0.05) higher inhibition than the bound phenolics in the three peels. The inhibition of proteasome and MMP activity in primary colon cancer cell line by phenolic extracts from these citrus peels showed that they could potentially be used in the management of colorectal cancer. However, bound phenolics exhibited stronger inhibition of proteasome activity, while free phenolics showed a stronger inhibition of MMP activity.
MASCC-0085
Impact of chemotherapy (regimens and doses) onthrombocytopenia in solid cancer patients
Z.M.Y.,M.A.H.,S.O. B.A.R. Hassan 1
1Clinical Pharmacy, 2Social and Administrative Pharmacy, Universiti Sains Malaysia, Penang, Malaysia
Introduction: Thrombocytopenia denotes abnormal decreases in platelet numbers and is a major detrimental side effect of the chemotherapy or cancer disease itself which can lead to hemorrhage from vital organ. This is particularly a problem for the brain specifically within solid cancer patients and has a great negative effect on cancer patients quality of life (QOL). This present study tries to find the association between thrombocytopenia onset and severity with different chemotherapeutics regimens and doses used in the treatment of several solid cancers.
Methods: This retrospective observational study was conducted in Penang General Hospital on 341 thrombocytopenic solid cancer patients who were admitted between 2003 and 2009. The main statistical tests used were Chi-square test and Logistic regression test for categorical data. While for continues data the main statistical tests were Linear regression and correlation test. The significance of the result will be when the P < 0.05, while the confidence interval for this study was 95 %.
Results: FEC and 5-FU + 5-FU have the strong association and correlation with thrombocytopenia onset and severity. However the associations and correlations with thrombocytopenia severity were stronger than those with the onset. Different doses of 5-FU and cyclophosphamide play a critical role in thrombocytopeniaonset and severity.
Conclusion: Monitoring and determination of platelet levels for cancer patients treated with FEC and 5-FU + 5-FU specifically with high doses must be emphasized and afocus of particular attention i.e., palliative and supportive care.
MASCC-0086
Comparison of the impact of breast cancer treatment within two different healthcare systems
S. Singh-Carlson1, C. gotz2, S. Smith3, F. Wong4
1Nursing, California State University Long beach, 2Rehabilitation, Todd Cancer Centre, Long Beach, USA, 3Radiation Oncology British Columbia Cancer Agency, Victoria, Victoria, 4Radiation Oncology British Columbia Cancer Agency, Surrey, Surrey, Canada
Introduction: Breast cancer survivors? (BCS) experiences and concerns of treatment impacts and perceptions of survivorship care plan (SCP) content and benefit seem to resonate for women regardless of different populations or healthcare structuring.
Objectives: This paper will compare how BCS of different ethnic background, residing in unlike healthcare systems report of the impact of breast cancer treatment. Discussions will include thematic findings from 4 studies that explored experiences/concerns of BCS post-treatment at different life-stages conducted in Southern California with American Caucasian/Hispanic and in British Columbia with Canadian Caucasians and South Asian (SA) BCS.
Methods: All studies utilized qualitative methodology and interviewed women ranging from 19 to 80 years old, 3–60 months post-treatment, with non-metastatic breast cancer. Canadian BCS were discharged from cancer-agency settings to family physicians, whereas American counterparts were followed by oncologists or family-physicians, dependent on types of medical insurance coverage. Comparison of themes will identify treatment-impacts variation among BCS in different healthcare-structuring.
Results: Some universal effects were fatigue-loss of physical energy/strength, fear/uncertainty, cognitive changes, and need to normalize post-treatment. Financial concerns due to loss of wages were common among BCS; however BCS in American healthcare system would seem to experience higher rates of mental distress due to medical insurance costs. Themes such as accessing inner strength and experiencing losses had different cultural and social nuances for BCS from all settings.
Conclusions: Comparison of these populations show need for development and implementation of appropriate SCP, that focus on varying ages, being mindful of different healthcare systems, social and cultural nuances.
MASCC-0087
Glioblastoma multiforme and neurocognitive functioning: own experience
B. Slovackova 1, L. Slovacek1, R. Zirko1, J. Kopecky1
1Charles University Hospital, Hradec Kralove, Czech Republic
Background: The authors evaluate in a pilot study the neurocognitive function of patients with GBM.
Patients and Methods: The evaluation of neurocognitive function had been performed during 2009–2010 in 11 patients with GBM (9 women, 2 men) with a mean age of 56.8 years (age range 45–72). The assessment of neurocognitive functions was performed by clinical neuropsychologist using the Methods sensitive for cognitive deficit
Results: Because of a limited set of patients and an insufficient number of scheduled check-ups (caused by severe tumour progression) the results could not be statistically evaluated. Due to these circumstances, the results of a pilot study are presented in the form of case reports. There are presented the results of three patients with different localization of GBM and with different type of neurosurgical intervention (total resection, subtotal resection and stereobiopsy).
Conclusion: The diagnosis of cognitive deficit can be based on careful assessment of personal medical history, present symptoms and physical examination. Laboratory tests and imaging technique help by the detection of secondary cognitive changes. Targeted examination of cognitive function relies in use of various neuropsychological tests. To monitor developments and changes in cognitive functions in patients with GBM the following battery of neuropsychological tests has shown helpful information: Addenbrooke’s Cognitive Examination, Trail Making Test, Rey-Osterrieth Complex Figure and Verbal Fluency Test. It seems that this battery of neuropsychological tests is suitable for repeated long-term monitoring of cognitive function in cancer patients undergoing radiotherapy of brain.
MASCC-0088
The effectiveness of innovative integrated teaching method on female adolescents’ knowledge of cervical cancer, health belief, and the intention of HPV vaccination
C.Y. Lai 1, W.W. Wu1, S.F. Cheng1
1National Taipei University of Nursing and Health Sciences (NTUNHS), Taipei, Taiwan R.O.C.
Introduction: Cervical cancer is not only the second leading cause of the death in the world, but also ranked as the second most prevalent cancer among women in Taiwan.
Objectives: The purpose of this study was to explore the effectiveness of innovative integrated teaching strategies on female adolescents’ knowledge of cervical cancer, health belief, and the intention of HPV vaccination.
Methods: A quasi-experimental pre-and post-test research design with two groups was used. A purposive sample of 200 female adolescents from a regional high school in Taipei were recruited. The research instruments used in this study included the structured demographic questionnaire, the scale of female adolescents’ knowledge of cervical cancer and health belief, and the acceptability scale. The innovative integrated teaching strategies were including: (1) the video CD provided by the Department of Health, Executive Yuan ROC (Taiwan) for the prevention of cervical cancer;(2) the teaching material’s Power Point made by authors according to their clinical experiences; and (3) Facebook used as a platform to facilitate students’ discussion and learning with the lecturer and classmates.
Results: GEE(Generalized estimating equations)was used to test the effectiveness of the innovative integrated teaching method were on promoting female adolescents’ knowledge of cervical cancer, health belief, and the intention of HPV vaccination.
Conclusions: The teaching method can be applied to Taiwan’s high school on promoting promoting women’s health.
MASCC-0089
The effect of halofuginone on radiation induced cardiovascular damage
M.C.,G.Y.,H.T.,H.E., C. Yavas 1
1Radiation Oncology, 2Thoracic Surgery, Konya Training and Research Hospital, 3Radiation Oncology, Selcuk University, 4Pathology, Necmettin Erbakan University, Konya, 5Anatomy, Hacettepe University, Ankara, Turkey
Purpose: We aimed to evaluate the effects of two different doses of Halofuginone (H) on radiation induced cardiovascular damage.
Methods: Sixty female rats were divided into 6 groups. Group (G) 1 was defined as control group. G2 was radiotherapy (RT) only group. Group 3 and 4 were 2.5 and 5 μg H groups respectively. Group 5 and 6 were RT plus 2.5 and 5 μg H groups respectively. A single dose of 12 Gy RT was given with 6 MV photon beams. H was applied intraperitoneally with daily doses, started immediately after administration radiotherapy and continued until the animals were sacrificed. Kruskal-Wallis and Mann–Whitney U tests were used for statistical analyses.
Results: The endocardial thickness of all study groups was significantly differed at 6th and 16th week of RT (p < 0.001 for each). The maximum thickness was observed in G2. There were significant differences between G2 and G5 (p < 0.001); G2 and G6 (p < 0.001) and; G5 and G6 (p = 0.001) regarding to endocardial thickness at 16th week of RT. There were significant differences within the study groups in terms of thoracic aorta fibrosis scores (p = 0.002). When the RT groups were compared there were significant differences between G2-G5, G2-G6 (p = 0,007 and = 0,002 respectively). There weren’t any difference between the control and H groups.
Conclusion: Our results suggested that H may improve radiation induced cardiovascular damage. The most prominent improvement was observed in 5 μg H + RT group at 16th week of RT.
MASCC-0090
Young adult cancer survivors: health behaviors and related discussions with healthcare providers
C. Berg 1
1Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
The increased incidence and decreased mortality of pediatric cancer has resulted in a growing population of survivors at risk for health problems and early mortality. We examined health behaviors and recent interactions with healthcare providers regarding health behaviors among 102 young adult survivors of pediatric cancers identified from medical records in the Southeastern US. We then conducted qualitative interviews with30 survivors and 20 healthcare providers. Our survey sample was on average22.22 (SD = 3.21) years old, 50 % female, and 19.4 % Black. In the past 30 days,14.0 % had smoked cigarettes, 11.1 % had used marijuana, and 59.2 % had used alcohol, with 22.2 % binge drank. Nearly a quarter (24.0 %) was sedentary. Predictors of engaging in positive health behaviors included greater health-related locus of control and social support (p’s < .05). Regarding interactions with healthcare providers during their last clinic visit, 59.0 %were asked about smoking, 56.0 % were asked about alcohol use, 46.5 % were asked about illicit drug use, 70.0 % were asked about nutrition, and 71.7 % were asked about physical activity. Qualitative interviews with young adults indicated that participants were rarely told about the specific need to engage in positive health behaviors for pediatric cancer survivors. Moreover, participants indicated that, while these factors were sometimes assessed, minimal intervention was delivered. Similarly, healthcare provider interviews indicated that, while many assessed tobacco use and weight-related factors, these assessments were not systematically done, and little support for interventions existed. Thus, increased resources to support healthcare providers in tertiary cancer prevention efforts are needed.
MASCC-0091
Tanshinone IIA could inhibit human hepatocellular carcinoma HA59T/VGH cells through ER stress in vitro
C.C. Su 1
1Surgery, Changhua Christian Hospital/China Medical University, Changhua, Taiwan R.O.C.
Introduction: Malignant tumor is the leading cause of death in Taiwan at recent 20 years. The 5-year survival rate is only 5 % in un-resectable patient. Looking for more effective medicine is necessary. DanShen (Salviae miltiorrhizae Radix) is a widely prescribed traditional herbal medicine for cardiovascular diseases. Tanshinone IIA (Tan-IIA) is one of the diterpene quinone extracted from DanShen.
Purpose: Our previous study showed that TanshinoneIIA (Tan-IIA) can inhibit human hepatic cancer cells HepJ5 through inducing endoplasmic reticulum stress (ER stress) in vivo and in vitro. For further evaluated the efficacy of Tan-IIA, the other human hepatic cancer cell line HA59T/VGH was used to study.
Material and method: The cytotoxicity of Tan-IIA in HA59T/VGH cells was measured by MTT assay. The ER stress related protein expressions (PERK, IRE1, Bip, PDI, Calnexin, Calreticulin, p38, ERK, TCTP and Mcl-1) in HA59T/VGH cells were treated with different concentrations of Tan-IIA for different durations by western blotting. Result: The results showed Tan-IIA could inhibit the HA59T/VGH cells with time and dose dependent. The concentrations of IC50 were 20.12, 16.66 and 10.30 μM for 24, 48 and 72 h, respectively. The protein expressions of ATF6, p38, Caspase-12, Caspase-9, Cleaved Caspase8 and Bax were up-regulated, but pERK, JNK, Bcl-xL, Bcl-2, Mcl-1 and TCTP were down-regulated when compare with control group.
Conclusion: Tan-IIA could inhibit the HA59T/VGH cells in vitro through inducing ER stress. These finding indicate that Tan-IIA could inhibit H.C.C through inducing ER stress in vitro.
MASCC-0092
Review on methods, risks & benefits of enteral nutrition in patients with head and neck cancers being treated with radiotherapy or chemotherapy
Z.v.,h.a.n.c.p. C. kereena 1
1Biotechnology, 2Botany & Microbiology, Acharya Nagarjuna University, Guntur, India
Background: Patients with head and neck cancer are at high risk of malnutrition due to dysphagia from the tumor and treatment. 40–50 % of head and neck cancer patients have a markedly impaired nutritional status at the time of their initial presentation. Despite difficulty with oral intake, these patients usually have a normal stomach and lower gastrointestinal tract. The preferred route of nutritional support for these patients is enteral nutrition. Two commonly used Methods for enteral feedings are nasoenteric and percutaneous endoscopic gastrostomy.
Objectives: To determine the Methods, risks and benefits of enteral feeding used in the nutritional management of patients with head and neck cancer receiving radiotherapy or Chemo radiotherapy using the clinical outcomes, nutritional status, quality of life and rates of complications.
Methods: Data were collected on demographics, diagnosis, types, nutritional status, management, benefits, risks and duration of enteral feeding.
Results: Malnutrition occurs frequently in head and neck cancer and may be overlooked in patients who do not look ‘underweight’ despite significant weight loss. Early and intensive nutrition intervention however has been shown to prevent or minimise nutritional deficits. Based on our findings, nutrition support should be indicated for cancer patients considering the potential effects to improve the quality of life.
Conclusions: Both baseline and treatment-induced malnutrition need to be addressed, and aggressive nutritional support can decrease the weight loss during the treatment and improve quality of life in patients with head and neck cancer.
MASCC-0093
Effect of soya and red kidney bean supplementation on lipid peroxidation and antioxidant levels of head and neck cancer patients
Z.V. C. kereena 1
1Biotechnology, 2Botany & Microbiology, Acharya Nagarjuna University, Guntur, India
Objectives: * To investigate whether supplementation with Soya and Red Kidney Bean recipe can improve biochemical status of enzymatic and non enzymatic antioxidants in head and neck cancer patients during treatment.
Methods and Materials: A total of 120 head and neck cancer patients were divided into three groups, each group consisting of 40patients Group A (GA) supplemented with Soy bean (SB), Group B (GB) supplemented with red kidney bean (RKB), Group C (GC) supplemented with SB & RKB combination. The serum was analyzed for enzymatic & non enzymatic antioxidants.
Results: There is no significant difference between cases before and after supplementation in SOD values. There is a significant difference between GA & GC cases and no significant difference in GB before and after supplementation in catalase values. There is a significant difference of MDA levels between the supplemental groups. There is a significant difference of vitamin A values in groups between GA & GC before and after supplementation and no significant difference in GB. The difference between GA, GB & GC for vitamin E values is significant. Vitamin C value is increased and significant in GA and GC and insignificant in GB. Soya bean showed positive antioxidant activity that may contribute to enhance the effect of antioxidant defense. Conclusion: The present study revealed that, Soya bean and red kidney bean, and combination of soy and red kidney bean supplementation has effectively reduced lipid peroxidation (LPO) and oxidative stress through increased antioxidant status in the head and neck cancer patients.
MASCC-0094
Home versus hospital cancer mortality (2006–2011) and palliative care
L.V. E. Vvedenskaia 1
1State Medical University, 2Regional Medical Statistics Center, Nizhny Novgorod, Russia
Objectives: Our aim was to examine the proportion of home versus hospital cancer mortality in a large Russian region in relation to demographic factors and to identify 5 year trends in home deaths from cancer.
Materials and Methods: The data on the place of death were derived from death registrations for all cancer deaths in the region between the years of 2006–2011.We examined 5 year trend in home and hospital cancer mortality for the whole region, for the city and for the rural area.
Results: Within this period the percentage of home deaths from all causes significantly increased: in the region from 55.67 % to 73.68 %, in rural areas from 60.10 % to 82.12 % and in the city from 30.32 % to 66.37 %. The number of deaths from cancer was consistently high and the rate of home cancer deaths was 85.0–89.0 % - 87.52 % on average for these years. Older people with cancer were more likely to die at home (85.16 % of all cancer deaths). Among all women and men died from cancer respectively 90.62 % and 79.60 % died at home. The proportion of homeland hospital deaths from cancer was 87.52 and 7.48 %, respectively.
Conclusions: High proportion of home cancer deaths is the result of reducing the hospital care supply and demonstrates low availability of inpatient palliative care. These findings today highlight the need for a palliative care service establishment for cancer patients and special attention should be paid to home care services and palliative care education of primarily care medical specialists.
MASCC-0095
Sense of coherence and symptom burden in women with breast cancer
M.B.,4.,5.,F.G.-J. E. Kenne Sarenmalm 1,2,3
1“Research and Development Centre, Skaraborg Hospital, Skövde, 2Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 3Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA, 4School of Life Sciences, University of Skövde, Skövde, 5Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden”
Introduction: Less is known about personal factors such as sense of coherence (SOC) that could interfere with the management of a variety of burdensome symptoms that challenge the patient from the moment of a breast cancer diagnosis through the treatment and its aftermath.
Objectives: To examine symptom burden and SOC in a cohort of 206 patients with breast cancer.
Methods: In this prospective and longitudinal study, the Memorial Symptom Assessment Scale, and SOC-scale were used to evaluate symptom burden and SOC at the diagnosis of primary or recurrent breast cancer, and 1 month, 3, and 6 months follow-ups. A two-step cluster analysis was used to categorize participants into clusters of individuals.
Results: The cluster analysis resulted in two clusters. Cluster I (61.1 %) included individuals who generally experienced fewer symptoms and lower levels of symptom burden. In contrast, cluster II (39.9 %) included individuals who experienced more symptoms and higher levels of symptom burden. There was a significant correlation between SOC and clusters, showing that cluster I had higher SOC mean level (mean SOC = 75 with 95 % CI 73–76) than cluster II (mean SOC = 69 with 95 % CI 67.5–71), p-value < 0.001.
Conclusion: Subgroups of patients are in need of targeted interventions. Patients, who reported high levels of symptom burden, differed distinctly in their symptom experience regarding symptom prevalence (frequency, severity and distress). These patients also differed in their coping capacities, and patients who reported lower SOC also experienced higher levels of symptom burden. Study findings suggest that SOC is an antecedent to symptom burden.
MASCC-0096
Percutaneous implantable port: infectious and thrombosis
R.d. E. noel-savina 1
1Chu Brest, Brest, 2Chu Brest, Brest, France
Taking care of patients in oncology needs safety venous access, as Percutaneous implantable port. These venous devices are sometimes responsible for serious adverse events. Infection and thrombosis are the two main complications that can occur early or be delayed. Clinical examination and especially, evaluation of the severity are very important keys to manage the patients. They both can lead to the ablation of the central venous device which is an option to keep always in mind. However, whatever the clinical situation is, the oncologic context such as life expectancy and the need for a venous access is also a data to counterbalance.
MASCC-0098
Delayed non invasive reduction of large bullae following thoracic irradiation
E. Noel-savina 1, R. Descourt1
1Chu-Brest, Brest, France
Abstract: Chest radiotherapy is a mainstay of management of thoracic oncology patients. Radiotherapy also injures non target tissues such as the lungs, coronary arteries, and esophagus and safe limits to the doses that can be delivered to tumors have been determined empirically. Patients afflicted with lung cancer due to smoking often have concomitant COPD which on occasion manifests as bullous emphysema. We describe a case and course of treatment of lung cancer found incidentally in a patient followed for severe pulmonary emphysema. Treatment consisted of radio-chemotherapy after induction chemotherapy. Three years after the end of anti-neoplastic treatment a follow-up CT scan revealed complete retraction a large emphysematous bulla that had been present prior to treatment.
MASCC-0099
Supporting advance care planning for patients through oncology professional education
A.B. E. Beddard-Huber 1
1Pain and Symptom Management/Palliative Care, 2Survivorship, BC Cancer Agency, Vancouver, BC, Canada
In Canada there is a growing aging population, and at the same time the incidence of cancer is also increasing. Advance care planning is a process of reflection and communication to identify the values, wishes and beliefs of an individual’s future healthcare plans, for if a time comes when they cannot speak for themselves.
In British Columbia, the Ministry of Health announced Advance Care Planning as new legislation on September 1, 2011. The legislation allows for a process that may result in an Advance Directive and/or Representation Agreement.
The BC Cancer Agency has implemented an Advance Care Planning education program for physicians, nurses and allied healthcare providers. Simultaneously the PRISM (Patient-Reported Information and Symptom Measurement) questionnaire was introduced which assesses multiple domains for all patients including their knowledge of advance care planning.
The education program includes both a compulsory introductory eLearning module and an advanced module consisting of in-person facilitated group sessions on enhancing communication skills. Staff will evaluate their knowledge and skills discussing advance care planning with patients and families. Along with staff performance, patient-reported outcomes will be analyzed. Through education our hope is to increase comfort and capacity to address advance care planning with patients and their families.
MASCC-0100
Octreotide prescribing patterns in the palliation of symptomatic inoperable malignant bowel obstruction patients at a single us academic hospital
E. Roeland 1, M. Hwang1, W. Mitchell1
1Medicine, University of California San Diego, La Jolla, CA, USA
Background: Medical management is the cornerstone of malignant bowel obstruction (MBO) therapy and includes antisecretory agents such as octreotide. Currently, little data exist regarding octreotide prescribing patterns in US academic hospitals in the palliation of inoperable MBO.
Methods: This retrospective chart review identified inpatients that received octreotide for palliation of inoperable MBO at a single academic US hospital (2008–2011). The prescribing primary service (medical vs. surgical), days to initiation, daily dose, cumulative dose, length of stay (LOS), and overall survival (OS) were analyzed. Multiple linear regression was used to assess if the association between dose and LOS was significant. Kaplan-Meier curves and log rank test were used to evaluate OS.
Results: A total of 767 patients received octreotide and 134 had a diagnosis of cancer. Thirty-seven (24 female, 13 male; mean age 56.7 years) had a radiographically confirmed inoperable MBO. The mean LOS was equivalent on both services (17 days). The mean octreotide dose was 201.2-μg on the medical service vs. 119-μg on the surgical service. Mean time to initiation was 8.4 days (7.9 medical vs. 8.8 surgical). Earlier initiation was associated with a shorter LOS (Spearman’s correlation = 0.76, p < 0.0001). No statistically significant association between average daily dose, cumulative dose, and OS was demonstrated.
Limitations: The data are retrospective from a single institution.
Conclusion: Early initiation of octreotide may lead to shorter LOS; the association remains after adjustment for patient age. Timing and dose of octreotide was not significantly associated with survival.
MASCC-0101
Octreotide prescribing patterns in the palliation of symptomatic inoperable malignant bowel obstruction patients at a single us academic hospital
E. Roeland 1, M. Hwang1, W. Mitchell1
1Medicine, University of California San Diego, La Jolla, CA, USA
Background: Medical management is the cornerstone of malignant bowel obstruction (MBO) therapy and includes antisecretory agents such as octreotide. Currently, little data exist regarding octreotide prescribing patterns in US academic hospitals in the palliation of inoperable MBO.
Methods: This retrospective chart review identified inpatients that received octreotide for palliation of inoperable MBO at a single academic US hospital (2008–2011). The prescribing primary service (medical vs. surgical), days to initiation, daily dose, cumulative dose, length of stay (LOS), and overall survival (OS) were analyzed. Multiple linear regression was used to assess if the association between dose and LOS was significant. Kaplan-Meier curves and log rank test were used to evaluate OS.
Results: A total of 767 patients received octreotide and 134 had a diagnosis of cancer. Thirty-seven (24 female, 13 male; mean age 56.7 years) had a radiographically confirmed inoperable MBO. The mean LOS was equivalent on both services (17 days). The mean octreotide dose was 201.2-μg on the medical service vs. 119-μg on the surgical service. Mean time to initiation was 8.4 days (7.9 medical vs. 8.8 surgical). Earlier initiation was associated with a shorter LOS (Spearman’s correlation = 0.76, p < 0.0001). No statistically significant association between average daily dose, cumulative dose, and OS was demonstrated.
Limitations: The data are retrospective from a single institution.
Conclusion: Early initiation of octreotide may lead to shorter LOS; the association remains after adjustment for patient age. Timing and dose of octreotide was not significantly associated with survival.
MASCC-0102
The prevalence of different HPV types in Turkish women with a normal pap smear
E.T. Demir 1
1Obstetric and gynecology, Private Yasam Hospital, Antalya, Turkey
Introduction: Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases in women and cause of cervical cancer and genital warts.
Objectives: We studied cervical smear samples of women from different regions of Turkey for investigate age-specific HPV prevalence, HPV type distribution, and the relationship between HPV positivity and several risk factors.
Methods: Between February 2010 and January 2011, 582 cervical smear samples from sexually active women aged between 15 and 68 years, admitted for regular examination at the departments of Obstetrics and Gynecology of five different centers were studied. Samples were analyzed for the presence of HPVby AmpliTaq. Positive samples were typed further for 37 different HPV genotypes by a line blot assay.
Results: HPV was positive in 17.9 % of the women. HPV prevalence was highest in the age group of 25–29 years (31.8 %), and decreased with increasing age. HPV 16 was the most common type (3.6 %) followed by type 6 (2.6 %) and type 45 (2.2 %). Types 11 and 18 were rare (0.6 % and 0.4 %, respectively). Among the risk factors, number of sexual partners and parity were positively correlated with HPV positivity.
Conclusions: HPV prevalence is frequent in Turkish women with normal cervical cytology contrary to the belief about the rarity of this virus in Islamic countries. The prevalence of HPV was 17.9 %. HPV positivity was reported between 12.8 % and 32.1 % in the recent regional studies performed in Turkey. Therefore, implementing the HPV vaccine into the national immunization program seems to be beneficial.
MASCC-0103
Communication the backbone of care to patients with life limiting illness
E.W. MUNGA 1
1Oncology, Aga Khan University Hospital Nairobi, Nairobi, Kenya
Introduction: Communication is the act of conveying information through exchange of thoughts, messages or information.
Communication to patients with life limiting illness is vital and rarely practiced by most physicians and health care providers during their contact with patients mainly due to time limitation or frequency of care to patients with the same illness hence they tend to overlook some very important aspects. During my clinical placement today 22/01/2013 I witnessed a patient breakdown in an outburst in tears 2 years later after a mastectomy done yet she was at the oncologist office having not yet accepted her diagnosis probably due to lack of understanding thoroughly to her nature of illness. Many times I have been approached by patients, relatives to explain further the discussed elements during their session with the physician.
Objective: Create the awareness to health care givers on the importance of thorougher communication to the patient, relatives of the patient who are suffering from a life limiting illness.
Methods:
Workshop forum
Conference
Practical example
Conclusion: Any time an individual is diagnosed with a life limiting illness e.g. cancer all the patient and relatives think about is death hence they are very sensitive and should be handled with the atmost care, the only people they can fully entrust their lives on for hope and improvement in condition is the health care givers hence they should be well trained and practise proper communication to patients with life limiting illness.
MASCC-0104
Outcomes of social support programs in brain cancer survivors in an Australian Community cohort
B.A.,I.R.,L.N.,3. F. Khan 1,2,3
1Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, 2School of Public Health and Preventive Medicine, Monash University, Clayton, 3Department of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, VIC, Australia
Introduction: Persons with primary brain tumour (BT) need continuing support to deal with their physical and psychosocial concerns after treatment.
Objectives: To evaluate the impact of social support programs on improving cancer related disability, neuro-cognitive dysfunction and enhancing participation in BT survivors.
Methods: Participants (n = 43) received an individualised social support program: face-to-face interview for education/counselling plus peer-support program or community education/counselling sessions. The assessments were at baseline (T1), 6-week (T2) and 6-month (T3) post-intervention using validated questionnaires: Depression Anxiety Stress Scale (DASS), Functional Independence Measure (FIM), Perceived Impact Problem Profile (PIPP), Cancer Rehabilitation Evaluation System–Short Form (CARES-SF), Cancer Survivor Unmet Needs Measure, McGill Quality of life questionnaire (MQOL) and Brief COPE.
Results: Participants’ mean age was 53 years (range 31–72 years), majority were female (72 %); median time since BT diagnosis was 2.3 years and almost half (47 %) had high grade tumours. At T2, participants reported higher emotional wellbeing (DASS ‘anxiety’ and ‘stress’ subscales, p < 0.05; FIM ‘cognition’ subscale, p < 0.01), improved function (FIM ‘motor’ subscale, p < 0.01) and higher QoL (CARES-SF ‘global’ score, p < 0.05; MQOL ‘physical symptom’ subscale, p < 0.05). At the T3 follow-up, most of these effects were maintained. The intervention effect for BT specific coping strategies emerged for the Brief COPE ‘self-distraction’ and ‘behavioural disengagement’ domains, (p < 0.05 for both). No adverse effects was reported.
Conclusion: Post-treatment social-support programs can improve physical and cognitive function, and enhance QoL of BT survivors. Social support programs need further evaluation and should be encouraged by clinicians within cancer rehabilitative services.
MASCC-0105
Health-state utilities in liver cirrhosis: a cross-sectional study
P. Adibi1, F. Abdi 1, L. Akbari1, L. Kahangi1
1Isfahan University of medical sciences, Isfahan, Iran
Objectives: Liver cirrhosis is a serious disease which can change many aspects of life of the patients and their family and effects society. Health-related quality of life (HRQL) in patients with cirrhosis can be evaluated using utility assessment techniques. We aimed to study the utility of cirrhosis from the point of view of the patients, their family, and their caretakers to find appropriate interventions, and training and counselling programmes to support patients.
Methods: In this cross-sectional study with a purposive sampling, 66 subjects constructed of 30 patients with decompensated cirrhosis (all of whom were on the liver transplant waiting list), 21 family caregiver and 15 caretakers, were included. We administered data collection in face to face interviews, through paper-based questionnaire. We also elicited utilities using formal approaches; standard gamble (SG), time trade-off (TTO), rating scale (RS) and willingness to pay(WTP).
Results: There were statistically significant differences in utilities assigned by three groups in all preference-based measures (P < 0.05). The total utility score of patients was lower in comparison to their family members and caretakers. The Spearman’s correlation coefficient showed that the three Methods of TTO, RS, and SG were convergent in the caretaker group and divergent in the patient group. The only significant correlations between utilities were between TTO and WTP in patient group and between TTO and RS in family caregiver group (P < 0.05).
Conclusions: utility assessments indicate that HRQL is compromised in patients with cirrhosis. These data can be the basis for cost-effectiveness analyses in studies of patients with chronic liver disease.
MASCC-0106
VEGF gene expression byzoledronic acid-treated keratinocytes and gingival fibroblasts submitted to lowlevel laser therapy
A.P.S.T.,C.K.,V.S.B. F.G. Basso 1
1State University of Campinas, 2Universidade Estadual Paulista, Araraquara, 3Universidade de São Paulo, São Carlos, Brazil
Bisphosphonate-induced osteonecrosis has been associated with the cytotoxicity of this drug on oral mucosa cells. Low-level laser therapy (LLLT) has been proposed as an adjuvant therapy for this condition. However, data about the effects of LLLT on bisphosphonate-treated cells are missing. The aim of this study was to evaluate the effects of LLLT on gene expression of vascular endothelial growth factor (VEGF) by gingival fibroblasts and keratinocytes previously treated with Zoledronic Acid (ZA). Cells were seeded using complete culturemedium (cDMEM) for 48 h. Then, cDMEM was replaced by free-serum culturemedium for 24 h, followed by addition of ZA (5 μM). After 48 h, fresh cDMEM was applied on the cells which were subjected to LLLT for 3 times (every 24 h) using a LaserTable (InGaAsP – 780 nm + −3 nm, 25 mW), at 0 (control group), 0.5, 1.5, 3, 5 and 7 J/cm2, associated or not to ZA. After 24 h of the last irradiation, gene expression of VEGF was assessed by Real Time PCR. Data were analyzed by Kruskal-Wallis and Mann-Whitney tests, considering 5 % of significance level. ZA caused significant decrease on VEGF expression by keratinocytes, but not for fibroblasts. LLLT increased VEGF expression by keratinocytes for all energy doses. For ZA-treated keratinocytes an increased VEGF expression was observed at 5 and 7 J/cm2. For gingival fibroblasts, all energy doses maintained a gene expression similar to control group. Specific parameters of LLLT could promote VEGF expression which may increase cell proliferation and accelerate oral mucosa healing.
MASCC-0107
Serum crosslinked-N-terminal telopeptide of type I collagen (NTX) has prognostic implications for patients with initial prostate carcinoma
M.L.W.,F.L.A.F.,M.S. F. Jablonka 1
1“Department of Oncology,) ABC Medical School, Department of Oncology - Santo André - Brazil, 2ABC Medical School, Department of Urology - Santo André - Brazil, ABC Medical School, Department of Urology - Santo André - Brazil, Santo André, Brazil”
Introduction: NTx is a metabolite of type I collagen, the main constituent of bone matrix, which has been previously shown to be increased in patients with bone metastasis. We wanted to evaluate NTx role in sample PCa patients at diagnosis when most of them have no overt bone involvement
Methods: Men with a histologic diagnosis of PCa at diagnosis were included. Serum Ntx was measured serially every 3 months up to 2 years by ELISA with the osteomark® NTx Serum kit
Results: Fifty-five PCa patients with a median age of 67 years (51 ? 83), 86 % with stage I, 4 % with stage II, 2 % with stage III and 10 % with stage IV were included. At entry median NTx was of 14.65 nM and it did not correlate with age, Gleason score or PSA but we observed a significant direct correlation with stage (p = 0.0094). With a median follow up of 23 months, at diagnosis, Seum Ntx correlated significantly with biochemical recurrence (p = 0.012) as did Gleason score (p = 0.00056), Stage (p = 0.012) and PSA (p < 0.0001). By multivariate analysis the only 2 independent variables significantly correlated with biochemical recurrence were PSA (p = 0.046) and NTx (p = 0.021).
Conclusion: We conclude that Serum Ntx has potential prognostic value in PCa patients at diagnosis and may improve current prognostic models. These data stress the potential prognostic importance of bone metabolism biomarkers for PCa patients even in the absence of overt bone involvement.
Supported by: FAPESP
MASCC-0108
Chemotherapy-induced neuropathy and its association with quality of life among 2–11 year colorectal cancer survivors; results from the population-based profiles registry
T.B.,V.L.,C.v.d.H., F. Mols 1,2
1Department of Medical Psychology, Tilburg University, Tilburg, 2Department of research, Comprehensive Cancer Centre South, Eindhoven, 3Department of internal medicine, Maxima Medical Centre, Veldhoven, The Netherlands
Aim: To gain insight into the prevalence and severity of chemotherapy-induced neuropathy and its influence on quality of life (QOL) among a population-based sample of CRC survivors, 2–11 years after diagnosis.
Methods: All currently alive individuals diagnosed with CRC between 2000 and 2009 as registered in the Dutch population-based Eindhoven Cancer Registry were eligible for participation. Eighty-three percent (n = 1648) of patients filled out the EORTC-QLQ-C30 and the EORTC-QLQ-CIPN20.
Results: The five neuropathy-related symptoms that bothered patients the most during the past week were erectile problems (42 % of men),trouble hearing (11.5 %), trouble opening a jars or bottles (11.1 %), tingling toes or feet (9.6 %), and trouble walking stairs or standing up (9.1 %). Also, patients who received oxaliplatin more often reported tingling (29 vs. 8.4 %;p = 0.001), numbness (17 vs. 5.2 %; p = 0.0047), and aching or burning pain (13 vs.5.9 %; p = 0.0293) in toes or feet compared to those not treated with chemotherapy and these symptoms were indeed significantly associated with oxaliplatin. Those with many neuropathy symptoms reported statistically significant and clinically relevant worse QOL scores on all subscales of the EORTC QLQ-C30.
Conclusion: 2–11 years after diagnosis of CRC, neuropathy-related symptoms are still reported, especially sensory symptoms in the lower extremities among those treated with oxaliplatin. Since neuropathy symptoms have a negative influence on health-related QOL, more attention should be paid to screen for these symptoms and to alleviate these symptoms in those that report them. Future studies should focus on possible ways to effectively prevent and treat chemotherapy-induced neuropathy.
MASCC-0109
MASCC palliative care leadership survey: palliative care program structure
N.C.,M.D.,P.M. F. Strasser 1
1Palliative Care Center, Cantonal Hospital St.Gallen, Switzerland Center, The Cleveland Clinic, Cantonal Hospital, St.Gallen, Switzerland, 2Shaare Zedek Medical Center, Jerusalem, Israel, 3Cleveland Clinic, Cleveland, OH, USA
Background: Palliative care (PC) program structure is evolving. This MASCC survey queried palliative care leaders regarding program structure.
Methods: A survey adapted from Hui et al(1) queried MASCC,ESMO and EAPC palliative care leaders through the MASCC website
Results: Sixty-two program leaders completed surveys. Most services included outpatient clinics (82 %), inpatient consultation (80 %) and inpatient palliative services (62 %). Programs were small, with 2 physician FTEs. Leaders were from Med Oncol, Int. Med, Anestheics and family medicine. All services incorporated inpatient and outpatient nursing. Paramedical staffing were: dieticians 66 %, pharmacist 46 %, psychologists 88 %, social workers 84 %. 75 % indicated had most referrals >4 weeks before death, 25 % reported referrals < i month prior to death. Symptoms were the most reason for referral to inpatient PC, other reasons incuded terminal, psychosocial care and respite. Average LOS 10 days and mortality 40 %. Half had weekly grand rounds; half rotations for medical oncology-hematology fellows.
Discussion: PC programs incorporate inpatient consultation services, outpatient clinic services and inpatient palliative care beds. A minority do not have acute palliative inpatient services. Staffing is low with small and constricted teams carrying very large clinical loads. Protected time for research and teaching is limited.
Conclusion: Characteristics and services anticipated from a palliative care service is still developing. Program development is hampered by inadequate allocation of resources to effectively staff interdisciplinary academic and clinical services.
1. Hui D, et al. Availability and integration of palliative care at US cancer centers. JAMA. 2010 Mar 17;303(11):1054–61.
MASCC-0110
Phenolic-rich extracts from orange peels (Citrussinensis) inhibit proteasome and metalloproteinase activities in metastatic (LoVo and loVo/ADR) cell lines
G.O.,S.p.,F.T. A.O. Ademosun 1
1Biochemistry Department, 2Department of Biochemistry, Federal University of Technology, Akure, Nigeria, 3Department of Life Sciences, University of Trieste, Trieste, Italy
This study sought to investigate the effect of free and bound phenolic extracts from orange (Citrus sinensis) peels on the activities of two contemporary anti-cancer therapeutic targets [proteasome and matrix metalloproteinase (MMP)]in metastatic (LoVo and LoVo/ADR) colon cancer cell lines. The free phenolics were extracted with 80 % acetone, while the bound phenolics were extracted from the alkaline and acid hydrolyzed residues with ethyl acetate. The results revealed that bound phenolic extracts had significantly (P < 0.05) higher inhibition of proteasome activity than free phenolics in extract-treated celllysates from the two cell lines. However, there was stronger inhibition of proteasome activity in LoVo/ADR cell lysates than the LoVo cell lysate. Furthermore, bound phenolics had significantly (P < 0.05) higher inhibition of proteasome activity in intact cells after 24 h treatment with the extracts. Free phenolics had a stronger dose-dependent inhibition of MMP activity in the cell lines, though there was no significant difference in the MMP inhibition by both free and bound phenolics in LoVo/ADR cells. Based on the ability of the phenolics to inhibit proteasome and MMP activity in both metastatic colon cancer cell lines, they could potentially be used in the management of the malignancy and in further anti-cancer drug development research. However, bound phenolics exhibited stronger inhibition of proteasome activity, while free phenolics showed stronger inhibition of MMP activities.
MASCC-0111
Patients with cancer in opioid treatment: renal function and symptoms/adverse effects
S.L. "G.P. Kurita 1,2, P.S.,4.,O.E.,L.C.,A. m3
1Section of Palliative Medicine, 2Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark, 3Stockholms Sjukhem Foundation and Dept. Oncology Pathology, Karolinska Institute, Stockholm, Sweden, 4Dept. Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 5National Institute of Public Health, University of Southern Denmark, 6Dept. Drug Design and Pharmacology, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark, 7The Royal Surrey County Hospital, NHS Foundation Trust, Guilford, UK, 8Dept. Oncology, St. Olavs Hospital, Trondheim University Hospital, 9Dept. Cancer Research and Molecular Biology, Faculty of Medicine Norwegian University of Science and Technology, 10European Palliative Care Research Centre, 11Dept. Intensive Care Medicine, St Olavs Hospital, Trondheim University Hospital, 12Dept. Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
Introduction: Renal impairment and the risk of toxicity due to accumulation of active metabolites or the opioid per se have raised the awareness of associations with symptoms/adverse effects.
Objective: To analyze if symptoms/adverse effects were associated with renal function in patients with cancer in opioid treatment.
Methods: Cross-sectional multicenter study (European Pharmacogenetic Opioid Study, 2005–2008). Inclusion criteria: cancer, age ≥18y and regular scheduled treatment for ≥3 days exclusively with only one of the most reported opioids (morphine/oxycodone/fentanyl) for moderate/severe cancer pain. 1154 patients were analyzed. Fatigue, nausea and vomiting, pain, loss of appetite, constipation and cognitive dysfunction were assessed (EORTC QLQ-C30). Renal function was analysed through Cockcroft-Gault formula (cutoffs: < 60 ml/min impaired function and < 30 ml/min severe impairment). Multiple logistic regressions were adjusted for age, sex, opioids and other medications.
Results: The three opioid groups had similar mean age (≈ 60y) and proportions between sexes. Renal impairment was observed in 48.0 % of morphine, 50.0 % oxycodone and 57.6 % fentanyl groups. Patients with mild and those with moderate/severe renal impairment in morphine treatment had higher odds of having severe constipation (OR: 2.16, 95 % CI: 1.37–3.39, P < 0.01) and loss of appetite (OR: 2.31, 95 % CI: 1.29–4.13, P = 0.02), respectively. No other significant associations.
Conclusion: Severe constipation and loss of appetite were the only symptoms/adverse effects associated with renal impairment in patients in morphine treatment. The use of oxycodone and fentanyl, in relation to the six symptoms studied, seems to be safe.
Study supported by EU Palliative Care Research Collaborative 6th Programme.
MASCC-0112
The effects of pain and opioids on cognitive function: an experimental model in cancer pain
L.P.M.,4.,T.A.,R.P. G.P. Kurita 1,2
1Section of Palliative Medicine, 2Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, 3Mech-Sense and Dept. Gastroenterology, 4Multidisciplinary Pain Centre, Aalborg Hospital, Aalborg, 5Dept. Drug Design and Pharmacology, Faculty of Health and Medical Sciences University of Copenhagen, 6Dept. Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Introduction: Pain and opioids are frequent in cancer, but their interference on patients’ cognitive function is not clear.
Objective: To study the effects of pain and opioids on sustained attention (SA).
Methods: Randomized, double-blind, placebo controlled, crossover study with 22 healthy Caucasian male volunteers (20–28y). SA, the ability to respond rapidly to external stimuli for an extend period of time, was evaluated by Continuous Reaction Times (CRT) software
Results were presented in percentiles. Three sessions for each participant were conducted. 1st session: CRT was tested under the influence of experimental pain of mild and moderate intensities induced by an electronic pneumatic tourniquet cuff; 2nd session: CRT was tested under the influence of placebo (saline) or remifentanil; 3rd session: CRT was tested under pain relief with remifentanil or placebo as well as breakthrough pain. Assessments occurred when the volunteers reported stable pain or 10 min after steady-state infusion. Study approved by Ethics Committee.
Results: 1st session: moderate and mild pain slowed CRT significantly from baseline, but no differences when comparing pain intensities. 2nd session: slower performance on remifentanil when compared to placebo (50th: P = 0.007; 90th: P < 0.001). 3rd session: decrease in pain intensity with remifentanil; placebo effect was minimal (P < 0.001); volunteers had slower CRT when receiving remifentanil (10th: P = 0.02; 50th and 90th: P < 0.001). When pain was increased (breakthrough pain), only a minor effect was noted prolonging CRT (50th: P = 0.045).
Conclusion: The results suggest that opioids interfere more with cognitive function than pain itself.
Study supported by The Danish Cancer Society.
MASCC-0113
Quality of life and symptoms in patients admitted to a comprehensive cancer centre
C.N.,N.S.,H.F.,U.B.T. “G.P. Kurita 1,2, mgren”4
1Section of Palliative Medicine, 2Multidisciplinary Pain Centre, 3Dept. Haematology, 4Dept. Oncology, Rigshospitalet, Copenhagen University Hospital, 5Dept. Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, 6Dept. Drug Design and Pharmacology, Faculty of Health and Medical Sciences University of Copenhagen, 7Dept. Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Introduction: Quality of life (QoL) and symptomatology in patients with malignancies admitted to comprehensive cancer centres are rarely investigated.
Objective: To investigate QoL and symptoms of inpatients at the departments of haematology and oncology.
Methods: Cross-sectional study, in which 124 cancer inpatients were assessed in May/June 2011. Inclusion criteria: Age ≥ 18 years. Exclusion criteria: absence at assessments, not able to complete the questionnaire or unwilling to give informed consent. Demographic data, diagnoses, symptoms, and health-related quality of life (EORTC QLQ-C30) were assessed. EORTC QLQ-C30 scores were converted into 0–100. Comparisons were analyzed using Wilcoxon two-sample, rank tests, and Fisher’s exact test.
Results: One hundred twenty-four patients were analysed, mean age = 59y (SD = 13.7), 42 % admitted to haematological department (14 % had allogenic stem cell transplantation), lung cancer was the most frequent diagnosis (15 %). Role functioning scale was the most severely impaired (mean score = 35), whereas cognitive function showed the best score (mean = 70). The mean overall QoL/global health score was 43 (SD = 25.6). The symptom burden of the inpatients was strikingly severe and especially fatigue and appetite loss were pronounced. Role and social functions appeared to be more impaired in oncology patients than in those admitted to haematology (P = 0.0372 and 0.0167, respectively). On the other hand, pain and constipation were more severely affected in haematology patients (P = 0.0194 and 0.0064, respectively).
Conclusions: Inpatients in a comprehensive cancer centre had low quality of life and a severe symptom burden. Fatigue and appetite loss were the most severe symptoms reported.
MASCC-0114
Further evidence supporting the association between a novel marker and delayed chemotherapy-induced vomiting (CIV)
A.C.,M.A.,G.H. G. Higa 1
1West Virginia University, 2West Virginia University Hospitals, Morgantown, WV, USA
Objective: The emetogenic classification of individual chemotherapy drugs is still the most important risk factor for developing CIV. Nonetheless, the classification system does not distinguish the phase in which emesis occurs following chemotherapy. We evaluated additional data to determine the association between a recently identified biomarker and delayed vomiting.
Methods: Pretreatment values of substance P (SP), the serotonin metabolite, 5-HIAA, and urine creatinine (Cr) were determined in 23 patients, all of who were treated with a high-dose melphalan-conditioning regimen. Emetic prophylaxis consisted of two daily doses of ondansetron and dexamethasone. The median duration of follow up was 116 h (range 72–144). Measured SP and 5-HIAA/Cr values and calculated ratios of SP to 5-HIAA/Cr were grouped according to the presence (+) or absence (-) of delayed vomiting. The data were analyzed by Wilcoxon’s Rank Sum Test.
Results: Delayed emesis occurred in seven patients, frequently beginning approximately 72 h after chemotherapy; the other 16 had no vomiting symptoms (although five of these patients complained of nausea). Neither neurotransmitter alone was associated with delayed symptoms as the between-group variance was not significantly different. However, the ratio of SP to 5-HIAA/Cr was significantly different between the (+), median 73.5 and (-), median 12, emesis groups, p = 0.0108.
Conclusions: The data obtained from this relatively homogenous cohort of patients are in accord with the recent publication and further suggest that the pretreatment SP to 5-HIAA/Cr ratio ≥70 is associated with the development of delayed vomiting. We are currently testing the predictability of this biomarker prospectively.
MASCC-0115
Endosponge treatment of anastomotic leaks
G. Milito 1, F. Cadeddu1
1General Surgery, Policlinico Tor Vergata Roma, Roma, Italy
Background: Endoluminal vacuum therapy using Endosponge is a new endoscopic method to treat extraperitoneal anastomotic leakage following low anterior resections or Hartmann’s stump leakage in the lesser pelvis, at an early stage and with no reintervention. This tool consists of an open-pored sponge inserted into the cavity. A drainage tube fixed to a low vacuum drainage system is then connected to the sponge through the anus. Thus, it is realized a continuous drainage of the secretion and the sponge cleans away the fibrin coatings, reduces in size and cleans the cavity.
Methods: Between January 2003 and December 2012, 12patients with anastomotic leakage following low anterior resection and neoadjuvant radiochemotherapy were treated with transrectal VAC. They were prospectively evaluated.
Results: Stapled straight end to end colorectal anastomoses were performed in all patients between 3 and 7 cm above the anal verge, a protective loop ileostomy was performed in every patients. The diagnosis of anastomotic leakage was performed after a median interval of 15 days (range 7–22) the median size of the cavity was 81 × 46 mm. Fluid collection was drained, percutaneosly in 10 cases, surgically in 2 patients who presented with a cavity of 80 × 55 mm and 85 × 50 respectively. The median duration of therapy was 35 days (range 16–51), with a 8–15 sponge exchanges for patient. Median healing time was 59 days (range 32–65). Nointraoperative complications were recorded. We found 5 cases of mild anal pain successfully treated medically
Conclusion: The Endosponge seems an effective minimally invasive procedure to treat extraperitoneal anastomotic leakage without reintervention reducing morbidity and mortality.
MASCC-0116
Dosimetric comparison of 3-dimensional conformal and field in field radiotherapy techniques for the adjuvant treatment of early stage endometrial cancer
C.Y.,H.A.,A.B.,G.C. G. Yavas 1
1Radiation Oncology, Selcuk University, 2Radiation Oncology, Konya Training and Research Hospital, 3Obstetrics and Gynecology, 4Medical Oncology, Selcuk University, Konya, Turkey
Background: We aimed to compare field-in-field radiotherapy (FIF) with conformal radiotherapy (CRT) in terms of dosimetric benefits for early stage endometrial cancer patients.
Materials and Methods: Ten consecutive early stage endometrial cancer patients who underwent adjuvant external beam radiotherapy were included to the study. For each patient, two different treatment plans were created. FIF and CRT plans were compared for doses in the planning target volume (PTV), the organ at risk (OAR) volume including rectum, bladder, bowel, bilateral femurs and bone marrow, the dose homogeneity index, and the monitor unit counts required for the treatment.
Results: The FIF technique significantly reduced the maximum dose of the PTV, rectum, bladder, bowel, left femur, right femur and bone marrow (p values were: < 0.001, 0.031, 0.003, < 0.001, 0.001, 0.001 and <0.001 respectively). When the OAR volumes irradiated with 30 and 45 Gy were compared, the results were in favor of the FIF technique. The volumes of rectum, bladder, bowel, left femur, right femur and bone marrow receiving more than the prescription dose of 45 Gy were significantly reduced with FIF technique (p values were 0.016, 0.039, 0.01, 0.04, 0.037 and 0.01 respectively). The dose homogeneity index (DHI) was significantly improved with FIF technique (p < 0.001).
Conclusions: FIF allowed more homogeneous dose distribution in the PTV and reduced the doses received by OAR. Considering the lower maximum doses in the OAR and PTV, FIF technique seems to be more advantageous than CRT during adjuvant radiotherapy for early stage endome
MASCC-0117
Comparison of two different radiotherapy techniques in stomach cancer patients who underwent concomitant chemoradiotherapy
C.Y.,G.C.,O.V.G.,H.A. G. Yavas 1
1Radiation Oncology, Selcuk University, 2Radiation Oncology, Konya Training and Research Hospital, 3Medical Oncology, Selcuk University, Konya, Turkey
Background: We aimed to compare four field radiotherapy technique (4 F) with three field technique with enhanced dynamic wedges (3F)in patients with stomach cancer who underwent postoperative chemo-radiotherapy.
Material and Methods: Ten stomach cancer patients who underwent total gastrectomy and lymph node dissection were included. For each patient, two different treatment plans were created for the tumor bed and regional lymph nodes. Three-field and 4F plans were compared for the doses in the planning target volume (PTV), the organ at risk (OAR) volumes (including kidneys, liver, spleen and spinal cord), the dose homogeneity index (DHI), and the monitor unit counts (MU) required for the treatment. Student-t test was used for statistical analysis.
Results: There was no difference between two techniques in terms of DHI (p:0.576). The mean dose received by the liver was significantly reduced with 3 F technique (p < 0.001);whereas the mean doses of the kidneys, spleen and spinal cord were decreased with 4Ftechnique (p values were 0.007, 0.021 and <0.001 respectively) (Table 1). The dose to %10, %30, %40 and %50 of the total liver volume were significantly reduced with 3Ftechnique (p values were 0.026, 0.009, 0.001 and <0.001 respectively). The MU counts required for the treatment was significantly lower with 4F technique (p < 0.001).
Conclusion: Four-field technique was found to be more advantageous than the 3F technique, with respect to the OAR, other than the liver, and monitor units required for treatment in patients with stomach cancer without any known liver disease.
MASCC-0118
Evaluation of doses in the Wernicke and Broca’s areas using two different radiotherapy techniques in patients with right frontal glioblastoma multiforme
C.Y.,H.A. G. Yavas 1
1Radiation Oncology, Selcuk University, 2Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey
Purpose: We aimed to evaluate the doses in the Broca’s and Wernicke’s areas using parallel opposed two field and three field technique in patients with right frontal glioblastoma multiforme (GBM).
Materials and Methods: The standard Rando phantom (Alderson) was used in this study for measuring of the Broca’s and Wernicke’s areas doses. Prior to the dose measurements, thermoluminesans dosimetry (TLD) were sorted into groups of equal sensitivity. The whole brain was scanned with 5 mm slice thickness and intervals. The PTV, Broca’s and Wernicke’s areas contours were delineated. Two different plans using parallel opposed field and parallel opposed fields and vertex field were compared. The doses measued in TLD and calculated by TPS were compared.
Results: The three field technique allowed the lower doses in the Broca’s and Wernickes’s areas when compared to two field technique. The doses calculated in the Broca’s area and Wernicke’s area were % 0.98 ± 0.03 and %0.09 ± 0.06 of the isocenter dose with three field and % 1.06 ± 0.04 and % 0.133 ± 0.03 of the isocenter dose with two field techniques respectively. When we compared the doses measured by TLD and calculated with TPS; for Broca’s area TLD was compatible with TPS % 3.23 and % 2.92 and for Wernicke’s area TLD was compatible with TPS % 4.12 ve % 3.95 in two field and three field techniques respectively.
Conclusion: In right frontal hemisphere tumors regarding to doses of Broca’s and Wernicke’s areas three field technique is superior.
MASCC-0119
How to decrease lens dose in patients with brain metastasis who underwent palliative whole brain radiotherapy?
C.Y.,H.A.,O.V.G.,O.A. G. Yavas 1
1Radiation Oncology, Selcuk University, 2Radiation Oncology, Konya Training and Research Hospital, 3Medical Oncology, Selcuk University, Konya, Turkey
Purpose: Palliative whole brain radiotherapy (WBRT) has been the standard treatment for brain metastases. Ionizing radiation is known to be one of the most potent cataractogenic agents. For a single treatment, the lowest cataractogenic dose was reported to be 2 Gy. We aimed to evaluate the lens, optic nerve and eye doses with two different radiotherapy techniques in patients with brain metastasis who undergone WBRT.
Materials and Methods: Ten patients with brain metastasis were included. The planned dose was 3,000 cGy in 10 fractions. For each patient, two different treatment plans were created for whole brain. Helmet-field (HF) (inferior border was the bottom of C2 vertebra) and classical technique with collimation (CT)(anterior border was defined as skin fall of, inferior border was the bottom of cranial base) were generated for all patients. Two techniques were compared with respect to the lens doses, the dose homogeneity index (DHI), and the monitor unit counts (MU) required for the treatment. Student-t test was used for statistical analysis.
Results: There was no difference between two techniques in terms of both DHI(p: 0.182) and MU counts (p: 0,167). The maximum and mean doses received by the right lens, left lens and right eye were significantly reduced with CT (p values for maximum doses 0,007, 0,012 and 0,010; for median doses 0,027, 0,046 and0,002 respectively).
Conclusion: CT with collimation was found to be more advantageous, with respect to the lens doses in addition the dose received by the right eye during WBRT.
MASCC-0120
Experience with adaptive IGRT at RGCI & RC, India
G.S. Wadhawan 1, M. Bhushan1
1Radiation Oncology, Rajiv Gandhi Cancer Institute& Research Centre, New Delhi, India
Purpose: Accurate image guided radiotherapy (IGRT) using MVCBCT is essential prerequisite to practice IMRT or 3DCRT and forms an important factor in the quality of actual radiation delivery. The capability of generating an entire volumetric MV-CBCT data set in a single-gantry rotation, allows 3D visualization of the tumor prior to the delivery of treatment and correlation with reference plan CT data. This permits corrections of shifts beyond an acceptable limit.
Material and Methods: Prior to treatment, 2D and/or CBCT on ARTISTE (M/s Siemens) was acquired and setup errors with reference to X, Y, Z were corrected online in 20 patients of breast, head & neck (H&N) and prostate. A second CBCT was acquired after the correction process and coordinates for daily set-up and images were obtained.
Results: A total number of 211 CBCT or 2D images were performed in 20 patients. The sites included—breast (n = 10), H&N (n = 6) and prostate (n = 4). Images were evaluated for 95, 58 and 58 fractions respectively. The shifts observed in X, Y and Z axes are summarized below: In addition, rotational errors were observed in 7 % (15/211 images). These include breast (2 %), H&N (1 %) and prostate (4 %), which were also corrected by IGRT.
Conclusion: Despite immobilization devices, shifts beyond the acceptable limits of 2 mm were observed during online CBCT or 2D with IGRT in breast (79.9 %), H&N (49.2 %) and prostate (96.6 %). IGRT permits detection and online corrections of these shifts which would have been otherwise gone unnoticed leading to dosimetric errors during radiation therapy
MASCC-0121
Peri-operative chemo-radio-therapy versus radiotherapy treatment in NSC-Lung cancer
H.L. Elayouty 1
1Cardiothoracic Surgery, Suez Canal University, Ismailia, Egypt
Objectives: A randomized prospective study designed to compare radio-therapy alone with concomitant chemo-radio-therapy in patients who have undergone lung-resection for non-small cell lung cancer. The goals are to assess the feasibility and reproducibility of the combined regimen and to evaluate its ability to improve local control and quality of life.
Methods: Forty two patients (25 men, 17 women) had. stage II or IIIA disease,. Their median age was 54 years (range 33–63 years.). All had experienced no weight loss. Group A (21 patients): Patients with marginally resectable disease received two cycles of chemotherapy pre-operatively and a maximum of four cycles post-operatively. Patients with initially resectable tumors received four cycles postoperatively. Radiation therapy was begun on day 1 or 2 concomitantly with chemotherapy. Group B (21 patients) received radiotherapy alone.
Results During chemo-radiotherapy two developed toxicity and were shifted to group B. Eighteen out of 19 remain alive at the end of chemo-radio-therapy and recorded median :survival of 51.3 months compared with 16 out of 23 in group B who had median :survival of 42.9 months (p = 0.001). Conclusion: Concomitant chemo-radio-therapy is feasible and reproducible as adjuvant treatment in non small- cell lung cancer.
MASCC-0122
Genome-wide association study, carcinogenesis, and the possibility to create drugs
H.-Y. Xu 1
1Department of Emergency Medicine, Clinical Institute, Clinical Institute, Workers Hospital of Nanyang Textile Corporation, Nanyang City, Henan Province, Nanyang City, China
The genome-wide association study has emerged as a powerful and successful tool to identify common disease alleles, including cancer. These research projects and results have further proved that genome-wide association and genome-wide gene-environment interaction of cancer has more than two susceptibility loci of genome association. Which have further supported the new theory of carcinogenesis, the carcinogenesis theory of gene multiple hits.
The gene susceptibility loci of cancer may be caused by environmental agents, chronic infection, et al., including alcohol drinking. The risk factors attributable fraction of susceptibility loci should be calculated. We should create the new way to prevent the cancer from the view points of the genetic etiology of multiple hits and susceptibility loci.
Preventing cancer caused by environmental agents and other risk factors of cancer could result in possible creation of drugs when they are the highest risk factors of cancer attributable fraction of susceptibility loci.
MASCC-0123
Washing the foodstuffs of seeds, promoting the health level, a proposal for legislation of national standard of food safety
H.-Y. Xu 1
1Department of Emergency Medicine, Clinical Institute, Clinical Institute, Workers Hospital of Nanyang Textile Corporation, Nanyang City, Henan Province, Nanyang City, China
Background and objectives: As the bad situation of pollution in the foodstuffs of seeds in and outside of China is more and more serious and critical. There is not any concrete regulation or national process standard of food safety to eliminate or reduce the pollution in the foodstuffs of seeds round the world. It is imperative to eliminate the danger pollution factors in the foodstuffs of seeds for promoting people’ health around the world before the pollution factors are eat and harm the human-being.
Methods: Summarize the bad situation of pollution in the foodstuffs of seeds around the world.
Results: Washing the foodstuffs of seeds to eliminate the danger pollution factors in the foodstuffs of seeds, promoting the health level, and a proposal for legislation of national standard of food safety was created.
Conclusions: The proposal for washing the foodstuffs of seeds, promoting the health level, a legislation of national standard of food safety was suggested to promote health food and health people around the world.
MASCC-0124
Revision of law of environmental protection to promote health and development of mankind, the strategy
H.-Y. Xu 1
1Department of Emergency Medicine, Clinical Institute, Clinical Institute, Workers Hospital of Nanyang Textile Corporation, Nanyang City, Henan Province, Nanyang City, China
Objective: In order to protect the health of mankind from worse environmental harming, the law must be addressed.
Methods: Summarize the bad conditions of environmental situation and the environmental protection law in China. The strategies to revise the law of environmental protection in China are suggested.
Results: The first proposal is to concretely build the law for campaign of educational, propagandistic publicity of environmental protection and health for all people. The second proposal is to create the law for building the department of prevention and treatment for environmental medicine in all the hospitals and health organizations. The third proposal is to create the law for building the national system to monitor, report and forecast the environmental situation like what the weather forecasting system does. The fourth proposal is to create the law for building the administration departments of environmental protection at the grass levels of villages. The fifth proposal is to create the law for building the administration departments of environmental protection at any unit. The sixth proposal is to create the law for building the administration departments of environmental protection for foreign units or investment in China. The six kinds of lawmaking proposals were suggested can be also for promotion of environmental protection and health all over the world.
Conclusion: The research is very good for environmental protection and health promotion if the proposals are adapted into laws and regulations by China. The proposals are much too worthwhile to be referenced by all related people and countries around the world.
MASCC-0125
Health policy needed immediately to administrate the patient ward of respiratory system far from pollution circle and polluted streets
H.-Y. Xu 1
1Department of Emergency Medicine, Clinical Institute, Clinical Institute, Workers Hospital of Nanyang Textile Corporation, Nanyang City, Henan Province, Nanyang City, China
Objective: In order to promote and enhance the results of treatment and prevention for respiratory diseases in the hospital, this research project has been done.
Methods: Summarizing the problems and shortcomings of the patient wards of respiratory system presented at some hospitals and the pollution bad situation in China. Which the patient wards of respiratory system are under pollution circle and polluted street. The environmental pollution can cause respiratory diseases. And so arouses the creation of proposals for curing them.
Results: There are 6 points of proposals have been suggested. Which the main principles are that the patient ward of respiratory system should be far from pollution circle and polluted street.
Conclusion: At the modern ecological environment or the present environmental pollution situation, the pollution can cause diseases. Especially the respiratory patients are more easy to suffering from the environmental pollution by the streets. In order to promote and enhance the results of treatment and prevention for respiratory diseases in the hospital, the proposals that the patient ward of respiratory system should be far from pollution circle and polluted street and its concrete 6 application points are suggested which are very useful. It is much too imperative to create the law or regulations of health policy according to the proposals to apply them at once and well. The proposals are worth to be referenced by China and foreign countries.
MASCC-0126
Recognizing and recording the tone of people’ and others’ language, to promote development of work, life and science, and promote administration of social security
H.-Y. Xu 1
1Department of Emergency Medicine, Clinical Institute, Clinical Institute, Workers Hospital of Nanyang Textile Corporation, Nanyang City, Henan Province, Nanyang City, China
Objective: In this paper, the author uses the modern information and computer science to solve the present problem which the computer has not recorded all the tone and the words at the same time when the people are speaking.
Method: Summarize the modern information and computer science. Create the new breakthroughs project of computer science.
Results: The author outlines, transmit the recognizing into computer with their tone and characters and store the tone and characters of the speaking information. Therefore, any people’s speaking could be recorded into the computer with their characters of tone at the same time.
Conclusion: This is a breakthrough creation project for information and computer science. The life, work, and security and other active things of mankind could be more easy and wonderful. There were much too harvesting in economical and practical gaining. And there were also much too harvesting in social development. So there are lots of chances waiting us to make her true in the near future when the paper of the new breakthrough creation for information and computer science is published and accepted for application. Because recognizing and recording the tone of people’ language and his characters of the speaking information are different from each other. Like the fingerprint, the public security and other practical gaining could be great.
The breakthrough technology project of computer science can be used for recognizing and recording the tone of language of other biology, and their characters of the speaking or voice information, apart from people’.
MASCC-0127
Outcome of palliative chemotherapy in recurrent head and neck cancer
T.M.,M.A.,A.M.,R.H. H. Iqbal 1
1Surgical Oncology, 2Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
Purpose: The aim of this retrospective study is to evaluate the outcome of palliative chemotherapy in recurrent head and neck cancer in our institution.
Methods: Between September 2005 and August 2009, 146 patients received palliative chemotherapy either due to recurrent or persistent disease after completion of radical treatment. With a median age of 48 years (range 18–70), there were 111 (76 %) males and 35 (24 %) females. Site distribution; Oral cavity 100 (68 %), Hypopharynx 3 (2 %), Nasopharynx 14 (10 %), Larynx 7 (5 %), Oropharynx 3 (2 %), Paranasal sinuses 14 (10 %) and others 5 (1 %). Patterns of recurrence included: local 65 (44 %), regional 32 (23 %), distant 8 (5 %) and persistent disease 41 (28 %) respectively. 106 (73 %) of patients already received cisplatin based chemotherapy either in neo-adjuvant or concurrent chemoradiation setting. Various first line palliative chemotherapeutic agents given included: Methotraxate (10 mg x 4 days/week PO or 40 mg/m2 weekly I/V), Cyclophosphamide (50 mg OD PO), Paclitaxel (80 mg/m2 weekly I/V) and Cisplatin (75 mg/m2 3 weekly I/V) respectively.
Results: One hundred sixteen patients (79 %) received Methotraxate, 19 (13 %) Cyclophosphamide, 4 (3 %) Paclitaxel, and 7 (5 %) received Cisplatin. A total of 9 (6 %) patients had toxicity related hospital admissions. One patient died due to drug toxicity. Mean time to progression; Methotrexate 7, Cyclophosphamide 9, Paclitaxel 10 and Cisplatin 7.8 months respectively. Overall mean time to progression was 7.8 months (range 1–39).
Conclusions: The disease control in our study is comparable with already published literature but very little has been gained in slowing the progression of the disease.
MASCC-0128
Acute management of neutropenic sepsis: a 12 month prospective analysis of 320 acute admissions in a large cancer centre in the UK
H. Mason 1, M. Afshar1, A. Young1
1Oncology, St James University Hospital, Leeds, UK
Introduction: Febrile neutropenia (FN) secondary to chemotherapy is well reported, but lacks consensus on management. Few prospective studies report ratios of suspected FN to confirmed FN, and their subsequent management. These data have fiscal implications for healthcare resource allocation, and patient management.
Objectives: To evaluate acute management of FN in a tertiary centre over a 12 month period, compare current practice against guidelines, and review subsequent outcomes.
Method: Data were collected from suspected FN patients (admitted 2011–2012). Variables analysed included chemotherapy regimen, neutropenic status, antibiotic prescription and reasons for deviation from guidelines.
Fifty admissions were sub-analysed retrospectively. Appropriateness of cultures, imaging, prescription/timing of antibiotics and MASCC scores were reviewed and statistical analyses performed. Treatment was compared to current guidelines.
Results: Of 319 patients admitted with suspected FN, 117(37 %) patients had confirmed FN. Mean time to administration of antibiotics from first contact was 130 min (range = 5–510 mins), and 48 min from arrival to the ward (range = 5–420 mins).
Of 50 patients sub-analysed, 4(8 %) received inappropriate antibiotics, 45(90 %) patients had blood cultures sent, not always adhering to local guidelines. CXR’s were requested in 47/50, with 11(22 %) considered unnecessary.
MASCC scores were calculated in 5/50(10 %) patients. Retrospectively calculated scores found mean duration of antibiotics in high risk patients was 8.3 days. 50 % of low risk patients met criteria to switch to oral antibiotics at 48 h; 30 % of these continued IV antibiotics longer than deemed clinically necessary.
Conclusion: FN management is variable in our centre. The development of a clerking proforma, incorporating national guidelines, aims to improve standards.
MASCC-0129
Hemophagocytosis/hyperferritinemia syndrome in children with acute monoblastic leukemia
H. Lackner 1, V. Strenger1, P. Sovinz1, W. Schwinger1, M. Seidel1, M. Benesch1, C. Urban1
1Medical University Graz, Graz, Austria
Background: Intensification of antileukemic treatment and progress in supportive management have improved the survival rates of children with acute myeloid leukemia (AML). However, mobidity and early mortality in these patients are still very high, especially in children with M5 subtypes of AML.
Patients: Over the last 2 decades we observed an inflammatory syndrome with fever, elevation of C-reactive protein (CRP), hyperferritinemia and hemophagocytosis in absence of any proven infections in 3 of 10 children treated for AML FAB M5. They were treated according the international protocol AML-BFM 2004. During prolonged aplasia following the first block of chemotherapy, all children developed high fever and elevation of CRP not responding to broad spectrum antibiotics and antimycotics. No infectious agents could be identified, serum levels of ferritin and soluble interleukin 2 (s-IL2) were extremely elevated, and hemophagocytosis was identified in bone marrow. Treatment with dexamethasone (DXM) was initiated, and the children immediately responded to DXM, however, the same syndrome was observed again after the second and third block of chemotherapy.
Discussion: Supportive care of children treated for AML is still an enormous challenge. Inflammatory syndromes complicating the management of these children have been reported after application of chemotherapy and due to hyperleukocytosis. Our patients clinically showed the symptoms of an inflammatory syndrome without evidence of acute infections and, additionally, fulfilled the criteria for hemophagocytosis. The co-incidence of AML FAB M5 with HLH might be explained by cytokines released from the monoblastic leukemic cells itself. Treating physicians should be aware of this possible complication.
MASCC-0130
The impact of dose calculation algorithms for peripheral dose distributions of enhanced dynamic and physical wedges
G.Y.,C.Y. H. Acar 1
1Radiation Oncology, Selcuk University, 2Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey
Background: The peripheral dose is important when anatomical structures with very low dose tolerances are involved. In this study, the two available calculation algorithms of the Varian Eclipse 8.6 treatment planning system(TPS), the anisotropic analytic algorithm(AAA) and pencil-beam convolution(PBC) was used to compare measured and calculated peripheral dose distribution of physical wedged(PW) and enhanced dynamic wedged fields(EDW).
Methods: Peripheral dose measurements were carried out for 6 and 18 MV photons using a 0.6 cc Farmer-type ionization chamber in the slab phantom. Measurements were performed using 15°, 30°, 45° and 60° PW and EDW for three different field sizes at dmax and up to a maximum distance of 50 cm beyond the field edges. Peripheral dose was further computed using two different algorithms of a TPS. The measured and calculated datas were then compared to find which algorithm calculates peripheral dose distribution more accurately.
Results: Both algorithms from the TPS adequately model the peripheral dose distribution up to 45°. For large field sizes with 60° EDW, the largest deviation between calculated and measured dose distribution is less than 3.5 % using the AAA, but can increase up to 9.7 % of the distribution using PBC.
Conclusion: The AAA models wedged peripheral dose distributions more accurately than the PBC does for all studied conditions; the differences between the algorithms are more significant for large wedge angles and large field sizes. It must be emphasized that the use of PBC for planning large-field treatments with 60° EDW could lead to inaccuracies of clinical significance.
MASCC-0131
Ovarian masses in children and adolescents in China: analysis of 203 cases
H. Liu 1, G. Shi1
1Department of Obstetric and Gynecologic, West China Second University Hospital, Sichuan University, Chengdu, China
Objective: The true incidence of ovarian tumors in children is unknown. Few studies beyond case reports and case series have been published concerning pediatric ovarian tumors. Herein we review a large number of ovarian tumor cases.
Methods: The charts of 203 patients who presented with adnexal masses were reviewed.
Results: The patient’s ranged in age from 2 to 18 years (mean = 15.6 years), with 30 being premenarchal (14.8 %). The main complaint was abdominal pain or abdominal distension in 117 patients (57.7 %). A high AFP level in a pre-pubic girl with an adnexal mass is indicative of a malignant ovarian tumor. The 214 adnexal masses (11 patients had bilateral cysts) consisted of benign tumorous oophoropathy (107 masses, 50.0 %), borderline and malignant tumors (29 masses, 13.6 %), and nontumorous oophoropathy (78 masses, 36.5 %). Of the 136 neoplasia, germ cell tumors accounted for 71.5 %. Surgical intervention was performed in 98.5 % of cases. There were decreased blood loss, surgery duration and days of hospitalization with the laparoscopic procedure when compared with an open surgery.
Conclusions: The incidence of ovarian tumor increases with age, especially in patients older than 14 years. Abdominal pain is the most common complaint in young patients with adnexal masses. AFP is the most useful diagnostic biomarker of ovarian tumors in young females. Laparoscopic resection of ovarian cysts is a safe operative approach
MASCC-0132
The beneficial effect of Zusanli (stomach-36) acupressure on postoperative gastrointestinal function of colorectal cancer patients
H.L.C.,S.J.M.,P.F.L.,H.H.-C. H.L. Chou 1
1Nursing, Far Eastern Memorial Hospital & Oriental Institute of Technology, New Taipei City, 2Nursing, 3Surgery, Cathay General Hospital, Taipei, Taiwan R.O.C.
Introduction: A loss of bowel peristalsis is common after abdominal surgery, and can lead to abdominal distention, pain, reduced bowel sounds, emesis, or other discomforts. If patients do not have bowel sounds or bowel movement by the fourth day postoperation, they are considered to be at risk for postoperative ileus (POI).
Objectives: To evaluate the effectiveness of Zusanli (ST-36) acupressure on recovery of postoperative gastrointestinal function in colorectal cancer patients.
Methods: Sixty colorectal cancer patients who had undergone abdominal surgery. Patients were randomly assigned to two groups: ST-36 acupressure group (n = 30) and a sham acupressure group (n = 30). Patients in the experimental group received acupressure procedure in a 3-minute cycle performed3 times per day during the 5 days after surgery. Generalized Estimating Equations were used to estimate longitudinal effects of the two groups of patients.
Results: Patients who received acupressure had significantly earlier flatus passage and time to liquid intake as compared to patients in the control group. Other main variables, including the first time to solid intake and defecation, did not show significant difference between the two groups. The GEE model revealed that all patients had increasing bowel sounds over time, and the experimental group had higher improvement than the control group of bowel motility within the period of 2–3 days postoperatively.
Conclusions: ST-36 acupressure was able to shorten the time to first flatus passage, oral liquid intake, and improve gastrointestinal function in patients after abdominal surgery.
MASCC-0133
Fatigue in breast cancer patients undergoing curative radiatherapy treatment
I. Hartmann 1, C. Lethan1, E. Dalvad1, U. Koehler1, L. Sigaard1, K. Dieperink1
1Department of Oncology. Odense University Hospital, Odense, Denmark
Background: Breast cancer patients undergoing radiotherapy often suffer from fatigue. Effectiveness of exercise in groups in the management of fatigue has been shown in studies. However, there is a lack of evidence to whether personal interview and motivation to home based exercise will have the same effect.
Objective: To investigate whether a personal interview combined with an easy accessible self-elected individual type of exercise improve the patients self-evaluated level of fatigue.
Methods: Breast cancer patients (n = 78) were randomized to intervention or control. All patients were previously treated with either lumpectomy or mastectomy followed by chemotherapy, and was undergoing curative radiotherapy.
Within 5 days after starting radiotherapy, all patients were baseline scored on a 1–5 scale, with 5 representing the maximum score for fatigue. In the intervention group individual agreements on type of exercise were made, followed by personal interviews after 14 and 30 days. Final score was conducted by telephone after 60 days. The control group achieved personal interviews but no motivation to exercise.
Results were descriptively analysed and differences in groups tested by non-parametric Mann–Whitney test.
Results: Average age was 50 years (21–78). A number of 60 patients were randomized to the intervention group and 18 patients to the control group. Average improvement was 1.32 in score in intervention group whereas average improvement in score was 0.67 (p = .004) in control group.
Conclusion: An intervention with motivation to exercise in patients suffering from fatigue have significant effect on patients self evaluated level of fatigue.
MASCC-0134
Psychosocial distress development among young Slovak early-stage breast cancer patients surviving 3 years after early breast—conserving surgery
J.S.,I.K.,V.B.,V.K. V. Bencova 1
1Ist Clinic of Oncology, Faculty of Health and Medical Sciences University of Copenhagen Medicine, Comenius University, 2Ist Clinic of Oncology, Faculty of Medicine, Comenius University Bratislava, 3Ist. Clinic of Oncology, Faculty of Health and Medical Sciences University of Copenhagen Medicine, Comenius University Comenius University Bratislava, 4Department of Mammology, St. Elisabeth Cancer Institute, 5Faculty of Public Health, St. Elisabeth University of Health and Social Sciences, Bratislava, Slovak Republic
Objective: The objective of this study was to evaluate the age-related long-term psychosocial morbidity development and health-related quality of life outcomes among disease-free outdoor breast cancer patients previously treated for early-stage breast cancer by breast conserving surgery (BCS).
Methods: One hundred twenty-eight eligible disease-free breast cancer patients previously treated by BCS or modified radical mastectomy (MRM) and surviving without tumor recurrence and any serious comorbidity were recruted for the survey. The assessment of the psychosocial morbidity was conducted 1 and 3 years after surgery using the standardised EORTC Quality of Life QLQ C3O.3 questionaire, the breast cancer specific module QLQ BR-23 and the Hospital Anxiety and Depression Scale (HADS) questionaire.
Results: Scoring cancer-specific quality of life and psychosocial morbidity over the time between 1 and 3 years after surgery have shown that nearly 70 % of breast cancer patients treated by BCS were surviving without profound impact onto psychosocial status and health-related quality of life. However, even 3 years after BCS, more than 30 % patients were suffering from emotional distress due to increasing anxiosity, nervousness, uncertainty and fear about future. Patients with higher psychosocial burden mainly belong to younger population aging between 35 and 50 years. The low quality of life and increased psychosocial distress seems not to be related to physical symptoms caused by cancer treatment.
Conclusion: The need to pay more attention to psychosocial care of outdoor breast cancer survivors being under long-term clinical control and suffering from emotional distress after each clinical check-up is emphasized.
MASCC-0135
The management of skin toxicity during erlotinib in advanced non-small cell lung cancer: how much does it cost?
M.M. J. Giuliani 1
1Palliative Care Unit - Mater Salutis Hospital, U.L.S.S. 21, Legnago (VR), 2Clinical Oncology Unit - St. Anna University Hospital, Ferrara, Italy
Objectives: The aim of this study is to estimate the costs for the foreseesable management of skintoxicity in patients treated with erlotinib for NSCLC in order to value the direct medical economical impact. No economical assessment has been published for management of skin toxicity during erlotinib for NSCLC.
Materials and Methods: We retrospectively analyzed all consecutive patients with NSCLC treated with erlotinib at Clinical Oncology Unit of University-Hospital of Ferrara (Italy) from June 2007 to May 2011. We evaluated severity and median duration of skin rash for each grade and we identified costs for the different therapeutic interventions.
Results: We evaluated 25 patients. Median time follow-up was 18.65 months (range5.69–88.36). At last follow-up 7 patients (28.0 %) were alive with metastases and 18 patients (72.0 %) were deceased. Nineteen patients(76.0 %) developed skin toxicities: 2 patients (10.5 %) mild rash, 11 patients(57.9 %) moderate rash and 6 patients (31.6 %) severe rash; no case of hospitalization was observed. Median duration of mild rash was 97 days (costs-range: 157.7–452.2 €), median duration of moderate rash was 89 days (costs-range: 438.7–1035.6 €) and median duration of severe rash was 34 days (costs-range: 460.3–1057.2 €).
Conclusions: Our experience showed that management of skin toxicities related to erlotinib is not so expensive, especially for low grade; therefore we also recommended to give particularly attention to low grade of toxicities for reducing progression to high grade and consequent risk of hospitalization, that really impact on costs.
MASCC-0136
Pain control of cancer patients in homecare setting: which role for the palliative homecare specialist?
J. Giuliani 1
1Palliative Care Unit - Mater Salutis Hospital, U.L.S.S. 21, Legnago (VR), Italy
Background: The aim of this study was to evaluate the pain management and control before and after intervention of a palliative home care specialist (second subgroup) compared with patients managed only by the General Practitioner (first sbgroup).
Materials and Methods: A retrospective analysis of homecare patients with advanced cancer disease and with an issue of pain management, in treatment with strong opioids, referred to our Local Unit Social Health was examined by 01/08/2012 to 31/10/2012.
Results: Eighteen patients were evaluated: 9 patients (50.0 %) were directly managed by a palliative home care specialist and 9 patients (50.0 %) were managed only by the General Practitioner. Generally, in the second subgroup ECOG PS was worse and patients had a worst pain control at the beginning of taking care in comparison with first subgroup both for frequency (3 vs 2) and intensity (3 vs 4). Considering second subgroup, after the intervention of the palliative homecare specialist, there was a decrease of both frequency (3 vs 2) and intensity (4 vs 2) of pain. Instead, in first subgroup, there was a substantial stationarity of frequency(2 vs 2) and a less decreasing in intensity of pain (3 vs 2) after the intervention of the General Practitioner compared with the intervention of the palliative homecare specialist.
Conclusions: Finally we can consider how useful the intervention of the palliative homecare specialist and we encourage the hope intervention in all cases where pain control is particularly difficult.
MASCC-0137
Which clinical impact of intravenous midline catheter usage in homecare patients?
J. Giuliani 1, L. Andreetta1
1Palliative Care Unit, Mater Salutis Hospital- U.L.S.S. 21, Legnago (VR), Italy
Introduction: Midline catheters are peripheral intravascular catheters commonly used in the home health care setting. The aim of this study is to evaluate the complications and durations of use of midline catheters in daily clinical practice referring to home care patients follow at our Local Unit Social Health. No results like the above have been published until now.
Materials and Methods: A retrospective analysis of homecare patients with positioning of midline at home referred to our Local Unit Social Health (catchment area of approximately 150,000 inhabitants) was examined by 01/09/2011 to 15/10/2012.
Results: Among 390 homecare patients with ongoing periodic medical care, 92 patients (23.6 %) have placed a midline at home. At last follow-up, 70 patients (76.1 %) were alive and 22 patients (23.9 %) were deceased. Thirty-six patients (39.1 %) had advanced cancer in best supportive care (BSC). In 7 patients (7.6 %) the midline has been removed: in 4 cases (4.3 %) for obstruction, in 1 (1.1 %) to damage of the catheter and in 2 (2.2 %) has marched accidentally. In any case, there were infectious complications. The median duration of catheter was 85 days (range 1–365 days). There was no statistical significance concerning a possible relationship between the positioning seat of the midline with the onset of complications and the presence of an advanced cancer with the onset of complications.
Conclusions: Midline catheters fill an important niche in the homecare patients. Better prospective studies of sufficient size to address all potential risk factors, insertion technique and details of follow-up care are needed.
MASCC-0138
Patient satisfaction with quality of life is a more powerful predictor of survival than symptom burden and functioning in advanced non-small cell lung cancer patients
D.G.,C.G.L.,R.D.L.,M.A.D. J.F. Grutsch 1
1Cancer Treatment Centers of America, Schaumburg, IL, 2Oncology Analytics Corporation, Plantation, FL, USA
Introduction: While there are data linking specific quality of life (QoL) symptom and functioning domains to improved survival, there are no data investigating the prognostic power of patient satisfaction with QoL in cancer.
Objectives: We investigated the relative prognostic power of these approaches in patients with advanced non-small cell lung cancer(NSCLC) participating in a clinical trial of concurrent chronotherapy with melatonin.
Methods:84 NSCLC patients (65 males, 19 females; 64 stage IV, 20 stage IIIB; mean age61.3) were randomized to receive placebo (n = 29), AM melatonin (n = 27), and PM melatonin(n = 28) in addition to cisplatin and etoposide chemotherapy. QoL was evaluated using EORTC-QLQ-C30 while patient satisfaction with QoL was measured using Quality of Life Index (QLI), incorporating four subscales: health & physical, social & economic, psychological &spiritual, and family. Cox regression evaluated the relationship between QoL and survival.
Results: Variables associated with survival on univariate analysis included age, ECOG, EORTC global, physical, role, social, fatigue, pain, QLI health & physical, psychological & spiritual(p < 0.05 for all). On multivariate analysis after adjusting for age and ECOG, while all EORTC scales lost their statistical significance, QLI health & physical functioning emerged as the most powerful prognostic indicator of survival (HR:0.94; 95 % CI:0.90–0.98, p = 0.003).
Conclusions: In this study, we found that patient satisfaction with health & physical functioning superseded all EORTCQoL variables. We suggest that patient satisfaction with their health might be used as a stratification as well as an outcome variable in future supportive care oncology trials.
MASCC-0139
Caphosol for mucositis: a case series
L.K. J. Younus 1
1Medical Oncology, London Regional Cancer Program, 2Nurse Practitioner, London Regional Cancer Program Regional Cancer Program, London, ON, Canada
Introduction: Mucositis is a common side effects due to chemo and/radiation therapy. Caphosol is a proven preventive strategy in randomized clinical trials. However, its efficacy to treat active mucositis is unknown.
Objectives: To evaluate the efficacy of Caphosol to treat mucositis by comparing the grade of mucositis before and after treatment (NCIC-CTG criteria) and documenting the duration of treatment.
Methods: A retrospective review was conducted on consecutive adult patients treated at London Regional Cancer Program who developed mucositis and were treated with Caphosol. This study was approved by ethics committee at University of Western Ontario.
Results: A total of 21 patients, two males (one with cancer esophagus and another with lung cancer) and 19 females (all with breast cancer), with a median age of 59 years were evaluated. Grade 3 mucositis was present in 4 patients which completely resolved with Caphosol in an average of 5 days of treatment, without needing any hospitalization. Fifteen patients with grade 2 mucositis reverted back to grade 0 by using Caphosol for an average of 3.5 days. One patient with no effect had grade 1 mucositis dating prior to chemotherapy and remained as such. Another patient with no initial improvement had oral candidiasis and once treated with Fluconozole and Caphosol had a complete resolution. No obvious side effects were reported by patients.
Conclusion: Our case series, for the first time, shows that Caphosol is potentially effective treatment against mucositis.
MASCC-0140
A pilot study of gentiana lutea (radix), zingiber officinalis, and curcuma longa for the treatment of anorexia in cancer patients
J.Y.,L.S. M. Sanatani 1
1Medical Oncology, Western University, 2Clinical Research Unit, London Regional Cancer Program, London, ON, Canada
Introduction: Anorexia is a common symptom for patients with cancer. Gentian, ginger, and turmeric have traditionally been used to stimulate appetite.
Objectives: We tested these agents in combination, in a pilot study to assess tolerability in patients not currently on chemotherapy, indicating 4/10 or worse anorexia on the Edmonton Symptom Assessment System. We collected exploratory data on the patient’s appetite using a visual analogue scale.
Methods: Between 2009 and 2012, 17 patients were enrolled in arm 1 (turmeric 1 g and ginger 1 g orally twice daily, and gentiana lutea tincture 1 ml three times a day, for 14 days). The three patients enrolled in arm 2 received the same doses of ginger and turmeric but no gentian. All patients completed a daily appetite diary, and weekly symptom assessment.
Results: In arm 1, 7 patients (41 %, 95 % CI 18 %–65 %) completed treatment. Seven patients (41 %) stopped early because of unacceptable toxicity or patient-initiated discontinuation, and 3 stopped because of other reasons. All patients in arm 2 stopped taking the study medication within a few days of starting treatment, leading the study committee to recommend stopping the trial. The most common adverse effects attributed to study drug were nausea (6 patients), vomiting (3), fatigue (3), diarrhea (2) and bloating (2). There was no significant effect seen on appetite.
Conclusions: At the doses used in this study, the combination of ginger, turmeric, and gentian is not tolerated well in cancer patients. Future studies should use fewer agents or lower doses.
MASCC-0141
Effect of fast track surgery on insulin resistance indexes of esophageal cancer patients
G. Zhao 1, S. Cao1, J. Cui1
1Department of Thoracic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
Objective: To investigate the influence of fast track surgery (FTS) on insulin resistance indexes in esophageal cancer patients.
Methods: A total of 68 esophageal cancer patients receiving radical operation in our hospital from November 2009 to March 2011 were randomly divided into 2 groups by envelope method: FTS group(n = 34) and control group(n = 34). The postoperative first passage of gas by anus and defecation, postoperative hospital stay, hospitalization expenditure, and postoperative complications were recorded. Insulin resistance indexes were measured before operation as well as on the 1st,3rd,and 7th postoperative days, including fasting blood-glucose(FBG),fasting insulin(FINS),serum level of interleukin-6(IL-6),and C-reactive protein(CRP). The insulin resistance index(HOMA-IR) was calculated at the flame time points.
Results: The postoperative time of first passage of gas[(1.91 ± 1.13)d vs.(2.95 ± 1.25)d, P = 0.000] and defecation [(3.75 ± 1.54)d vs.(4.84 ± 1.76)d, P = 0.007] in FTS group were significantly shorter compared with control group, and the total hospitalization expenditure was significantly lower in FTS group [(31.9 ± 4.2) thousand yuan vs. (39.8 ± 3.6) thousand yuan, P = 0.000]. The preoperative insulin resistance indexes showed no significant differences between the two groups (all P > 0.05). One day after operation, the levels of log-HOMA-IR(0.97 ± 0.52 vs.1.54 ± 0.57, P = 0.000), FINS[(11.87 ± 4.55)μU/ml vs. (17.16 ± 6.90) μU/ml, P = 0.000], IL-6[(124.15 ± 21.39)ng/L vs. (138.78 ± 23.60)ng/L, P = 0.009], and CRP[(62.92 ± 14.78)mg/L vs. (71.07 ± 14.51)mg/L, P = 0.025] in FTS group were significantly lower than those in control group. Three days after operation, the levels of log-HOMA-IR(0.86 ± 0.47 vs. 1.27 ± 0.58, P = 0.002), FINS[(9.56 ± 4.37) μU/ml vs. (14.91 ± 6.54) μU/ml, P = 0.000], IL-6[(140.94 ± 25.12)ng/L vs. (153.89 ± 24.06)ng/L, P = 0.035], and CRP[(138.59 ± 21.61)mg/L vs. (153.17 ± 25.20)mg/L, P = 0.019] in FTS group were significantly lower than those in control group. Seven days after operation, the level of CRP in FTS group was significantly lower than that in control group [(53.07 ± 15.84)mg/L vs. (61.59 ±16.28)mg/L, P = 0.032].
Conclusion: FTS may promote the early recovery of gastrointestinal function, reduce stress reaction and postoperative insulin, thus being conducive to fast rehabilitation of esophageal cancer patients.
MASCC-0142
Paediatric pain approach in Cameroon
C.E.,P.c.C.,D.N. J.N. Menang 1
1“Pediatric ward, Baptist Hospital Mutengene, 2Administration, CALMEF Health Center, Yaoundé, Cameroon”
Background: Generally, children and infants are either unable to express themselves verbally or adequately give medical history. They often cry in their pain, hunger, thirst and other discomforts. Unfortunately, carers on most children’s wards in Cameroon often scold at them and in some cases, nurses also threaten kids since the general conception is that children always cry unnecessarily.
Method: Two combined retrospective case studies of a 9 year old osteomylitis case and 3 year 5 month burn cases of 2008–2009. Visits to CALMEF Health Centre and 4 other pediatric clinics, survey questionnaires to carers and nurses, observation of approach to child pain and interviews are the approached considered.
Results: Study revealed that, about 50 % of infants and children hospitalized, crying probably from pain are either scolded by carer or visitors and neighbours, 30 % are threatened to stop crying by nurses and about 20 % managed to keep silent or are supported by carers to bear the pain successfully. Many nurses stick to time interval prescription even when the child is in pain. Most pain cases are not identified and most practices lack opiates or appropriate analgesics; often without pain control protocol.
Conclusion: Overall view of study reveal that child pain management approach in Cameroon is still full of challenges and available professionals. This therefore calls for partnership and net-working with international institutions like ASCO, MASCC IASP-PAIN and others. Active involvement in forums like conferences, training or discussion for available professionals is very vital.
MASCC-0143
Validation of a Korean translation of the Edmonton symptom assessment scale
S.-H.N.,S.K.,Y.S.H.,K.H.L. J.H. Kwon 1
1Internal Medicine, Hallym University, Kangdong Sacred Heart hospital, 2Internal Medicine, VHS medical Center, Seoul, 3Internal Medicine, Good Samaritan Hospital, Gyeongsanbuk-do, 4Division of Oncology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, 5Internal Medicine, Yeoungnam Medical Center, Yeoungnam University Medical School, Taegu, 6Internal Medicine, Korea University Medical Center, Seoul, 7Hematooncology, Daegu Fatima hospital, Daegu, 8Hematooncology, Kokuk University Medical Center, Seoul, Republic of Korea, 9Palliative Care and Rehabilitation Medicine, 10Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Aim: We developed a Korean version of the Edmonton Symptom Assessment Scale (K-ESAS), a brief, widely adopted multidimensional questionnaire to evaluate patient-reported symptoms, and performed a psychometric analysis in Korean patients undergoing treatment for advanced cancer.
Methods: We tested the K-ESAS in 2 pilot studies with 15 patients each. We assessed internal consistency, test-retest reliability, and concurrent validity in 163 Korean patients, who completed the K-ESAS along with Korean versions of the MDAnderson Symptom Inventory (K-MDASI) and the Hospital Anxiety and Depression Scale (K-HADS) twice. Thirty-eight patients repeated the questionnaires again 7 days later to assess responsiveness.
Results: K-ESAS scores had good internal consistency, with a Cronbach alpha coefficient of 0.88, indicating that no questions had undue influence on the score. Pearson correlation coefficients for K-ESAS symptom scores between baseline and after 2–4 h ranged from 0.72 (95 % CI:0.64–0.79) to 0.87 (95 % CI: 0.82–0.90), indicating strong test-retest reliability. For concurrent validity, Pearson correlation coefficients between K-ESAS symptom scores and corresponding K-MDASI symptom scores ranged from 0.70(95 % CI: 0.62–0.77) to 0.83 (95 % CI: 0.77–0.87), indicating good concurrent validity. For K-HADS, concurrent validity was good for anxiety (r = 0.73, 95 %CI: 0.65–0.79) but moderate for depression (r = 0.4, 95 % CI: 0.26–0.52). For responsiveness, changes in K-ESAS scores after 7 days were moderately correlated with changes in K-MDASI scores but weakly correlated with changes in K-HADS scores.
Conclusion: The K-ESAS is a valid and reliable tool for measuring multidimensional symptoms in Korean cancer patients.
MASCC-0144
Circadian activity rhythms and quality of life in hepatocellular carcinoma patients
T.-W.H. J.-H. Lai 1,2
1Department of Internal Medicine, Erlin Branch of Changhua Christian Hospital, Changhua, 2Department of Nursing, Hung Kuang University, Taichung, Taiwan R.O.C.
Introduction: Little is known about the relationships between circadian activity rhythms and quality of life inhepatocellular carcinoma patients.
Objectives: The objectives of this study were to describe values for nocturnal sleep/rest, daytime wake/activity, and circadian activity rhythm parameters measured using actigraphy and to evaluate the relationships between these subjective and objective measures of sleep disturbance and quality of life in HCC patients.
Methods: The patients (n = 71) completed self-report measures for sleep disturbance (ie, Pittsburgh Sleep Quality Index, PSQI) and quality of Life (the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, EORTC QLQC30) and wore wrist actigraphs for 72 h. Pearson correlations were calculated between variables.
Results: Based on the patients’ subjective responses to the PSQI, 87 % had a global PSQI score greater than 5. In addition, the mean global quality of life was poor. An actigraphy-sleep efficiency revealed percent wake at night and total sleep time were worsen than normal adult ranges, and data of daytime activity and rest parameters were deteriorate than healthy adult values; the data on Circadian Activity Rhythms were also worsen than healthy adult values, all the above results indicated that patients with HCC experienced clinically significant levels of sleep disturbance.
Conclusions: According to our results, most of the HCC patients experienced clinically significant levels of sleep disturbance and poor QOL. Physicians, nurses and family caregivers need to be assessed, along with patients, for sleep disturbance, and appropriate interventions initiated for improving the QOL for HCC patients.
MASCC-0145
Rehabilitation for patients with high grade gliomas and their relatives—a feasibility study
M.J.,3.,J.J.,M.J. K. Piil 1,2,3
1“Neurosurgery Dep., 2The Center for Integrated Rehabilitation of Cancer Patients (CIRE), 3The University Hospitals Centre for Nursing and Care Research, 4The Neuroscience Centre, 5Dept. of Neurosurgery, The University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark”
Background: In Denmark approximately 500–600 patients are diagnosed annually with a malignant brain tumor of the type glioblastoma. High grade glioma occurs most frequently between 45 and 70 years of age. Median survival time is 12–15 months and 5 year survival is 10 %. Patients with gliomas have a symptom burden that leads to numerous complications and high mortality.
We lack evidence based knowledge about how disease-and treatment related symptoms and complications are experienced by and affects the patients and their relatives during and after treatment. The literature confirms that there is a need for a systematic evaluation of patients and relative’s needs in order to recommend national/international and disease-specific rehabilitative interventions for patients with gliomas and their relatives.
Aim: The project aims to elucidate patients and relatives life situation, needs, wishes and preferences for rehabilitative interventions during and after surgical and medical treatment for high grade glioma. Furthermore, the aim is to develop and test a rehabilitative intervention based on patient and family perspectives and research literature.
Design: The study will be conducted in 2 parts from 2012 to 2015. Part 1 is a longitudinal, qualitative, explorative, and descriptive interview study of patients and their relatives’ life situation and rehabilitation needs and a quantitative evaluation of the patients health related quality of life. Part 2 is a pilot study with a pre experimental one-group design testing a rehabilitative intervention program. The intervention program will be developed from existing intervention literature and the findings from part 1 of the study.
MASCC-0147
Chemotherapy-induced bipolar disorder in a female patient with breast cancer: a case report
B.S. L. Slovacek 1
1Department of Clinical Oncology and Radiation Therapy, Charles University Hospital, 2Department of Psychiatry, Charles University Hospital University Hospital, Hradec Kralove, Czech Republic
The authors report on a case of chemotherapy-induced bipolar disorder after non-adjuvant chemotherapy AC-TH in a 45-year-old woman with breast carcinoma. This case report highlights the potential risk of chemotherapy causing bipolar disorder. At the same time it indicates the need to cooperate with the psychiatrist. Early symptomatic psychopharmacological intervention enabled the smooth completion of non-adjuvant chemotherapy followed by partial mastectomy and axilla exenteration including adjuvant therapy (radiation therapy, biotherapy, hormonal therapy).
MASCC-0148
Quality of life analysis in colorectal cancer ostomates in Kenya
L.I. Gichini 1, J.G. Marete1
1Oncology, Aga Khan University Hospital, Nairobi, Nairobi, Kenya
Background
Introduction: Fashioning of a stoma is often done in colorectal cancer patients. Ostomates face many challenges. Anxiety over a stoma causes alteration in life-style, including: work, desire to travel and staying away from home overnight, overall Self image. Sexuality is greatly affected. This change of lifestyle and a challenging adaptation that needs to be made has not yet been documented in colorectal ostomates in Kenya.
Objectives: The aim of this study was to document the impact of stoma on the QOL of colorectal cancer ostomates, Document the impact of physical and psychosocial impact of a stoma on a colorectal cancer patient, Trigger the mechanism for improving QOL for such patients
Methods: The study was conducted amongst patients in the colorectal cancer support group that meets at the Aga Khan University, Hospital Nairobi. The inclusion criteria were colorectal cancer ostomates. Forty ostomates were included in the study. The Coloplast(R) QoL Questionnaire was used to survey all possible areas of changes in QOL after surgery. Statistical analyses: all data were entered and analysed using SPSS software
Results: This study confirms that having a stoma significantly diminishes QOL in Kenyan ostomates. There is a definite correlation between the impact of stoma on the lifestyle, self perception, relationship with others, sexuality and QOL.
Conclusion: Institutionalising stoma clinics, rehabilitation of colorectal cancer patients by formation and streghtening of colorectal cancer survivors support groups and quality ostomy appliances are factors that will improve QOL in colorectal cancer patients with stoma in Kenya
MASCC-0149
Validation of late oral health outcomes, an oral health subscale of the Vanderbilt head and neck symptom survey in post-radiotherapy head and neck cancer patients
J.D.,J.B.E.,C.A.M., L. Kolnick 1
1Department of Medicine, 2School of Nursing, Vanderbilt University Medical Center, Nashville, TN, 3Oral Medicine Services, Otolaryngology and Head and Neck Surgery, City of Hope National Medical Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 4Department of Diagnostic Sciences and Oral Medicine, College of Dentistry, University of Tennessee Health Sciences Center, Memphis, 5Division of Dentistry, Department of Oral and Maxillofacial Surgery, 6Department of Biostatistics, Schools of Medicine and Nursing, Vanderbilt University Medical Center, Nashville, TN, USA
Introduction: The Vanderbilt Head and Neck Symptom Survey (VHNSS) version 2.0 oral symptom subscale was developed to address potentially overlooked and underreported oral health issues.
Objectives: To report the validation of questions pertaining to xerostomia (4 items), dental health (4 teeth), dentures (1 item) and trismus (1 item).
Methods: Between May 2011 and April 2012, 50 patients treated with chemoradiotherapy for head and neck cancer completed the 50-item VHNSS survey, underwent an oral health assessment by a dentist, salivary flow and inter-incisal opening (IIO) measurements.
Results: Patient reported problems with dry mouth correlated with unstimulated salivary flow rates (−.43, p = .002). Cracked teeth (−.55, p = < .001) or difficulty chewing due to teeth (−.43, p = .004) correlated with urgent or emergent dental care issues identified on exam. Using a cut off of >4 on any of four the dental questions, we identified 83 % of patients with urgent or emergent dental issues. The ROC curve was useful (.89, p < .001) for separating patients with and without urgent/emergent dental issues. Limitations in jaw movement correlated with IIO (−.43, p = .002). Small numbers of patients with dentures precluded meaningful analysis of this subsample.
Conclusions: Clinically significant oral health issues pertaining to xerostomia, dental health and trismus may be identified using the oral health subscale of the VHNSS version 2.0. Patients who score >4 on any of the teeth related items should be referred for immediate dental evaluation; and for trismus should be referred for physical therapy.
MASCC-0150
Prevalence and treatment of neuropathic cancer pain
L. Sima 1, B. Fan1, B. Liu1
1National Pain Management an Research Center, China-Japan Friendship Hospital, Beijing, China
Objective: Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. 19 % to 39 % of patients with cancer pain have concurrent neuropathic pain. We investigated the characteristics and prevalence of neuropathic cancer pain (NCP) in China, prospectively to assess current management.
Methods: A cross-sectional and prospective follow-up survey was performed. Cancer patients met NP define and with a score of ID-Pain Scale ≥1 were diagnosed NCP. Pain management was according to NCCN guideline. The main outcome measures were 24-h NRS, five symptoms indicated in ID-Pain scale (prickling, burning, electric shock, numbness and allodynia) by a 10-point score, and SF-6D quality of life scale.
Results: Six hundred fifty-eight patients were recruited from National Pain Management and Research Center. One hundred forty-seven patients met NCP diagnosis. One hundred eighteen patients completed the questionnaire and first treatment and enrolled ITT analysis. The common symptoms of NCP included numbness, prickling, burning, allodynia and electric shock by turns. The most involved nerves were lumbosacral plexus, cervical plexus, brachial plexus and sciatic nerve. NRS score was reduced to 3.7 ± 1.5 (P < 0.001) on d3 and 2.9 ± 1.4 (P < 0.001) on d21. Relief began on d3 for allodynia (P = 0.020), and on d7 for burning and electric shock (P = 0.003 and 0.018, respectively). The intensity of prickling and numbness remained unchanged. The quality of life was improved from d3 (P = 0.002).
Conclusion: NCP has a high incidence in China. NCP can be rapidly relieved in a majority patients. The symptoms of numbness and prickling are difficult to control.
MASCC-0151
Neurometabolic activities of arginine, apoliprotein e, and alpha-synuclein: implications for the development of fatigue during localized radiation therapy
L. Saligan 1,. Fatigue1
1National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
Introduction: The etiology behind fatigue development during radiation therapy remains unknown.
Objectives: This study investigated the differential gene/protein expressions during the development of fatigue while receiving external beam radiation therapy (EBRT).
Methods: Thirty, Caucasian men (meanage = 65.5 ± 6.9) with non-metastatic prostate cancer scheduled for EBRT were enrolled. Fatigue (FACIT-F; lower scores mean higher fatigue) and blood were collected pre-treatment (baseline), and at midpoint of EBRT (day21). Microarray analysis was performed from whole blood RNA using the filtering criteria (foldchange >2.0 or <2.0, p < .05). Proteins were identified from depletedsera using 2-dimensional gel electrophoresis. Fatigue phenotype was maximized by categorizing subjects into high (HF: N = 20 [66 %], mean age = 66.6 ± 7.4) and low fatigue (LF: N = 10, mean age = 62.8 ± 5.4), based on a 3-point change in FACIT-F score from baseline to day21 of EBRT
Results: Fatigue changed from baseline (HF = 44.5 ± 6.9, LF = 44.4 ± 11.1) to midpoint (HF = 35.6 ± 6.9, LF = 45.3 ± 10.2) of EBRT. Microarray results from all subjects showed α-synuclein upregulation (fold changes >2.9, p < .001) from baseline to midpoint of EBRT. In subgroup analysis between the 2 time points, the HF group showed upregulation of ARG1 (arginase1; foldchange =2.41, p < .05) and significantly increased serum apolipoprotein (ApoE, fold change >1.5, p < .001).
Conclusion: Injury increases astrocytesecretion of ApoE instigated by α-synuclein overexpression. Increased ARG1 expression induces argininedeficiency altering ApoE-related metabolic activities during synaptogenesis. The neurometabolic activities of arginine, ApoE, and α-synuclein during synaptogenesis may provide information of the etiology of EBRT-related fatigue.
MASCC-0152
Effects of electric stimulation to acupoints on gastrointestinal hormones and motility among old postoperative patients with gastrointestinal tumors
L.X.,Y.S.,P.Y. L. Hou 1
1“Department of Nursing, Shanghai Pulmonary Hospital, 2Department of Nursing, Putuo Hospital, Shanghai University of Traditional Chinese Medicine,, 3Department of Nursing, Tenth People’s Hospital of Tongji University, 4Department of General Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China”
Objective: To evaluate the effects of electric stimulation to acupoints on gastrointestinal hormones and motility among old postoperative patients with gastrointestinal tumors and explore an efficient and noninvasive method for postoperative recovery of bowl functions.
Methods: We selected 40 old patients with gastrointestinal tumors receiving surgeries between January 2009 and December 2010 and evenly randomly assigned them into regular nursing care group(RNC) and acupoint electric stimulation group(AES) group each with 20 cases. Patients in the RNC group received regular nursing care and patients in the AES group received regular nursing care plus electric stimulation on acupoints. We evaluated the serum concentration of gastrin(GAS), motilin(MOT), cholecystokinin(CCK) and electrogastrogram(EGG) on the first, third and fifth day after surgery. We also recorded the anal exhaust time and the number of cases with such gastrointestinal function disorders as abdominal pain, abdominal distention and diarrhea
Results: Comparison between two groups in GAS, MOT, EGG, the anal exhaust time, abdominal pain, abdominal distention and diarrhea showed significant statistical difference(P < 0.05). Conclusion: Electric stimulation on acupoints could increase postoperative GAS, MOT levels, promote recovery of gastrointestinal functions and decrease complications among senile patients with gastrointestinal tumors.
MASCC-0153
A randomized clinical comparison of a non-alcohol barrier film and standard care for radiotherapy skin protection in nasopharyngeal cancer patients
J.-M.J.,Y.-C.T.,C.-F.H. L.-L. Chang 1
1Center for Advancement of Nursing Education, 2Department of Radiation Therapy, 3Department of Clinical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan R.O.C.
Purpose: The aim of this study is to evaluate the efficacy of using a non-alcohol barrier film to prevent or reduce the incidence of radiation-induced moist desquamation among nasopharyngeal cancer (NPC) patients.
Methods: This study was prospective, randomized, open label, paired comparison of a radiotherapy skincare standards with and without the use of a non-alcohol barrier film skinprotectant. The barrier film was randomized to the left and right areas of theradiation field twice per week during the 7 weeks of radiotherapy. No other prophylactic skin care products were allowed within the radiation field of treatment during the study. A modified version of the RTOG radiation morbidity scoring index was used to quantify the degree of skin damage.
Results: Thirty-eight patients were included in the final analysis. The incidence of moist desquamation was 26 % of the total study population. Treatment effects between the experimental and control sides were compared using the GEE method. The average in RTOG scores for both sides changed significantly with time effects at 3, 4, 5, 6, and 7 weeks with estimate beta of 0.185,0.638, 1.064, 1.559, and 1.806 respectively. The experimental sides had significantly lower RTOG scores than the control sides at 6 and 7 weeks (estimate beta = –0.129 and –0.213 respectively, P value < .05).
Conclusions: The non-alcohol barrier film reduced both the duration and frequency of RT-induced moist desquamation better than no treatment. This skin care strategy has shown promise to prevent moist desquamation in this population.
MASCC-0154
Oral health considerations among cancer survivors
H.H.M.,N.S.T. M.A. Al-Mohaya 1
1Dentistry, Prince Sultan Military Medical City, Riyadh, 2Faculty of Dentistry/Division of Oral Medicine, King Abdulaziz University, Jeddah, Saudi Arabia, 3Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
Usually, patients with cancer encounter assaults on their oral health from both the disease and the treatment option. While most of these are manageable, complications can have a profound impact on quality of life. Compromised oral health prior to, during, and following cancer therapy can affect treatment outcomes.
Despite the significant advances in the cancer therapy which had a great impact on prolonging the survival rate, these patients are potentially at high risk for developing a number of oral complications, ranging from acute oral complications including mucositis and infections, to late complications including hyposalivation, caries, taste changes, trismus and jaw osteonecrosis.
Cancer survivors, depending on the specific cancer and modalities of therapy, may remain at life-long risk of developing oral complications which require increased awareness and recognition to promote prevention and appropriate intervention as well as long-term dental follow-up after completion of cancer therapy.
It is therefore important for the primary oncologist and the dentist to be aware of these complications. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time. Patients should typically undergo thorough oral examination prior to initiation of therapy, during and after therapy to identify any active infection. The aim of this presentation is to discuss potential oral complications as a result of cancer therapy and their management and what are certain precautions we should be aware of for these patients.
MASCC-0155
The beliefs, knowledge, understanding, attitudes and treatment access to breast cancer amongst rural women in Northern Nigeria
M. Tagbarha 1
1Community Health and Policy, University of Abuja, Abuja, Nigeria
Goal: The goal of this study is to ascertain the beliefs, knowledge, understanding, attitudes and treatment access to breast cancer among rural women in Nigeria.
Background: Breast cancer has become a popular topic in recent years with several thousands of women diagnosed to be positive every year. The availability of care/treatment upon early detection is key to survival.
Methods: An interview guide was designed specifically for this study in which 200 women, age 45 and over took part in. It contained questions about beliefs, knowledge, understanding and attitudes about Breast Self-Examination (BSE), Clinical Breast Examination(CBE) and mammogram. The data were obtained during face-to-face interviews in the primary language of the participating woman.
Results: Out of the 200 women who participated, only 1 % of the participants practiced BSE monthly, 8 % had undergone at least one CBE during their lives, and 91 % had never had a mammogram. There were little or no access to treatment even at early detection in these rural areas causing thereby vulnerability to loss of life. Majority of these rural women (95 %) said they knew little or nothing about breast cancer. While 15 % of the women said detecting cancer early was important, only 3 % reported that cancer could be cured.
Conclusions: The level of awareness and treatment access to breast cancer amongst Northern Nigeria’s rural women is extremely low. This alarming situation calls for urgent intervention of health organizations to provide immediate breast cancer awareness, screening and care so as to reduce incidences at early detection.
MASCC-0156
Extravasation of vinca alkaloids: development of an action algorithm for quick and effective treatment
S.M.,2.,M.M.,2.,O.F. M. Mendes 1
1Health Sciences Faculty, University of Beira Interior, 2Pharmaceutical Services, Hospital Centre of Cova da Beira, Covilhã, Portugal
Introduction: Due to the increase of cytotoxic infusions given, healthcare professionals endeavour to minimize chemotherapy complications. A potential complication is vesicant chemotherapy extravasation, such as vinca alkaloids (VA). The extravasation may affect the quality of life of patients and their survival. Therefore, fast acting and effective treatment are essential.
Objectives: To develop an algorithm for management of extravasation of VA.
Methods: A literature review was performed, through research and analysis of guidelines and articles obtained from PubMed since January/2000 to December/2012, intersecting the terms chemotherapy extravasation and extravasation treatment.
Results: The first course of action is to stop the infusion immediately, not remove the cannula, disconnect the infusion, and with a new syringe aspirate as much of the infusate as possible. The medical staff on service is then notified, the extravasation kit is collected and the extravasated drug is identified. Thereafter, the extravasation area is marked and photographed and the cannulais removed. Warm compresses should be applied to the affected area for 20 min, 4 times/daily for 1–3 days, with minimal pressure, and the antidotehyaluronidase 150 IU/mL must be administrated (several subcutaneous injections of 1–6 mL of hyaluronidase into the extravasation area in a clockwise manner). Analgesia should be provided if required. Each incident of extravasation must be thoroughly documented and the follow-up and long term management is central.
Conclusions: The developed algorithm is a valuable tool for all hospital services that prepare and administrate VA, contributing to a quick and effective response to episodes of extravasation.
MASCC-0157
Parenteral feeding during methotrexate-induced gastrointestinal mucositis prevents weight loss in the rat
M. Fijlstra 1, W.J.E. Tissing1, H.J. Verkade1, E.H.H.M. Rings1
1Department of Pediatrics, Beatrix Children’s Hospital/University Medical Center Groningen, Groningen, The Netherlands
Background: It is unknown what feeding strategy to use to prevent weight loss in patients with chemotherapy-induced gastrointestinal mucositis. When possible, enteral nutrition is preferred to parenteral nutrition because of negative side effects. In a mucositis rat model, we demonstrated disaccharide maldigestion and fat malabsorption but up to normal absorption of glucose and amino acids upon their continuous enteral administration. We now determined the effects of4 different (par)enteral feeding strategies during mucositis on body weight and intestinal recovery.
Methods: From day 2–5 after injection with methotrexate (MTX, 60 mg/kg), rats continued ad libitum purified diet (AIN-93G, strategy 1), received continuous enteral feeding [force-feeding, normal daily amounts] with glucose and amino acids (Nutriflex®, strategy 2) or with standard formula (Nutrini®, strategy 3), or received continuous parenteral feeding with standard formula (NuTRIflex®Lipid, strategy 4). Saline-treated controls continued ad libitum purified diet
Results: From day2 on, MTX-treated ad libitum-fed rats showed a reduced food intake and bodyweight (P < 0.05), as seen before. Most continuously enterally-fed rats (88 %) were terminated early because of severe abdominal distention. Parenterally-fedrats grew similarly like controls. On day 5, the jejunum of MTX-treated adlibitum-fed rats showed hypertrophic crypts and a normal villus length. In contrast, parenterally-fed rats showed no increase in crypt length and a reduced villuslength, compared with controls (P < 0.05).
Conclusion: Continuous enteral feeding in normal daily amounts during mucositis is poorly tolerated in rats. Parenteral feeding prevents weight loss during mucositis while enteral feeding in limited amounts accelerates intestinal recovery.
MASCC-0158
The emerging role of exercise and health counseling in patients with acute leukemia undergoing chemotherapy during outpatient management
L.A.,3.,L.K.,H.B.,A. M. Jarden 1,2
1Center for Integrated Rehabilitation of Cancer Patients and The University Hospital’s Centre for Health Care Research, 2Department of Hematology, Rigshospitalet, Copenhagen University Hospital, 3Faculty of Health Sciences, Copenhagen University, Copenhagen, 4Department of Hematology, Herlev Hospital, Herlev, 5Department of Basic Sciences and Environment, Faculty of Life Sciences, Copenhagen University, Copenhagen, Denmark
Objective: The primary objective of the study was to determine the feasibility and safety of a supervised, structured and combined exercise intervention in patients with acute leukemia undergoing treatment in the outpatient setting. The secondary objectives were to investigate the effect of the intervention unphysical and functional capacity, physical activity levels, symptom burden and health-related QOL.
Method: This pilot study is a prospective, single group trial of an exercise and health counseling intervention in patients with acute leukemia during the course of consolidation treatment in the outpatient clinic.
Results: Seventeen of 20 patients completed study requirements (85 %), adherence to exercise was 73 % and for health counseling 92 %. There were improvements in the 6-minute-walk-distance (p = 0.0013), sit-to-stand test (p = 0.0062), the right and left biceps arm-curl tests p = 0.0002 and p = 0.0002, respectively; health-related quality of life (p = 0.0209) (FACT-An), vitality (p = 0.0015), mental health (p = 0.0471) and physical component scale (p = 0.0295) (SF36). Significant reduction in the symptom burden (p = 0.0021) and symptom interference on daily life activities (p = 0.0069) (MDASI). No adverse reactions were observed.
Conclusions: This 6 week supervised and structured exercise and health counseling intervention proved feasible, safe and well tolerated with physical, functional, psychosocial and symptom benefits in a small sample of patients with acute leukemia undergoing intensive chemotherapy during outpatient management. The intervention proved to be well fitted to the outpatient clinical setting and addresses the concerns associated with exercising patients during treatment for acute leukemia, i.e. low hemoglobin and platelet counts, infections, frequent visits to the hospital and the long term treatment trajectory.
MASCC-0159
The effect of combined decongestive therapy and pneumatic compression pump on lymphedema indicators in patients with lymphedema secondary to breast cancer treatment
B.J.,A.R.T.,S.P.,S.T. M. Moattari 1
1"Nursing, 2Surgery, 35.
Background: Lymphedema treatment is difficult and there is no consensus on the best treatment. This study evaluated the effect of combined decongestive therapy (CDT) and pneumatic compression pump on lymphedema indicators in patients with lymphedema secondary to breast cancer treatment.
Methods: Forty-two women with breast cancer related lymphedema participated. The volume difference of upper limbs, the circumference at 9 areas and shoulder joint range of motion were measured in all patients. Then, they were divided randomly into an intervention or control group. The intervention of the study performed for the intervention group for 8 weeks At the end of 4 and 8 weeks the same primary measurements were done for both groups. Data were analyzed using SPSS.
Results: The mean volume difference of the upper limbs and mean difference in circumference in all areas measured at different phases in the intervention group decreased significantly. However, there were no significant differences between the groups for these two variables. Mean flexion, extension, abduction and external rotation (in degrees) at different phases increased significantly in the intervention group and decreased significantly in the control group, and the changes in mean values differed significantly between the two groups.
Conclusions: CDT significantly increased shoulder joint range of motion. The finding support the effects of CDT in the treatment of secondary lymphedema of upper extremity.
MASCC-0160
Level of understanding of nurses from Goma city of breast self examination (BSE) ASA breast cancer prevention method
H.M.K.,2.,V.H. M.K. Sahani 1
1Health Department, Agir Ensemble, Goma, The Democratic Republic of the Congo, 2Gynecology, Rwamagana Hospital, Rwamagana, Rwanda
Background: Breast cancer is major public health problem in DRC and is among the leading cause of death by cancer in our country. Almost all sicks arrive at hospital at late stage of disease while health professionals can’t do anything. In this study we want to know if nurses who are supposed to inform people and sick about BSE to prevent this disease know well this method to give message that can save lives of women in community.
Method: For data collection, we used questionnaire of enquiry completed by nurses. Sample size has been determined using EPI-INFO setup calculation. We have used EPI-INFO setup for analysis of data. Tests used: T test of Student, Kruskal-Wallis test.
Results: -32 nurses know that breast cancer is public health issue (74.4 %) and 11 don’t know (25.6 %); n = 43, Khi2 = 20.5, p = 0.000006. -25nurses (58.1 %) know that BSE is a method to prevent breast cancer and 18 (41.9 %) don’t know; n = 43, Khi2 = 2.28, p = 0.131130; -6 nurses (14 %) know the procedure of BSE and 37 (86 %) don’t know; n = 43, Khi2 = 44.70, p = 0.000000. -There is no implication of the duration in career as nurse to the knowledge of BSE. -The level of study has influence on knowing that breast cancer is a public health issue: people with level know well than people with low level. -The sex does not have any influence on knowledge of nurses of BSE.
Conclusions: More nurses in Goma know that breast cancer is a public health problem and they know what mean BSE but they don’t know how to proceed and what elements to look for during BSE. Training is a need for nurse focusing on breast cancer prevention Methods. Hospital-based training can help nurses to increase their skills.
MASCC-0161
The incidence of adverse opioid events on an inpatient palliative unit requiring naloxone
M. Davis 1, A. Aung1
1Cleveland Clinic, Cleveland, OH, USA
Background: Opioids are the most common medication use in palliative care setting. Opioid toxicity in terminally ill patients may be multifactorial. Naloxone, pure opioid antagonist especially at mu opioid receptor sites in the CNS is useful for reversal of sedation and respiratory depression due to opioid toxicity but little has been report about naloxone usage in palliative care.
Method: A retrospective chart review of 1,814 adult patient admitted to palliative medicine unit over a 2 year period was performed to determine the incidence and reason of naloxone usage.
Result: Among 1,814 patients admitted to palliative medicine unit and who are on opioid, 25 patients (1.37 %) received naloxone to reverse opioid side effect. Circumstances surrounding naloxone usage were as follows: 7 overmedicated, 10 received simultaneous benzodiazepines, 2 underwent procedural sedation within 12 h, 2 received haloperidol, 1 received chlorpromazine, 3 could not be determined. There were no medication errors or equipment failures. 23 patients had their opioid dose decreased/held and 2 patients experienced adverse effects from withdrawal. The effective naloxone dose did not correlated with the opioid dose 24 h before respiratory depression. Naloxone dose varied based on practitioners. Palliative medicine physician used lower dose of naloxone relative to covering physicians.
Conclusion: The need for naloxone to reverse opioid-induced respiratory depression is less than 2 % of individuals on opioids who are treated on an acute palliative care inpatient unit. The combination of a benzodiazepine and opioid are significant contributing factors to adverse respiratory events with opioids.
MASCC-0162
Can initial admission serum creatinine and albumin help in predicting symptoms, in arranging appropriate discharges, and predict survival on a palliative unit?
M. Davis 1, A. Aung1, S. Alqudihy1, R. Lisa1
1Cleveland Clinic, Cleveland, OH, USA
Background: Low albumin and creatinine are common among patients with advance illnesses and probably reflect low muscle mass and cachexia. The presences of both a low creatinine, and albumin upon admission could predict a lower survival.
Method: This was a retrospective review of patients admitted to the palliative medicine unit over 2 month’s period, November and December 2011. Patient diagnosis and SSN (for purposes of survival information): (a) Age, (b) Gender, (c) Admission albumin and creatinine used for survival. Analysis was based on 81 patients. Recursive partitioning analysis with a log-rank splitting method was used to identify cut points in albumin or creatinine that predict survival. Cox proportional hazards analysis was used to identify prognostic factors.
Results: Variables found prognostic for worse survival in univariable analysis included male gender, lower albumin, and higher creatinine. Every variation of albumin was significant (continuous, median, RPA, tertiles). For creatinine, only by RPA was significant. In multivariable analysis, only two variables were prognostic for worse survival: albumin <3.1 and creatinine >0.91. Albumin (n = 80) per 1 unit increase HR 0.51 (0.34−0.77), p < 0.001: > 3.1/< 3.1 HR 0.28 (0.15−0.50) p < 0.001, overall HR 0.28 (0.15−0.52), p < 0.001. Creatinine >0.91/< 0.91 HR 1.83 1.03−3.25 p = 0.038, overall HR 1.80 (1.01–3.21), p = 0.046.
Discussion: Hypoalbuminemia is an adverse prognostic factor. Albumin has not been used in standard prognostic scales except for the Glasgow Prognostic Scale. Determining if albumin adds to the Palliative Prognostic Score will follow.
Conclusion: Hypoalbuminemia is a prognostic factor.
MASCC-0163
Cannabinoids for dysgeusia and metallic taste
M. Davis 1, R. Bloise1
1Cleveland Clinic, Cleveland, OH, USA
Background: Delta-9-tetrahydrocannabinol, (THC) is used for nausea and as an appetite stimulant. A recent study suggested that THC relieves dysgeusia and metallic taste.
Patient histories: An 80 year old Caucasian female presented to the outpatient supportive clinic with diabetes, coronary artery disease, and multiple myeloma. She was on a number of treatment regimens for myeloma with partial response and poor tolerance, having severe peripheral neuropathic pain. She was seen for odynophagia and metallic taste. Treatment for thrush failed to relieve her metallic taste. She was admitted through the emergency department for nausea and metallic taste. THC 2.5 mg daily completely resolved the symptom. A 56 year old Caucasian female with rheumatoid arthritis on study (Tocilizumab vs. placebo + methotrexate) was admitted with histoplasmosis complicated by respiratory failure, liver and kidney injury from antifungal therapy. She was discharged on amphotericin B 300 mg. Amphotericin B was stopped doses for severe nausea and vomiting and itraconazole started. She was readmitted and a palliative care consultation was initiated for nutritional failure, food aversion, metallic taste and nausea. THC, 2.5 mg, twice daily resolved her metallic taste and food aversion by day 4.
Discussion: Chemosensory abnormalities are under recognized leading to nutritional failure. THC increases food intake by stimulating orosensory reward pathways, increasing the motivation to eat. CB1R located in CNS reward-related and olfactory epithelium and bulb modulate odor perception and taste.
Conclusion: THC effectively treats metallic taste
MASCC-0164
MASCC Palliative Care (PC) survey: integration into cancer care
N.C.,F.S.,P.C. M. Davis 1
1Cleveland Clinic, Cleveland, OH, USA, 2Shaare Zedek Cancer Center, Jerusalem, Israel, 3Palliative Care Center, Cantonal Hospital, St Gallen, Switzerland
Background: The purpose of this survey was to determine palliative care service integration into cancer care.
Method: A survey, from Hui et al. by permission of the authors (1) was completed by MASCC, ESMO and EAPC members on the MASCC website. Questions were scored on 0–10, low scores 0–3 indicating a negative response.
Results: 183 respondents, 19 NCI, 34 ESMO designated centers, completed the survey. 83 % had PC, 93 % under M.D. leadership. 72 % had consult teams, 64 % outpatient clinics, 39 % acute inpatient units, 21 % hospices. Barriers to PC were; funding (55 %), lack of trained M.Ds or RNs (40 %), reimbursement (32 %). Over 5 years PC effectiveness increased in 63 % and quality improved in 69 %. Most agreed PC should be integrated into oncology and PC research funding should increase, only 17 % indicated their institution was likely to increase funding. <50 % were planning to increase PC personnel or beds. NCI and ESMO centers were more likely to have PC services during the past 10 years, have PC physicians on staff, and offer PC services more frequently than urban hospitals. ESMO and NCI centers scored PC quality higher, were more likelihood to increase PC physicians and inpatient beds than other centers.
Discussion: PC is important to cancer care, but a lack of interest in increasing PC funding is a barrier. NCI and ESMO centers have more interested in resourcing PC.
Conclusion: PC integration into cancer care is highly regarded but in funding and development lags behind.
1. Hui D, et al. JAMA. 2010 Mar 17;303(11):1054–61.
MASCC-0165
Does hope correlate with symptom burden in advanced cancer?
M. Davis 1, A. Rao1, S. Majeed1, A. Parala1, L. Rybicki1
1Cleveland Clinic, Cleveland, OH, USA
Introduction: Symptom burden may be detrimental to a sense of hope in patients with advanced illnesses. We did a feasibility study comparing hope to symptom burden and to patient and cancer characteristics.
Method: The Herth Hope Scale was compared to symptom burden measured by the ESAS[lr1] and to ESAS fatigue and depression scores. Herth Hope Scale was compared by gender, marital status, and duration of illness. We determined completion rate and explored associations with Herth Hope Scale using Spearman correlation (r) or Wilcoxon rank sum test.
Results: Twenty-five advanced cancer patients were surveyed using the Herth Hope Scale and ESAS with nearly 100 % completion rate. Hope[lr2] was not correlated with total ESAS score (r = −0.01; P = 0.98) or fatigue (r = 0.16; P = 0.45) but it was weakly and negatively correlated with depression (r = −0.27; P = 0.19). There was a weak association with marital status (median hope 41 if married vs. 38 not married; P = 0.11). There was no association between hope and duration of illness (median 40 <1 year of illness vs. 39 >1 year; P = 0.34) or gender (median 40 female vs. 40 male; P = 0.98)
Discussion: Hope appears to be independent of symptom burden in this small feasibility trial. This trial allowed us to power a definitive study which is in progress and will survey 198 patients to confirm this independence.
Conclusions: There is preliminary evidence that there is no association between a sense of hope and symptom burden.
MASCC-0166
The silent cancer—male breast cancer
M.J. Pritchard 1
1Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Liverpool, UK
Breast cancer is considered by the general public as a women’s illness. In 2008 some 1.38 million women were diagnosed with breast cancer that’s nearly a quarter of all female cancer cases. As health professionals our role is to offer hope and support to both the patient and their family members as they undergo cancer treatment. So when we talk about breast cancer we inevitably talk about women’s breast cancer. Issues of gender appear not to be at the forefront of the health professionals mind. Consequently we as health professionals have devoted both time and energy to develop sophisticated support systems to aid the patient’s physical and emotional well being. Speciality clinics, access to breast care nurses and of course the option to undergo re-constructive surgery. However what happens to this support mechanism when the patient’s gender short circuits this network? What if the cancer suffer is a man? Where does a male breast cancer patient go for support and treatment?. Male breast cancer makes up only 1 % of the total number of breast cancers worldwide. In the United Kingdom approximately 300 men are diagnosed with breast cancer each year. The aim of this paper is to raise the profile of this particular group of patients who have been diagnosed with this disease.
MASCC-0167
Comparison of baseline quality of life scores in patients with bone and brain metastases as assessed using the EORTC QLQ-C30
L.Z.,L.Z.,L.-M.T.,M.-F.H. M. Poon 1
1Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 2Department of Surgery, Taipei Veterans General Hospital, Taipei, 3Department of Gastroenterologic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan R.O.C., 4Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada, 5Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus, 6Department of Orthopedic Oncology, Federal University of Sao Paulo, Sao Paulo, Brazil, 7Department of Clinical Oncology, Tanta University Hospital, Tanta, Egypt, 8Division of Gynaecology and Genitourinary Oncology, Department of Radiation Oncology, Regional Cancer Center, Trivandrum, India, 9Unit of Clinical Research, Innovation, and Pharmacology, Saint-Etienne University Hospital, Saint-Etienne, France, 10Department of Public Health and Institute of Epidemiology and Preventative Medicine, National Taiwan University, Taipei, Taiwan R.O.C., 11Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada
Introduction: In advanced cancer patients, quality of life (QOL) as a clinical endpoint is of utmost importance as patients have shorter life expectancies and treatment intent is palliative in nature. Since 1993, the European Organization for Research and Treatment of Cancer Core 30 Questionnaire (EORTC QLQ-C30) has been widely used to study cancer-specific health-related QOL.
Objectives: To compare baseline EORTC QLQ-C30 scores in patients with bone and brain metastases internationally.
Methods: The EORTC QLQ-C30 was used to assess QOL in bone metastases patients with histological confirmation of their primary cancer and patients with brain metastases with documented single or multiple metastases. A univariate linear regression model was applied to detect significant differences between both groups on each QLQ-C30 subscale at baseline. To normalize the distribution, natural log-transformations were applied for each C30 summary scale.
Results: Karnofsky performance status, gender, marital status, and primary cancer site were significantly different between groups (p < 0.005). After accounting for these confounding factors, three EORTC-C30 scales significantly differed between the two patient groups: physical functioning (p < 0.0001), role functioning (p < 0.0004), and pain scale (p < 0.0001). Bone metastases patients reported worse pain and physical functioning, while brain metastases exhibited greater role functioning deficits.
Conclusions: Patients with bone metastases have more pain and reduced physical functioning. However, patients with brain metastases have more severe role functioning deficits. The use of disease-specific assessment modules such as the QLQ-BM22 and QLQ-BN20 will enhance the capture of relevant QOL in these populations.
MASCC-0168
Skeletal morbidity rates over time in patients with bone metastases from solid tumors reported in bone modifying agents randomised trials
L.Z.,L.Z.,M.P.,R.C. M. Poon 1
1Rapid Response Radiotherapy Program, Department of Radiation Oncology, 2Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 3Department of Medical Oncology, St. Michael’s Hospital, Toronto, ON, Canada
Introduction: Skeletal related events (SREs) in patients with bone metastases decrease patients’ quality of life and functional status. While bone-modifying agents have been found to reduce the time to first on-trial SRE and decrease the total incidence of SREs, standard practice in the management of bone metastases has changed concurrently.
Objective: The purpose of this review was to investigate if advances in bone-targeted therapies have decreased the incidence of individual types of SREs and to delineate the trend of SREs.
Methods: A literature review was conducted to identify phase III, randomized bone-targeted therapy trials. For all studies, a mean year of enrolment ([start of enrolment + end of enrolment]/2) was calculated. Incidences of skeletal related events were tabulated and expressed as percentages of on-trial patients. Generalized linear mixed models were used to search for the trends of SRE over time for all placebo and intervention arms.
Results: A total of 20 eligible studies were identified which reported SRE data from phase III trials, of which 11 were suitable for the quantitative analysis. Enrolment periods for all included data ranged from 1990 to 2009. Statistically significant overall downward trends in pathological fractures and need for surgery were seen over time. Also significant differences between intervention and placebo were seen with all SREs.
Conclusion: The decrease in SREs over time may not only be a result of the development of new generation bone-modifying agents, but also due to better systemic management and awareness of events associated with bone metastases.
MASCC-0169
Adverse events across generations of bone-modifying agents in patients with solid tumor cancers reported in phase III randomized trials
L.Z.,F.M.,K.L.,U.E. M. Poon 1
1Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 2Pamela Youde Nethersole Eastern Hospital, 3Queen Elizabeth Hospital, Hong Kong, China, 4Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Introduction: Treatments of advanced cancers that have metastasized to bone are palliative in nature. Therefore, treatment tolerability with minimal adverse effects is of primary importance. Many adverse effects of bone-modifying agents have been documented. However, no study has previously attempted to compare individual adverse events experienced while taking bone modifying agents or placebos.
Objective: The objective of this study is to compare adverse events experienced among different bone-modifying agents.
Methods: A literature search was conducted to identify phase III bisphosphonate and bone-modifying agent trials reporting adverse effects. Thirty-seven adverse events of interest were identified for six different treatment options. Weighted linear regression modeling was performed on the adverse event proportions with treatment groups, normalized through applying natural log-transformations.
Results: There were significant differences on the single item events of vomiting (p = 0.045) and osteonecrosis of the jaw (p = 0.017), and combined item events of nausea/vomiting (p = 0.048), hematological and lymphatic system toxicities (p = 0.020), and any respiratory system problem (p = 0.023) between bone-modifying agent and placebo trials. The significant toxicities were observed even after adjusting for the two confounding factors of age and primary cancer site.
[pic_01][pic_02]
Conclusion: While adverse effects are consistently experienced more frequently in patients receiving bone-modifying agents when compared to placebos, we find that the majority of individual side effects are not significantly more frequent inpatients receiving bone-modifying agents as compared to placebo.
MASCC-0170
Incidence of skeletal morbidity rates over time in patients with multiplemyeloma-related bone disease as reported in randomised trials employing bone-modifying agents
L.Z.,L.Z.,J.H.,E.W., M. Poon 1
1Rapid Response Radiotherapy Program, Department of Radiation Oncology, 2Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Introduction: Patients with progressive osteolytic bone lesions are at a high risk of developing skeletal related events. Bisphosphonates have been found to inhibit osteoclast recruitment and activity and have been used for prophylaxis of SREs resulting from multiplemyeloma.
Objective: The purpose of this review was to investigate if advances in bone-targeted therapies have decreased the incidence of skeletal morbidity rate (SMR) over time in patients with multiple myeloma related bone disease.
Methods: A literature search was conducted over the OvidSP platform in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to identify phase III results from bone-targeted therapy trials in patients with multiple myeloma. The SMR was the endpoint of interest and for each study, a mean year of enrolment ([start of enrolment + end of enrolment]/2) was calculated.
Results: A total of 8 study arms were identified, with only 2placebo arms, therefore a weighted linear regression was not feasible, and only intervention treatment arms were analyzed. A statistically significant downward trend in the SMR was observed in all intervention arms.
[pic_01]
Conclusion: The incidence of skeletal morbidity rates has decreased significantly over time in patients with multiple myeloma over the years of 1994–2007.
MASCC-0171
Incidence of skeletal related events over time from solid tumor bone metastases reported in randomised trials employing bonemodifying agents
M. Poon 1, L. Zeng1, L. Zhang1, H. Lam1, U. Emmenegger1, E. Wong1, G. Bedard1, N. Lao1, R. Chow1, E. Chow1
1Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Introduction: Skeletal related events (SREs) in patients with bone metastases decrease patients’ quality of life and functional status. While bone-modifying agents have been found to reduce the time to first on-trial SRE and decrease the total incidence of SREs, standard practice in the management of bone metastases has changed concurrently.
Objective: The purpose of this review was to investigate if advances in bone-targeted therapies have decreased the incidence of individual types of SREs and to delineate the trend of SREs.
Methods: A literature review was conducted to identify phase III, randomized bone-targeted therapy trials. For all studies, a mean year of enrolment ([start of enrolment + end of enrolment]/2) was calculated. Incidences of skeletal related events were tabulated and expressed as percentages of on-trial patients. Generalized linear mixed models were used to search for the trends of SRE over time for all placebo and intervention arms.
Results: A total of 20 eligible studies were identified which reported SRE data from phase III trials, of which 11 were suitable for the quantitative analysis. Enrolment periods for all included data ranged from 1990 to 2009. Statistically significant overall downward trends in pathological fractures and need for surgery were seen over time. Also significant differences between intervention and placebo were seen with all SREs.
Conclusion: The decrease in SREs over time may not only be a result of the development of new generation bone-modifying agents, but also due to better systemic management and awareness of events associated with bone metastases.
MASCC-0172
Cancer caregiver information seeking behavior
1Cancer Resource and Education Center, Universiti Putra Malaysia, Serdang, Malaysia
A report by the Malaysian National Cancer Registry (NCR) has published that in between 2003–2005, a total of 67,792 new cases were diagnosed among 29,596(43.7 %) males and 38,196 (56.3 %) females in Peninsular Malaysia. Nearly all these patients have or will have family members involved in their care. Family caregivers face numerous challenges when providing care for their loved ones. Thus, they need to have knowledge and skills pertaining to all aspects in cancer care and survivorship. To achieve this, they need to search for information. Generally, this study aims to explore the information seeking behavior among cancer care giver. This include to identify their source of information and type of information needed, and also to understand the reason why they seek these information. Besides that, this study also targets To explore other information needed by the care giver to cope with their responsibility. This research will employ a qualitative approach, using in depth interviews technique with 30 cancer care givers. The interviews will be guided by interview protocol developed from literature review. Ethical clearance will be obtained for the study protocol and consent to participate in the study will be elicited from subjects. The findings from this study will provide guidelines in the development of the intervention module or educational program to the cancer care giver and also the most effective strategies to disseminate reliable information regarding the disease.
MASCC-0173
Monitoring of radiotherapy results using 3DCRT technique for local prostate cancer with PSA
R.c.c.g. M. dorchin 1,2
1Oncology, Ganjavian Hospital, Dezfoul, Iran, 2Al-Bairouni hospital, Damascus University, Damascus, Syria
Patients and methods: Between 1.6.2006 and 1.6.2008, a total of 135 patients were treated with Three Dimensional Conformal Radiation Therapy (3DCRT) for clinical stages T1–T3 Adenocarcinoma of the prostate. The median age was 67 years (50–83), 10 % had family history. 81 % were smokers. The median PSA level was17.5 ng/ml (3.1–95). 32 % were T2a and 50 % T2b. The median Gleason score was 6 (3–7). 34 % received the treatment after radical surgery for biochemical relapse and 64 % as primary treatment. 60 % received 66–70 Gy and 40 % received 72–76 Gy. Patients were followed with PSA 3 monthly for 24 months. The median follow up was 12 months. 39 patients didn’t follow and therefore cancelled from the study. Only 96 patients ended the treatment
Results: The Bone scan was positive (bone metastases)in the 27 cases that PSA level had increased.24 cases from these patients received 66–70 GY XRT (low dose) and their median age was more than 70 years and18 cases/27cases were directly treated with EBRT.
Conclusion: Recurrence after RPR was good controlled by RT, but primary RT was not sufficient in the majority of our patients. Those patients received only 66–70 Gy, therefore Patients should receive a maximum dose of RT, and however more complications are expected. Measurement of Prostatic Specific Antigen (PSA) after Radiation Therapy is a good marker for specificity and sensitivity of the treatment. PSA was a powerful predictor of local relapse and distant metastases (DM) and Patients who develop biochemical relapse should be considered for systemic therapy as distant metastases are expected.
MASCC-0174
Sentinel-node biopsy comparison with routine axillary dissection in breast cancer in Al-Bairouni Hospital in Damascus City
R.c.c.g. M. dorchin RCCG
Al-Bairouni Hospital, Damascus University, Damascus, Syria
Methods: From July 2007 to November 2009, we randomly assigned 423 patients with primary breast cancer (PBC) in whom the tumor was less than or equal to 2 cm in diameter (T1) either to sentinel-node biopsy and total axillary dissection (the axillary-dissection group) or to sentinel-node biopsy followed by axillary dissection only if the sentinel node contained metastases (the sentinel-node group).
Results: The number of sentinel nodes found was the same in the two groups. A sentinel node was positive in 69 of the 208 patients in the Axillary -dissection group (33.17 %), and in 74 of the 186 patients in the sentinel-node group (39.78 %). In the Axillary dissection group, the overall accuracy of the sentinel-node status was 96.9 %, the Sensitivity 91.2 % and the specificity 100 %. There was less pain and better arm mobility in the patients who underwent sentinel-node biopsy only than in those who also underwent Axillary dissection. There were 16 events associated with breast cancer in the Axillary -dissection group and 9 such events in the sentinel-node group. Among the 112 patients who did not undergo axillary dissection, there were no cases of overt axillary metastasis during follow-up.
Conclusions: Sentinel-node biopsy is a safe and accurate method of screening the axillary nodes for metastasis in women with a small breast cancer.
MASCC-0175
Role of thymoquinone in animal models of schizophrenia
R.A.K.,A.K.N.,M.A.,M.M. M. Akhtar 1
1Pharmacology, Faculty of Pharmacy, 2Pharmaceutics, 3Pharmacognosy and Phytochemistry, Jamia Hamdard (Hamdard University), New Delhi, 4Clinical Pharmacology and Pharmacokinetics (CPP), Ranbaxy Research Laboratories., Gurgoan, India
Purpose: The present study evaluated the possible role of thymoquinone (TQ, a major constituent of Nigella sativa plant) in animal models of schizophrenia (SCZ).
Method: TQ (20 mg/kg i.p) was administered daily for 28 days in mice. Different models of SCZ like haloperidol-induced catalepsy, apomorphine-induced climbing behaviour and elevated plus maze test were used. After the last dose of TQ on 28th day, behavioural tests were performed followed by biochemical estimations
Results: Pre-treatment of TQ alone and in combination with haloperidol observed cataleptic behaviour. Administration of TQ in apomorphine induced climbing behaviour reduced maximum time of single climb and climbing index (p < 0.001). Scopolamine-induced prolongation of transfer latency (TL) was suppressed by TQ (p < 0.001). There was no change in the percentage alternation of animals in TQ treated group. However, a significant possible alternation was observed (p < 0.001), suggested its anti-amnesic effect. The anti-amnesic effect of TQ was associated with decrease in acetyl cholinesterase (AChE) activity in mice brain. A decrease in TBARS levels and increase in glutathione (GSH) and Catalase levels were observed in all models used, thus, confirming its antioxidant properties. TQ administration also showed reduction in dopamine levels indicating the involvement of dopamine receptors in all three models thus, suggesting its antipsychotic like activities.
Conclusion: The present study observed antipsychotic like profile of TQ. However, our results are preliminary, further studies are required using specific animal models of positive and negative symptoms of SCZ in understanding the possible role of TQ in SCZ.
MASCC-0177
Introducing a new cost-effective alternative method preventing post-radiotherapy hyposalivation
N. Mirjalili 1
1Shahid Sadoughi University of medical sciences, Yazd, Iran
Introduction: Salivary gland dysfunction is one of the debilitating complications of head and neck radiation therapy. Depending on radiation schedule, salivary gland hypofunction may range from absolute lack of saliva to severely reduced excretion. Ideally, there are some modern measures, such as prescribing Amifostin or shielding the major glands that enable health-care providers to reduce the extent of hyposalivation. However, a considerable number of patients particularly in developing countries can barely tackle the costs.
Objective: Introducing a new cost-effective alternative method preventing post-radiotherapy hyposalivation.
Methods: A 27-year-old female with carcinoma of nasopharynx was referred for oral health evaluations. As she was not capable of paying for Amifostin, and couldn’t tolerate the side effects of Pilocarpin, a combination of hydration and topical saliva stimulation including salivary gland massage and gum chewing was instructed. During the radiotherapy sessions gum chewing was omitted due to dry mouth and she continued with massage only. Her unstimulated whole saliva flow rate and severity of oral dryness feeling were measured before, during and after the radiotherapy.
Results: The flow rate at first visit was 6.2 ml/min which fell to a minimum of 0.81 ml/min during the radiotherapy and rose to 1.3 ml/min after the first month of radiotherapy. The severity of oral dryness feeling, according to Tompson’s score, at the first visit was 15 which increased to a maximum value of 45 and then decreased to 24 1 month after the last radiotherapy session.
Conclusion: Salivary gland massage is a promising low-cost method in reducing post-radiotherapy hyposalivation.
MASCC-0178
Study of the relationship between individual and social factors of women on screening of breast cancer by using health belief model
N. Fouladi 1, F. Purfarzi1, H. Alimohammadi1, A. Massumi1
1Ardebil University of Medical Sciences, Ardebil, Iran
Breast cancer is the most common cancer in women. More than 90 % of the patients can be cured by early recognition. Breast self-examination and mammography can be useful in this case.
Materials and methods: In this study 380 women aged 30 and older who had gone to health centers of Ardabil were choose to measure their use of breast cancer screening in the last year. HBM questioner that was reliable and valid for Iranian women was used in this case. Logistic regression was used to identify leading independent predictors of breast cancer screening.
Results: In this study 27 % of the women performed BSE in the last year but only 6/8 % of them used mammography as a way of screening during the last year.
There was a significant difference in all parts of model unless in perceived severity between women that had performed BSE in the last year and who did not performed this behavior. The regression analysis revealed that intentions to perform BSE were predicted by perceived self-efficacy and perceived barriers for BSE and intentions to perform mammography were predicted by perceived barriers for mammography.
Conclusion: This study indicates that self-efficacy can cause performing BSE and perceived barriers can cause not performing BSE and mammography.
MASCC-0179
A screening tool to identify patients’ psychosocial difficulties and to establish a supportive relationship at cancer diagnosis
O.D.-C.,B.Q.,Y.S. N. Stadelmaier 1
1“Institut Bergonié, 2Laboratoire de Recherche ‘Santé et Qualité de Vie’ EA 4139, Université Victor Segalen Bordeaux 2, Bordeaux, France”
Context: In France, following all cancer diagnoses, nurses offer a consultation dedicated to providing information, listening, and identifying supportive care needs. To assist nurses in structuring these consultations and to enable them to approach any psychosocial difficulties encountered with the patient, in a Cancer Centre we introduced The Basic Documentation for PsychoOncology (Po-Bado), a semi-directive interview guide validated in Germany.
Hypothesis: We tested the hypothesis that, above and beyond it capacity for screening, the Po-Bado would encourage the establishment of supportive relationships and improve satisfaction of nurses regarding their relational competencies with patients and the structure of consultations.
Method: We retranscribed and analysed (NVIVO8) 62 consultations, carried out by 15 nurses divided into two groups. The first consisted of four nurses already experienced with the use of the Po-Bado (20 consultations), and the second consisted of 11 trained on the tool during the study (21 before training and 21 after training). Satisfaction of the 15 nurses was evaluated by semi-directive interviews.
Results: There was a significantly greater use of techniques encouraging the expression of patients’ experiences and significantly less use of non-encouraging techniques in consultations using the Po-Bado (inexperienced after training and experienced). Healthcare professionals felt more competent after training on the Po-Bado and stated that they felt more legitimate, particularly in their referrals to psychologists.
Conclusion: The PO-Bado is beneficial for the quality of the supportive relationship with the patient, consultation structure, and the satisfaction of healthcare professionals with regard their relational skills.
MASCC-0180
Developing a community-based complex intervention to improve quality of life in people with colorectal cancer: evidence, theory and acceptability
J.L.A.,P.M.,S.B.,S.H. N. Gray 1
1Division of Applied Health Sciences, University of Aberdeen, Aberdeen, 2General Practice and Primary Care, University of Glasgow, Glasgow, 3Cancer Care Research Centre, University of Stirling, Stirling, 4Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, 5Hull York Medical School, Hull York Medical School, Hull/York, 6Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, 7Department of Oncology, Aberdeen Royal Infirmary, Aberdeen, 8Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
Background: People with colorectal cancer report significantly impaired quality of life (QoL). Many physical, psychological, and social factors associated with lower QoL are modifiable, and therefore amenable to intervention. The present study reports the development of a theory-based intervention to improve QoL in people with colorectal cancer.
Methods: MRC complex intervention guidelines informed four development activities; (a) literature review of existing evidence of modifiable predictors of QoL in people with cancer, (b) development of a theoretical basis and causal model for the intervention, (c) modelling of processes and outcomes and identification of appropriate behaviour change techniques by a multi-disciplinary group, and (d) assessment of feasibility and acceptability through semi-structured interviews with people with colorectal cancer (n = 28), cancer specialists (n = 16), and primary care health professionals (n = 14) and pilot testing with patients (n = 12).
Results: Modifiable predictors of QoL identified were: symptoms (fatigue, pain, diarrhoea, shortness of breath, insomnia, anorexia/cachexia, poor psychological well-being, sexual problems); and impaired activities. To modify these symptoms and activities, an intervention based on Control Theory was developed to help participants identify personally important symptoms and activities; set appropriate goals; use action planning to progress towards goals; self-monitor progress; and identify (and tackle) barriers limiting progress. Interview responses were generally favourable and included recommendations about timing and style of delivery that were incorporated into the intervention. The pilot study demonstrated the feasibility of intervention delivery.
Conclusions: Through multi-disciplinary collaboration, a theory-based, acceptable and feasible intervention to improve QoL in colorectal cancer patients was developed, and can now be evaluated.
MASCC-0181
Oral ulcers in patients with advanced breast cancer receiving everolimus: clinical presentation and management.
A.N.,I.A.,E.P. O. Nicolatou-Galitis 1
1Dental School, University of Athens, 2Oncology Department, Mitera Hospital-Ygeia, Athens, Greece, 3Divisions of Oral Medicine Brigham and Women’s Hospital and the Dana-Farber Cancer Institute, Dana-Farber Cancer Institute, Boston, MA, USA
Purpose: Oral aphthous-like ulcers, referred to as «stomatitis» or «oral mucositis» represent a frequent dose-limiting toxicity related to mTOR inhibitors in oncology. The aim of this study was to report the clinical features and management outcomes in patients with everolimus-related stomatitis.
Patients and methods: Fifteen women with hormone-receptor-positive advanced breast cancer received everolimus combined with exemestane. Patients reporting the occurrence of oral pain during the course of antitumor therapy were referred to trained assessors for oral assessment
Results: Seven of 15 patients (46.6 %) were evaluated with stomatitis. Presenting pain was severe in 6 patients. The median time to development of pain was 13 days. Ulcers affected the non-keratinized mucosa, while the keratinized gingival mucosa was also affected in one patient. Topical dexamethasone solution was an effective intervention in all 7 patients. Everolimus was temporarily discontinued for a median time of 2 weeks in 4 patients. Two of those 4 patients developed a second event of stomatitis and everolimus was again discontinued and resumed after 2 weeks. At present all 7 patients continue everolimus therapy without any further toxicity; 5 receive full dose and 2 receive reduced dose
Conclusions: Everolimus-related oral ulcers were frequent and led to temporary discontinuation to 4 (57.1 %) and permanent dose modifications to 2 (28.6 %) patients. Topical dexamethasone was effective in managing stomatitis. Well-designed prospective trials, endorsing a consensus in terminology and an appropriate grading scale are needed to evaluate measures on prevention and management of this unique toxicity, aiming at improving overall cancer treatment outcomes.
MASCC-0182
The effects of concomitant hormonotherapy on radiation induced cardiac toxicity
G.Y.,C.Y.,H.A.,H.T. O.Y. Ata 1
1Medical Oncology, 2Radiation Oncology, Selcuk University, 3Pathology, Necmettin Erbakan University, Konya, Turkey
Background: We aimed to evaluate the effects of Anastrozole(A), Letrozole (L) and Tamoxifen (T) on radiation induced cardiac toxicity.
Methods: Eighty female rats were divided into 8 groups. Group (G) 1 was defined as control group. G2 was radiation therapy (RT) only group. Group 3, 4 and 6 were T, A and L control groups respectively. Group 6, 7 and 8 were RT plus T, A and L groups respectively. A single dose of 12 Gy RT was given to thorax with an anterior field. T, A and L were started 1 week before the RT and continued until animals were sacrificed 16 weeks after the RT. The extent of cardiactoxicity for each rat was quantified with image analysis of histological sections of the lung.
Results: The endocardial thickness and cardiac fibrosis scores were significantly differed between all the study groups (p values were <0.001 and 0.001 respectively). Endocardial thickness was significantly higher in RT + T group when compared to the other RT groups (p < 0.001 for each). The medianendocardial thickness was 1233, 5 micron RT + L group and 986, 5 micron for RT + Agroup (p < 0.001). When compared to RT groups with respect to fibrosis scores to there was a significant difference only in between RT + T and RT + A groups (p:0.008).
Conclusion: When used with concomitant RT, A is the safeties whereas T seems to be the most toxic drug regarding to radiation induced cardiac toxicity. This finding should be clarified with further clinical studies.
MASCC-0183
Compritive knowledge of breast self examination in midwifery and nursing students
K.N. P. Ashkvari 1
1Islamic Azad University of Iran Karaj Branch, 2Islamic Azad University, Karaj, Iran
Introduction: Breast cancer is the most common type of cancer among women world wide ranking second in mortality from cancer. Bse is a screaning method that should be taught at an early age so as to educate women about the importance of early detection of breast cancer.
Aim: the aim of this study was to evaluate the level of knowledge of midwifery and nursing student regarding breast self-examination.
Materials and methods: This study is descriptive on 23 midwifery and 69 nursing student. Data collection tool was a questionnaire the included 6 questions about demographic characteristics, and 14 question about knowledge breast self examination. Data analyzed by descriptive statistics.
Result: Our results show that the average age being (21–35), majority of them are single (%67/4) and (%29/3) twin. Our result showed no significant differences in midwifery and nursing knowledge. (p > 5 %). Our result showed the students of midwifery and nursing have mild knowledge.
Conclusion: It seems that despite of the importance of the bse in early diagnosis of breast cancer the majority of women have poor knowledge and practice about BSE. Based on the positive attitude of most women about BSE, it is that increasing the knowledge of women by education ways of breast cancer, especially BSE, this will be available by more attention of public health centers, TV and newspaper for increasing women awareness.
MASCC-0184
Psychological and demographic predictors of negative self-perception in a culturally diverse sample of head and neck cancer patients
1Psychology, University of Notre Dame, Notre Dame, IN, 2University of Miami School of Medicine, Miami, FL, USA
Background: Head and neck squamous cell carcinomas (HNC) and their various treatments are associated with psychological distress and negative self-perception that can impact patients’ psychosocial functioning and quality of life (QoL). Identifying factors that lead to psychological distress and negative self-perception is essential to the development and testing of interventions to improve QoL for HNC patients.
Methods: This study included 150 English-fluent HNC patients between 20 and 88 years old (Mean = 64, SD = 14). Fifty-six percent were US-born and 44 % were foreign-born from Cuba, Haiti, Dominican Republic, Jamaica, Puerto Rico, Nicaragua, and Peru. These patients provided demographic data and completed psychometrically valid measures of anxiety, depression, and self-perception. We conducted a standard multiple regression (MR) analysis, using scores on measures of anxiety and depression, age, sex, race, education, income, and employment status to predict self-perception.
Results: We found a statistically significant MR model (p < .001). Education (Standardized Coefficient Beta (SCB) = −.20, t = −2.39, p = .02), race (SCB = .156, t = 2.084, p = .04) and anxiety (SCB = .199, t = 2.078, p = .04) statistically significantly predicted self-perception. However, age, sex, employment status, income and depression did not make a statistically significant contribution to the prediction of self-perception (all ps > .05).
Conclusion: Race, education, and anxiety can negatively influence patients’ self-perception. Demographics and psychological distress data need to be integrated in the development and testing of interventions to improve QoL for HNC patients.
MASCC-0185
Struggling through a difficult time: experiences from patients with larynx cancer during active treatment phase
P. Wu 1
1Nursing Dept, Eye & ENT Hospital, Fudan University, Shanghai, China
Aim: To explore laryngeal cancer patients’ experiences during the active treatment phase.
Methods: A qualitative methodology was adopted. A purposive sample of 11 people with advanced-stage laryngeal cancer was included. Participants were recruited from Eye and Ear Nose Throat hospital in Shanghai. Data were collected over a 3-month period through open-ended interviews (in which some patients mainly using writing) and informal observations. Data collection occurred between postoperative Day 5 and discharge day to ensure the participants were medically stable enough to participate. A thematic analysis of the data was performed.
Findings: The core theme identified during interpretation of data was demonstrated in four interwoven themes: (1) A strong sense of life threat; (2) Perceived a great deal of pain; (3) Loss of control due to unable to communicate orally; and (4) Moving between hope and despair. Ways to cope with these disturbances were captured in one theme: ‘Keep thinking of survive’.
Conclusion: This study extends a nuanced understanding of laryngeal cancer patients’ experiences during the active treatment phase. Our results address the experience or problem of voicelessness immediately after surgery. Our data indicates that the patients had been struggling through a difficult time. Patients have episodes of substantial pain and psychosocial distress. Despite advances in symptom management, the distress relief is incomplete. However, patients seemed to minimize these problems and instead focused on gaining control of the situation, relying on the support of their family and healthercare givers. Hence, there is a great need for support for this population.
MASCC-0186
Qualitative exploration of experience and needs of informal caregivers of geronto-oncology patients undergoing ambulatory chemotherapy
J.R.,A.G.,L.I. P. Stolz-Baskett 1
1Zurich University of Applied Sciences, Institute of Nursing, Winterthur, Switzerland, 2FNSNM, King’s College, London, UK, 3Tumor- und Brustzentrum ZeTuP, St. Gallen, Switzerland
“Objectives: To understand and describe experiences and needs of informal caregivers of older cancer patients receiving parenteral chemotherapy.
Methods: Semi-structured face-to-face interviews were conducted with informal caregivers (n = 19) of patients 70 years and older receiving chemotherapy. Interviews were transcribed verbatim and analysed using the Framework approach to thematic analysis.
Setting: Three ambulatory cancer clinics in the German speaking part of Switzerland, during 2011–2012.
Results: Caregivers experienced manifold negative and positive emotional, spiritual, physical and social needs. Frequent issues of concern were the psychological impact of diagnosis, such as shock or disbelief, treatment side-effects, difficulties communicating with health care professionals, including the perception of long waits between tests and being told results, and thoughts about death/dying or loss respectively. Positive experiences included, for example, a sense of gaining valuable life experience and deepening of relationships. The patient’s age made some experiences appear normal to caregivers rather than cancer dependent. Caregivers were subsequently categorised: caregivers with needs that have been met by the Health Care Team (HCT); caregivers with unmet needs; and caregivers declining support from the HCT; as well as caregivers for whom more than one of these scenarios applied.
Conclusions: Caregiver needs were mostly articulated around emotional, social and spiritual issues. Not all caregivers accepted support for their needs from the health care team. In summary, caregivers of older cancer patients vary in the level of support needed and individual and on-going assessment of informal caregivers needs is required in order to ensure the provision of adequate and appropriate support.”
MASCC-0187
Long term outcome in thyroid cancer with intermediate differentiation following systematic total or near-total thyroidectomy plus high dose radioactive iodine therapy
P. Hagag 1, M. Vaiman1, E. Kummer1, V. Tosker1, M. Weiss1
1Assaf Harofeh Medical Center, Zerifin, Israel
Aim: To determine the long-term outcome of thyroid cancer with intermediate differentiation following standardized therapy.
Methods: Thirty patients (study group) with palpable tall-cell, columnar cell, diffuse sclerosing, insular and Hurthle cell variants of thyroid carcinoma, as well as 45 follicular and 99 pure papillary controls, underwent systematic total or near-total thyroidectomy followed by at least one high dose of radioactive iodine. Patients with poorly differentiated thyroid carcinoma according to the Turin consensus conference criteria were excluded from the study.
Results: After a mean follow-up of 12 years, the recurrence rate was very elevated (37 %) in the study group (p < 0.001 versus controls), even in Stage I or Stage II subjects (p < 0.001), but the disease-specific mortality in the same cohort (7 %) was comparable to that of the follicular carcinoma group (p > 0.28) and better than that of previous studies. Essentially, insular histology was associated with a poor outcome (recurrence 83 %, mortality 33 %). The mean interval between thyroidectomy and onset of new metastases was 4 years in the study group. The recurrence was only locoregional in diffuse sclerosing carcinoma, whereas distant metastases (lung, mediastinum, bone, brain) were observed in all cases of recurrent insular, tall-cell and Hurthle cell carcinoma. In all metastatic cases, the iodophile status was permanent and no cases of dedifferentiation of metastases were described.
Conclusions: Despite the aggressive behavior of thyroid cancer with intermediate differentiation, intensive surgical and isotopic therapy may ameliorate the prognosis. However, in insular thyroid carcinoma, thyrosin kinase inhibitor treatment should be early prescribed, even in cases of iodophile tumor.
MASCC-0188
The assessment of tissue eosinophiliain head and neck squamouscell carcinoma by luna staining
P. Motahhary 1
1Tehran Dental School, Tehran, Iran
Introduction: Tumor associated tissue eosinophilia (TATE) has been described in a variety of neoplasms, but it’s role in tumors has not yet been defined, SCC is the most common malignancy of the head and neck. The aim of this study was to evaluate the association between TATE and histopathologic grading in HNSCC with luna staining.
Method: Out of 83 cases 67 paraffin blocked of HNSCC were selected, hematoxylinand eosin stained sections were reviewed for histopathologicgrading according to Broderssystem and divided to three groups: well, moderate and poor differentiated. 4 μ sections were stained with lunafor detection of eosinophilic infiltration within the tumor. A blind pathologist counted eosinophilsin 10HPF in each slide and categorized as: none (0), low (1–4), medium (5–19), high (≥20). Clinic opathologic factors including: age, sex, location and histopathologicgrading were tested statistically.
Results: TATE was negative in one (1.5 %) case, which was moderately differentiated and was positive in 66 (98.5 %) There was no correlation between TATE and age, sex, location, and histopathologicgrading (P > 0.05).
Conclusion: TATE has no correlation with histopathologic factors, but TATE was lower in poorly differentiated group than two others.
MASCC-0189
The assessment of tissue eosinophiliain head and neck squamouscell carcinoma by luna staining
P. Motahhary 1
1Tehran Dental School, Tehran, Iran
Introduction: Tumor associated tissue eosinophilia (TATE) has been described in a variety of neoplasms, but it’s role in tumors has not yet been defined, SCC is the most common malignancy of the head and neck. The aim of this study was to evaluate the association between TATE and histopathologic grading in HNSCC with luna staining.
Method: Out of 83 cases 67 paraffin blocked of HNSCC were selected, hematoxylinand eosin stained sections were reviewed for histopathologicgrading according to Broderssystem and divided to three groups: well, moderate and poor differentiated. 4 μ sections were stained with lunafor detection of eosinophilic infiltration within the tumor. A blind pathologist counted eosinophilsin 10HPF in each slide and categorized as: none (0), low (1–4), medium (5–19), high (≥20). Clinic opathologic factors including: age, sex, location and histopathologicgrading were tested statistically.
Results: TATE was negative in one (1.5 %) case, which was moderately differentiated and was positive in 66 (98.5 %) There was no correlation between TATE and age, sex, location, and histopathologic grading (P > 0.05).
Conclusion: TATE has no correlation with histopathologic factors, but TATE was lower in poorly differentiated group than two others. "
MASCC-0190
Evaluation of dengue and dengue like illness in a place of 15–20 lackcs population by serological methods
M.N.J.,M.H.D.,M.K.,M.D. P. Panda 1
1Microbiology, T.N. Medical College, Mumbai, India, Rourkela, 2Microbiology, Apollo Hospitals, Bilaspur, India
We are 300 beded tertiary care hospital. Situated in central India. We had many cases of fever with rashes and some of them were with severe hypotension and shock. The lab investigations included IgG, IgM and NS1 Antigen for Dengue virus, Hemaptological parameters and Liver function test. Many cases were found to have raised SGOT and SGPT with severe depletion of platelet count.
MASCC-0191
Frequency of hepatitis B and C in surgical patients, Civil Hospital Karachi
R. Rafaqat 1, S. Khawaja1
1Dow Medical College, Karachi, Pakistan
Background: Hepatitis B and C is a serious health problem worldwide. Infections with hepatitis B and C virus have been escalating in Pakistan and it has reached in endemic state. This study was carried out to determine the frequency of hepatitis B and C in surgical patients.
Methods: This cross-sectional study was conducted in Civil Hospital Karachi. Total 662 patients admitted in surgical department were approached. All patients were screened for HBsAg and anti-HCV using immunochromatography ICT. The information about risk factors was also assessed. The data was analyzed on SPSS 17.
Results: Out of 662, 325 (49.1 %) were males and 337 (50.9 %) were females. Mean age of patients was 37.52. Hepatitis B surface antigen (HBsAg) was positive in 19 (2.9 %) and Hepatitis C (anti-HCV) in 45 (6.8 %) patients. HBsAg was positive in 12 (63.15 %) males and 7 (36.84 %) females. Whereas anti-HCV was positive in 21 (46.66 %) males and 24 (53.33 %) females. The results show that out of 19 positive patients for HbsAg, 17 (89.47 %) have history of intravenous injections and out of 45 anti-HCV, 44 (97.77 %) have the same history. The other major risk factors found were blood transfusion, blood donation, ear-nose piercing, dental procedure and barber shave.
Conclusion: The study suggests a moderate to high prevalence of hepatitis B and hepatitis C in surgical patients. Routine serological screening prior to surgery should be made mandatory so that health care workers especially surgeons can take precaution before surgery.
MASCC-0192
Skin cancer knowledge and sun protection behaviors in medical and non-medical university students in Karachi, Pakistan
R. Rafaqat 1, S. Khawaja1
1Dow Medical College, Karachi, Pakistan
Objective: To examine skin cancer knowledge and sun protection behaviors in Medical and Non-Medical university students in Karachi, Pakistan
Methods: We surveyed 768 students (16–27 years) at two large public sector universities (401 Medical Students and 367 Non-Medical Students) in Karachi, Pakistan. Survey data were collected regarding skin cancer knowledge and sun protection behaviors. Differences between the 2 groups were compared with chi-squared test.
Results: Of all the respondents, sun exposure as a risk factor for skin cancer was identified by 77.7 %, genetics by 44 %, ultraviolet radiation by 87.1 %, multiple skin moles by 19.1 % and fair complexion by 27.7 %. Knowledge of risk factors was greater among the Medical Students as compared to the Non-Medical Students. Of the total, 56 % of the participants ‘always’ wears sun-protective clothing, 41.4 %‘always’ wears hat/dupatta, 13.2 % ‘always’ seeks shade, 10.5 % ‘always’ wears sun glasses, and 27.9 % ‘always or most of times’ apply sunscreen with sun protection factor of ≥15. The most frequent method of sun protection was found to be wearing sun-protective clothing, which was significantly more common among the Medical Students (64.1 % vs. 47.1, p < .001); while wearing of sun-glasses was significantly more common among the Non-Medical Students (15.8 % vs. 5.7 %, p < .001). In terms of the wearing of hat/dupatta, seeking shade and wearing sunscreen, no significant difference was evident between Medical and Non-Medical students.
Conclusion: University programs for increasing knowledge of skin cancer risk are warranted. Changing attitude and behaviors regarding exposure and protective measures is increasingly important.
MASCC-0193
Knowledge & self-perceived practice regarding infection control among nursing students of Civil Hospital Karachi.
R. Rafaqat 1, M. Ahmed1
1Dow Medical College, Karachi, Pakistan
Introduction: Health-care associated infections cover all clinically evident infections that are not the part of patient’s original illness for which patient is admitted. Most of these infections clinically become evident after 48 h of admission. In all settings, nurses can play a dominant role in infection prevention and control by using their knowledge, skill and judgment. This reflects the importance and need of such type of study among nursing students.
Methods: A cross-sectional study was conducted at Civil Hospital Karachi. Nursing students practicing in Civil Hospital Karachi were approached for the study. A pre-designed interview based questionnaire was used for data collection. The collected data was analyzed using SPSS version 17.
Results: Total 241 students were interviewed including 41.5 % males and 58.5 % females. Of all students, 71.4 % had received guidelines about infection control from their seniors nursing staff. Hand hygiene facility was available in 78.8 % of wards. Among all students 80.9 %were aware of WHO guidelines on hand washing but only 20.3 % performed complete steps. Only 128 students (53.1 %) were aware of the term Health-care Associated Infections. Overall half of the students of this study reported lack of proper practice such as washing hand before and after procedure, using gloves and applying proper alcohol.
Conclusion: There is lack of proper practice among nursing students and lack of knowledge regarding health care associated infections. This study warrants the health associated education programs to fill the gap in knowledge as well as in practice.
MASCC-0194
Efficacy and safety of a 6-hour continuous overlap method for converting intravenous to transdermal fentanyl in cancer pain
Samala1, R. Espinal1, 1, R.(. M.1, Davis1
1(1) Cleveland Clinic, Cleveland, OH, USA
Objective: To determine the efficacy and safety of a 6-hour continuous overlap method for converting intravenous to transdermal fentanyl (TF) in patients with cancer pain.
Background: Cancer pain requires opioids like fentanyl, which is used parenterally (intravenous or subcutaneous), then converted to TF once pain is controlled. Little evidence exists to guide conversion. We determined the efficacy of a 6-hour continuous overlap when converting intravenous to transdermal fentanyl.
Method: We switched from IV fentanyl to TF, using a 1:1 (IV:TF) conversion and overlapped by 6 h without tapering IV fentanyl dose starting with the first transdermal fentanyl dose. Pain intensity by numerical rating scale, rescue analgesic doses, and presence and severity of opioid-related adverse events were assessed immediately before TF placement, and at 6, 12, 18, and 24 h thereafter.
Result: Seventeen consecutive patients with cancer pain controlled by IV fentanyl were converted to TF. Median age was 65 years, 10 were female. Pain intensity at 6 and 24 h and number of rescue doses remained stable following TF placement. At 12 and 18 h there was a statistically pain was significantly but not clinically significantly increased (p = 0.01 and 0.02, respectively).
Conclusion: A continuous 6-hour overlap is safe and effective when converting from IV fentanyl to TF. A slight increase in pain intensity may occur but does not lead to increased rescue dosing. A 6 h IV to TF conversion strategy rather than a 12 h stepped dose reduction strategy is simpler, and reduces care burden.
MASCC-0195
A man with pancoast syndrome: lessons from his painful journey to disease discovery and palliative care
N.W.,S.L. R. Samala 1
1Center for Home Care and Community Rehabilitation, 2Radiation Oncology, 3The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA
Introduction: Over 80 years have passed since Henry Khunrath Pancoast described growths in the thoracic cavity apex that present with misleading symptoms.
Objectives:
1. Describe a case of Pancoast syndrome.
2. Understand the historical background, clinical characteristics, and diagnostic challenges of superior sulcus tumors.
3. Discuss the management of superior sulcus tumors, focusing on palliative care.
Case description: A 60-year-old man was transferred to our hospital for further management of a newly detected right apical lung mass. His painful journey began 7 months prior with a constant tearing pain between his shoulder blades radiating to his entire right upper extremity, and accompanied by progressive hand weakness. Three months into his disease, the patient had seen several specialists, found little relief from assorted pain regimens, and undergone surgery for suspected carpal tunnel syndrome. By the time he sought treatment at the hospital which discovered the lung mass, he had lost use of his right hand, as well as 41 lb of weight. On assessment at our institution, the patient exhibited right-sided ptosis and miosis, and right claw hand. Biopsy revealed non-small cell lung cancer. He was moved to our palliative care unit where optimal pain control was achieved using multiple medications, a course of radiotherapy, and various interventions delivered by an interdisciplinary team.
Conclusions: Being mindful of the clinical features of superior sulcus tumors, including the classic attributes of Pancoast Syndrome, may lead to earlier disease discovery. Providing effective palliative care is crucial as patients sail through multiple treatment alternatives.
MASCC-0196
Nonconvulsive status epilepticus in a palliative care unit: a crucial consideration
A.P.-M.,M.D. R. Samala 1
1Center for Home Care and Community Rehabilitation, 2The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA
Introduction: In patients with impaired mental state, discovering an underlying cause can vary from being clear-cut to nebulous.
Objectives:
1. Recognize nonconvulsive status epilepticus as an important consideration in patients with altered mental status.
2. Review the clinical presentation, differential diagnoses, and management of nonconvulsive status epilepticus.
3. Discuss the implications of nonconvulsive status epilepticus in addressing goals of care and prognosis.
Case description: A 66-year-old man was admitted to our palliative care unit with severe lower back pain and muscle spasms of a few weeks duration. He was diagnosed with prostate cancer 5 years prior, which metastasized to bone. Pain control was subsequently achieved with transdermal fentanyl, oxycodone, diazepam, diclofenac, and gabapentin. During hospitalization, his consciousness fluctuated between unresponsiveness and brief wakefulness. Attempted remedies—naloxone, empiric antibiotics, and careful revision of opioid regimen—were unsuccessful. Magnetic resonance imaging of his brain showed leptomeningeal disease, and an electroencephalogram demonstrated nonconvulsive status epilepticus (NCSE). He was placed on multiple anticonvulsants with significant improvement in mental state. NCSE is a rarely implicated cause of impaired consciousness. It is worsened by neuroleptics, which are used for delirium, and reversed by anticonvulsants. In the setting of a serious medical illness, such as leptomeningeal disease, which is rare in prostate cancer, NCSE bears a poor prognosis.
Conclusions: Discerning the cause of mental status change can be frustrating and not beneficial at times. NCSE, however, should be considered, especially for patients with diseases that potentially affect the brain.
MASCC-0197
Osteoporotic vertebral compression fractures: a rare complication of radiotherapy in a patient with lung cancer
E.n.-s. R. descourt 1
1Chu Brest, Brest, 2Chu Brest, Brest, France
The development of bone fractures after radiotherapy is a rare event which mainly concerns the pelvis or the long bones. This complication is unusual in the vertebrae. We describe the case of a 66-year-old male patient with lung cancer who was treated with combined radio-chemotherapy and developed dorsal pain secondary to vertebral compression 4 months after the end of radiotherapy. Investigations led to a diagnosis of post-radiotherapy vertebral osteonecrosis. It is important to differentiate metastatic lesions from radiological complications. It is not possible to differentiate a metastasis from a recent osteoporotic compression fracture by imaging. A bone biopsy may therefore be necessary. Metastatic bone involvement is common in patients with lung cancer. When images are not typical of secondary progression, however, and there is no change in the general state of the patient, evidence of thoracic progression of the tumour or distal progression other than bone, vertebral osteoporotic complications should be considered. It is important that a wrong diagnosis is not made without histological proof of metastasis which has a poor prognosis.
MASCC-0198
Exercise after radical prostatic radiotherapy linked to better sexual function and reduced late toxicity
M.H.,J.A.,J.M. R. Thomas 1,2,3
1Oncology, Cambridge University, Cambridge, 2Post graduate Medicine, Cranfield University, 3Oncology, Bedford Hospital, Bedford, 4Medicine, The Royal Marsden Hospital, 5Oncology, Mount Vernon Hospital, London, UK
Introduction and objectives: More and more men are surviving prostate cancer yet living with the consequences of their disease and treatments. This retrospective study evaluated a link between exercise, smoking and obesity with the symptoms of late pelvic toxicity post radiotherapy.
Methods: 440 (94 %) of an entire cohort of 470 alive men who were treated with radical radiotherapy at Addenbrooke’s/Bedford Hospital between 2000 and 2010 completed a questionnaire consisting of the Vaizey Rectal Toxicity score, theNCI common toxicity scores for rectal bleeding, erectile function and urinary incontinence, a General Practical Physical Activity Questionnaire and questions concerning BMI and smoking. The effect of each lifestyle criteria on erectile function, urinary and rectal symptoms was investigated using a non-parametric ANOVA (Kruskal–Wallis) test or chi-squared test (significance level α = 0.05).
Results: At the time of the survey, 63 % were over-weight or obese (BMI >25); 58 % were inactive, 27 % moderately inactiveand 15 % active. Active men had significantlybetter erectile and urinary function and lower rectal toxicity. Men smoking >5/day had significantly worserectal toxicity as did overweight men.
Conclusion: This is the first comprehensive evaluation of exercise and lifestyle habits duringand after radical radiotherapy for prostate cancer. Although a retrospective analysis, the data strongly suggests higher late toxicity among smokers, inactive and overweight men. We recommend that men should receive, written information, lifestyle counselling before and after radiotherapy and if necessary referral to smoking cessation clinics, dieticians and local gyms via the national exercise referral scheme.
MASCC-0199
Palliation of of cervical spine metastases with stereotactic body radiosurgery
R.K.,2.,N.B.,J.B.,K.S. H. Lomas IV 1
1Department of Radiation Oncology & Radiosurgery, Riverside Regional Medical Center, Newport News, 2Department of Radiation Oncology, University Of Virginia, Charlottesville, 3Department of Neurosurgery, Riverside Regional Medical Center, Newport News, 4Department of Neurosurgery, University Of Virginia, Charlottesville, VA, USA
Objectives: Stereotactic body radiosurgery for progressive spinal metastases provides excellent palliation in well selected patients. The authors examine a series of spinal metastasis patients treated with stereotactic body radiosurgery (SBRT).
Methods: Using our institutional database we collected data from 253 cases of spinal radiation for metastasis. There were 37 cases of cervical spine radiation for metastasis treated between 2007 and 2011. There were 26 patients who were treated with radiosurgery initially and 11 patients had previously received external beam therapy. The primary indication for intervention was pain (35/37 patients). Spinal MRI was performed before treatment initiation and CT or MRI at regular follow-up intervals to evaluate for disease progression, and clinical follow-up visits were examined for improvement in pain. The National Cancer Institute Common Toxicity Criteria version 3.0 was used to evaluate toxicity.
Results: Mean and median follow-up was 18.36 months and 15 months respectively with a range of 4 to 60 months. None of the patients experienced myelitis, progression of fracture or a new fracture. Radiographic local control was 100 %. Palliation of pain was observed in 33/35 patients (94.3 %). Toxicity was limited to 3 patients with grade 1 dysphasia and1 patient with grade 1 dermatitis. The cumulative doses for the SBRT ranged from 15 to 24 Gy with a mean dose of 20.45 Gy given in 3 or 4 treatment fractions with one treatment per week.
Conclusion: Treatment of progressive cervical spinal metastases with stereotactic body radiosurgery results in excellent palliation and local control with minimal toxicity.
MASCC-0200
Gene polymorphism in estrogen receptor-b (exon 7) and breast cancer risk in women
S.K.,P.I. S. Abbasi 1
1Dept. Medical biotechnology, School of Allied Medicine, Tehran University of Medical Sciences, 2School of Veterinary Medicine, University of Tehran, Tehran, Iran, 3Department of Biomedical Science, Faculty of Medicine and Health Sciences Universiti Putra Malaysia, Sedang, Malaysia
Gene polymorphism in estrogen receptor-b (exon 7) and breast cancer risk in women
Sakineh Abbasi 1, Samira Kalbasi2, Patimah Ismail3
Abstract
Background: Evidence suggests that alterations in estrogen signaling pathways, including estrogen receptor-a (ER-a) and -b (ER-b) occur during breast cancer development. Epidemiologic studies have revealed that age–incidence patterns of breast cancer in Middle East differ from those in Caucasians. Genomic data for ER-b is therefore of value in the clinical setting for that ethnic group and we have investigated whether polymorphisms in the ER-b gene are associated with breast cancer risk among Iranian women
Methods: Two selected coding regions in ER-b gene (exons 3 and 7) were scanned in Iranian women with breast cancer referred to Imam Khomeini Hospital Complex clinical breast cancer group (150 patients) and in healthy individuals (147 healthy control individuals). PCR single-strand conformation polymorphism technology was performed
Results: A site of silent single nucleotide polymorphism (SNP) on exon 7 was found, but, we did not found any variation on exon 3. The frequency of allele 1 in codon 392 (CTC → CTG was found only in breast cancer patients (5.7 %) (X2 = 17.122, P = 001). We found that allele 1 in codon 392 (C1176G) had direct association with the occurrence of lymph node metastasis
Conclusions: Our data suggest that ER-b polymorphisms in exon 47 codon 392 is correlated with various aspects of breast cancer in Iran. ER-b genotype, as determined during presurgical evaluation, might represent a surrogate marker for predicting breast cancer lymph node metastasis.
MASCC-0201
Olanzapine for post-chemotherapy dysgeusia and anorexia: the unidentified saviour?
G.K.,D.K.B.,P.A.K.,P. S. Mukhopadhyay 1
1Pharmacology, Christian Medical College, Ludhiana, 2Radiation Oncology, Christian Medical College & Hospital, Ludhiana, 3Preventive & Social Medicine, 4Biochemistry, Christian Medical College, Ludhiana, Ludhiana, India
Introduction: Patients on chemotherapy with some anticancer drugs experience dysgeusia and anorexia after chemotherapy. Secretion of the agent in saliva, cytotoxic action on the test buds, radiation in the head-neck region causing damage the taste buds and associated nausea-vomiting are considered contributory.
Objective: To find out the efficacy of olanzapine in protection from anorexia in patients with head and neck cancer on chemotherapy.
Method: In this prospective, randomized, controlled, open label study total 60 chemotherapy naïve patients undergoing cisplatin chemotherapy with or without radiation for head and neck cancer were enrolled. They were divided into control and study groups. Treatment offered to these groups and assessment schedule is summarized in the figure.[pic_01] A four point categorical scale (1–4) was used to assess anorexia on day1 and day 10.[pic_02] Higher score was suggestive of more anorexia. Anorexia was compared and analysed within the groups and in between groups before and after chemotherapy, p value less than 0.05 was considered statistically significant
Results: Total 51 patients (26 in control and 25 in the test) were enrolled till analysis of data. Anorexia, though noted after chemotherapy in both the groups, was less in olanzapine group and was statistically significant (post-chemotherapy median score 1 vs. 2.5). Progression to higher anorexia after chemotherapy was less in olanzapine group.[pic_03]
Conclusion: Olanzapine offers protection from anorexia after chemotherapy.
MASCC-0202
Prevalence and associated factors of metabolic syndrome in Korean cancer survivors
K.L. S.M. Park 1
1Seoul National University, College of Medicine, 2Department of Family Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
Purpose: This study was designed to evaluate the prevalence of metabolic syndrome among cancer survivors compared to non-cancer controls from a population-based sample and to identify risk factors associated with metabolic syndrome among cancer survivors.
Methods: Data from the fourth Korean National Health and Nutrition Examination Survey were analyzed to compare the prevalence of metabolic syndrome, as defined by 2009 consensus criteria. Factors associated with metabolic syndrome were identified using multiple logistic regression analysis among cancer survivors.
Results: The prevalence of metabolic syndrome in cancer survivors (n = 335) was similar to non-cancer population (n = 10,671). Age of more than 60 years (adjusted odds ratio [aOR] 4.83, 95 % confidence interval [CI] 1.94–12.03), BMI between 23 and 25 (aOR 6.71, 95 %CI 2.90–15.57), BMI more than 25 (aOR 12.23, 95 % CI 5.20–28.77) were significantly associated with metabolic syndrome in cancer survivors. Gastric cancer survivors showed lower risk of metabolic syndrome than other cancer survivors (aOR 0.36, 95 % CI 0.14–0.94).
Conclusions: Cancer survivors were not more likely to have higher risk for metabolic syndrome than non-cancer control in Korea. These findings may be due to higher proportions of gastric cancer survivors among Korean cancer survivors. The risk for metabolic syndrome among cancer survivors varies according to oncological and non-oncological factors.
Implications for cancer survivors: Cancer survivors who are elderly and obese had increased risks for metabolic syndrome. Healthcare providers should assess and screen the metabolic syndrome, especially for vulnerable groups.
MASCC-0203
Exploring post-treatment experiences and concerns of south Asian breast cancer survivors residing in California
S.s.-c. K. Chahal 1
1Nursing, City of Hope, 2Nursing, California State University Long beach, Long Beach, CA, USA
Methods: The purpose of this study was to explore theexperiences and concerns of South Asian women breast cancer survivors post-treatment. Qualitative research methodology was used to collect data through semi structured interviews. Data was coded and categorized into themes using qualitative analysis Methods. The sample included five South Asian women breast cancer survivors, ages 54–68, who were 3 months to 5 years post-treatment. This pilot study was done as part of my Masters in Nursing thesis project.
Findings indicated that all these women had a fear of cancer recurrence which resulted in changing their lifestyle, especially with being more active in search for information on nutrition, exercise, and side effects. Some of the side effects included feelings of depression, fear of the uncertainty, and physical muscle and nerve pain. Most reported support from spouses, family, and/or friends; whereas others reported strain on their relationship with their spouses. Most women wanted the following information included in survivorship careplans: diagnosis, treatment, prognosis, and potential acute and late toxicities as well as statistical, psychological, sexual, spiritual, social, nutritional, and exercise information. They wanted each area customized to their needs.
Health care professionals can incorporate these findings in designing culturally appropriate survivorship care plans for South Asian women breast cancer survivors. Because of language and cultural barriers it was hard for them to speak to their oncologists or their family physicians. Most women felt isolated since they did not have any peer support from others who had gone through through breast cancer.
MASCC-0204
Concerns and perceptions of breast cancer survivors’impact of treatment from differing geographical populations and ethnicity
C.g.,S.S.,F.W. S. Singh-Carlson 1
1Nursing, California State University Long beach, 2Rehabilitation, Todd Cancer Centre, Long Beach, CA, USA, 3Radiation Oncology, British Columbia Cancer Agency, Victora, Victoria, 4Radiation Oncology, British Columbia Cancer Agency, Surrey, Surrey, BC, Canada
Introduction: Breast cancer survivors’ (BCS) experiences and concerns of treatment impacts and perceptions of survivorship care plan (SCP) content and benefit seem to resonate for women regardless of different populations or healthcare structuring.
Objectives: This paper will compare how BCS of different ethnic background, residing in unlike healthcare systems report of the impact of breast cancer treatment. Discussions will include thematic findings from 4 studies that explored experiences/concerns of BCS post-treatment at different life-stages conducted in Southern California with American Caucasian/Hispanic and in British Columbia with Canadian Caucasians and South Asian (SA) BCS.
Methods: All studies utilized qualitative methodology and interviewed women ranging from 19 to 80 years old, 3–60 months post-treatment, with non-metastatic breast cancer. Canadian BCS were discharged from cancer-agency settings to family physicians, whereas American counterparts were followed by oncologists or family-physicians, dependent on types of medical insurance coverage. Comparison of themes will identify treatment-impacts variation among BCS in different healthcare-structuring.
Results: Some universal effects were fatigue-loss of physical energy/strength, fear/uncertainty, cognitive changes, and need to normalize post-treatment. Financial concerns due to loss of wages were common among BCS; however BCS in American healthcare system would seem to experience higher rates of mental distress due to medical insurance costs. Themes such as accessing inner strength and experiencing losses had different cultural and social nuances for BCS from all settings.
Conclusions: Comparison of these populations show need for development and implementation of appropriate SCP, that focus on varying ages, being mindful of different healthcare systems, social a
MASCC-0205
Fascin expression in pleomorphic adenoma and mucoepidermoid carcinoma
S. Rahrotaban 1
1Tehran Dental School, Tehran, Iran
Abstract
Background: Salivary gland tumors constitute an important part of oral and maxillofacial pathology. Pleomorphic adenoma (PA) and mucoepidermoid carcinoma (MEC) are the most common benign and malignant salivary gland tumors. Fascin is an actin-bundling protein that increases the motility of normal and transformed epithelial cells. The aims of the study was to determine the expression of fascin in these tumors to determine its role in their progression.
Materials and methods: Forty formalin fixed paraffin embedded tissue blocks of PA, and 20 blocks of MEC were included in this study. Diagnostic confirmation was performed through examination of hematoxylin and eosin sections. Both tumors were immunohistochemically analyzed for the presence of Fascin using Avidin-Biotin complex method and evaluated via light microscope by 2 independent observers.
Results: In both tumors the percentage of stained cells was significantly correlated with intensity of staining (p = 0.01 in PA and p = 0.00 in MEC). In pleomorphic adenoma, statistical analysis showed a significant direct correlation between percentage of stained cells and recurrence (p = 0.00). There was no significant difference between intensity and percentage of staining with clinicopathologic factors in mucoepidermoid carcinoma.
Conclusion: Fascin might be a useful marker for recurrence of pleomorphic adenomas and patients with high fascin expression in primary PA should be fallowed up periodically to detect potential recurrence as soon as possible.
MASCC-0206
Epithelial ovarian cancer in young women is an 8 cases report
S. Sakhri 1,2
1Algiers, CHU Tizi Ouzou, Algiers, 2Algiers, CHU Tizi Ouzou, Algeria, Algeria
Background: As the most lethal of the gynaecologic malignancies, ovarian cancer remain the sixtieth most common cause of cancer related death for women in Algeria. Epithelial ovarian cancer mostly appears in aged women, but rarely in young women.
Methods: Retrospective study [January 2010–December 2011], O8 medical records were analyzed; the young patients were aged under than 40 years old. We have evaluated the clinical pathologic features such as the histological type, stage, and the follow up.
Result: Followed it after 34 month showed that the mean age was 37 years (range: 30–40), the average time of diagnosis was 6 months. The majority were stage III, cystadenocarcinome were the most commonpathologic types. The recurrence was observed in one case (pleural and bone metastasis) due to platinum-resistance
Conclusion: Our study showed that the majority of cases weresplatinum- sensitivity those who confirms with the literature or the good prognosis.
MASCC-0208
The effectiveness of group hope therapy on hope and depression of mothers with children suffering from cancer in Tehran
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Background: Researches mainly focus on patients who suffer from cancer. Families and parents have been neglected in these researches although they experience levels of stress, depression and anxiety. This research aims at studying the effectiveness of Hope Therapy based on group therapy on hope and depression of mothers with children suffering from cancer in Aliasghar Children’s Hospital, Tehran (2010).
Methods: In this applied and semi-experimental research, 20 mothers were selected based on Snyder Hope Scale and Beck Depression Inventory (pre-test). They were randomly assigned into two groups of experimental and control. Intervention based on Hope Therapy protocol was executed on the experimental group for 8 weeks (eight sessions, each lasted for 2 h). Afterwards, posttest was performed for both groups. After 8 weeks, the experimental group completed questionnaires and the follow up phase.
Results: Results demonstrated that Hope Therapy increases hope (p < 0.05), and decreases depression in mothers of children with cancer (p < 0.001).
Conclusion: Covariance analysis indicated that Hope Therapy significantly decreases depression and increases hope of mothers whose children suffer from cancer. Follow up results showed no significant changes in hope of this group of mothers in the 2 months after post-test, but depression was decreased significantly during this period. It was concluded that effectiveness of Hope Therapy may be continued during the follow up phase
MASCC-0209
Higher corticosteroid dose declines physical function, but does not affect psychosocial function among allogeneic hematopoietic stem-cell transplantation patients
K.K.,S.Y.,K.S.,S.I. S. Morishita 1
1Department of Rehabilitation, Hyogo College of Medicine Hospital, 2Division of Haematology, Department of Internal Medicine, 3Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
Purpose: The aim of this study was to investigate the effect of corticosteroid dose toward degree of physical and psychosocial function in allogeneic hematopoietic stem-cell transplantation (allo-HSCT) patients during the early period.
Methods: The study included 113 patients who underwent allo-HSCT between July 2007 and April 2012 at Hyogo College of Medicine Hospital in Japan. The evaluation was performed up to 3 weeks before and 6 weeks after transplantation. Physical function was evaluated using tests for hand-grip strength and knee-extensor strength, and the 6-min walk test (6MWT). Psychosocial function was measured using Hospital Anxiety and Depression Scale (HADS). Total corticosteroid dose was collected from medical records.
Results: Significant decrease was observed inhand-grip strength, knee-extensor strength, and the 6-min walk test (6MWT) after transplantation (22 % in handgrip, 25 % knee-extensor strength and 15 % in 6MWT, P < 0.01). Total corticosteroid dose was correlated with decrease of hand-grip and knee-extensors strength (r = 0.3 ~ 0.4. P < 0.01) but was not correlated with 6MWT performance (r = 0.1. P > 0.05). There were no differences in anxiety and depression scale between transplantation times. The anxiety and depression scale was not different before and after HSCT both in patients with and without corticosteroid.
Conclusions: This study showed the relationship between corticosteroid dose and declines in physical function among allo-HSCT patients. The results of this study suggest that muscle strengthening of allo-HSCT patients could be adjusted according to the corticosteroid dose administered to the patient.
MASCC-0211
The effects of illness conceptions on the patients’ quality of life
M.M.K.,F.B. S. Kreitler 1,2
1Pediatric Hemato-Oncology, Sheba Medical Center, Tel Aviv, 2Psychology, Tel-Aviv University, Tel-Aviv, 3Psychology, Tel-Aviv UniversityAviv University, Tel Aviv, 4Oncology, Barzilai Medical Center, Ashkelon, Israel
Illness conceptions (ICs) are opinions and attitudes about medical diagnoses and states, e.g. concerning the origin, course, and effects of diseases. ICs reflect socially prevalent ideas rather than medical facts. They have gained in importance in view of increased emphasis on patients’ empowerment and on the need to consider the patients’ cultural background. ICs are important for cancer patients since they are often concerned with the meaning of their disease and suffering. The purpose was to explore whether and to what extent the ICs of cancer patients are correlated with their quality of life (QOL). The participants were 230 patients of both genders (mean age 56 years), with different cancer diagnoses in different stages and mean disease duration 3.4 years. All were administered the ICs Inventory, which assesses attitudes concerning attribution of diseases, its manifestations and effects, and the Multidimensional QOL of Adults questionnaire. Both tools have satisfactory reliability and validity. The findings showed that some conceptions were related negatively to QOL, e.g., the disease affects many domains, its origin depends on the individual’s personality, it is a total systemic phenomenon and persists beyond symptoms. Some conceptions were related positively to QOL, e.g., disease course is affected by psychological factors, its origin depends on one’s life style, recovery is possible, and the doctor is the major healing agent. The finding that patients’ beliefs affect their QOL indicates the importance of communicating to patients evidence-based beliefs and information that correct misconceptions and contribute to enhancing positive effects on their QOL.
MASCC-0212
Where to die? Factors affecting the place of death
S.K.,3.,S.L.,H.K.,R. F. Barak 1
1Oncology, Barzilai Medical Center, Ashkelon, 2Pediatric Hemato-Oncology, Sheba Medical Center, Tel-Hashomer, 3Psychology, 4Faculty of Social Sciences, Tel-Aviv University, 5Oncology, Macabi Sick Fund, Tel-Aviv, Israel
Most patients prefer to die at home but barely 30 % do so. The study deals with examining the variables contributing to dying at home. The participants were 326 cancer patients, of both genders, with a mean age of 63.25 years, who have died in 2000–2008 and have been treated by the palliative care unit of the Barzilai Hospital. 65.7 % died at home and 33.4 % in the hospital. The data was extracted from the patients’ files. The examined variables were demographic (age, gender, marital status, ethnic background, number of years in Israel until death), medical (age at diagnosis, diagnosis, nature of last treatment one got, patient having got nursing care, patient having got care of social worker, patient having got care of a psychologist, family got care of a social worker, patient had a special caregiver) and sociological (having insurance, having worked in Israel, living alone or with family, living with one’s children, living in self-owned or rented house, family members working). The findings indicate that the chances of dying at home are higher if the patient is non-Ashkenazi, the family got social worker care, the patient lived in a self-owned house, the patient lived with his family, the family members worked, and the patient’s stay in Israel since immigration was longer. Logistic regression showed that all the predictors together yielded a significant model accounting for 10.9–12.3 % of the variance. The findings suggest that dying at home requires maintaining continued care for the patient and family in the community context.
MASCC-0213
The relationship between opioid-taking self-efficacy and quality of life in Taiwanese oncology outpatients
S.-Y. Liang 1, S.-A. Ding1, S.-L. Tsay1, S.-F. Wu1, Y.-Y. Lu1
1National Taipei University of Nursing and Health Sciences (NTUNHS), Taipei, Taiwan R.O.C.
Social and behavioral scientists have proposed that a person’s belief system crucially influences his or her behaviour, and therefore may affect outcomes of pain management. The purpose of this study was to explore the relationship between opioid-taking self-efficacy and quality of life amongst Taiwanese cancer outpatients. The cross-sectional study included 109 oncology outpatients in one cancer center in the Taipei area of Taiwan. The research instruments included the Opioid-Taking Self-Efficacy-Cancer (OTSES-Ca.) and the Chinese version of European Organization for Research Treatment of Cancer Quality of Life Group Questionnaire Core 30, EORTC QOL-C30 (version 3.0). Opioid-taking self-efficacy demonstrated a significant relationship with patients’ functional status of quality of life (r = 0.30, p < .01) and symptom problem of quality of life (r = −0.22, p < .05). The higher perceived opioid-taking self-efficacy was related to a good functional status and a lower level of symptom problem. However, there was no significant correlation between opioid-taking self-efficacy and patients’ global health status of quality of life (r = 0.12, p > .05). This study highlights the potential importance of a patient’s confidence in their ability to manage their prescribed opioid regimen in their quality of life.
MASCC-0214
Depressive and anxiety disorders among family caregivers of breast cancer patients receiving oncologic treatment in Kuala Lumpur Hospital
1Department of Psychiatry and Mental Health, Tuanku Jaafar Hospital, Seremban, 2Department of Psychiatry, Universiti Kebangsaan Malaysia, 3Department of Psychiatry and Mental Health, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Introduction: Caring for a family member diagnosed with cancer can be highly stressful thus rendering the caregivers vulnerable to psychological morbidities.
Objectives: To determine the rates of depressive and anxiety disorders among the caregivers of breast cancer patients undergoing oncologic treatment and their predictive factors.
Methods: A total of 130 caregiver-patient dyads attending the oncology center for breast cancer treatment participated in this cross-sectional study. Data on the patients’ socio-demographic and illness characteristics were obtained from their medical record while the caregivers completed three self-report measures: 1) socio-demography and the caregiving factor questionnaire, 2) Multi-dimensional Perceived Social Support (MSPSS) and 3) Depression, Anxiety and Stress Scale (DASS-21). Subsequently, those who met the cut-off points in DASS-21 were interviewed using The Mini-International Neuropsychiatric Interview (MINI) to diagnose depressive and anxiety disorders.
Results: There were 49.2 % (n = 64) caregivers who scored positively in DASS-21where 17.7 % (n = 23) were diagnosed to have depressive disorders while 11.5 % (n = 15) had anxiety disorders. Patients’ functional status (p < 0.05, OR = 12.78, CI = 3.76–83.49) and the caregivers’ education level (p < 0.05, CI = 9.30, CI = 1.82–47.57) significantly predict depressive disorders while shared caregiving (p < 0.05, OR = 6.29, CI = 1.91–20.77) and patient’s treatment type (p < 0.05, OR = 4.55, CI = 1.12–18.44) significantly predict anxiety disorders among the caregivers in this study.
Conclusions: A significant proportion of family caregivers were psychologically affected while caring for the breast cancer patients. The predictive factors for depressive and anxiety disorders found in this study may guide in identification and prevention of these c
MASCC-0215
Quality of life in cancer patients due to disfigurement
S. Gaur 1
1Barnard Institute Of Radiation Oncology, Madras Medical College and Government General Hospital, Chennai, India
Introduction: Majority of cancers/cancer treatments lead to some disfigurement, like-removal of body part, scarring, swelling, ulceroproliferative lesions, alopecia, skin changes, permanent feeding/breathing interventions. Changes in the appearance can have far reaching effects, reduced self confidence, self esteem, difficulty in social interactions and ultimately social withdrawal. It is necessary that psychological and social effects of appearance are studied in order to assess what can be done to improve the quality of life in such patients.
Objectives: To assess the effect of disfigurement in patients because of cancer or cancer treatment, and its importance in the wholesome management of the patient.
Methods: Study type—Cross-sectional study
Study population—100. Patients suffering from cancer and undergoing/completed cancer treatment,with disfigurement
Study tool—WHOQOL-BREF questionnaire,which was filled by personal interviewing.
Data analysis—to determine the psychosocial impact of disfigurement and assess QOL in mainly 4 domains-Physical, Psychosocial,Social relations,environmental health
Results: •Total QOL score range was 30–70 (41.88). Most people rated their quality of life as poor. Younger age group and women were more affected by, in all spheres. People were not able to accept their bodily appearance and had negative feelings quite often.
Conclusions: Disfigurement has clearly been found to be stressful. It is imperative that the quality of life is given its due importance, especially in a developing nation like India, which can be achieved by multiprofessional involvement at individual &community level.
References: Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments; Duraipandi Arunachalam. Indian J Palliat Care. 2011 Sep–Dec; 17(3)
Scarring, disfigurement,quality of life in long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor study: Kinahan kE.JC
MASCC-0216
Has nurses been avoiding palliative-end of life care seminars/workshop/training in Kenya? Is it morphine, death, burn out, burden of work?
S. Rithara 1,2
1Kenya Medical Training College, Nairobi, 2Ongata Ngong Palliative Care, Kajiado, Kenya
Introduction: Palliative care is an expert care and has potential to greatly reduce burden and distress of those facing life limiting illness and ability to offer support. Nurses stay with palliation patients 90 % of their life hence increasing need for palliative care services.
Purpose: To explore the challenges and fear the nurses have.
Method: A survey done September 2010–September 2011, after explaining the purpose of the study, a total of 36 subjects were given questionnaire to complete t he survey between 20 and 45 years old nurses.
Outcome: Majority of nurses are willing to do other specialty away from palliative care. There has been increasing palliative awareness in the country and short courses. 80 % fear of breaking bad news, 55 % it consume time, 65 % burn out, 50 % fear of prescribing morphine and addiction, 70 % family dependant, 45 % fear of dealing with death after work, 40 % course very expensive, 45 % lack of motivation, 80 % work in rural with no idea of palliative care, 55 % not visited hospices which are located in big towns, 30 % willing to do home care than hospital care, student nurses less aware of the palliative care, less trained tutors on palliative care and clinical instructors.
Conclusion: Palliative awareness especially in the rural set-up, encouragement and financial support for course. Need Government active participation in palliative care delivery. Majority of the nurses’ work in government sector at the rural set-up who are willing to work in the palliative field hence supported. Community awareness in support of the nurses.
MASCC-0217
Medico-social factors associated with late presentation in women with cancer of the cervix in northern Nigeria
I.A.Y.,S.A. S.A. Gaya 1,2
1Obstetrics and Gynaecology, Bayero University Kano, 2Obsterics and Gynaecology, Bayero University/Aminu Kano Teaching Hospital Nigeria, Kano, 3Obsterics and Gynaecology, Bayero University/Aminu Kano Teaching Hospital Nigeria, 4Community Medicine, Bayero University Kano/Aminu Kano Teaching Hospital Kano, Kano, Nigeria
Background: Cancer of the cervix is one of the commonest types of cancer afflicting women globally. Most prevalent in developing countries amongst socially disadvantaged women. Comprehensive and multidisciplinary medical care for cancer of the cervix is generally unavailable in Nigeria. Purpose Identify risk factors amongst women with late presentation of cervical cancer and interventions to reduce their vulnerability.
Methods: Review of medico-social and histo-pathologic patterns of cases of cancer of the cervix at the Gynae-Oncology Unit, Aminu Kano Teaching Hospital, Kano Nigeria from January 2006 to December 2010. Information extracted and analyzed on Epi-Info statistical software, using the mean for quantitative data, frequencies and percentages to summarize categorical data. Associations between categorical variables tested using chi squared test and significance levels set at ≥0.05.
Results: Ninety-one cases of cancer of the cervix were retrieved. Mean age 49 years, SD 10.8 years. 86.8 % had advanced stage disease, were grand multiparous married more than once. Majority were unemployed over half had no formal education. Commonest presenting complaint and complication was vaginal bleeding (72.5 %), anemia (45.1 %). Only 18 had undergone HIV testing, 28 % tested positive. Commonest histological type (85.7 %) squamous cell carcinoma. There were statistically significant associations between advanced disease and age, parity and number of lifetime marriages.
Conclusions: Majority of the women present with advanced disease. Complications appear most commonly amongst severally married, poor, uneducated women in their fourth and fifth decades of life. Government and non-governmental health agencies should design community-based health education and screening programs targeting this vulnerable group.
MASCC-0218
Efficacy of single fraction palliative radiotherapy in bone metastases
M.A.,A.M.,H.I.,N.I. T. Mehmood 1
1Radiation Oncology, 2Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
Introduction: Bone metastases (BM) is a major complication of many solid tumors like breast, prostate, thyroid and lung cancers. Radiotherapy has established role in relieving pain caused by BM. Worldwide different radiotherapy schedule are being used for BM.
Objective: Aim of this study is to determine the efficacy of single fraction palliative radiotherapy for painful bone metastases.
Methods: Between March 2010 and September 2010, 120 patients with pathologically proven breast or prostate cancer with radiological evidence of bone metastases were treated with 8Gy in single fraction palliative radiotherapy in our institution. There were 56 (46.7 %) males and 64 (53.3 %) females. All patients had pain score of more than five on Brief Pain Inventory (BPI). Response was evaluated as complete response (CR) if no pain, partial response (PR) if 2 or more points decrease in pain, Stable disease (SD) no improvement in BPI score and progressive disease (PD) as increase in BPI score, after 3 months of treatment.
Results: The median age was 56 years (range 25–84 years). Fifty six (46.7 %) patients had prostate cancer and sixty four (53.3 %) had breast cancer. The response of pain after 3 months of radiotherapy was CR in 25 (20.8 %) patients, PR in 48 (40 %), SD in 29 (24.2 %) and PD in 18 (15 %) patients. The efficacy of treatment was 60.8 % with CR 20.8 % and PR 40 %.
Conclusions: Single fraction palliative radiotherapy of 8Gy has shown significant efficacy in painful bone metastases in our setting and merits further investigation in our population.
MASCC-0219
Outcome of palliative chemotherapy in recurrent head and neck cancer
T.M.,M.A.,A.M.,R.H. H. Iqbal 1
1Surgical Oncology, 2Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
Purpose: The aim of this retrospective study is to evaluate the outcome of palliative chemotherapy in recurrent head and neck cancer in our institution.
Methods: Between September 2005 to August 2009, 146 patients received palliative chemotherapy either due to recurrent or persistent disease after completion of radical treatment. With a median age of 48 years (range 18–70), there were 111 (76 %) males and 35 (24 %) females. Site distribution; Oral cavity 100 (68 %), Hypopharynx 3 (2 %), Nasopharynx 14 (10 %), Larynx 7 (5 %), Oropharynx 3 (2 %), Paranasal sinuses 14 (10 %) and others 5 (1 %). Patterns of recurrence included: local 65 (44 %), regional 32 (23 %), distant 8 (5 %) and persistent disease 41 (28 %) respectively. 106 (73 %) of patients already received cisplatin based chemotherapy either in neo-adjuvant or concurrent chemoradiation setting. Various first line palliative chemotherapeutic agents given included: Methotraxate (10 mg × 4 days/week PO or 40 mg/m2 weekly I/V), Cyclophosphamide (50 mg OD PO), Paclitaxel (80 mg/m2 weekly I/V) and Cisplatin (75 mg/m2 3 weekly I/V) respectively.
Results: 116 patients (79 %) received Methotraxate, 19 (13 %) Cyclophosphamide, 4 (3 %) Paclitaxel, and 7 (5 %) received Cisplatin. A total of 9 (6 %) patients had toxicity related hospital admissions. One patient died due to drug toxicity. Mean time to progression; Methotrexate 7, Cyclophosphamide 9, Paclitaxel 10 and Cisplatin 7.8 months respectively. Overall mean time to progression was 7.8 months (range 1–39).
Conclusions: The disease control in our study is comparable with already published literature but very little has been gained in slowing the progression of the disease.
MASCC-0221
Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials
J.-H.L.,2. T.-W. Huang 1
1Department of nursing, Hung Kuang University, Taichung, 2Department of Internal Medicine, Erlin Branch of Changhua Christian Hospital, Changhua, Taiwan R.O.C.
Introduction: Lymphedema is a common complication ofaxillary dissection for breast cancer. We investigated whether manual lymphaticdrainage (MLD) could prevent or manage limb edema in women after breast cancersurgery.
Methods: We performed a systematic review andmeta-analysis of published randomized controlled trials (RCTs) to evaluate theeffectiveness of MLD in the prevention and treatment of breast-cancer-relatedlymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro),SCOPUS, and Cochrane Central Register of Controlled Trials electronic databaseswere searched for articles on MLD published before December 2012, with nolanguage restrictions. The primary outcome for prevention was the incidence ofpostoperative lymphedema. The outcome for management of lymphedema was a reductionin edema volume.
Results: Ten RCTs were identified with 566 patients. Two studies evaluating thepreventive outcome of MLD found no significant differences in the incidence oflymphedema between the MLD and standard treatment groups, with a risk ratio of0.63 and a 95 % confidence interval (CI) of 0.14–2.82. Seven studies assessedthe reduction in arm volume, and found no significant difference between the MLDand standard treatment groups, with a weighted mean difference of 75.12 (95 % CI, −9.34 to 159.58).
Conclusion: The current evidence from RCTs does not support the use of MLD to prevent or treat lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema.
MASCC-0222
Facing the other: transformation of palliative nurses in reflective group
H.H.C.,M.O. T.Y. Lee 1
1Nursing, Cheng Hsin General Hospital, 2Yang Ming University, 3Yang Ming UniversityMing, Taipei, Taiwan R.O.C.
Reserch aim: The purpose of this study was to explore the personal and professional transformation of the nursing group members during the process of group dialogues.
Research method: Qualitative research method was adopted. Data collection was through theparticipatory observation of the non-structured experiencial group of the 15 nurses. Twelve times of vertibatim transcribed group process recording was analyzed by thematic analysis method.
Research finding: Three themes were found: (A) The reality beyond imaginations—impeacefulness in hospice care and uncaring in taking care; (B) Facing the other—among the nursing colleagues and among patients/families; (C) Cultivating self to comfort the other—letting-go self and being co-existence with the other.
Research implications: Mirroring from the research finding, Nurses can reflect, gain more self-awareness, respect and empathize the others, self-adapt and then enhance the quality of palliative care for patients and also families. On the other hand, it offers some possible clue for nursing facaulties’ in-service growth for nursing educators and administraters.
MASCC-0223
Concurrent chemoradiation for locally advanced non-small cell lung cancer: results of 2 focus group interviews
M.v.d.h.,M.k.,n.a.v. W. uyterlinde 1
1NKI-AVL, Amsterdam, 2Thoracic Oncology, 3Radiation Oncology, NKI-AVL, Amsterdam, The Netherlands
Purpose: To evaluate Quality of care topics in patients treated with concurrent chemoradiation (CCRT) for non-small cell lung cancer.
Patients and methods: Two focus group interviews (I–II) were performed with a 2 year interval. Randomly assigned patients with stage 3 NSCLC treated with CCRT were asked to participate. Inclusion criteria were: non progressive disease; treatment finished between 3 months and 1 year. Topics included screening, -treatment and follow up care. The focus group interviews were performed conform format with an educated and experienced interviewer and a 20 multi-disciplinary audience
Results of interview I were embedded in a clinical pathway and were evaluated in interview II. The interviews were taped and written out. Qualitative statistics included descriptive analysis and labelling of clusters.
Results: Interview I included 9 patients; 2 female; 7 male with a median age of 61 (49–73). Main clusters were poor logistics and lacking supportive care management. In interview II, 15 patients participated; 5 male, 10 female with a median age of 63 (36–81). In this group problems with reintegration was the main cluster. Logistics and supportive care management were not recorded.
Conclusions: The focus group interview is an important tool for Quality of Care measurement and evaluation. Between interview I and II, a clinical pathway was developed which led to improved logistics and supportive care management. Follow up care and reintegration is addressed and will be reported on later.
MASCC-0224
Safety and health related quality of life of concurrent chemo radiotherapy for locally advanced non-small cell lung carcinoma
J.k.,J.b.,M.v.d.h. W. uyterlinde 1
1NKI-AVL, Amsterdam, 2NKI-AVL, Amsterdam, The Netherlands
Purpose: To report on the relation between toxicity, lung function and health related quality of life (HRQL) of radiotherapy and concurrent chemotherapy with or without Cetuximab in patients with locally advanced non-small cell lung cancer (NSCLC).
Patients and methods: Patients with locally advanced NSCLC received daily Cisplatin 6 mg/m2 followed by radiotherapy (66 Gyin 24 days) with or without additional weekly Cetuximab. Toxicity was scored weekly during treatment and thereafter at 8 weeks, 13 weeks, 3, 6 and 12 months from randomization. Pulmonary function and HRQL was assessed at baseline, at the end of treatment and after 1 year.
Results: Between Feb 2009 and May2011, 102 patients with locally advanced NSCLC were included. Twelve percent ofthe population was unable to complete treatment because of toxicity. Overall toxicity grade ≥3 was seen in 71 % of the Cetuximab and in 49 % in the control arm (P = 0.04). HRQL was completed in 50 %. For both arms, dyspnea and coughing was increased at week 59 reported by patients and doctors and the median FEV1 was decreased by 11 % (p = <0.001).
Conclusions: Although more grade ≥3toxicity was seen in the Cetuximab arm, toxicity was manageable. Patient reported outcomes on coughing and dyspnoea corresponded with toxicity and decreased pulmonary function. This study displays the advantage of combining HRQL and toxicity in objectivising side effects and can be used for management and patient education as well as further research.
MASCC-0225
Improving quality of life in patients with kidney cancer through a patient organized support group
W. Tan 1, Q. Life1
1Hematology Oncology, Mayo Clinic, Jacksonville, FL, USA
Background: There are no kidney cancer (KC) specific support groups in the Southeastern United States. A family of a kidney cancer patient based on their personal experience of not being able to get information regarding her cancer, saw the need to improve information access, get emotional and social support to patients and families with KC through the formation of a support group
Methods: Patients and family members were recruited through personal referral from friends, relatives, physicians and through an online website to The Judy Nicholson Foundation.
Results: Nineteen patients with kidney cancer or relatives of kidney cancer cancer were willing to participate in the support group over a year period (2011–2012). 5/19 (26 %) of the patients had early stage cancer and were in remission., 5/19 (26 %) had a friend or relative that had KC, 9/19 (47 %) patients had stage 4 kidney cancer, 2 had lung metastectomy and are in complete remission, and 7 were actively receiving treatment. The monthly meetings were attended by 3–5 patients/relatives. The positive benefits of the support group included emotional and psychological support during periods of difficulty, able to ask others about the side effects of medications from a person who actually had been taking the medication and additional information regarding their disease and resources available. 7/19 (36 %) patients reported a positive improvement in their quality of life based on their experience with the support group. Conclusion: Initial experince with a patient formed/run support group showed positive improvement of quality of life in some patients.
MASCC-0226
Hospital utilization of patients with cervical cancer
W. Prasanatikom 1
1Utilization Management, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
Utilization review is a part of nurses’ role in case management. Since the Diagnostic Related Groups introduced in the health economic, financial indicators such as length of stay, readmission, and cost-effectiveness have been studied. Cervical cancer is one of the high-cost-high-volume diseases that has consumed large amount of hospital resources. Though data of this disease have been collected in the hospital data base, transforming these data to evidence-based has never been done. The retrospective study was to explore hospital utilization of patients with cervical cancer. The sample was 2,804 cases of patients with principle diagnosis of cervical cancer from 2006 to 2011. The data were extracted from the Hospital Information System at the Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand. The results showed that the number of patients with cervical cancer increased from 211 cases in 2005 to 423 cases in 2011. An average age was 52 ± 10.10 years. Admission assessment showed that only 2.6 % were unplanned readmission with the same disease within 28 days. The length of stay (los) varied from 1 to 89 days with the mean of 3 ± 5.47 days. Patients with total abdominal hysterectomy and/or operation on ovary had longer los than those with chemotherapy. Eighty percents of the sample had los 1 day for chemotherapy. In conclusion though hospital utilization depended on patients’ needs, effective case management and ambulatory care would help to decrease los.
MASCC-0227
Comparison of biomarkers for assessment of mucosal barrier injury induced by chemotherapy
X.P.,J.W.,J.S.,X.N.,F. Y. Li 1
1Department of Surgery, 2Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Mucosal barrier injury induced by chemotherapy has come to clinical attention. Oral mucositis can be easily assessed by direct inspection, however, the assessment of intestinal mucositis still pose challenges. The aim is to compare different biomarkers to dual sugar gut permeability test on assessment of intestinal permeability during chemotherapy. Forty-two patients with gastric or colorectal cancer underwent chemotherapy including FAM or FOLFOX4 regimens. Patients were asked to grade and record symptoms of gastrointestinal toxicity daily. Intestinal permeability was assessed by measuring urinary lactulose-mannitol ratio. Plasma levels of citrulline, diamine oxidase (DAO), D-lactic acid, and endotoxin were also measured. Intestinal permeability was observed in the subgroup of patients with diarrhea or constipation. The urinary lactulose-mannitol ratio and plasma citrulline levels increased on 3rd, 6th post-chemotherapy day, respectively. There were no significant difference in plasma levels of D-lactic acid, endotoxin and DAO activity compared to pre-chemotherapy. The urinary lactulose-mannitol ratio in diarrhea patients was significant higher than that of constipation patients. These results indicated that urinary lactulose-mannitol ratio and plasma citrulline level were proper biomarkers for assessment of intestinal permeability in patients receiving chemotherapy. Intestinal permeability in diarrhea patients was significant higher than that of constipation patients.
MASCC-0228
Nutritional assessment and perioperative nutrition support in patients with chronic radiation intestinal injury
Y. Li 1, L. Zheng1, J. Wang1, X. Ni1, J. Li1
1Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Objective: To investigate the potential role of perioperative nutritional support in the management of patients with chronic radiation intestinal injury (CRII).
Methods: From the 2000 to 2010, 206 patients with CRII underwent operations were analyzed, retrospectively. The nutritional status was evaluated using SGA sheet. The information of perioperative nutrition support was collected.
Result: 206 CRII patients received 229 surgical therapies. Malnutrition evaluated by the SGA sheet was 86.16 % on admission. Perioperative nutrition support and surgery improved nutrition status, however, the incidence of malnutrition was still very high.
Conclusion: The rate of malnutrition in CRII patients is much high. The patients needed more time for perioperative nutrition support. Perioperative nutrition support and sugery improved the nutritional status in CRII patients.
MASCC-0229
Global gene network analysis about the relationship between the bio-functional food “coral calcium hydride” and the antioxidant effect on the rat brain
S.T.,A.K.,T.K.,3., Y. Ueda 1
1BIOTH, Co.Ltd., Miyazaki, 2Research Equipment Center, Hamamatsu University School of Medicine, Hamamatsu, 3Computational Systems Biology Research Group, Advanced Science Institute, RIKEN, Yokohama, 4TAANE, Co. Ltd., Sendai, Japan
In our previous study, we reported that a diet rich in antioxidants, such as coral calcium hydride (CCH), increased the endogenous antioxidant ability in the hippocampus of rat. In order to test the hypothesis that antioxidant CCH supplementation to rat would change the gene expression and understand how CCH enhances antioxidant ability. In the current study, we used a DNA array to compare the expression levels in the rat hippocampus fed with CCH for 2 weeks. Immune response-related and tumor-related genes were modulated, while Nrf-2 and ALDH3A promoting endogenous antioxidant ability were up regulated. Our findings about changes in these mRNA well explain the physiological finding of enhanced antioxidant ability in rat brain.
MASCC-0230
The determination of life quality and satisfaction and pain perception in cancer patients
Koç, ". 1, Sağ, Z. lam"1
1"Ondokuz Mayıs University, Samsun, Turkey"
Introduction: Life quality is an expression of individual wellness and on the other hand is an important result measurement in evaluation of health condition of the individual and the effects of the medical treatments applied to the individual.
Objectives: This study was made descriptively to determine the life quality and satisfaction and pain perception in cancer patients.
Methods: One hundred forty-seven patients that are under treatment in the oncology service of a hospital between 10.01.2012 and 20.04.2012 have been taken under the scope of the study. Data was collected by using survey form consisting of 31 questions aiming to determine the socio-demographical and clinical properties of the patients, EORTC QLQ-C30 Life Quality Scale, Satisfaction with Life Scale and verbal numerical scale.
Results: The age average of the patients is 53.2 ± 10.7. It was determined that 27.2 % of the patients were diagnosed with gastrointestinal system, that 32.7 % are in 2nd stage, that 95.2 % of them have fatigue, 85.0 % of them have pain and 72.8 % of them have nausea-vomiting symptoms due to the illness. It was determined that the Life Satisfaction Scale total score average of patients is 18.2 ± 7.8 and their verbal numerical scale score average is 6.4 ± 2.3. The EORTC QLQ-C30 life quality subscales (general wellness and functional status) are respectively determined as 8.7 ± 3.0 and 46.7 ± 9.0.
Conclusions: It was determined that patients evaluate their life quality as a whole, that their general wellness is very low, that they are partially not happy with their life satisfaction and that they have more than average pain perception.
MASCC-0231
Determination of selfcare power of cancer patients receiving chemotherapy
Koç, ". 1, Sağ, Z. lam"1
1 “Ondokuz Mayıs University, Samsun, Turkey”
Introduction: Self care power is a combination of action and power components which determine the self care performance related with the maintenance and development of health.
Objectives: This study was made descriptively to determine selfcare power of cancer patients receiving chemotherapy.
Methods: One hundred forty-four patients that are under treatment in the chemo-therapy unit of a hospital between 01.05.2012 and30.08.2012 have been taken under the scope of the study. Data was collected by using survey form consisting of 22 questions aiming to determine the socio-demographical and clinical properties of the patients and self care agency scale. The lowest score that can be obtained from the scale is 35 and the highest score is 140. High score is an indicator of greatest self-care degree.
Results: The age average of the patients is 53.7 ± 14.5. It was determined that 38.2 % of the patients were diagnosed with hematological cancer, that 27.8 % are in 1st stage, that 78.5 % of them have fatigue, 69.4 % of them have alopesia and 61.8 % of them have nausea–vomiting symptoms due to the chemo-therapy. It was determined that 42.4 % of them express their health level as average, that 96.5 % of them are satisfied with the treatment they receive. The self care agency scale score average of the patients was determined as 112.3 ± 13.3.
Conclusions: In light of the obtained findings, it was determined that self care power score average is high in young people, in people whose income is equal or higher than their expenses and in people who perceive their health as good.
MASCC-0232
Determination of factors effecting the care takingload of care takers for individuals diagnosed with cancer
“. Koç 1, Sağ, Z. lam1, Ş, T. ahin”1
1 “Ondokuz Mayıs University, Samsun, Turkey”
Introduction: The physical and psychological effects occurring in care taker during care taking cause the situation to occur which is named as load.
Objectives: This study is made descriptively to determine the factors effecting the care taking load of care takers for individuals diagnosed with cancer.
Methods: One hundred seventy patients that are under treatment in the chemo-therapy unit of a hospital between 18.09.2012 and 31.12.2012 and patient relatives have been taken under the scope of the study. Data was collected by using survey form consisting of 37 questions and care taking load scale. This scale is a likert type scale consisting of 22 expressions. The lowest score that can be taken from care taking load scale is 0 and the highest score is 88. The high scale score shows that the nuisance is high.
Results: The age average of the patients is 58.0 ± 13.8 while the age average of the care takers is 45.0 ± 13.2. It was determined that 20.6 % of the patients were diagnosed with breast cancer, that 37.1 % are in 1st stage, that 71.2 % of them have fatigue and 48.2 % of them have nausea symptoms due to the illness and that 24.7 % of the patients are dependent to others for discharge activities. It was determined that the care taking load scale average of care takers was 55.6 ± 13.0 and that 48.8 % of them have medium care load and38.8 % of them have heavy care load.
Conclusions: It was determined that care takers have medium and heavy social and emotional nuisance.
MASCC-0233
Establishment of a new prognostic system for advanced hepatocellular carcinoma
Z. Chen 1, X. Li1, X. Wu1, M. Dong1, X. Zhong1
1Oncology Department, the Third Affiliated Hospital of Sun Yat-Sen University, Canton, China
Aim: To establish a new prognostic system for Advanced hepatocellular carcinoma (HCC)
Methods: We analyzed a prospective cohort of patients with newly diagnosed HCC from 2008 to 2010. All the patients were staged with Advanced Liver Cancer Prognostic System (ALCPS), which is now the best predictive system for 3-month survival and overall survival for HCC. And all the patients were staged with our new system.
Results: A total of 253 patients (87.4 % with chronic Hepatitis B virus infection) were analyzed. The median follow-up is 38.5 months and the median survival is 7 months. Multivariate analyses identified alfa-fetoprotein, Blood Urea Nitrogen, Child-pugh stage, vascular involvement and tumor size to be independent prognostic factor. We give different scores to these five factors and establish a new prognostic system. Using the new system, we scored the patients by 0–8 and the patients were classified as high-risk (6–8), intermediate risk (3–5) and low risk groups (0–2). When predicting 3-month survival, ROC analysis show AUC of ALCPS and our new system is similar (0.822 VS 0.821, p = 0.98). When predicting overall survival, likelihood ratio test show χ 2 of our new system is higher than that of ALCPS (98.65 vs 85.02, p < 0.01) and AIC of our new system is lower than that of ALCPS (1939 vs 1953, p < 0.01), Our new system has better performance in terms of discriminatory ability, homogeneity and monotonicity.
Conclusion: Our new system is an appropriate prognostic system for advanced HBV-related HCC.
MASCC-0234
Joint modeling quality of life and survival using a terminal decline model in palliative care studies
T.T.,M.B. Z. Li 1
1Department of Community and Family Medicine, 2Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
Palliative medicine is a relatively new specialty that focuses on preventing and relieving the suffering of patients facing life-threatening illness. For cancer patients, clinical trials have been carried out to compare concurrent palliative care with usual cancer care in terms of longitudinal measurements of quality of life (QOL) until death, and overall survival is usually treated as a secondary endpoint. It is known that QOL of patients with advanced cancer decreases as death approaches; however, in previous clinical trials, this association has generally not been taken into account when inferences about the effect of an intervention on QOL or survival have been made. We developed a new joint modeling approach, a terminal decline model, to study the trajectory of repeated measurements and survival in a recently completed palliative care study. This approach takes the association of survival and QOL into account by modeling QOL retrospectively from death. For those patients whose death times are censored, marginal likelihood is used to incorporate them into the analysis. Our approach has two submodels: a piecewise linear random intercept model with serial correlation and measurement error for the retrospective trajectory of QOL and a piecewise exponential model for the survival distribution. Maximum likelihood esti-mators of the parameters are obtained by maximizing the closed-form expression of log-likelihood function. An explicit expression of quality-adjusted life years can also be derived from our approach. We present a detailed data analysis of our previously reported palliative care randomized clinical trial.
MASCC-0235
Patterns of practice in the prescription of palliative radiotherapy for bone metastases at the rapid response radiotherapy program from 2005 to 2012
N. Thavarajah 1, L. Zhang1, K. Wong1, G. Bedard1, E. Wong1, M. Tsao1, C. Danjoux1, E. Barnes1, A. Sahgal1, L. Holden1, N. Lauzon1, E. Chow1
1Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: Radiation therapy (RT) has been used for the palliation of painful bone metastases with partial pain relief seen in 50 to 80 % of patients, and complete relief in one third of patients [1].
Objectives: To examine whether the patterns of practice in the prescription of palliative RT for bone metastases has changed over time in the Rapid Response Radiotherapy Program (RRRP). Secondary outcomes include examining factors that may have influenced the treatment regimen prescribed.
Methods: A review between August 1, 2005 and April 30, 2012 was conducted. Patient demographics, disease, and organizational factors, and reasons for prescribing RT fractionation schedules were analyzed. The chi-square test, univariate logistic regression analysis, and the simple Fisher exact test were used to conduct the statistical analyses.
Results: A total of 2,549 cases of RT were prescribed during the study period. Sixty-five percent of cases were prescribed a single fraction of RT, while 35 % of cases were prescribed multiple fractions. A single fraction was more frequently prescribed in older patients, patients with a history of previous RT, with a prostate primary and by radiation oncologists who were qualified before 1990.
Conclusions: There was a significantly greater frequency in the prescription of a single fraction of radiation therapy for patients with bone metastases.
References: [1] Chow E, Harris K, Fan G, Tsao M, Sze WM. Palliative radiotherapy trials for bone metastases: a systematic review. Journal of Clinical Oncology 2007 Apr 10;25(11):1423–1436.
MASCC-0236
Continued success in providing timely palliative radiation therapy at the rapid response radiotherapy program: a review of 2008–2012
N. Thavarajah 1, K. Wong1, L. Zhang1, G. Bedard1, E. Wong1, M. Tsao1, C. Danjoux1, E. Barnes1, A. Sahgal1, K. Dennis2, L. Holden1, N. Lauzon1, E. Chow1
1Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada, 2Radiation Oncology, The Ottawa Hospital Cancer Centre University of Ottawa, Ottawa, Canada
Introduction: The Rapid Response Radiotherapy Program (RRRP) at the Odette Cancer Centre (OCC) in Toronto, Canada is an outpatient palliative radiation therapy (RT) clinic with the primary goal of providing timely RT for symptom relief in patients with locally advanced or metastatic cancers.
Objectives: To review and evaluate the clinical activity of the RRRP over the past 4 years.
Methods: A retrospective review of a prospective database of patients referred to the RRRP between August 1, 2008 and June 30, 2012 was conducted with patient demographics, case dispositions and wait times in days from referral to consultation and from consultation to treatment.
Results: A total of 2,742 cases were referred to the RRRP. Of the total cases, 1,458 (53 %) were males and 1,284 (47 %) were females. The median age was 64 years. The most prevalent primary cancer sites were lung (33 %), breast (21 %), and prostate (17 %). The most common reasons for referral were for bone metastases (53 %) and brain metastases (21 %). A total of 1,890 cases received palliative RT. The median wait time from referral to consultation was 3 days. Sixty percent of patients were treated on the same day of consultation and 33 % within 1 to 6 days.
Conclusions: The RRRP continues to deliver timely palliative RT to patients and remains comparable to our previous reviews. The continued success of the RRRP will serve as a model for future rapid access palliative RT clinics.
MASCC-0237
Symptom clusters in patients with metastatic cancer: a literature review
N. Thavarajah 1, E. Chen1, L. Zeng1, G. Bedard1, J. Di Giovanni1, M. Lemke1, N. Lauzon1, M. Zhou1, D. Chu1, E. Chow1
1Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: A symptom cluster is commonly defined as two or more concurrent symptoms experienced by a patient [1].
Objectives: To present a review of the literature reporting empirically determined symptom clusters in patients with metastatic cancer.
Methods: A literature search was conducted on symptom clusters within heterogeneous metastatic cancer patient populations using MEDLINE, EMBASE, and CINAHL. Studies examining predetermined symptom clusters were excluded.
Results: A total of eight relevant studies published between 2005 and 2011 were identified. The majority of studies were cross-sectional in nature, with the exception of one study, observing baseline symptom data within inpatients and outpatients. The most common cancer sites include lung, breast, colorectal, and prostate. The number of symptom clusters extracted varied from two to eight clusters per study, comprising of two to eight symptoms per cluster. There were no clusters consistently identified within all eight studies. However, four out of eight studies utilized the Edmonton Symptom Assessment Scale (ESAS), revealing anxiety and depression to cluster together in all four studies. Differences in symptoms assessed, assessment tools, statistical analysis, patient demographics can account for discrepancies between the studies.
Conclusions: Controlling for factors that introduce variation in symptom cluster analysis may enable the development of more consistent, defined symptom clusters to facilitate efficient and effective symptom management in future clinical practice and ideally improve patient outcomes.
References: [1] Dodd MJ, Miaskowski C, Paul SM. Symptom clusters and their effect on the functional status of patients with cancer. Semin Oncol Nurs 2010;26(3):168–74.
MASCC-0238
Patterns of practice in the prescription of palliative radiotherapy for the treatment of thoracic symptoms at the rapid response radiotherapy program between 2006 and 2012
N. Thavarajah 1, K. Wong1, L. Zhang1, E. Wong1, G. Bedard1, N. Lauzon1, L. Holden1, M. Tsao1, C. Danjoux1, E. Barnes1, A. Sahgal1, E. Chow1
1Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: Radiation therapy can often be used for the palliation of thoracic symptoms in patients presenting with locally advanced lung cancer or lung metastases.
Objectives: The aim of this study was to examine whether the patterns of practice in the prescription of palliative thoracic radiation therapy has changed over time in the Rapid Response Radiotherapy Program (RRRP). Secondary outcomes included factors that may have influenced the treatment regimen prescribed including patient, disease, and organizational factors.
Methods: A retrospective review conducted for patients with locally advanced lung cancer or lung metastases referred to the RRRP for thoracic symptoms between July 1, 2006 and April 30, 2012. Patient demographics, organizational, and disease factors were descriptively analyzed. Differences in proportions between unordered categorical variables were examined using a chi-square test. Univariate logistic regression analysis and backward stepwise selection procedure were also used to determine the most significant factors in the prescription practice.
Results: A total of 175 courses of palliative thoracic radiation therapy were prescribed. The median age of patients overall was 71 years, and the median Karnofsky Performance Status (KPS) was 60. The most commonly prescribed treatment regimen was 20 Gy in 5 fractions (20 Gy/5) which made up 64 % of all courses prescribed. There has been a significant increase in frequency of the prescription of 20 Gy/5 over time.
Conclusions: A significant increase in the prescription of 20 Gy/5 was observed over time. However, the prescription of a higher dose fractionation schedule prescribed for patients with a higher performance status, as seen in other clinical trials and guidelines, was not observed.
MASCC-0239
Paulinia Cupana (Pc) (Guaraná) dry extract for breast cancer (bc) women with hot flashes (hfs): results of a pilot study.
A.B. del Giglio 1, T.G. Lerner1, S.O. Oliveira1, L. Reifur1, L.T. Cavicchioli1, R.M. Zanellato1, A. del Giglio1
1Oncology, Faculdade de Medicina do ABC, Sao Paulo, Brazil
Introduction: HFs are a very disturbing for BC patients, affecting about two thirds of them. PC is an amazonic plant that has show to have anti-fatigue activity for BC women undergoing chemotherapy.
Objectives: Evaluate efecness of PC fo HFs control in women with BC
Methods: We included BC women at least 3 months after finishing their treatment with at least 14 HFs per week. Patients recived 50 mg PO of PC dry extract twice daily for 6 weeks. We assessed both HF frequency and its severity and patients graded their own toxicities weekly. We employed a phase II Simon design in which 9 out of 15 patients would be required to have at least 50 % decrease in their HF severity score.
Results: We included 24 women with median age of 50.2 (36–65). Only 18 started Pc and 15 completed the 6 weeks of the study. Three patients declined participation right after starting PC for difficulty in participation and for noncompliance. Ten out of 15 patients had more than 50 % decrease in their HF severity score. Throughout the 6 weeks of treatment we observed statistically significant decreases in HFs number (p = 0.0331) and Severity Scores (p = 0.0039). As compared to week 0, patients reported worsening of anorexia (1), insomnia (1), nausea (1), fatigue (1), sweating (1), constipation (1), anxiety (1), humor change (1), and headache (1). None of these toxicities warranted discontinuation of the study.
Conclusions: We conclude that PC was effective for HF control achieving the pre-specified threshold with acceptable toxicity and warrants further confirmatory studies
MASCC-0240
Exploring the quality of life and the impact of the disease among patients with colorectal cancer
T.T. Loi 1, S. Chan2, R. Wong3, C.L. Tang1
1Colorectal Surgery, Singapore General Hospital, Singapore, Singapore, 2Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, 3Gastroenterology & Hepatology, National University Health System, Singapore, Singapore
Introduction: Colorectal cancer has emerged as the most common cancer in Singapore. The quality of life (QoL) has become increasing important in measuring the outcomes of colorectal cancer patients and the impact of the disease on a person’s life
Objectives: To explore the range of factors that affect patient QoL and to identify patient who are at risk for adverse psychological distress.
Methods: The targeted population for the study were recruited 1 year after diagnosed with colorectal cancer at Singapore General Hospital. Subjects were assessed using the EORTC QLQ-C30, EORTC QLQ-CR29 and Hospital Anxiety and Depression Scale.
Results: The analysis was based on 300 subjects. One hundred and seventy-nine (59.7 %) patients were males and 121 (40.3 %) were females. Only 31(10.3 %) patients had stomas. Most of the patients perceived some worsening of physical functioning, role functioning, cognitive functioning and social functioning after colorectal surgery. The majority of patients reported having satisfactory global health status and overall QoL. However, 158 (53 %) of them reported having elevated level of anxiety and 127 (42 %) of the patients worried about their weight.
Many patients suffered from symptoms such as fatigue (n = 127, 42 %), constipation (n = 106, 35 %), insomnia (n = 97, 32 %) and approximately 23 % (n = 68) of them were still having pain, dyspnoea and diarrhoea symptoms. One hundred and thirty-two (44 %) patients reported having financial difficulties
Conclusions: This study found that the most important factor affecting the patient’s QoL was anxiety score which account for 53 % of the patients.
MASCC-0241
RAD51 (G135C) gene polymorphism and the modulation of risk in colorectal cancer patients of Kashmir
A.S. Sameer 1, S. Nissar2, S. Baba2, T. Akhter2
1Biochemistry, SKIMS Medical College, Srinagar, India, 2Immunology and Molecular Medicine, Sher I Kashmir Institute of Medical Sciences, Srinagar, India
Introduction: Colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women worldwide. In the Kashmir valley, CRC represents the third most common GIT cancer after oesophageal and gastric cancer. RAD51 plays an important role in the homologous recombination, the process frequently involved in cancer transformation.
Objectives: The main objective was to find the modulation of the colorectal risk in the ethnic Kashmiri population by the three polymorphic forms of RAD51 gene.
Methods: We tested the association between the 135G>C polymorphism of the RAD51 gene and colorectal cancer risk and various clinicopathological parameters. Polymorphism was evaluated by restriction fragment length polymorphism polymerase chain reaction (RFLP-PCR) in 100 CRC patients and 120 sex, age matched cancer-free controls
Results: There was a significant association between RAD51 genotypes and the CRC (p < 0.05) and the GC genotype was associated with the elevated risk of CRC (OR > 3.84) and CC variant genotype was associated with an increased risk of CRC in various clinic-pathological parameters.
Conclusions: We conclude that there is a significant relationship between the polymorphism of RAD51 (G>135C) gene and the risk of CRC in the ethnic Kashmiri population.
References:Thacker J. The RAD51 gene family, genetic instability and cancer. Cancer Letters 2005; 219:125–135
Krupa R, Sliwinski T, Wisniewska-Jarosinska M, et al. Polymorphisms in RAD51, XRCC2 and XRCC3 genes of the homologous recombination repair in colorectal cancer--a case control study. Mol Biol Rep 2011; 38:2849–2854.
Romanowicz-Makowska H, Samulak D, Michalska M, et al. RAD51 gene polymorphisms and sporadic colorectal cancer risk in Poland. Pol J Pathol 2012; 63:193–198.
MASCC-0242
Quality of life in patients with primary and metastatic brain cancers as reported in the literature using the EORTC QLQ-BN20 and QLQ-C30
L. Chiu 1, N. Chiu1, L. Zeng1, L. Zhang1, M. Popovic1, R. Chow1, H. Lam1, M. Poon1, E. Chow1
1Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: Primary brain cancer and metastatic brain cancer are both associated with poor prognoses. Therefore, quality of life (QOL) becomes more of a priority than traditional endpoints such as survival.
Objectives: The objective of this review is to compare the differences in QOL as assessed by the EORTC QLQ-BN20 and the EORTC QLQ-C30 in patients with primary and metastatic brain neoplasms.
Methods: A systematic literature search was conducted over the OvidSP platform in MEDLINE (1980 to July 2012), and EMBASE (1980 to July 2012). Articles were included if they reported scores of at least one subscale of the QLQ-C30 and QLQ-BN20 for patients with either metastatic or primary malignant brain tumors. Weighted analysis of variance was conducted to compare scores in these patients.
Results: A total of 14 studies (16 arms: 3 brain metastases, 13 primary brain tumors) were included in data analysis. Performance status of patients in both cohorts was similar: of all subscale scores, only cognitive functioning from the QLQ-C30 was significantly worse in patients with primary brain tumors when compared to metastatic brain patients (p = 0.0199).
Conclusions: Despite cognitive function being significantly worse in patients with primary brain tumors, there is reason to suggest that patients with metastatic brain tumors and patients with primary brain tumors have similar QOL profiles. This study is limited by the large discrepancy in cohort sizes and the lack of clinical data. More research in assessing QOL in brain metastatic populations with the QLQ-BN20 should be conducted to confirm and validate the present findings.
MASCC-0243
Innovation of pharmacotherapy to cancer-related fatigue
Y. Lai 1, W. Su1, Y. Lin1
1Hospice Palliative Care Center, Mackay Memorial Hospital, Taipei city, Taiwan
Introduction: Cancer-related fatigue (CRF) has not been properly treated by physicians. It is still an unmet medical need to provide proper treatment for relieving fatigue and improving quality of life among cancer patients. In traditional Chinese medicine, Astragalus membranaceus (AM) is commonly used to treat the deficiency of qi (vital energy), which manifests as fatigue and lack of appetite. Studies have shown that AM-based Chinese herbal remedies improve quality of life, alleviate chemotherapy toxicity, and boost immune functions in cancer patients.
Objectives: To investigate the efficacy of the botanical-derived drug, PG2, a partially purified extract of AM for cancer-related fatigue.
Methods: A randomized, double-blind, placebo-controlled phase III trial was used. Patients with advanced cancer and moderate to severe CRF were randomized to receive either PG2 or a placebo.
Results: PG2 was shown to be safe and effective in relieving cancer-related fatigue. The fatigue improvement response rates of PG2 revealed a much stronger effect up to 29 %, better than the placebo, and this result was statistically significant. In addition, approximately 82 % of patients who reported an improvement of fatigue symptoms following the first cycle of PG2 experienced sustained benefits after administration of the second treatment cycle. Among patients treated with PG2 who did not report an improvement in symptoms throughout the first treatment cycle, approximately 71 % showed significant improvement after the second treatment cycle. No major or irreversible toxicities were observed with PG2 treatment.
Treatment N = 44 | Control N = 40 | |
All AEs | 226 | 195 |
AEs in severity | ||
“Mild” | 91 (40.27) | 69 (35.38 %) |
“Moderate” | 121 (53.54 %) | 109 (55.90 %) |
“Severe” | 14 (6.19 %) | 17 (8.72 %) |
Patients with AEs | 41 (93.18 %) | 40 (100.00 %) |
Patients with SAEs | 8 (18.18 %) | 9 (22.50 %) |
Patients discontinued due to AE | 2 (4.55 %) | 1 (2.50 %) |
Patients with treatment-related AEs | 8 (18.18 %) | 8 (20.00 %) |
Conclusions: PG2 might be an effective and safe treatment to such an unmet medical need.
MASCC-0244
Analytical study to see the effect of nandrolone decanoate in patients of advanced stage oral cavity cancer undergoing treatment (CCRT)
D. kumar 1, M.C. Pant1, N. Jamal1, S. Singh1, M.L.B. Bhatt1
1Radiotherapy, CSMMU, Lucknow, India
Introduction: A study comprising of 75 male pts and 75 control of adv stage oral cancer conducted at CSMMU, India (Jan 2010–Jan 2011).
Objectives: To study the effect of N.decanoate in pts undergoing chemoradiotherapy
Methods: Inj N.decanoate 50 mg IM injected wkly for 5 week in pts while control group received placebo. Included pts- KPS >=60, n.blood parameters. Excluded pts-postop, stage I & II, with comorbid conditions and derranged testosterone levels
Results: Pr.end point- to analyse mucosal toxicity, pain, hemoglobin level, well being and, weight changes, if any. The secondary end point- to measure hormonal changes, if any. Nandrolone decreased mucosal toxicity, pain, frequent breaks during the treatment and also there was a feeling of wellness among the patients. Weight and Hb levels remained static in the majority of patients in whom the drug was administered, which was in contrast to their counterparts, who experienced a significant weight loss and required frequent blood transfusions. Statistical analysis was done using Chi square test The results were found to be statistically significant. Also serum testosterone levels were assessed at 3 monthly interval post treatment for desired period of time. No hormonal imbalances were detected on follow up
Conclusions: Nandrolone reduces chemoradiation induced complications with no major side effects.
References:
1. Hormonal treatment of advanced breast cancer. A randomized trial of tamoxifen versus nandrolone decanoate. Kellokumpu-Lehtinen
2 Cyclophosphamide and n.decanoate in the treatment of adv ca of the breast results of a comparative controlled trial of the agents used singly and in combination. M. P. COLE
3. Nandrolone decanoate treatment in anemia of patients with cancer: Phase II clinical study.
Citation:J Clin Oncol 29: 2011
MASCC-0245
Acceptability of alternative routes of administration of rescue (“breakthrough”) medication: an observational study of 840 European oncology patients
A. Davies 1, A. Buchanan1, G. Zeppetella2
1Palliative Care, St. Luke’s Cancer Centre, Guildford, United Kingdom, 2Palliative Care, St. Clare Hospice, Hastingwood, United Kingdom
Introduction: Rescue (‘breakthrough’) medication can be given via a number of different routes (e.g. oral transmucosal, intranasal).
Objectives: To determine the acceptability of alternative routes of administration, and identify factors associated with/reasons for unacceptability.
Methods: Eight hundred forty cancer patients with breakthrough pain from 11 European countries were asked about the acceptability of four routes of administration (oral transmucosal, intranasal, intrapulmonary, subcutaneous), and all/main reasons for unacceptability. They were also asked about adherence with current rescue medication, and all/main reasons for non-adherence.
Results: 70 % patients reported the oral transmucosal route acceptable, with only country of origin being statistically significant; 53 % patients reported the intranasal route acceptable, with age, country of origin, and previous use of route being statistically significant; 51 % patients reported intrapulmonary route acceptable, with only country of origin being statistically significant; 61 % patients reported the subcutaneous route acceptable, with ECOG performance status, country of origin, and previous use of route being statistically significant. Only 53 % patients took medication every time they experienced pain, with the most common reasons being pain not always severe, and pain not always long lasting.
Conclusions: The acceptability of alternative routes of administration is affected by numerous factors, but especially by the country of origin and previous experience of the route of administration.
References: Davies AN, Dickman A, Reid C et al. The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. European Journal of Pain 2009; 13: 331–8.
MASCC-0246
Quality of life in patients with primary and metastatic brain tumors as assessed by the FACT-Br: a literature review
N. Chiu 1, L. Chiu1, L. Zeng1, L. Zhang1, D. Cella2, M. Popovic1, R. Chow1, H. Lam1, M. Poon1, E. Chow1
1Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada, 2Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
Introduction: The FACT-Br is a quality of life (QOL) assessment tool originally developed for use in patients with primary brain tumors. However, the tool has also been used to assess QOL in patients with metastatic brain tumors.
Objectives: The current review compares the differences in QOL responses as assessed by the FACT-Br in primary and metastatic brain neoplasm patient populations
Methods: A literature search was conducted using the OvidSP platform in MEDLINE (1946 to July 2012) and EMBASE (1980 to July 2012). Studies using at least one FACT-Br subscale for QOL assessment in either primary or metastatic brain tumor patients were included. The weighted means of FACT-Br subscale and overall scores were calculated for the studies. To compare scores, weighted analysis of variance was conducted and PROC GLM was performed.
Results: Twenty-three studies using the FACT-Br were identified (4 in brain metastases, 18 in primary brain tumors and 1 in a mixed sample). Social and functional well-being were significantly better in patients with primary brain tumors (weighted mean score of 22.2 vs. 10.7, P = 0.0026, and 16.9 vs. 6.2, P = 0.0025, respectively). Other FACT-Br scales and performance statuses of patients in both groups were similar.
Conclusions: Primary brain cancer patients seemed to have better social and functional well-being scores than metastatic brain tumor patients while other QOL domains were similar. The heterogeneity in the studies and the low sample size of metastatic brain tumor studies could have confounded our findings. As such, further investigation is recommended.
MASCC-0247
CAP program (circumvent anxiety of patients) during chemotherapy delivery at one-day hospital.
J. Kattan 1, A. Daher1, L. Assaker1, Y. Jreige1
1Department of Hematology/Oncology, Saint Joseph Hospital/Raymond and Aida Najjar Medical Center, Beyrouth, Lebanon
Introduction: Transforming patient anxiety to comfort during chemotherapy delivery is the desire of every cancer care giver. For the first time, a beauty care clinic services are offered to adult cancer patients, while receiving one-day chemotherapy
Objectives: To evaluate the impact of the beauty clinic services on the patient anxiety and on the department atmosphere
Methods: Professional physiotherapists in beauty care and relaxation massage offer their services for every patient during 15 min session at his own bed. CAP program was approved by Saint Joseph ethical committee and supported by Jane Nassar Institute. Evaluation questionnaires were filled by randomly selected patients.
Results: CAP program was initiated in August 2012. Around 10 patients per day were included. 90 % of our patients welcome the program and participate. Men choose hands or feet relaxation massage and women usually face beauty care. 22 patients were randomly selected to fill the CAP-evaluation questionnaire. Among these 22 patients, only 2 (9 %) refused to participate in the program. Among these 20 patients, 90 % had at least two sessions, 100 % would advise other patients to participate, 95 % of them believe that this service adds an advantage to delivered care and provides a restful atmosphere, and all of them encourage the department to continue to provide this service.
Conclusions: Psychosocial support is almost lacking in the management of our patients leading to increase their anxiety while receiving chemotherapy. CAP program represents an innovative intervention that improves patient apprehension and soften chemotherapy atmosphere.
MASCC-0248
Quality of life assessment in advanced cancer patients treated at home, a day care centre and a palliative care unit
W. Leppert 1
1Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
Introduction: Quality of life (QOL) assessment is paramount in advanced cancer patients.
Objectives: QOL assessment is crucial in patients with advanced cancer. The aim of the study was to compare QOL in advanced cancer patients treated at home, at a day care centre (DCC) and at a palliative care unit (PCU).
Methods: QOL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire—Core 15—Palliative Care (EORTC QLQ-C15-PAL) along with the modified ESAS (Edmonton Symptom Assessment System) and the Karnofsky performance status (KPS). Two measurements were performed at baseline and after 7 days of symptomatic treatment.
Results: A total of 129 patients completed two QOL measurements with 51 patients treated at home and at PCU each and 27 patients treated at DCC. In the EORTC QLQ-C15-PAL significant improvement in functional and symptom scales was observed except for physical functioning and fatigue; patients at DCC had better physical functioning, global QOL, appetite and less fatigue. KPS scores were better at DCC comparing to patients treated at home and at PCU, and in the latter group deteriorated. ESAS results demonstrated improvement in all items except for drowsiness, which was stable in DCC and deteriorated in patients staying at home and at PCU. Higher activity, better appetite, well-being and less drowsiness were observed in patients treated at DCC.
Conclusions: QOL improved in all patients comparing the baseline and follow-up assessments, with better results observed in those treated at DCC and similar scores in patients staying at home and at PCU
MASCC-0249
Palliative chemotherapy in terminal stage of patients with ovarian cancer
M. Mallaev1, Z.A. Olimova 1, R.M. Valieva1, G.J. Khakimova1
1Chemotherapy, National Cancer Research Center, Tashkent, Uzbekistan
Introduction
Background: We conducted trial to evaluate the therapeutic efficacy and toxicity of paclitaxel with albumin in patients with terminal stage of ovarian cancer. It’s known that normal concentration of albumin in blood considerably increased the efficiency of chemotherapeutic agents.
Objectives: We selected 12 patients with terminal stage of ovarian cancer T4N2M1with ascites.
Methods
Methods: We carried out to all patients Paclitaxel 50 mg/m2 in 5 % 500 ml of dextrose during 180 min with albumin 20 %–100 ml during 5 h intravenously, simultaneously and repeated that course each 7 days during 2 month depending on common condition of the patient and laboratory analysis
Results
Results: After appropriate postchemotherapeutic and symptomatic therapy we took normal blood tests and decreasing of tumor. Common condition of patients improved after 4th course, decreased ascites and observed less toxicity of paclitaxel.
Conclusions
Conclusions: As we showed above we selected patients at the stage of T4N2M1, by ECOG standard 3 points conducted micro dose long term chemotherapy with albumin and took expected results. We observed patients that by ECOG points decreased even to 1, disappeared ascites, and improved quality of life.
MASCC-0250
Quality of life of family caregivers in hematologic cancer
H. Bektas 1, G. Yigit2
1Medical Nursing, Akdeniz University Antalya School of Health, Antalya, Turkey, 2Hematology Unit, Akdeniz University Hospital, Antalya, Turkey
Introduction: Cancer is a chronic illness that affects the entire family and deteriorates the quality of life (QoL) of family caregivers.
Objectives: The objective of this descriptive study was to assess the QoL of family caregivers in hematologic cancer
Methods: Fifty family caregivers of the hematologic cancer patients were interviewed. Data were collected with a demographic questionnaire and QoL was assessed using the Turkish version of The Caregiver Quality of Life Index-Cancer (CQOLC) scale. Descriptive statistics, multivariate regression, internal consistency analyses were utilized in the data analyses
Results: The majority of the patients were male (56 %), housewife (38 %) and retired (36 %). The median age (range) for caregivers was 42.5 years (20–68 years), the majority of family caregivers were female (64 %), married (82 %), housewifes (58 %), spouses (44 %), and children (30 %). The majority of family caregivers (62 %) had at least one chronic illness including diabetes, hypertension, arthritis, and depression. The CQOLC score of the family caregivers was 72.63 ± 16.08, (Min.32, Max.114), and scores of the four subscales were as follows: Burden 14.29 ± 7.26, distruptiveness 11.09 ± 5.61, positive adaptation 14.82 ± 5.43, and financial concerns 6.48 ± 3.94. Hematologic cancer caregivers had lower QoL scores. The mean CQOLC score differed with age, gender, education levels and marital status (p < 0.05). The Cronbach’s alpha value of the CQOLC was 0.88
Conclusions: Evidenced-based supportive programs for family caregivers of hematologic cancer patients should be developed and tested to meet their needs and support caregiving roles. The health team can plan more efficient interventions, with a view of enhancing the QoL of family caregivers.
MASCC-0251
Sexual dysfunction in patients with breast cancer
H. Bektas 1, I. Ozkan2
1Medical Nursing, Akdeniz University Antalya School of Health, Antalya, Turkey, 2Maternal Nursing, Akdeniz University Antalya School of Health, Antalya, Turkey
Introduction: All women diagnosed with breast cancer, regardless of ethnicity, have concerns regarding sexuality and body image
Objectives: The objective of this descriptive study was to assess the sexual function in patients with breast cancer
Methods: This research was carried out on 230 patients diagnosed with breast cancer. Personal information forms developed by the researcher and the Female Sexual Function Index were used as the data tools. Data were collected through personal interviews with the patients
Results: The breast cancer patients in the sample averaged 48.9 years of age (range 26–78) and included most patients who were married (79.6 %), housewife (76.0 %) and had completed primary education (53.9 %). According to the results of the research, 94.3 % of patients had chemotherapy, 48.2 % had radiotherapy, 93.9 % had surgical treatment. Also 68.7 % of the patients were satisfied with their sexual functions before they had diagnosed with cancer, 49.6 % of the patients sexual functions were affected after receiving the cancer diagnosis, 39.1 % of patients had no sexual activity. Female Sexual Function Index scores of the patients with an average were 26.3 (Min.6, Max.83) and found to be low. The Cronbach’s alpha value of the Female Sexual Function Index was 0.97
Conclusions: Patients with sexual dysfunction in individuals affected by negative body image, especially in patients who were diagnosed with breast cancer evaluated with caution, sexual dysfunction, the level of reliability and validity of assessment scales were to be made using the appropriate interventions to individuals in planning and directing the units is recommended.
MASCC-0252
The association between malnutrition and psychological distress in patients with advanced head and neck cancer
L. Ma 1, P. Poulin2, A. Feldstain3, M. Chasen4
1Division of Palliative Care, Ottawa Hospital Research Institute The Ottawa Hospital Cnacer Certre, Ottawa, Canada, 2Psychosocial Oncology Program, The Ottawa Hospital Health Institute, Ottawa, Canada, 3School of Psychology, University of Ottawa, Ottawa, Canada, 4Division of Palliative Care, The Ottawa Hospital Cnacer Certre Ottawa Hospital Research Institute, Ottawa, Canada
Introduction: Malnutrition and psychological distress are often seen in patients with head and neck cancer, but little is known about their interrelationships.
Objectives
This study aims to examine the relationship between malnutrition and psychological distress in patients with advanced head and neck cancer.
Methods: One hundred patients with advanced stage head and neck cancer were screened for nutritional status, using the Patient-Generated Subjective Global Assessment, for psychosocial distress, using the Distress Thermometer, and for psychosocial issues, using the Problem Checklist. The relationship between malnutrition and psychosocial distress was determined by regression and correlation analysis. We also used t-tests to compare distress levels among patients with or without specific nutrition-related symptoms.
Results: There were 80 male and 20 female patients; the mean age was 58.4 ± 10.9 years (range 23 to 85). The correlation between poorer nutritional status and levels of psychological distress was significant r = 0.37 (p < .001). Specifically, reduced food intake, symptoms, and greater disability were all positively associated with distress (respectively r = .27, r = .29, and r = .56, all significant at p < .01). After controlling for the effects of psychosocial problems and pain, nutritional status remained a significant predictor of distress, explaining 3.8 % of the variance in patients’ distress scores (p < .05)
Conclusions: Malnutrition and disability were strongly related to distress in patients with advanced head and neck cancer. Our results suggest the need for further research into the complex relationship between nutritional status and distress, as well as into their management in cancer care.
MASCC-0253
Intercostobrachial syndrome after nerve-sparing axillary lymph node dissection
M. Kostanyan 1
1Mammology-1, National Centre of Oncology, Yerevan, Armenia
Introduction: Intercostobrachial nerve syndrome is the most frequent postoperative complication of axillary lymph node dissection (ALND) due to surgical injury of intercostobrachial nerve (ICBN). Intercostobrachial neuralgia represents neuropapthic pain typically accompanied by remarkable sensory abnormalities in the distribution of the ICBN.
Objectives: We conducted a prospective study to evaluate the frequency, character and location of sensory disturbances of upper extremity in two consecutive groups of women who underwent level-2 ALND for operable breast cancer at National Centre of Oncology in the period of 2005–2010 years.
Methods: In group I (experimental group—110 patients) besides of motor nerves (long thoracic and thoracodorsal nerves) the ICBN was preserved. In group II (control or nerve-sacrificed group—110 patients) the ICBN was transsected. Tactile sensitivity was assessed after 3 months from the surgery by special questionnaire and using standard neurological Methods.
Results: The analyses of results showed, that prevalence rate of sensory disturbances of upper extremity was 12.7 % in the experimental group, which was significantly different from that of the control group (88.2 %, p < 0.01). In the nerve-preserved group sensory changes had character of hypesthesia (5/14) or paresthesia (9/14). Meantime, in the control group, sensory changes had more severe character in the form of dysesthesia (37/97) or anesthesia (60/97), and in 5 patients the phenomenon of allodynia (painful response to innocuous stimulus) was observed.
Conclusions: Our study demonstrates, the preservation of the ICBN during ALND produces minimal postoperative alterations in sensitivity significantly improving quality of life of operated patients.
MASCC-0254
General review: influence of managerial practices on caregivers’ quality of working life in oncology wards
P. Colombat 1, N. Gillet2, E. Fouquereau2, A.M. Pronost3, I. Krakowski4
1Haematology, CHU Tours, Tours, France, 2Psychology, University Tours, Tours, France, 3Psychology, Clinique Pasteur, Toulouse, France, 4Oncology, Centre Alexis Vautrin, Nancy, France
Introduction: Several studies have examined stress and professional burnout among healthcare workers in oncology wards. Although researchers have for a long time targeted their analyses on the negative indicators of health at work (e.g. stress, burnout, emotional distress), recent studies propose a more holistic approach to work quality of life of caregivers.
Objectives: In 2008, we demonstrated in a sample of 574 caregivers in oncology a significant relationship between several characteristics of onco-hematology services and health indicators, as the need for time and recognition, the importance of training (in palliative care, pain management, and help relationship), the care of patients and their families, the interdisciplinary efficiency
Methods: Specifically, results showed that participative management (e.g. implementation of service projects and of multidisciplinary staff) has a positive influence on health professionals’ quality of working life.
Results: Then we have looked at the impact of the proximal leadership of the nurse supervisor, i.e. transformational leadership and organizational justice on quality of working life and work engagement of 343 nurses. We observed that distributive justice and interactional justice fully mediate the relationship between transformational leadership and nurses’ quality of working life. In addition, nurses’ quality of working life positively related to their work engagement
Conclusions: We thus encourage health organizations to develop and offer to their proximal managers professional trainings aiming at strengthening transformational leadership and organizational justice.
MASCC-0255
Psychosocial adjustment, marital intimacy and family support of post-mastectomy patients
J. Jin 1, O.H. Cho2, Y.S. Yoo3
1Internal Medicine Bucheon St.Mary’s Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea, 2Department of Nursing, Hyechon University, Daejeon, Korea, 3Department of Nursing, The Catholic University of Korea, Seoul, Korea
Introduction: After mastectomy due to breast cancer patients experience lots of physical and psychosocial stress. Necessary factors should find out to support and reduce the psychosocial stress.
Objectives: This study was to explore the psychosocial adjustment, marital intimacy and family support of post-mastectomy patients
Methods: The subjects were 90 post-mastectomy patients (stage I or II) who were eligible and agreed to participate in the study. Subjects completed a survey including demographics, psychosocial adjustment scale by Lee (a 4-point Likert scale), marital intimacy scale by Kim (a 4-point Likert scale), and family support by Shim (a 5-point Likert scale). Data were analyzed using SAS (ver 9.0) program and frequency, mean (SD) t-test, ANOVA and Pearson correlation coefficients were used.
Results: The mean scores of the psychosocial adjustment and marital intimacy were 2.8 (±0.4) and 2.5 (±0.5). Also, the mean score of the family support was 3.6 (±0.7). Regarding the correlation between the psychosocial adjustment, marital intimacy and family support, there was a positive correlation.
Conclusions: These results showed that subjects who had higher marital intimacy and family support showed better in psychosocial adjustment. To improve psychosocial adjustment of post-mastectomy patients for breast cancer more effectively, there is an necessity to provide various strategic supports and intervention for effective communication with spouse and family.
References: Ginzburg K, Wrensch W, Rice T, Farren G, Spiegel D. Breast cancer and psychosocial factors: early stressful life event, social support, and well-being. Psychosomatics 2008;49:407–12.
MASCC-0256
Higher corticosteroid dose declines physical function, but does not affect psychosocial function among allogeneic hematopoietic stem-cell transplantation patients
S. Morishita 1, K. Kaida2, S. Yamauchi1, K. Sota1, S. Ishii2, K. Ikegame2, N. Kodama3, H. Ogawa2, K. Domen3
1Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan, 2Division of Haematology Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan, 3Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine, Nishinomiya, Japan
Introduction: We hypothesized that total corticosteroid dose is associated with muscle weakness in allo-HSCT patients
Objectives: The aim of this study was to investigate the effect of corticosteroid dose toward degree of physical and psychosocial function in allo-HSCT patients during the early period
Methods: The study included 113 patients who underwent allo-HSCT between July 2007 and April 2012. The evaluation was performed up to 3 weeks before and 6 weeks after transplantation. Physical function was evaluated using tests for hand-grip strength and knee-extensor strength, and the 6-min walk test (6MWT). Psychosocial function was measured using Hospital Anxiety and Depression Scale (HADS). Total corticosteroid dose was collected from medical records
Results: Significant decrease was observed in hand-grip strength, knee-extensor strength, and the 6-min walk test (6MWT) after transplantation (22 % in handgrip, 25 % knee-extensor strength and 15 % in 6MWT, P < 0.01). Total corticosteroid dose was correlated with decrease of hand-grip and knee-extensors strength (r = 0.3 ~ 0.4. P < 0.01) but was not correlated with 6MWT performance (r = 0.1. P > 0.05). There were no differences in anxiety and depression scale between transplantation times. The anxiety and depression scale was not different before and after HSCT both in patients with and without corticosteroid
Conclusions: This study showed the relationship between corticosteroid dose and declines in physical function among allo-HSCT patients. The results of this study suggest that muscle strengthening of allo-HSCT patients could be adjusted according to the corticosteroid dose administered to the patient.
MASCC-0257
Cell adhesion protein expression is altered during chemotherapy-induced mucositis: a histopathological study
N. Al-dasooqi 1, S. Masooma2, J. Bowen3, J. Finnie4, D. Keefe5, R. Gibson2
1Medicine, University of Adelaide, Adelaide, Australia, 2School of Medical Sciences, University of Adelaide, Adelaide, Australia, 3Discipline of Physiology, University of Adelaide, Adelaide, Australia, 4Pathology, Institute of Medical and Veterinary Science, Adelaide, Australia, 5Cancer centre, Royal Adelaide hospital, Adelaide, Australia
Introduction: Chemotherapy-induced mucositis is characterised by damage of mucous membranes throughout the AT. Extracellular matrix (ECM) components play a vital role in maintaining mucosal barrier integrity by regulating cellular apoptosis, proliferation and differentiation of overlying epithelium. However, tissue expression of adhesion molecules which mediate the activity of ECM during mucositis is not known.
Objectives: This study aims to investigate the expression of a number of adhesion molecules which are vital for ECM component signalling
Methods: Dark agouti rats were treated with irinotecan and killed at various timepoints after treatment. Picosirius red staining was used to illustrate expression of ECM components, and immunohistochemistry was used to assess integrins α1, integrin α4, E-selectin, P-selectin and E-Cadherin expression in these tissues
Results: Picosirius red staining indicated a substantial increase in collagen and other basement membrane components around crypts from 24 h in both regions and this diminished at the later time-points. Intergrin α1 and 4 significantly decreased early on after treatment and correlated with maximum apoptosis at 6 h. E-Cadherin expression peaked at 48 h in villi but decreased significantly in the crypt region in a delayed fashion. E-selectin was absent in crypts of untreated animals but increased at 24–72 h. P-selectin expression significantly increased in the submucosa at 24–48 h after irinotecan administration. These changes correlated with diarrhoea scores recorded
Conclusions: Irinotecan induced a significant alteration adhesion protein expression in both the jejunum and colon. These changes correlated with diarrhoea scores recorded. Changes in adhesion molecule expression may have a direct impact on the loss of mucosal layer integrity seen in mucositis.
MASCC-0258
MASCC score and prognostic factors in patients with febrile neutropenia in Colombia
J. Combariza 1, M. Lombana2, L. Pino2, K. Galvez1
1Hematology, Pablo Tobon Uribe Hospital, Medellin, Colombia, 2Hematology and Oncology, Nueva Granada University, Bogotá, Colombia
Introduction: There are no studies evaluating the utility of the MASCC score in colombian patients with febrile neutropenia
Objectives: To determine the prognostic value in overall survival at 30 days of MASCC score, clinical variables and CRP in patients with febrile neutropenia in a Colombian population
Methods: Retrospective prognostic cohort study of patients with febrile neutropenia in Pablo Tobon Uribe Hospital from Medellin, Colombia. It was determined using information from the medical records. Survival analysis was performed by Kaplan–Meier method. We used STATA 11.2 for statistical analysis
Results: We included 237 patients. Infection was documented in 59 % of cases, bacterial infection in 96.4 %, fungal infections in 2.9 % and 0.7 % for Tuberculosis. Gram negative infection occurred in 83 % of cases. MASCC score was significantly associated with serious outcomes such as the need for admission to ICU for severe infections (RR 3.55, 95 % CI 2.73–6.62 p < 0.00001) and death (RR 2.21, 95 % CI 1.74–2.79 p < 0.00001). Multivariate survival analysis demonstrated the strong association of MASCC score (HR 3.0 95 %CI 1.12–13.54; P = 0.032), and mean PCR >15 (Day 1 to 5) (HR 17 95 %CI 2.21–136.48; P = 0.007). Survival at 30 days was 100 % in patients with MASCC risk-low and mean CRP ≤ 15 mg/dL, but only 51 % in patients with high-risk MASCC score, mean CRP > 15 mg/dL and need ICU
Conclusions: The MASCC score is a useful tool for the prognostic stratification of patients with febrile neutropenia in a Colombian population. Using the mean PCR could help improve this prognostic stratification and should be confirmed in prospective studies.
MASCC-0259
Supportive care needs of patients with lung cancer: a longitudinal study
V. Lopez 1, D. Larkin2
1School of Medicine and Health Sciences, Australian National University, Canberra, Australia, 2Research Centre for Nursing and Midwifery, Canberra Hospital, Canberra, Australia
Introduction: The burden experienced by patients with lung cancer is well described in the literature. Research on needs of patients with cancer has identified high level of unmet needs depending on the cancer population. However, none has been done to assess lung cancer patients’ needs across four time points
Objectives: The aim of this study was to determine the support care needs of patients with lung cancer at four time points
Methods: Sixty consecutive patients with lung care were recruited from the oncology units in two states in Australia. The Supportive Care Needs Survey (SCNS) was used to collect patients’ perceived needs in five areas: Physical and daily living, psychological, health system and information, patients care and support and sexuality. Patients were asked to respond to the SCNS at baseline and after two, four six months
Results: The participants consisted of 52 % female and 48 % male lung cancer patients with a mean age of 64.34 years. Majority of them were married and living with their spouse. Fifty seven percent had NSCLC and 45 % were undergoing chemotherapy. Patients’ perceived supportive care needs was mostly related to psychological needs followed by health system and information needs. Sexuality needs were the least needed type of support. There were no significant differences in supportive care needs across the four time points
Conclusions: The study provides information that may be valuable in identifying areas where interventions could be implemented and evaluated to address the unmet needs of patients with lung cancer.
MASCC-0260
Diagnostic performance of C-Reactive Protein in patients with febrile neutropenia in Colombia
J. Combariza 1, M. Lombana2, L. Pino2, K. Galvez1
1Hematology, Pablo Tobon Uribe Hospital, Medellin, Colombia, 2Hematology and Oncology, Universidad Nueva Granada, Bogotá, Colombia
Introduction: There are no studies about the diagnostic value of CRP (C-Reactive Protein) in Colombian patients with febrile neutropenia
Objectives: To determine the diagnostic performance of PCR in patients with febrile neutropenia for determination of infections, bacteremia or severe infections.
Methods: Retrospective cohort type validation of diagnostic tests for patients with febrile neutropenia. It was determined using information from the medical records. The CRP was measured in all patients at the time of the episode of febrile neutropenia. The analysis of the diagnostic performance of PCR was performed using ROC curves. We used STATA 11.2 for statistical analysis.
Results: We included 237 episodes of febrile neutropenia at the Hospital Pablo Tobon Uribe in Medellin, Colombia. Infection was documented in 59 % and bacteremia in 34 % of episodes. The ROC curve for documented infection and bacteremia, showed that basal CRP was not useful as a diagnostic method. In multivariate analysis, severe neutropenia (<100/mm3) (RR 1.77, 95 % CI 1.00–3.14 P = 0.049) and the MASCC score (RR 1.87, 95 % CI 1.07–3.25 P = 0.026) were the only preditors of infection and bacteremia. For severe infections MASCC score (OR 30 95 %CI 11.33–83.75; P < 0.00001) and bacteremia (OR 3.44 95 %CI 1.55–7.64; P = 0.002) were the only significant predictors.
Conclusions: Baseline CRP is not useful as a diagnostic method in patients with hematologic diseases and febrile neutropenia in our population. The severity of neutropenia and the MASCC score were the only determinants significantly associated with documentation of infection or bacteremia
MASCC-0261
Clinicians’ awareness about CINV: risk factors, symptom experience and the goals of care
S. Rha1, J. Lee 2, I. Cho3, Y. Park2, S. Song4, C. Lee4
1College of Medicine, Yonsei University, Seoul, Korea, 2College of Nursing, Eulji University, Daejeon, Korea, 3College of Medicine, Eulji University, Daejeon, Korea, 4Yonsei Cancer Center, Severance Hospital, Seoul, Korea
Introduction: Corresponding clinicians’ understanding about symptom experience and the goals of care with that of patients’ would contribute improving symptom management
Objectives: To measure clinicians’ awareness about Chemotherapy-Induced Nausea and Vomiting (CINV), risk factors and the goals for symptom management.
Methods: A descriptive survey was conducted at two university hospitals including clinicians with at least 2 years of oncology care experience. The MAT items and lists of CINV risk factors were utilized to generate survey questions. Descriptive statistics and T-test were used to analyze the data.
Results: A total of 60 clinicians (MD: 47 % and RN: 53 %) with mean oncology care experience of 7 years. participated in the study. With moderately to highly emetogenic chemotherapy, clinicians estimated patients would vomit 1 ~ 2 times in acute phase, and 2 ~ 3 times during delayed phase. The mean intensity nausea of both phases was estimated as 6/10 after highly emetogenic chemotherapy, and 4/10 after moderately emetoegenic chemotherapy. Previous CINV experience was considered as the most contributing factor for symptom development. Clinicians aimed to control vomiting to occur once and the nausea intensity of 3/10. RNs estimated more delayed symptoms than MDs (p < .01), however, MDs’ goals for delayed symptom control were significantly tighter than that of RNs (p < .05).
Conclusions: This study provides detailed estimation about clinicians’ understanding about CINV experience, risk factors, and the goals of care. CINV are considered as significant symptom with room for further improvement. Further study is warranted to compare the findings of this study to the actual symptom experience of patients.
References
Keywords: Chemotherapy, Nausea, Vomiting
MASCC-0262
The influence of caregiving burden on health promoting behaviors and quality of life of family caregivers of cancer patients
J. Lee 1, S. Rha2, I. Cho3, K. Kim3, J. Hwang3, J. Jang3, Y. Park1
1College of Nursing, Eulji University, Daejeon, Korea, 2College of Medicine, Yonsei University, Seoul, Korea, 3College of Medicine, Eulji University, Daejeon, Korea
Introduction: Family caregivers’ role in cancer care are continued to expand with transition of care environment more towards home.
Objectives: To describe the influence of caregiving burden on health promoting behaviors and quality of life of family caregivers of cancer patients
Methods: A descriptive survey was conducted at two university hospitals including family caregivers of adult cancer patients. K-ZBI, questionnaires about health promoting behaviors, and Korean version of WHOQOL-BREF were used to collect data. Descriptive statistics, T-test and Pearson correlation were utilized to analyze data
Results: A total of 227 family caregivers of patients with various cancer diagnoses participated in the study. The caregivers were mostly middle aged (mean age = 46 year) and female (80.1 %) either spouse or children of patients. Caregivers with burden (K-ZBI score > 44) had become physical inactive and had experienced difficulty in keeping healthy diet (p < .01). Fatigue was the most troublesome symptom. With regards to cancer screening tests, 69.4 % received EGD, whereas 38.1 % received colonoscopy. Female caregivers reported high rate of receiving mammography (80 %) and PAP smear (71.6 %). Caregivers with less burden were having higher quality of life (p < .01).
Conclusions: Staying physically active and maintaining healthy diet were challenging subjects for caregivers of cancer patients. Fatigue would be the symptom of interest for caregiver intervention. Caregivers were attentive in receiving cancer screening tests except for colorectal cancer screening. More emphasis needs to be provided to identify caregivers with high caregiving burden to support them to engage in healthy life style and maintain quality life.
References
Keywords: Caregiver, Caregiving burden, Health promoting behavior, Quality of Life
MASCC-0263
Computer aided implant surgery in oncologic patients reconstructed with free-flaps. Two years follow-up results of a prospective clinical study
S.M. Meloni 1, G. De Riu1, M. Pisano1, A. Deledda1, A. Tullio1
1Surgical Microsurgical and Medicine, University of Sassari, Sassari, Italy
Introduction: Bone continuity defects following ablation for tumours, may generate a large series of problems. The osseous free-flap, has become the gold-standard for reconstructing these defects. Implant-supported prosthetic rehabilitation is enabled with this microvascular reconstructive option, although it still represents a major challenge.
Objectives: The aim of this prospective clinical study is to present the assets of implants restorations performed according to a modified computer-assisted surgical NobelGuide protocol in patients reconstructed with free-flaps.
Methods: Ten consecutive patients has been treated. Computer assisted, flapless dental implant placement was based on accurate prosthetic and aesthetic analysis. A total of 56 fixtures were installed Replace Tapered Groovy (Nobel Biocare).In order to assess the success of treatment were examined the following parameters: survival of implants; marginal bone-level changes; prosthetic complications; biological complications; implants abscesses; swelling implants mucosa; bleeding; soft tissue aspects (PPD, and BOP index) and patient satisfaction.
Results: All the cases have at least 24 months follow-up, 3 implants were lost (CSR 94.6 %). Every patient received a correct prosthetic rehabilitation with high degree of satisfaction when it comes function. Radiological examination showed a mean marginal bone loss of 1.12 mm ± 0.50 mm. All of the patients present healthy soft tissues with stable probing depth (PPD) and good bleeding on probing (BOP) values after 24 months, with values of their 4.85 ± 0.82 and on 13 % ± 5.2 %.
Conclusions: From these preliminary findings this approach seems valuable when it comes to function, improving prosthetic restorations and aesthetics in challenging patients.
MASCC-0264
Cervical cancer—use of vaginal dilator
L. Sigaard 1, A.G. Andreasen1, K.B. Dieperink1, C.L. Madsen1, B. Soerensen1
1Department of Oncology, University Hospital Odense, Odense, Denmark
Introduction: Prevention of agglutination after radiotherapy for cervical cancer is required to maintain a normal functioning sexual life, which can be seen as an element in patient’s overall quality of life. Use of vaginal dilator after radiotherapy is recommended in most guidelines in Western countries. Reviews show that evidence and compliance in relation to use of the dilator are uncertain and imprecise.
Objectives: To identify the use of vaginal dilator in patients with cervical cancer who have been treated with external and internal radiotherapy.
Methods: Out of 60 invited patients with cervical cancer, 42 (70 %) accepted and completed a self-administered questionnaire.
Results: The average age was 50.9 years (range: 30–80) and 29 (69 %) were in permanent relationships. The average disease duration was 2.9 years (range: 1–6) and 13 (31 %) patients had furthermore undergone surgery. A total of 32 (76 %) patients reported that they had received a vaginal dilator; of these patients 17 (40 %) used the vaginal dilator in accordance with recommendations. Eighteen women (56 %) reported discomfort with dilator such as: pain, bleeding, reduced vaginal size and discomfort with the idea of ?? using it.
Conclusions: There was no correlation between use of dilator and age, marital status, surgery, abdominal problems and stage of disease. In this study less than half of the patients used the vaginal dilator despite recommendations. This is explained by physiological as well as psychological causes. Increased use of vaginal dilator requires special educational abilities in the clinical staff.
MASCC-0265
Cervical cancer—unpleasant vaginal smell—a neglected problem?
L. Sigaard 1, A.G. Andreasen1, K.B. Dieperink1, C.L. Madsen1, B. Soerensen1
1Department of Oncology, University Hospital Odense, Odense, Denmark
Introduction: Many side effects have been identified after radiotherapy of cervical cancer which have an impact on the overall quality of life. We find that there neither in literature nor in the clinic has been a major focus on unpleasant vaginal smell. And we wonder is it a neglected problem?
Objectives: To examine whether unpleasant vaginal smell is a problem compared to the more well-known long-term problems after external and internal radiotherapy.
Methods: Out of 60 invited patients with cervical cancer, 42 (70 %) accepted and completed a self-administered questionnaire.
Results: The average age was 50.9 years (range: 30–80). In all 29 (69 %) were in permanent relationships. The average disease duration was 2.9 years (range: 1–6) and 13 (31 %) patients had furthermore undergone surgery.
After treatment patients had the following problems:
Gastrointestinal (72 %),
Unpleasant smell from the vagina (56 %)
Urinary (53 %)
Mental health (41 %)
Pain (41 %)
Emotional (28 %)
Nausea (25 %)
Conclusions: The majority of patients suffered from unpleasant vaginal smell. Also in this study, patients had many gastrointestinal and urinary tract problems. It is relevant to examine how all these abdominal problems affect women’s experience of femininity, sexuality and quality of life. Unpleasant vaginal smell is a relevant topic in supportive care and for clinical development.
MASCC-0268
Risk factors for oral mucositis in patients after hematopoietic stem cell transplantation under intensive oral care
N. Yamada1, Y. Soga 2, K. Takahashi1, Y. Kawamura-Murayama1, H. Nishimoto1, Y. Sugiura3, E. Kondo4, Y. Maeda4
1Department of Nursing, Okayama University Hospital, Okayama, Japan, 2Division of Hospital Dentistry Central Clinical Department, Okayama University Hospital, Okayama, Japan, 3Division of Dental Hygienist Clinical Support Department, Okayama University Hospital, Okayama, Japan, 4Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
Introduction: We reported previously that oral mucositis in hematopoietic stem cell transplantation (HCT) patients can be alleviated by intensive oral care starting prior to HCT and aimed at keeping the oral cavity clean and moist in the immediate post-transplant phase (Soga Y et al. Support Care Cancer 2010). We have been performing such oral management, while risk factors other than oral hygiene could be determined more clearly by investigating our patients.
Objectives: This study was performed to determine the risk factors for oral mucositis in patients HCT under intensive oral care.
Methods: A total of 209 consecutive patients (2006–2011) receiving HCT in our hospital were enrolled. All patients received intensive oral management as in our previous report, and oral mucositis was scored daily (CTCAE v3.0). Subjects were divided into two groups by peak score until 14 days after HCT: (A) without ulcer (grade 0–1); (B) with ulcer (grade 2–4). Statistical analysis were performed for the following factors between groups A and B: age, sex, donor type, intensity of conditioning regimen (conventional or reduced intensity), with/without total body irradiation, use of methotrexate, source of hematopoietic cells, renal dysfunction, and malnutrition.
Results: Intensity of conditioning regimen and use of methotrexate were significantly different between groups A and B (χ2 test, P < 0.05).
Conclusions: Conditioning regimen (conventional or reduced intensity) and use of methotrexate were revealed as risk factors of more severe oral mucositis in HCT. Patients with these factors should receive intensive care with prediction of severe oral mucositis.
MASCC-0269
Development of a pioneering holistic needs assessment (HNA) and care planning e-learning package for international nurses at www.hnaforcancer.com
N. Doyle 1, R. Henry1, M. Simpson1, B. Hartley1
1Living With and Beyond Cancer Forum, United Kingdom Oncology Nursing Society, London, United Kingdom
Introduction: A nurse-led project team initiated by the United Kingdom Oncology Nursing Society developed a blended e-learning website to facilitate nurses to further develop their confidence and competencies in a range of skills related to assessing holistic needs, thus enabling and empowering members to lead change at a local level.
Objectives: Development of a Holistic HNA and care planning e-learning package for nurses, via a web portal.
Methods: The project team identified three areas which were integral to an HNA implementation project. These were project support information, project management skills and practical competencies delivered in a blended e-learning package containing a series of accessible video presentations, supporting documents and practical activities. The team worked with internal and external partners to ensure that a robust and inspiring programme was created.
Results: http://www.hnaforcancer.com/ was launched in October 2012 as a blended learning programme that incorporates e-learning on core subjects. These are videoed presentations with supporting learning material accessed via the Members section of the UKONS website. Participants are additionally offered free UKONS membership for 1 year.
Conclusions
By the end of the programme the majority of participants reported improved skills in identifying and exploring holistic needs and initiating care to prevent or minimise the risk of complications. Participants had also developed their confidence and competency in new skills, including basic project management.
References: National Cancer Action Team (2011) Holistic Needs Assessment for people with cancer. A practical guide for healthcare professionals NCAT: London
MASCC-0270
Make a change, live well" events to capture the teachable moment for those living with and beyond cancer in an NHS Trust (UK)
N. Doyle 1, T. Wiseman1, B. Hartley1
1Living With And Beyond Cancer, The Royal Marsden NHS Foundation Trust, London, United Kingdom
Introduction: The Royal Marsden NHS Foundation Trust designed health and wellbeing events to raise awareness of the benefits of healthy living, and to support patients to make healthy lifestyle choices.
Objectives: Evidence suggests that adopting a healthy lifestyle helps patients to live well after treatment for cancer. We aimed to develop interactive events to benefit from the ‘teachable moment’ at the end of patients’ initial treatment for cancer.
Methods: The intervention comprised:
* an interactive event with short presentations from health care professionals
* a quiz using electronic voting pads, participants were encouraged to use a self-management tool to set personal goals for improving their lifestyle.
* an opportunity for the attendees to meet informally, talk to relevant health care professionals and visit information stands for further input
The event was evaluated by questionnaire at T1 (on the day) and T2 (3 months post-intervention)
Results: 95 % of respondents (n = 120) reported learning new information, 83 % found the day helpful and 85 % found the information stands helpful. Three month data suggests that 65 % of attendees have increased their exercise, and 40 % intend making further lifestyle changes.
Conclusions: The proposed service built on findings of the pilot National Cancer Survivorship Initiative Health and Well-being clinics by offering a different model with a focus on healthy living and lifestyle change
Results showed that this was a timely intervention to make use of a teachable moment. Further research will determine if change is sustained. Several more events are planned for the future.
MASCC-0271
Restore: an online intervention to enhance self-efficacy to self manage cancer related fatigue; an exploratory trial protocol
C. Grimmett 1, M. Breckons1, L. Calman1, L. Yardley1, A. Richardson1, P. Smith1, D. Fenlon1, J. Corner1, C. Foster1
1Faculty of Health Sciences, Macmillan Survivorship Reserch Group, Southampton, United Kingdom
Introduction: The majority of cancer survivors will experience some adverse effects as a result of their cancer and its treatment. Lack of information and support can make managing these problems challenging for survivors. Here we describe an exploratory trial protocol of the RESTORE online intervention to support self-management of cancer related fatigue
Objectives: The primary objective is to test the value (provide ‘proof of concept’) of an online intervention to increase self-efficacy to self manage problems related to cancer related fatigue. Secondary aims include impact on the perception and experience of fatigue, and quality of life
Methods: A two-armed randomised controlled trial (RCT) will compare the RESTORE intervention with the Macmillan Cancer Backup ‘Coping with Fatigue’ leaflet. The intervention includes five weekly sessions with components and activities informed by self-efficacy theory. The study population consists of cancer survivors within 5 years of completion of treatment with curative intent (target sample size N = 125). An initial pilot phase determined feasibility and acceptability of proposed recruitment
Methods: Outcome measures will be collected at baseline, 6 weeks (completion of intervention) and 3 months. Process evaluation (including telephone interviews) will also be conducted. This will explore participant’s experiences of using RESTORE, and clinician’s experience of recruitment and attitudes towards the online intervention
Results: Expected early 2014
Conclusions: Data from this trial will be used to refine the intervention and conduct a full-scale RCT. We hope to roll out the intervention in clinical practice and expand it to address other cancer related problems important to survivors following primary cancer treatment.
MASCC-0272
Relaxation with guided imagery improves health-related quality of life of cancer patients during chemotherapy: a quasi-experimental study
A.C.N. Adriana Cristina Nicolussi 1, N.O.S. Namie Okino sawada1, J.L.F.S. Jair Licio Ferreira Santos2, F.M.C. Fernanda Mara Coelho3, V.A. Viviane Andrade3, J.M.P. Juliana Maria de Paula3
1General of specialized, College of Nursing at ribeirão Preto at University of São Paulo, Ribeirão Preto São Paulo, Brazil, 2Medicina Social, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto São Paulo, Brazil, 3General and specialized, College of nursing at Ribeirão Preto, Ribeirão Preto São Paulo, Brazil
Introduction: The cancer diagnosis and its treatment has reduced the Health-Related Quality of Life (HRQoL) of survivors. Complementary and Alternative Therapies has been used by cancer patients to reduce symptoms and other side effects of treatment.
Objectives: To evaluate the effects of Relaxation with Guided Imagery (RGI) on HRQoL in cancer patients during chemotherapy.
Methods: A quasi-experimental study conducted in two chemotherapy centers, at Ribeirão Preto-SP, Brazil. The Quality of Life Questionnaire-Core30 was used.
Results: The sample was composed mostly of women, between 40 and 59 years. The most common cancers were breast, bowel and gastric. At one time, both groups (control and intervention) showed most common symptoms: pain, fatigue, insomnia and loss of appetite. During the study, the comparison between groups, statistically significant differences were found in Time 1 with control group showing better scores for global Quality of Life, social functioning, and nausea and vomiting. In Time 2, the differences were significant for physical functioning and Time 3 to physical, emotional, and role functioning, fatigue, and nausea and vomiting, with better scores for intervention group. Comparing the times, the control group had impairment in physical, emotional and social functioning, nausea and vomiting, and constipation, while the intervention group showed improvement in emotional functioning.
Conclusions: The results showed that RGI was effective for improving HRQoL in various functions and symptoms. This technique is simple, low-cost, safe and beneficial. This intervention provides improvement in HRQoL in adult cancer patients undergoing chemotherapy.
MASCC-0273
Depression in cancer patients who underwent chemotherapy
N. Sawada 1, F.M.C.C. FERNANDA MARA COELHO CARDOZO1, A.C.N. ADRIANA CRISTINA NICOLUSSI1, J.L.F.S. JAIR LICIO FERREIRA SANTOS2, V.A. VIVIANE ANDRADE2, J.M.P. JULIANA MARIA DE PAULA2
1General of Specialized, College of Nursing at Ribeirão Preto at University of São Paulo, Ribeirão Preto São Paulo, Brazil, 2Medicina Social, Faculdde De Medicina De Ribeirão Preto, Ribeirão Preto São Paulo, Brazil
Introduction: Depression has been widely investigated in cancer patients. It is identified as an important manifestation and often resulting from imbalance of physical and psychological aspects of patients.
Objectives: To characterize the sample and to evaluate the frequency and degree of depression in cancer patients in three different moments of the chemotherapy treatment.
Methods: Quantitative, prospective descriptive study conducted in two chemotherapy centers, at Ribeirão Preto-SP, Brazil, from June 2009 to January 2010. The Beck Depression Inventory was used to assess the degree of depression in an initial sample of 40 patients and late 34.
Results: Regarding socio-demographic and clinical, there was homogenous with respect to sex, a predominance of patients over 40 years, married, Catholic and elementary education level. Regarding the diagnosis, there was a predominance of gastrointestinal cancer in men and breast cancer in women. An increased depression frequency of 10.15 % in the patients from the first to the third moment was observed. It was observed that the frequency of depression increased at all times. At first, 7.5 % of patients had depression, the second time, this rate increased to 16.7 %, and the third time was 17.6 % of the sample with depression
Conclusions: The results showed a gradual increase of depression in cancer patients during chemotherapy. It is important that the nurse can assess and identify these symptoms, which may occur during treatment to compose strategies/interventions to minimize them and provide a better quality of life for these patients.
MASCC-0275
(-)-Epigallocatechin-3-gallate inhibits the growth of HPV positive cervical cancer hela cell line and downregulates the expression of HPV E6 and E7
S. Hussain 1, P.R.O.F. Mohammed M Safhi1, P.R.O.F. Fakhrul Islam1
1Biochemistry, Jazan University, Jazan, Saudi Arabia
Introduction: To elucidate the antiproliferative effects of Epigallocatechin-3-gallate (EGCG), a green tea polyphenol, in the HPV 18 positive human cervical cancer HeLa cell line.
Objectives: The purpose of this study was to examine the effect of EGCG on HPV 18 positive HeLa cervical cancer cell line and also to investigate whether it can modulate HPV viral oncogene E6 and E7 expression
Methods: The viability of the cells was assessed by MTT and Trypan blue dye exclusion method. Cell cycle analysis and apoptosis by FITC-Annexin V were measured by flow cytometry. Protein expression was detected by Western blotting. Morphological changes were observed by phase contrast microscope.
Results: EGCG strongly decreased HeLa cell line proliferation in a dose- and time-dependent manner. Microscopic examination and flow cytometry assay showed that EGCG causes reduction in cell number by its antiproliferative property. Furthermore, western blot assay of EGCG treated HeLa cell lines showed activation of caspase-3, caspase-9, cleavage of PARP, increased Bax and decreased Bcl-2 expression, decreased expression of E6 and E7 oncoproteins and increased expression of p53 and pRB proteins.
Conclusions: EGCG strongly inhibited the growth of HPV positive cervical cancer cells and induce apoptosis.
MASCC-0277
Complementary therapy promotes physical relaxation in cancer patients during chemotherapy
A.C.N. Nicolussi 1, N.O.S. Sawada2, J.L.F.S. Santos3, V.A. Andrade4, J.M.P. Paula4
1General and Specialized, College of nursing ata Ribierão Preto at University of são Paulo, Ribierão Preto, Brazil, 2General and Specialized, College of nursing ata Ribeirão Preto at University of são Paulo, Ribierão Preto, Brazil, 3Medicina social, Faculdde de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil, 4General and Specialized, College of nursing at ribeirão Preto at University of São Paulo, Ribeirão Preto, Brazil
Introduction: Complementary and Alternative Therapies has been used by cancer patients to reduce disease symptoms and treatment side effects.
Objectives: To identify changes in physiological parameters: Blood Pressure (BP), Heart Rate (HR), Respiratory Rate (FR) occurred before and after the complementary therapy of relaxation with guided imagery in adult cancer patients during chemotherapy, evaluated at the beginning—first day of chemotherapy (Time 1—baseline) and after 6 months follow-up (Time 2).
Methods: A quasi-experimental study conducted in two chemotherapy centers, at Ribeirão Preto-SP, Brazil, from May 2009 to December 2011. Patients underwent complementary therapy: relaxation with guided imagery, driven by a CD recording, lasting about 15 min each session.
Results: Seventy-three patients participated in the survey. The most common cancers were breast, bowel and gynecological. We used the paired t-test to assess the difference between before and after relaxation with guided imagery at times T1 and T2. Statistically significant differences were found with p?? < 0.001 for Systolic Blood Pressure, Diastolic Blood Pressure and Heart Rate at times 1 and 2 and statistically significant with p < 0.05 for Respiratory Rate (p = 0.033) at time 1.
Conclusions: Changes in physiological parameters studied (BP, HR and RR) showed that intervention relaxation with guided imagery provided to these patients a physiological relaxation, whereas these parameters decreased after the intervention, and this reduction was statistically significant, implying that complementary therapy promoted an effective physical relaxation.
MASCC-0278
Presence of fatigue in cancer patients undergoing chemotherapy
N. Sawada 1, F.M.C.C. Cardozo1, A.C.N. Nicolussi1, J.L.F.S. Santos2, V.A. Andrade1, J.M.P. Paula1
1General of specialized, College of Nursing at ribeirão Preto at University of São Paulo, Ribeirão Preto São Paulo, Brazil, 2Medicina Social, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto São Paulo, Brazil
Introduction: Patients with cancer undergoing chemotherapy have negative feelings and symptoms related to the disease and treatment that can affect their quality of life, and among the most common symptoms is fatigue.
Objectives: To evaluate the frequency and degree of fatigue in cancer patients in three different moments of the chemotherapy treatment.
Methods: Quantitative, prospective descriptive study conducted in two chemotherapy centers, at Ribeirão Preto-SP, Brazil, from June 2009 to January 2010. The Piper Fatigue Scale-reviewed was used to assess fatigue in an initial sample of 40 patients and late 34.
Results: The sample was homogeneous regarding sex. There was a predominance of gastrointestinal cancer in men and breast cancer in women. At first, 5 % of patients had fatigue, the second time, this rate increased to 38.9 %, and the third time was 64.7 % of the sample with fatigue. These results showed an increase of fatigue in 59.7 % of patients from the first to the third moment.
Conclusions: The results showed a gradual increase of fatigue in cancer patients during chemotherapy. It is important that the nurse can assess and identify these symptoms, which may occur during treatment to compose interventions to minimize them and provide a better quality of life for these patients.
MASCC-0279
Interventions for managing cancer-related fatigue in men treated for prostate cancer: a systematic review
D. Larkin 1, V. Lopez1, E. Aromataris2
1Research Centre for Nursing and Midwifery Practice, ACT Government Health Directorate, Woden, Australia, 2Joanna Briggs Institute, University of Adelaide, Adelaide, Australia
Introduction: Cancer-related fatigue is the most frequently reported long-term side effect of treatment for prostate cancer. To provide quality supportive care for men treated for prostate cancer, it is important for nurses to understand effective non-pharmacological interventions for treating cancer related fatigue. To assess the effectiveness of non-pharmacological interventions for managing cancer-related fatigue in men treated for prostate cancer.
Methods: Multiple databases and trial registries were searched to locate eligible studies. Only experimental studies, primarily randomised controlled trials, were included. Standardised instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) were used to assess studies for methodological validity and data extraction. As statistical pooling was not possible, the findings were presented in narrative form.
Results: Of the 1,480 citations identified by searching, 15 matched the eligibility criteria of the review. Seven were excluded following critical appraisal. Of the eight included studies, five evaluated physical activity (aerobic and resistance exercise) in 447 participants and three psychosocial interventions (cognitive behavioural therapy or education interventions) in 153 participants. Exercise as an intervention to reduce fatigue has the strongest evidence for improving fatigue and the expected benefits exceed the expected harms. Psychosocial interventions such as education and cognitive behavioural therapy also were beneficial in reducing fatigue.
Conclusions: Whilst physical activity appears to show the greatest benefit, other non-pharmacological interventions such as education and cognitive behavioural therapy have demonstrated effectiveness and should also be considered as a strategy for reducing cancer-related fatigue in men treated for prostate cancer.
MASCC-0280
Review of morphine prescribing practice at the Oncology Directorate, Komfo Anokye Teaching Hospital, Ghana
K. Mensah 1
1Onocolgy Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
Introduction: There are few opioids available in Ghana, e.g. morphine, pethidine, etc. Fentanyl patches, oxycodone, etc. are not affordable in Ghana. Morphine is the only strong opioid paid for by the National Health Insurance, hence making it easily available for patients with or without health insurance. Morphine mixture is cost-effective. Morphine as oral and parenteral preparation is the only option left to treat severe cancer pain in our clinical setting. Despite doctors prescribing oral morphine at the directorate, many cancer patients with severe cancer pain do not achieve adequate pain relief.
Objectives: This review was done to assess oral morphine prescribing pattern at the Directorate of Oncology, Komfo Anokye Teaching Hospital
Methods: A review of morphine prescription of 566 new patients folder were analysed against an established standard guideline which was modified to suit local population
Results: 7 % of patients were prescribed morphine. Several deficiencies in morphine prescribing were identified. These include prescribing morphine at 8 hourly intervals, absence of review after prescribing morphine, lack of double dosing at night, omission of breakthrough doses. Location of pain was often not indicated in the patient’s hospital folder
Conclusions: Although much is know about morphine, there is inappropriate prescribing of morphine which leads to uncontrolled cancer pain. Education and implementation of local guideline will improve the use of morphine in cancer pain management. Review of the guideline must also be carried out from time to time to determine whether such guideline has improved morphine prescription pattern.
MASCC-0281
Effects of telephone follow-up consultations on discharged patients with liver cancer following non-surgical treatment
S.N. Chang 1, S.C. Shun1, Y.H. Lai1, C.H. Chen2, J.C. Sheu2
1Nursing, National Taiwan University College of Medicine, Taipei City, Taiwan, 2Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei city, Taiwan
Introduction: Due to the average of 3 to 4 days’ hospitalization, patient with liver cancer after receiving treatments still experience some levels of physical and psychological distress when they are discharged in Taiwan
Objectives: The aim of this study was to explore effects of a telephone follow-up education program on aftercare of receiving non-surgical treatments in liver cancer patients.
Methods: A randomized clinical trial study was conducted to recruit patients receiving non-surgical treatment in oncology wards at medical center in Taiwan. The control group (n = 58) received unstructured usual care by case manager and the experimental group (n = 37) received 7 times of telephone follow-up education before discharge, and at 1, 2, 3, 4, 6 and 8 weeks after discharge by a well-trained research assistant. The education included 7 issues to deal with their physical and psychological distress. The outcome of symptom distress, fatigue, anxiety, depression, self-efficacy of cancer behavior and quality of life were assessed by a set of questionnaire on the day before discharge, at 8 and 12 weeks after discharge. Data was analyzed by generalized estimating equations
Results: The level of symptom distress, fatigue, anxiety and depression in both groups decreased and the self-efficacy of cancer behavior and QOL improved monthly. However, there were no significant differences in the outcome in two groups
Conclusions: The usual care and telephone follow-up education program had the similar effect in this study. The effect of telephone education program might not be effective for liver cancer patients in Taiwan.
MASCC-0282
The psycho-spiritual empowerment process for the terminal hepatocellular carcinoma patient
Y. Chen 1
1Nursing, Changhua Christian Hospital, Changhua County, Taiwan
Introduction: Hepatocellular carcinoma is the leading cancer for male in Taiwan. Patients in terminal cancer not only experience physical discomfort, but also psychological-spiritual distress. It is noteworthy that the psychosocial and spiritual needs of patients with terminal cancer patients often are neglected by families and healthcare providers in Taiwan. However, psychosocial and spiritual well-being for patient at the end of life is urgently important,
Objectives: The objectives of the study is to explore experiences and the psycho-spiritual empowering process of the end-stage hepatocellular carcinoma patient.
Methods: The author presented a case report of a middle-aged cancer near the end of life who experienced the psychosocial and spiritual distress.
Results: Psychosocial and spiritual distress in the middle-aged hepatocellular carcinoma patient included come to loss control and powerlessness resulted from the rapidity of disease progressional; disrupted family relationships resulted from loss the main source of income and burdens on families; loneliness and worthlessness resulted from the caducity of life. The author used empowering process to encourage the patient emotional expression, strengthen families’ relational connectedness, reconstruct belongingness, fine the meaning of life, and ultimately personal strengthen and self-empowerment.
Conclusions: By sharing the experience of care, it provided important information that healthecare professionals must be strongly sensitive to psychosical and spiritual needs. In addition to ongoing psychological, social and spiritual support, meaning-making process in terminal stage is the central part of palliative care. It’s expected to the best quality of life and psycho-social-spiritual well-being will be reached.
MASCC-0283
How to decrease lens dose in patients with brain metastasis who underwent palliative whole brain radiotherapy?
G. Yavas 1, C. Yavas2, O.V. Gul1, H. Acar1, O. Ata3
1Radiation Oncology, Selcuk University, Konya, Turkey, 2Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey, 3Medical Oncology, Selcuk University, Konya, Turkey
Introduction: Palliative whole brain radiotherapy (WBRT) has been the standard treatment for brain metastases.
Objectives: We aimed to evaluate the lens, optic nerve and eye doses with two different radiotherapy techniques in patients with brain metastasis who undergone WBRT
Methods: Ten patients with brain metastasis were included. For each patient, two different treatment plans were created for whole brain. Helmet-field (HF) (anterior border was 2 cm posterior to lens, inferior border was the bottom of C2 vertebra) and classical technique with collimation (CT) (anterior border was defined as skin fall of, inferior border was the bottom of cranial base) were generated for all patients. Two techniques were compared with respect to the lens doses, the dose homogeneity index (DHI), and the monitor unit counts (MU) required for the treatment. Student-t test was used for statistical analysis
Results: There was no difference between two techniques in terms of both DHI (p: 0.182) and MU counts (p: 0,167). The maximum and mean doses received by the right lens, left lens and right eye were significantly reduced with CT (p values for maximum doses 0,007, 0,012 and 0,010; for median doses 0,027, 0,046 and 0,002 respectively). CT with collimation was found to be more advantageous, with respect to the lens doses in addition the dose received by the right eye during WBRT.
References: Kocer I, Taysi S, Ertekin MV. et al. The effect of L-carnitine in the prevention of ionizing radiation-induced cataracts: a rat model. Graefe’s Arch Clin Exp Ophthalmol 2007; 245:588–594.
MASCC-0284
Comparison of two different radiotherapy techniques in stomach cancer patients who underwent concomitant chemoradiotherapy
G. Yavas 1, C. Yavas2, G. Cobanoglu1, O.V. Gul1, H. Acar1, O. Ata3
1Radiation Oncology, Selcuk University, Konya, Turkey, 2Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey, 3Medical Oncology, Selcuk University, Konya, Turkey
Introduction: Postoperative chemoradiotherapy has been the standard treatment for patients with stomach cancer.
Objectives: To compare two different radiotherapy techniques
Methods: Ten stomach cancer patients who underwent total gastrectomy and lymph node dissection were included. Two different treatment plans were created for the tumor bed and regional lymph nodes. Three-field and 4 F plans were compared for the doses in the planning target volume (PTV), the organ at risk (OAR) volumes (including kidneys, liver, spleen and spinal cord), the dose homogeneity index (DHI), and the monitor unit counts (MU) required for the treatment. Student-t test was used for statistical analysis
Results: There was no difference between two techniques in terms of DHI (p: 0.576). The mean dose received by the liver was significantly reduced with 3F technique (p < 0.001); whereas the mean doses of the kidneys, spleen and spinal cord were decreased with 4F technique (p values were 0.007, 0.021 and <0.001 respectively) (Table 1). The dose to %10, %30, %40 and %50 of the total liver volume were significantly reduced with 3F technique (p values were 0.026, 0.009, 0.001 and <0.001 respectively). The MU counts required for the treatment was significantly lower with 4F technique (p < 0.001)
Conclusions: Four-field technique was found to be more advantageous than the 3 F technique, with respect to the OAR, other than the liver, and monitor units required for treatment in patients with stomach cancer without any known liver disease.
References: Buergy D, Lohr F, Baack T et al. Radiotherapy for tumors of the stomach and gastroesophageal junction. Radiat Oncol. 2012 Nov 16;7:192.
MASCC-0285
The impact of dose calculation algorithms for peripheral dose distributions of enhanced dynamic and physical wedges
H. Acar1, G. Yavas 1, C. Yavas2
1Radiation Oncology, Selcuk University, Konya, Turkey, 2Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey
Introduction: The peripheral dose is important when anatomical structures with very low dose tolerances are involved.
Objectives: In this study, the two available calculation algorithms of the Varian Eclipse 8.6 treatment planning system(TPS), the anisotropic analytic algorithm(AAA) and pencil-beam convolution(PBC) was used to compare measured and calculated peripheral dose distribution of physical wedged(PW) and enhanced dynamic wedged fields(EDW)
Methods: Peripheral dose measurements were carried out for 6 and 18 MV photons using a 0.6 cc Farmer-type ionization chamber in the slab phantom. Measurements were performed using 15°, 30°, 45° and 60° PW and EDW for three different field sizes at dmax and up to a maximum distance of 50 cm beyond the field edges. Peripheral dose was further computed using two different algorithms of a TPS. The measured and calculated datas were then compared to find which algorithm calculates peripheral dose distribution more accurately
Results: Both algorithms from the TPS adequately model the peripheral dose distribution up to 45°. For large field sizes with 60° EDW, the largest deviation between calculated and measured dose distribution is less than 3.5 % using the AAA, but can increase up to 9.7 % of the distribution using PBC.
Conclusions: The AAA models wedged peripheral dose distributions more accurately than the PBC does for all studied conditions; the differences between the algorithms are more significant for large wedge angles and large field sizes. It must be emphasized that the use of PBC for planning large-field treatments with 60° EDW could lead to inaccuracies of clinical significance.
MASCC-0286
Evaluation of doses in the Wernicke and Broca’s areas using two different radiotherapy techniques in patients with right frontal glioblastoma multiforme
G. Yavas 1, C. Yavas2, H. Acar1
1Radiation Oncology, Selcuk University, Konya, Turkey, 2Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey
Introduction: Broca’s and Wernicke’s areas, which are important language areas of the brain, are commonly irradiated in patients with right frontal lobe glioblastoma multiforme (GBM).
Objectives: We aimed to evaluate the doses in the Broca’s and Wernicke’s areas using parallel opposed two field and three field technique in patients with right frontal GBM.
Methods: Two different treatment planning techniques of right-frontal GBM were generated for Rando phantom: two field technique using parallel opposed field and three field technique (two field parallel opposed and a vertex field). Both plans were compared for doses in planning target volume (PTV), Broca’s and Wernicke’s areas. Additionally to test the accuracy of treatment planning system (TPS) dose calculation; thermoluminescent dosimeters (TLD) were used to measure PTV and organs at risk (OAR) doses
Results: The three field technique allowed the lower doses in the Broca’s and Wernickes’s areas when compared to two field technique. The doses calculated in the Broca’s area and Wernicke’s area were 0.98 % ± 0.03 and 0.09 % ± 0.06 of the isocenter dose with three field and 1.06 % ± 0.04 and 0.133 % ± 0.03 of the isocenter dose with two field techniques respectively. When the doses measured by TLD and calculated with TPS were compared; for Broca’s area, TLD measured dose was compatible with TPS calculated dose were 3.23 % and 2.92 % for two field and three field techniques respectively. In the same manner for Wernicke’s area, they were 4.12 % and 3.95 %
Conclusions: Three field technique seems to be more advantageous than two field technique in terms of doses of Broca’s and Wernicke’s areas three field technique is superior to two field technique.
MASCC-0287
Management of anemia and iron deficiency in a cancer center in France
F. Lai Tiong 1, C. Brami1, N. Jovenin1, P. Soibinet1, C. Crespel1, O. Dubroeucq1, H. Curé1
1DOM, Institut Jean Godinot, Reims, France
Introduction: About 75 % of cancer patient treated by chemotherapy suffer at least once from severe or moderate anemia. Even if cancer-related anemia is multifactorial, anemia of chronic disease due to the inflammatory status of cancer disease reduced iron level and its absorption required for utilization of erythropoietin.
Objectives: Description of management of anemia in an oncology day unit in 2012 to improve our practices
Methods: Prospective analytic study between May to November 2012 in an oncology day unit at “Institut Jean Godinot Cancer Center” in Reims, France. All patients included suffered from moderate or severe anemia (OMS) and they were at least treated by chemotherapy
Results: One hundred thirty-three patients were included, 30 men (22,55) and 103 women (87,5 %), medium age were 60 yo. and 52 % of patient were metastatic. We had 50 % of breast cancer, 17 % of gynecological cancer, 10 % of head and neck cancer. Even if 42 % (n = 56) of patient have been treated for anemia by recombinant human erythropoietin (EPO) (n = 46) or by blood transfusion (n = 32/56). Only 46 % of patient (n = 61) have been tested for iron deficiency according to the guidelines, 26 suffered from an iron deficiency and only 15 patients have been treated (n = 12: IV supplement)
Conclusions: Iron deficiency in cancer-related anemia is more often than expected and remains under diagnosed. More study is needed, but it is interesting to be more vigilant given the role of iron on the effectiveness of EPO.
MASCC-0288
Molecular and cellular mechanisms of EGFR-inhibitor-associated cutaneous adverse effects: new insights into skin immunity
P.A. Gerber 1, B.M. Lichtenberger2, B.A. Buhren1, M. Holcmann2, V. Smolle2, H. Schrumpf1, P. Ansari1, E. Boelke3, C. Mackenzie4, K. Pfeffer4, A. Wollenberg5, J. Harder6, W. Budach3, J.M. Schroeder6, M. Sibilia2, B. Homey1
1Dermatology, Heinrich-Heine-University, Duesseldorf, Germany, 2Institute for Cancer Research, Medical University of Vienna, Vienna, Austria, 3Radiation-Oncology, Heinrich-Heine-University, Duesseldorf, Germany, 4Medical Microbiology, Heinrich-Heine-University, Duesseldorf, Germany, 5Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany, 6Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
Introduction: Papulo-pustular eruptions (rash) are considered the most frequent adverse effects of inhibitors of the epidermal growth factor receptor (EGFR). Despite its clinical relevance, the underlying molecular and cellular mechanisms of the rash have remained largely elusive.
Objectives: To characterize the molecular and cellular mechanisms of EGFR-inhibitor (EGFRI)-associated cutaneous adverse effects.
Methods: We characterized the inflammatory infiltrate and microbial colonization of the rash of EGFRI-patients by immunohistochemistry. Subsequently, we assessed the effect of EGFRI on the expression of chemokines and antimicrobial peptides using quantitative real-time PCR, ELISA and immunohistochemistry. The functional relevance of observed regulation pathways was determined by analyzing the chemoattractive and antimicrobial activities of respective conditioned media. Corresponding analyses were performed in mice lacking epidermal EGFR (EGFRΔep).
Results: The inflammatory infiltrate of the rash was dominated by Langerhans cells, macrophages and T cells. Furthermore, more than 50 % of patients showed a marked colonization of the skin with Staphylococcus aureus (S. aureus). Correspondingly, EGFRI induced the expression of proinflammatory and skin-associated chemokines, while the production of antimicrobial peptides and skin barrier genes was suppressed. Conditioned media of EGFRI-treated keratinocytes exposed a strong chemotactic potential on leukocytes, while baring a significantly reduced cytotoxic activity against S. aureus. EGFRΔep mice showed a similar phenotype, which was accompanied by chemokine-driven skin inflammation, decreased host defense and deficient skin barrier function as well as early lethality.
Conclusions: Our findings support a dual role for the EGFR controlling inflammation and sustaining microbial defense and barrier functions at the interface between host and environment.
MASCC-0289
Screening for distress in radiation oncology: description of fatigue and its relation with distress-related symptoms
M.C. Blais 1, L. Fillion2, A. St-Hilaire3, A. Tremblay1, M. de Serres1, J.F. Desbiens2, M.A. Robitaille1
1Psycho-Oncology, CHU de Québec, Quebec City, Canada, 2Nursing, Laval University, Quebec City, Canada, 3Psychology, Laval University, Quebec City, Canada
Introduction: Distress is ‘a multifactorial unpleasant emotional experience of a psychological, social and/or spiritual nature’ (NCCN, 2008). Around 35–45 % of all cancer patients report emotional distress, physical-related symptoms, and practical problems (Carlson, 2004; Zebora, 2001). Screening for distress using validated tools is now recognized as the 6th vital sign in cancer care (Bultz, 2011), and is now considered essential for addressing patients’ comprehensive needs (Howell, 2012). Under the Canadian Partnership Against Cancer (CPAC) initiative, nine jurisdictions across Canada screened approximately 60,000 patients, between 2009 and 2012.
Objectives: This naturalistic study is part of the quality evaluation of one of the Canadian jurisdictions. The goal was to describe the importance of fatigue and to compare the intensity of this symptom with other distress-related symptoms, at two phases of the cancer care continuum.
Methods: Data was collected from a University Hospital in the Canadian province of Quebec that treats over 5 000 cancer patients each year. Oncology nurses and radiation technicians conducted a total of 4758 and 1,600 screenings at initiation and mid-term radiation, respectively.
Results: At both times, fatigue was the most intense symptom reported (M = 3.04, M = 3.32). Highest level of fatigue was associated with highest intensity of distress and all other symptoms (p < .001).
Conclusions: Screening is not enough. Challenges in responding to distress-related symptoms such as fatigue were identified in all CPAC jurisdictions and by other studies (Blais, 2013; Mitchell, 2011; Howell, 2012). The implementation of fatigue guidelines may contribute to better distress and symptom management.
MASCC-0290
Tactic of resistant ovarian cancer palliative treatment in elderly patients
V. Dubinina1, O. Kuznetsova 2, A. Rybin3
1Center of Reconstructif Medecine (University Clinic), Odessa National Medical University, Odessa, Ukraine
2Odessa Regional Oncology Dispensary, Odessa National Medical University, Odessa, Ukraine
3Odessa Regional Oncology Dyspensary, Odessa National Medical University, Odessa, Ukraine
Introduction: The correct choice of drugs for palliative therapy resistant ovarian cancer (ROC) helps to minimize the symptoms of the disease, and complications of chemotherapy, as well as to ensure a good quality of life of patients, especially in view of the age of the patients and the presence of concomitant pathology. As is known, elderly patients have a decreased tolerance to cytostatics and at the same time a high frequency of complications and adverse reactions of chemotherapy
Objectives: Fifty patients after 75 years with ROC
Methods: First group (25 patients)—palliative monochemotherapy (docetaxel, irinotecan, carboplatin, cisplatin) was not previously used as a second line. Second group (25 patients)—palliative hormonal therapy (tamoxifen)
Results: Level of response to palliative monochemotherapy on first group was 28 %, time to progression—6 months, and median survival—10 months. In first group was registered haematological (64 %) and nonhematological toxicity (36 %). Time to progression in the second group—4 months, median overall survival—9 months, hematological and nonhematological manifestations were not registered. On EORTC QLQ—C30 indicators of physical activity, «social functioning» were higher in group II
Conclusions: Quality of life is the second most important criterion for evaluation of the results of anticancer therapy and is more important in elderly patients than the achievement of a better clinical effect by the appointment of an infinite number of courses chemotherapy. Palliative care is not about whether to treat or not to treat but about what is the best treatment.
References: ESMO Hanbook of cancer in the senior patient. - Dirk Schrijvers., New York/London.//2012
MASCC-0291
Nurses’ experiences with catastrophic upper gastrointestinal bleeding in patients with hepatocellular carcinoma
R. Zheng 1, F. Dong1
1Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
Introduction: Upper gastrointestinal (UGI) bleeding is one of the most severe complications in hepatocellular carcinoma (HCC) patients. The overall incidence of UGI bleeding associated with HCC is 15 %–30 %. In some cases, catastrophic UGI bleeding becomes the immediate cause of death. Although catastrophic bleeding is rare, it has always been a distressing and exhausting experience for nurses, doctors, patients and their families. Managing catastrophic bleeding can lead to emotional exhaustion, stress and job burnout
Objectives: To explore how oncology nurses experienced catastrophic UGI bleeding in HCC patients.
Methods: Data were collected by semi-structured interviews. Twenty-one registered nurses who had taken care of HCC patients with catastrophic UGI bleeding were purposely recruited from a cancer hospital in mainland China. Qualitative thematic analysis was used to analyze the data for significant statements and phrases that in turn were organized into themes and subthemes
Results: Almost all the nurses reported negative experiences and feelings when managing catastrophic bleeding. Identified themes and subthemes were being fearful, stress and confusion, shirking from the event and death, powerlessness and guilt, strong senses of obligation and psychological overload and job burnout. Subjects described managing catastrophic bleeding as having a negative impact on personal life, work and philosophy of life
Conclusions: This study indicates nursing leaders need to take effective measures to improve nurses’ critical skill set, provide education in palliative care, offer services that address nurses’ psychosocial health and to provide nurses with emotional support.
MASCC-0292
Chinese nurses’ experiences in caring for terminally ill cancer patients
R. Zheng 1, F. Dong1
1Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
Introduction: Cancer is the second leading cause of death in China. Oncology nurses have the most frequent contact with patients and take care of them over the trajectory of illness. Caring for dying patients is stressful but an unavoidable responsibility of nurses. Little is known about Chinese oncology nurses’ experiences of caring for dying patients
Objectives: To explore nurses’ experiences in caring for terminally ill cancer patients
Methods: A phenomenological study using a qualitative approach with semi-structured interviews was utilized to elucidate views of convenient sample of 24 nurses who have taken care of terminally ill patients in a cancer hospital in Tianjin, China. Qualitative thematic analysis was used to analyze the data for significant statements and phrases that in turn were organized into themes and subthemes
Results: Subjects expressed negative experiences and feelings when caring for dying cancer patients. Nurses, especially the younger and experienced ones. Reported feelings of fear, stress, and helplessness along with sense of loss and sadness when caring for the dying. They were inexperienced in psychological care and how to communicate with the dying, but tried their best at promoting comfort and maintaining dignity for patients and family members
Conclusions: Based on findings, it is recommended educational programs in palliative care be offered to nurses. The younger and less experienced oncology nurses need to be provided more in-depth skill training in palliative care with emphasis on positive coping and communication skills.
MASCC-0293
Role of prostaglandin pathways in radiotherapy-induced mucositis
S.M. Grunberg 1, M. Vithala1, M.A. Vizzard2, N.B. Adams1, H. Gagne3, W. Brundage4, T. Ashikaga5
1Medical Oncology, University of Vermont, Burlington VT, USA, 2Neurological Sciences, University of Vermont, Burlington VT, USA, 3Radiation Oncology, University of Vermont, Burlington VT, USA, 4Otolaryngology, University of Vermont, Burlington VT, USA, 5Medical Biostatistics, University of Vermont, Burlington VT, USA
Introduction: Proinflammatory pathways are upregulated in oral mucositis. Lalla (Support Care Cancer 18:95, 2010) found an association between mucositis pain scores, tissue COX-1, and salivary prostaglandins after dose-dense chemotherapy.
Objectives: We investigated whether similar changes would be seen with radiotherapy (XRT)-induced mucositis.
Methods: Patients receiving oropharyngeal XRT were evaluated before XRT, midway through XRT, end of XRT, and 1 month after XRT. Subjective report of pain and objective mucositis scores were recorded. 5-minute stimulated saliva specimen at each time point was collected on ice with a protease inhibitor cocktail. Proteins were estimated using a Bradford assay. Prostaglandins were measured using ELISA assays.
Results: Eight evaluable patients included 7 male/1 female, median age 60 (range 48–66), primary site (oropharynx 1, unknown primary 1, base of tongue 3, tonsil 1, tongue 1, supraglottis 1), median XRT 7,000 rads (range 6,000–7,200 rads), concomitant chemotherapy (cisplatin 7, none 1), histology (squamous 7, mucoepidermoid 1). Pain and mucositis scores increased during XRT and improved 1 month after XRT. No increase in COX-2 levels was seen. Greatest change in salivary PGD2, PGE2, and PGF2 was seen 1 month after XRT. There was a significant time effect for PGF2 (p = 0.028) and marginal time effects for PGD2 (p = 0.107) and PGE2 (p = 0.069).
Mean pg/ug total protein | Pre-XRT | Mid-XRT | End-XRT | 1 mo post-XRT |
PGD2 | 28.80 | 34.96 | 42.82 | 158.53 |
PGE2 | 2.07 | 1.89 | 1.53 | 7.58 |
PGF2 | 8.98 | 9.78 | 1.56 | 35.55 |
COX2 | 4.84 | 2.06 | 1.44 | 0.28 |
Conclusions: Salivary prostaglandins increase during and after XRT-induced oral mucositis, suggesting a role for proinflammatory mediators.
MASCC-0294
ICU nurses’ evaluation of the use of the Critical-Care Pain Observation Tool (cpot) among intubated patients
C. Tan 1, R. Tamparon2, J. Tan3
1College of Nursing, University of Santo Tomas, San Fernando, Philippines, 2College of Nursing, University of Santo Tomas, Bacolod, Philippines, 3College of Nursing, University of Santo Tomas, Bulacan, Philippines
Introduction: Pain assessment is a necessary and significant basis of effective pain management.
Objectives: This study aims to evaluate the use of the Critical-Care Pain Observation Tool (CPOT) among nonverbally communicating intubated patients in the intensive care units in the Philippine setting.
Methods: This study is descriptive-evaluative having 33 ICU nurses purposively selected as participants. Evaluation of the CPOT was based on five parameters: simplicity, accuracy, usability, efficiency, and practicability.
Results: Mean and mode were used as basis to interpret data. Mean scores obtained are: simplicity = 16.88, accuracy = 16.15, usability = 16.58, efficiency = 17.03, and practicability = 16.82. The modes are: simplicity = 15, accuracy = 15, efficiency = 15, efficiency = 15, and practicability = 15.
Conclusions: Findings revealed that ICU nurses perceive the CPOT as a simple, accurate, usable, effective, and practical tool in assessing pain among conscious, non-verbally communicating, intubated patients. Therefore, it can be used as a pain assessment tool for non-verbally communicating patients in the local (Philippine) setting.
References: Gélinas, C., Fillion, L., Puntillo, K. A., Viens, C., & Fortier, M. (2006). Validation of the Critical-Care Pain Observation Tool in adult patients. American Journal of Critical Care, 15 (4), 420–427.
Gelinas, C., Arbour, C., Michaud, C., Vaillant, F., & Desjardins, S. (2011). Implementation of the critical-care pain observation tool on pain assessment/management nursing practices in an intensive care unit with nonverbal Critically-ill adults: a before and after study. International Journal of Nursing Studies 48, 1495–1504.
MASCC-0295
Sleep disturbances in a outpatient palliative rehabilitation population: prevalence, assessment, education, and evaluation
L. Savage-Larose 1, D. Gravelle1, R. Bhargava1, M. Chasen1
1Palliative Rehabilitation Program, Elisabeth Bruyere, Ottawa, Canada
Introduction: Patients with advanced cancer often suffer from sleep disturbances that can affect quality of life. Many factors can contribute to the sleeplessness. The overall importance of sleep and its relationship with other symptoms such as pain and fatigue is not clear. In order to optimize management of cancer realted symptoms, treatment of sleep disturbances in patients undergoing treatment for cancer is important.
Objectives:
-To identify patients suffering from sleep disturbances
-To develop a “sleep hygiene” toolkit
-To teach this “sleep hygiene”
-To evaluate the effectiveness of “teaching sleep hygiene”
Methods
Method: The Patients were assessed utilizing data from the following:
The Patients were assessed utilizing data from the following:
1. Nursing history and physical examination including bloodwork.
2. Self reported questionnaires including –
-The Edmonton Symptom Assessment Scale (ESAS)
-The Distress Thermometer,
-The M.D.Anderson Symptom Inventory Core Items MDASI).
-Medication review
-Folstein Mini Mental State Questionaire
-A sleep journal and the “Insomnia severity Index”
Results: To be presented. Insufficient data at present
Conclusions: The sleep hygiene tool kit is able to identify, assess severity, teach an intervention and evaluate sleep disturbances in patients with advanced cancer
References:
The SymtomsCluster of Sleep,Fatique and Depressive Symptoms in Breast Cancer PatientsNIH Public Acess http://www.ncbi.nlm.nih.gov/pubmed/3228259
Sleep Impairment Index (Morin, 1991) now called Insomnia Severity Index (Morin, 1993, 2003 Clinical guide Morin,Epsie Ca.)
Distress Thermometer www.nccn.org
MASCC-0296
Neurone specific enolase, a biomarker fo the breast cancer metastasis: a two groups, non-randomized, preliminary study
C. Dumitrescu 1, D. Lossignol2
1Medical Oncology, Institut Jules Bordet, Brussels, Belgium, 2Supportive Care Unit, Institut Jules Bordet, Brussels, Belgium
Introduction: Neurone Specific Enolase(NSE) is a specific marker of the neuroendocrine tumor but also of the neuronal destruction, the same tissue alteration produced by the metastatic dissemination in the cerebral parenchyma.
Objectives: To evidence the diagnostic and prognostic value of the NSE in brain metastases due to breast cancer.
Methods: There were studied two groups of 20 patients each, all women diagnosed with breast cancer. One group included patients with no brain metastasis, and the other patients with brain metastasis. In both groups the absence or the presence of cerebral metastasis was demonstrated by a cerebral magnetic resonance and the NSE was dosed only once. Were excluded patients with a neuroendocrine tumor, history of epilepsy, stroke, dementia, brain injury or intrathecal treatment.
Results: According to NSE normal values that are inferior to 18 ng/dL, we observed a significantly increased level of this marker in the group with breast cancer brain metastasis with a median value of 84,83 ng/dL, while the group without brain metastasis had a median value of 12,44 ng/dL
Conclusions: Data resulting from the above study proves its interest in the early diagnosis of brain metastasis in the breast cancer patients. As this study is ongoing, the prognostic value is one objective that will be concluded in short time, demanding a greater number of patients.
References: Choi YC, Kim JH, Kim WJ.: Serum neuron-specific enolase level as a biomarker in differential diagnosis of seizure and syncope, J Neurol. 2010 Oct;257(10):1708–12. Epub 2010 Jun 8
MASCC-0297
Feasibility of 6 months maintenance cetuximab after adjuvant concurrent chemoradiation plus cetuximab in squamous cell carcinoma of the head and neck
C. Matuschek1, E. Boelke1, C. Belka2, U. Ganswindt2, M. Bamberg3, S. Welz3, M. Henke4, P. Stegmaier4, J. Debus5, A. Gioules5, T. Wendt6, C. Ohmann7, T. Wiegel8, J. Schipper9, P. Gerber 10, W. Budach1
1Radiation-Oncology, Heinrich-Heine-University, Duesseldorf, Germany, 2Radiation-Oncology, Technical University Munich, Munich, Germany, 3Radiation-Oncology, University Hospital Tuebingen, Tuebingen, Germany, 4Radiation-Oncology, University Hospital of Freiburg, Freiburg, Germany, 5Radiation-Oncology, University Hospital Heidelberg, Heidelberg, Germany, 6Radiation-Oncology, University Hospital Jena, Jena, Germany, 7Coordinating Center for Clinical Trials, Heinrich-Heine-University, Duesseldorf, Germany, 8Radiation-Oncology, University Hospital Ulm, Ulm, Germany, 9Head and Neck Surgery, Heinrich-Heine-University, Duesseldorf, Germany, 10Dermatology, Heinrich-Heine-University, Duesseldorf, Germany
Introduction: The prognosis for squamous cell head and neck cancer (HNC) after surgical treatment and adjuvant chemo radiation is unsatisfactory in cases of close resection margins <5 mm (CM) or extra capsular extent at the lymph nodes (ECE)
Objectives: We conducted a multicenter Phase II study to investigate the toxicity and efficacy of adjuvant radiotherapy in combination with concurrent cisplatin, 5-fluorouracil (5FU), and cetuximab followed by maintenance therapy with cetuximab for 6 months. Here, we present the preliminary results on feasibility and toxicity
Methods: HNC patients after primary surgery were eligible for the study, if a CM or ECE was detected. Cisplatin and 5-FU were given concurrently to postoperative radiotherapy. Cetuximab started 7 days prior chemoradiotherapy followed by weekly cetuximab during chemoradiotherapy. Maintenance cetuximab started after completion of chemoradiotherapy
Results: Fifty pts were evaluable for toxicity. Chemoradiotherapy plus cetuximab was associated with grade 3–4 (CTC 3.0) mucositis, radiation dermatitis, and skin reactions outside the radiation portals in 46 %, 28 %, and 14 % of pts. One toxic death occurred (peritonitis at day 57). Cetuximab was terminated in 10 % of all pts (allergic reactions) after the first application. In 22 % of all pts cetuximab was discontinued during the last 2 weeks or at the end of chemoradiotherapy. Of those pts embarking on maintenance therapy, 80 % were still on cetuximab after 3 and 63 % after 5 months. 48 % completed 6 months maintenance therapy
Conclusions: Adjuvant radio chemotherapy in combination with cetuximab followed by maintenance cetuximab is feasible with toxicity in the expected range.
MASCC-0298
‘I just write to say..... goodbye’—major themes of personal hand writing condolence letters to mourning families
T. Granot 1, S.M. Stemmer2
1Breast Cancer Unit, Institute of Oncology Davidoff Center Rabin Medical Center, Petach-Tiqva, Israel, 2Medical Oncologist Institute deputy, Institute of Oncology Davidoff Center Rabin Medical Center, Petach-Tiqva, Israel
Introduction: Oncology nurses, frequently interact with mourning families. After patient death, the family might need words of comfort. Limited literature deals with the role of treating staff in the mourning process, mostly retrospective surveys, describing different practices such as: phone call, funeral attending, letter of condolence and visiting the mourning family (Kusano, Kenworthy-Heinige & Thomas, 2012). Personal hand writing letter of condolence, was not yet described. This report will describe the major represented themes in 95 personal hand writing condolence letters, written by a nurse in one breast cancer unit
Objectives: The aim of this work is to describe the structure and major themes in personal hand writing letters of condolence, written by a single nurse of the breast cancer unit, in the last 3 years, in one institute of oncology
Methods: Ninety-five personal letters of condolence were sent to mourning families in the years 2009–2012. These letters have a repetitive pattern which includes a short paragraph on the disease progression until death, and then describe the unique personality and qualities of the patient and her family. The presence of children, the patient’s spouse and other significant family members are mentioned by names and kinds of support, so does themes as conflict with treating staff members, and difficult decision making process
Results: Letters, phone calls and visiting of the mourning families reveal the impact of the intervention
Conclusions: It seems that personal letters may give the mourning family strength and perspectives sometimes difficult to appreciate while on the bereavement period.
MASCC-0299
From research to practice: acute and early postmenopausal symptoms among young women with breast cancer, under chemotherapy treatment—can we do something?
T. Granot 1, I. Ben Aharon1, I. Meisner2, S. Rizel1, R. Yerushalmi1, A. Sulkes3, S.M. Stemmer4
1Breast Cancer Unit, Institute of Oncology Davidoff Center Rabin Medical Center, Petach-Tiqva, Israel, 2Genicology, Institute of Genicology Rabin Medical Center, Petach-Tiqva, Israel, 3Head of Institute, Institute of Oncology Davidoff Center Rabin Medical Center, Petach-Tiqva, Israel, 4Deputy of Institute, Institute of Oncology Davidoff Center Rabin Medical Center, Petach-Tiqva, Israel
Introduction: Chemotherapy which is usually offered to young women with breast cancer (BC) under 44 years, may induce ovarian failure, manifested by postmenopausal symptoms, followed by decreased quality of life. Review of the nursing literature, reveals that chemotherapy-induced postmenopausal symptoms have been assessed mostly in a retrospective fashion and usually after completion of the chemotherapy regimens, and/or during the hormonal therapy.
Objectives: The purpose of this study was to portray the possible correlation between early postmenopausal symptoms and objective parameters of ovarian toxicity, during chemotherapy treatment.
Methods: Twenty patients under 42y with early BC were evaluated, prospectively before chemotherapy started and at the end of it. Subjective parameters included hot flashes, night sweats, vaginal dryness, dyspareunia, mood disturbances, and libido, based on Common Toxicity Criteria Ver.3. Objective parameters included vaginal sonography and blood levels of reproductive hormones.
Results: There was a significant increase in the incidence of hot flashes, vaginal dryness, sweats and substantially decreased libido from baseline values to post-treatment values. Postmenopausal symptomes appeared very early. These findings were correlated with the objective significant decrease in ovarian blood flow and reproductive hormones level which decreased immediately following chemotherapy.
Conclusions: Results illustrates a correlation between subjective symptoms and objective parameters related to acute ovarian failure due to chemotherapy. Based on our results, symptom-assessment tool, and an intervention program should be part of the nursing comprehensive support before and during chemotherapy treatment. As well as taking proactive treatment regarding nausea and vomiting though we should do according to postmenopausal symptoms.
MASCC-0300
Palliative sedation (PS) therapy, first experience of 4 years in a Colombian population
M. Lombana 1, J. Santacruz2, L. Pino1, M. Camacho2, A. Acevedo2, M. Buendia2, I. Zamora2, C. Mendez2, A. Torres3, A.F. Cardona2
1Hematology and Oncology, Universidad Nueva Granada, Bogotá, Colombia, 2Instituto de Oncologia, Fundacion Santa Fe de Bogota, Bogotá, Colombia, 3Epidemiology, El Bosque University, Bogotá, Colombia
Introduction: Around 50 % of advanced-stage cancer patients have inadequate control of symptoms during the final period of life; palliative sedation (PS) would seem to be appropriate in such scenario.
Objectives: Primary objective is to determine the effectiveness and safety in terms of no decline in overall survival of PS, in patients suffering advanced-stage cancer.
Methods: Retrospective prognostic cohort study in Oncology Institute, Fundacion Santa Fe de Bogota, Colombia. Survival analysis was performed by Kaplan-Meier method. We used STATA 11.2 for statistical analysis.
Results: We included 145 patients recorded between July 2008 and October 2012. Median age was 68 years. The main motives for considering PS were dyspnoea (30 %), uncontrolled pain (25 %), delirium (26 %) and presenting more than one of these symptoms (19 %). Using PS led to symptoms becoming controlled in 79 % of the cases compared to 53 % without it; symptoms became controlled in 85 % of the cases in less than 24 h when PS was used compared to 15 % when it was not used (p < 0.001). Mean overall survival (OS) was 6.8 days for those who received PS and 7.2 for those who did not (HR 0.94, 0.97–1.33 95 %CI; p = 0.72 Log Rank test) and final days of life after starting PS was 2.2 days (<1–16 days). Multivariate analysis showed that using PS (HR 1.49, 1.08–2.07 95 %CI; p = 2.04) and the presence of oedema (RR 0.79, 0.61–1.0 95 %CI; p = 0.01) modified the course of controlling symptoms.
Conclusions: PS improved the time to controlled cancer symptoms in patients suffering terminal illness without modifying the OS
MASCC-0301
An exploratory study of the support needs of Australian men with prostate cancer and their significant others.
D. Larkin 1, T. Tez1, V. Lopez1
1Research Centre for Nursing and Midwifery Practice, ACT Government Health Directorate, Woden, Australia
Introduction: The support needs of men with prostate cancer (PC) may be quite different to those of their significant other who is usually the primary caregiver. Unmet support needs could affect patients’ and caregivers’ quality of life.
Objectives: To examine the support needs of men with prostate cancer and their significant other and to compare the needs of those who attend prostate cancer support groups against those who do not.
Methods: The Cancer Survivors’ Unmet Needs Measure and the Cancer Survivors’ Partners Unmet Needs Measure questionnaires were used to gather information on met and unmet support needs of men with PC and their significant others. Participants were recruited through a tertiary hospital urology and radiation oncology clinics and local support groups.
Results: There were 25 PC survivors and 22 partners who participated in this study. The highest unmet need for patients was existential survivorship and relationships for the partners. There were lower existential survivorship and relationships mean unmet needs for patients who attended the support group and lower mean unmet needs across all domains for partners. Patients indicated lowest needs for quality of life and relationships while partners showed lowest need for emotional support and information. Men who had undergone prostatectomy and their partners both scored higher for unmet needs in all domains.
Conclusions: The study findings are similar to previous findings in other cancer populations. Cancer care providers need to pay attention to the differences in needs between men with PC and their significant other.
MASCC-0302
Tanshinone IIA could inhibit human hepatocellular carcinoma HA59T/VGH cells through ER stress in vitro
C. Su 1
1Surgery, Changhua Christian Hospital, Changhua, Taiwan
Introduction: Malignant tumor is the leading cause of death in Taiwan at recent 20 year. The 5-year survival rate is only 5 % in un-resectable hepatic malignant tumor patient. Looking for more effective medicine is necessary. Tanshinone IIA (Tan-IIA) is one of the diterpene quinone extracted from DanShen. Tan-IIA could inhibit many human cancer cells through different pathways. However, the molecular mechanisms for Tan-IIA to inhibit human hepatocellular carcinoma (H.C.C) are not clear.
Objectives: Our previous study showed that Tanshinone?A (Tan-?A) can inhibit human hepatic cancer cells HepJ5 through inducing endoplasmic reticulum stress (ER stress) in vivo and in vitro. For further evaluated the efficacy of Tan-?A, the other human hepatic cancer cell line HA59T/VGH was used to study.
Methods: The cytotoxicity of Tan-?A in HA59T/VGH cells was measured by MTT assay. The ER stress related protein expressions (PERK, IRE1, Bip, PDI, Calnexin, Calreticulin, p38, ERK, TCTP and Mcl-1) in HA59T/VGH cells were treated with different concentrations of Tan-IIA for different durations by western blotting.
Results: The results showed Tan-?A could inhibit the HA59T/VGH cells with time and dose dependent. The concentrations of IC50 were 20.12, 16.66 and 10.30 μM for 24, 48 and 72 h, respectively. The protein expressions of ATF6, p38, Caspase-12, Caspase-9, Cleaved Caspase8 and Bax were up-regulated, but pERK, JNK, Bcl-xL, Bcl-2, Mcl-1 and TCTP were down-regulated when compare with control group.
Conclusions: Tan-IIA could inhibit HA59T/VGH cells through inducing ER stress
References: Cheng CY, Su CC, Tanshinone IIA inhibits Hep-J5 cells by increasing calreticulin, caspase 12 and GADD153 protein expression, International Journal of Molecular Medicine. 26(2010)379–385
MASCC-0303
The development and psychometric testing of OCAS: Oral Chemotherapy Adherence Scale
G. Bagcivan 1, N. Akbayrak1
1School of Nursing, Gülhane Military Medical Academy, Ankara, Turkey
Introduction: There is no available easy-to-use standard scale with valid psychometric evaluations for evaluation of the adherence of patients with oral chemotherapy use.
Objectives: The aim of this study was to develop an “Oral Chemotherapy Adherence Scale” (OCAS), and to analyze the validity and reliability of this scale for evaluation of the adherence of the patients with oral chemotherapy.
Methods: The validity and reliability of the scale was analyzed via the data obtained from 306 patients using oral chemotherapy. The “Data collection form” and the OCAS were used for collection of the data, and the “Medication Adherence Self-Efficacy Scale (MASES)” was used for evaluation of the criterion validity of the scale. The internal consistency analysis and the test re-test analysis were performed for the reliability of the scale. The content, surface, criterion and construct validities were evaluated for the validity of the scale.
Results: The Cronbach alpha calculated for OCAS was 0.738. A highly significant and positive correlation was observed between the test–retest scores of the participants. A positive significant correlation was observed between the total scores of the participants obtained from OCAS and MASES. As a result of the factor analysis performed for the construct validity of the scale, 3 factors have been defined that accounted for approximately 43 % of the total variance.
Conclusions: The data obtained from this study show that OCAS including 19 items, is a reliable and valid scale that may be used in the determination of adherences of the patients with oral chemotherapy.
MASCC-0304
Comparison of symptoms and clinical signs in hospitalised cancer and non-cancer patients in the last 3 days of life
S. Steindal 1, L.W. Sørbye1
1Institute of Nursing and Health, Diakonhjemmet University College, Oslo, Norway
Introduction: A limited number of studies have investigated symptoms and clinical signs in older hospitalised patients during the last stage of life
Objectives: This study investigated whether there were differences in healthcare workers documentation of symptoms and clinical signs in hospitalised cancer patients and non-cancer patients
Methods: The study included 220 patients: 110 cancer patients and 110 non-cancer patients from a general hospital in Oslo, Norway. Data were extracted from the patients’ electronic records using the Resident Assessment Instrument for Palliative Care
Results: The cancer patients were younger (75.3 years, SD = 12.4) than the non-cancer patients (84.3 years, SD = 9.7, p < 0.001). The mean length of stay in the hospital was 14.6 days (SD = 12.5) for cancer patients and 9.3 days (SD = 9.5) for non-cancer patients (p < 0.001). A higher proportion of cancer patients lived in a private home, while no significant differences were found between the two groups with regard to living arrangement and ward admittance. Pain (OR = 2.34, 95 % CI 1.14–4.77), nausea (OR = 3.71, 95 % CI 1.60–8.58) and peripheral oedema (OR = 2.92, 95 % CI 1.45–5.91) were documented more frequently in cancer patients than non-cancer patients. No significant differences were found between the two groups regarding fatigue, dyspnoea, falls, tract secretion, constipation, diarrhoea, vomiting, difficulty falling or staying a sleep, too much sleep, dry mouth, excessive sweating, and fever.
Conclusions: Distressing symptoms and clinical signs were common in dying hospitalised patients. However, healthcare workers should be aware that cancer patients were more likely to experience pain, nausea, and peripheral oedema compared to non-cancer patients.
MASCC-0305
Dental care and oral complaints of hematopoietic stem cell transplant patients: a survey
J. Bos-den Braber 1, C.M.J. Potting2, E.M. Bronkhorst1, M.C.D.N.J.M. Huysmans1, N.M.A. Blijlevens2
1Dentistry, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands, 2Hematology, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands
Introduction: The aim of this study was to explore patients’ experience and opinions of dental care before and after hematopoietic stem cell transplantation (HSCT) and their short and long term oral complaints.
Objectives: This was related to their mucositis score (Oral Mucositis Nursing Instrument) during hospitalization. This study also explored their dentists’ knowledge and experience of care provision for these patients.
Methods: All surviving adult patients who had undergone HSCT in 2010/2011 (n = 108) were sent a questionnaire with 20 questions about their dental visits before and after transplantation, and oral complaints shortly (≤3 months) after transplantation and current complaints. The dentists of these patients were sent a questionnaire about the dental care they had provided before and after the HSCT and a checklist that had been provided for their information.
Results: Ninety-six patients responded. The average period since HSCT was 19 months, range 8–31 months. 59.4 % of them had short-term oral complaints after transplantation, 30.7 % had current oral complaints. During hospitalization the mucositis score had been significant higher of patients with complaints after HSCT than without (p = 0.032, difference 1.5). Of the 8 persons who didn’t visit the dentist before HSCT, 87.5 % had oral complaints shortly after HSCT, as compared to 56.8 % of those who did visit the dentist before HSCT. Dental visit after HSCT was significant related to their former mucositis score (p = 0.035, mean difference 1.8).
Conclusions: The high response rate and the high rate of oral complaints surrounding HSCT highlight the importance of further research in this area.
MASCC-0306
Treatments in hospitalised cancer and non-cancer patients in the last 3 days of life
S. Steindal 1, L.W. Sørbye1
1Institute of Nursing and Health, Diakonhjemmet University College, Oslo, Norway
Introduction: Knowledge concerning treatment in older hospitalised patients at the end of life is deficient.
Objectives: This study examined healthcare workers documentation of frequency of treatment and whether there were differences in the documentation of treatment received by hospitalised cancer and non-cancer patients in the last 3 days of life
Methods: The study included 220 patients: 110 cancer patients and 110 non-cancer patients from a general hospital in Oslo, Norway. Data were extracted from the patients’ electronic records using the Resident Assessment Instrument for Palliative Care.
Results: The cancer patients were younger (75.3 years, SD = 12.4) than the non-cancer patients (84.3 years, SD = 9.7, p < 0.001). The mean length of stay in the hospital was 14.6 days (SD = 12.5) for cancer patients and 9.3 days (SD = 9.5) for non-cancer patients (p < 0.001). A higher proportion of cancer patients lived in a private home, while no significant differences were found between the two groups with regard to living arrangement and ward admittance.
Of the total sample, intravenous medication (84 %), oxygen therapy (71 %), and turning program (53 %) were the treatment that were most frequently recorded by healthcare workers. A higher proportion of non-cancer patients received suctioning (OR = 0.42, 95 % CI 0.18–0.99) compared to cancer patients. No significant differences were found between the two groups regarding bowel regimen, oxygen therapy, intravenous medication, turning program, mechanical ventilation support, and wound care
Conclusions: Only one difference was found between hospitalised cancer and non-cancer patients regarding treatment. Suctioning was more often documented in non-cancer patients.
MASCC-0307
Changes in physical functioning, psychological functioning, and quality of life in advanced cancer patients following an exercise-based palliative rehabilitation program
C. Richardson 1, A. Feldstain1, R. Bhargava1, M. Chasen1
1Palliative Care, Bruyere Research Institute, Ottawa, Canada
Introduction: Patients with advanced cancer often experience decreased quality of life due to the disease and therapy thereof. Growing evidence shows that exercise is safe and feasible for the cancer population and it is an effective way to enhance patient function and improve quality of life.
Objectives: The study explored the impact of an exercise-based rehabilitation program on physical function and quality of life in advanced patients with cancer.
Methods: Eighty two patients participated in an 8-week exercise program twice a week. Pre- and post- assessments were completed to assess changes in the 6 min Walk Test (6MWT) while the Edmonton Symptom Assessment Scale (ESAS) well being subscale, the MD Anderson Inventory Core Items (MDASI) and the General Self Efficacy Scales (GSES) measures assessed changes in quality of life.
Results: The 6MWT demonstrated improvement in the advanced cancer population from 349.75 m to 401.22 m (t = 6.5, p = 0.000). The quality of life measures indicate the following trends: Improved well being subscale (t = 3.66, p = 0.000), enjoyment (t = 5.89, p = 0.000), and general self-efficacy (t = 26.2, p = 0.000).
Conclusions: Based on the findings of this study, a comprehensive exercise program including cardiovascular training, resistance training and flexibility improves physical function. In combination with the program’s other interprofessional interventions, it contributes towards an improved quality of life for patients with advanced cancer.
MASCC-0308
A new once-a-day fentanyl citrate patch (Daily Fentos®) could be a new treatment option for cancer pain
K. Koike 1, T. Terui1, K. Ishitani1
1Palliative Care Medicine, Higashi Sapporo Hospital, Sapporo, Japan
Introduction: The approved dosing interval for traditional transdermal fentanyl(Durotep® MT) is every 72 h. However, some patients require a shorter dosing interval to obtain adequate pain relief.
Objectives: Daily Fentos® was developed in Japan since June 2010. We investigated analgesic effects of Daily Fentos® in patients with achieving inadequate pain control using Durotep® MT.
Methods: A retrospective analysis of 445 cancer patients treated with Durotep® MT at the Higashi Sapporo Hospital.
1) The change in average pain intensity(PI) from 48 h baseline (0 to 48 h after application of Durotep® MT) to the 3rd day (48 to 72 h after), measured with NRS.
2) The change in average PI from 24 h baseline (0 to 24 h after switching to Daily Fentos®) to the 3rd day (48 to 72 h after switching).
Results: At the 3rd day after application of Durotep® MT, 45 patients(10.1 %) showed the increase in PI of 30 % or more baseline PI.
38 patients(84.4 %) were converted from equivalent dose of Durotep® MT to Daily Fentos®.
At the 3rd day after switching, 23 patients(60.5 %) showed a reduction of more than 30 % from baseline PI.
Average monthly cost per person was $ 343.1 in Daily Fentos® 2 mg/day (equivalent to Durotep® MT 4.2 mg) and $ 559.3 in Durotep® MT 4.2 mg dosing interval of 48 h.
Conclusions: Daily Fentos® provided stable pain control and cost effective analgesia. Its use may be considered as the dominant strategy for achieving inadequate pain control using traditional transdermal patch.
References: Takakuwa O, Am J Hosp Palliat Care 2012 Dec.
MASCC-0309
Factors influencing death at home in patients followed by a homecare team in Barcelona, Spain
A. Calsina-Berna 1, T. Ribot-Berenguer2, J. González-Barboteo1, E. Poyato Gómez2, M. López Postigo2, J. Maté-Méndez3, A. Apolinar Martinez2
1Palliative Care Service, Institut Català d’Oncologia Hospital Duran i Reynals, L’Hospitalet de Llobregat, Spain, 2Palliative Care Service, Corporació Parc Taulí Sabadell, Sabadell, Spain, 3Psycho-Oncology Unit, Institut Català d’Oncologia Hospital Duran i Reynals, L’Hospitalet de Llobregat, Spain
Introduction: Several studies have been performed in different countries about place of death. In Spain end of life (EOL) issues are not usually widely talked about among relatives.
Objectives: To describe factors that appear to influence death at home in Spain.
Methods: Observational descriptive study. Advanced cancer patients visited by homecare teams were included throughout 6 months. Neoplasm, functional status, physical, emotional symptoms, EOL issues and place of death data were collected. The study was approved by the local ethics committee.
Results: One hundred fifteen pts were assessed. Mean age 72.9 ± 13.2 years. 67.8 % were men. Main cancer diagnoses: lung 23.5 %. PPS index at 1st visit was 50 [10–70]. 31.3 % died at home.
In the bivariate analysis, there was a relationship between dying at home and PPS <40 at 1st visit (p = 0.001), caregivers without emotional suffering (p = 0.012), main caregiver without illness (p = 0.045), caregivers not overwhelmed (p = 0.004), having talked about EOL issues with patient and family together (p = 0.003) and patients copying well with the situation (p = 0.000).
Logistic regression analyses revealed that PPS <40 (OR: 0.911; 95 % CI 0.881–0.984), having talked about EOL issues (OR: 12.055; 95 % CI 2.366–61.430) and patients copying well with the situation (OR: 5.001; 95 % CI 1.777–14.073) predicted dying at home. When the three factors were present in concomitance, the probability of the patient dying at home was 83.7
Conclusions: In a culture where we do not generally allude to end of life conversations, approaching the subject with patients and families together elevates the chances of the patient dying at home.
MASCC-0310
Utilization of sperm banking in young men undergoing chemotherapy for testicular cancer (TC)
M. Brames 1, L.H. Einhorn1
1Medicine, Indiana University, Indianapolis, USA
Introduction: TC accounts for 1 % all male malignancies, the most common carcinoma in the 15-35-year-old age group. 95 % newly diagnosed patients are cured, 80 % of those with metastases achieve disease-free status with chemotherapy +/− resection of residual disease. Standard first-line chemotherapy is BEP (Bleomycin, Etoposide, Cisplatin) for 3–4 courses. 40 % of patients receiving chemotherapy have long-standing oligospermia, even azoospermia. Many have impaired spermatogenesis prior to chemotherapy. Sperm banking, an effective method of collecting and storing sperm for future fertility, can be costly and not covered by insurance, banking facilities may not be geographically available, or sperm banking may not have been offered.
Objectives: Determine incidence of sperm banking, ascertain reasons sperm banking declined, determine the incidence of achieving pregnancy.
Methods: Eligibility: ≥ 18 years, diagnosis of germ cell tumor, 1 year post-chemotherapy with BEP x 3–4, able to complete 5 question-questionnaire.
Charts screened for eligibility at follow-up visits. Eligible patients will be given study information sheet explaining purpose of the study, along with 5-question- questionnaire. Patients who miss appointment will be mailed questionnaire with self-addressed stamped envelope. Our goal is to obtain 200 completed questionnaires in order to estimate incidence of sperm banking to within 7 % using a 95 % two-sided large-sample confidence interval.
Results: Pending
Conclusions: In order to improve the survivorship process, we hope to gain a further understanding of incidence and success of sperm banking in this patient population.
MASCC-0311
Self-perceptions of age among 292 chemotherapy-treated cancer patients: exploring associations with symptoms and survival
A. Jatoi 1, M.Y. Lim1, E.K. Stephens1, P. Novotny1
1Oncology, Mayo Clinic, Rochester, USA
Introduction: A growing literature suggests that older individuals who report feeling younger than their actual chronological age enjoy better health and survival.
Objectives: The purpose of this study was to explore similar associations in cancer patients.
Methods: Chemotherapy-treated cancer patients completed a previously-validated questionnaire item on self-perception of age. Concurrent patient-reported number of symptoms and pain severity were recorded. Baseline and longitudinal data captured demographics and vital status, respectively.
Results: Among 292 patients, 185 (63 %) reported they perceived themselves as younger than their actual age, 45 as older (15 %), 56 (19 %) as the same age (unable to be determined in 6). The mean actual chronological age (standard deviation) among those who perceived themselves as younger, older, or the same age were 63 years (11), 54 (12), and 60 (10); (p < 0.0001). An inverse relationship was observed between self-perceived age and actual age (odds ratio 1.05 with 95 % confidence interval of 1.02, 1.07; p = 0.0001) but, otherwise, no statistically significant relationships were observed with gender, cancer curability potential, number of symptoms, or pain severity. Improved survival was associated with fewer symptoms and the potential for curing the cancer but not with age perceptions. Qualitative themes such as positive thinking, staying engaged with life, the importance of family, and maintaining a sense of humor emerged among those who felt younger.
Conclusions: A substantial percentage of cancer patients—particularly older ones—reported feeling younger than their actual age; this perception has no relevance to symptoms or survival.
MASCC-0312
Using a computerized version of the LCSS (ELCSS-QL) to overcome barriers in evaluating pros: results of the prospective 622 patient AP-QL lung cancer trial
R.J. Gralla 1, P.J. Hollen2, S. Thongprasert3, H.K. Kim4, T.C. Hsia5, S. Yuankai6, N. Kohn7, M. Lesser7
1Medical Oncology, Albert Einstein College of Medicine Jacobi Medical Center, New York NY, USA, 2School of Nursing, University of Virginia, Charlottesville VA, USA, 3Medical Oncology, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 4Medical Oncology, St. Vincent’s Hospital, Suwon, Korea, 5Medical Oncology, China Medical University Hospital, Taichung, Taiwan, 6Medical Oncology, Chinese Academy of Medical Sciences, Beijing, China, 7Biostatistics, Feinstein Institute for Medical Research, Manhasset NY, USA
Introduction: Few trials evaluate well survival and quality of life. Often only a minority of patients have PROs followed over time, preventing such data from assisting in key decisions concerning value and effectiveness of treatment. The eLCSS-QL requires only 2 min to complete the patient version.
Objectives: We tested this computerized version of the LCSS to determine if we could overcome barriers to evaluating QL in clinical trials.
Methods: Patients received initial chemotherapy at 65 sites in 9 Asian countries. 70 % male; 65 % adenocarcinoma; median: KPS = 90; ECOG = 1. Stages: IV (72 %), IIIB (28 %). 84 % had > two major symptoms. The eLCSS-QL was completed every 3 weeks at the clinic. We also surveyed 98 treating physicians and nurses regarding communication, usefulness and acceptability of the eLCSS-QL.
Results: 97 % of patients completed the eLCSS-QL at baseline; 90 % completed follow-up evaluations. Over 90 % found the eLCSS-QL easy to use, acceptable to complete at each visit; >80 % reported increased awareness of symptoms. Physicians/nurses: >90 % found the eLCSS-QL easy to use and increased symptom awareness; >80 % reported improved communication, enhanced satisfaction with the patient visit. Nearly 90 % of physicians reported they could identify benefit from chemo earlier; 76 % would order fewer imaging tests and 80 % said the eLCSS-QL could save time.
Conclusions: Patients, physicians, nurses all found the eLCSS-QL to be highly acceptable and easy to use with 90 % of patients doing repeated QL measures. This large prospective trial demonstrates the potential for QL/PROs to aid in decision making and to guide appropriate use of chemotherapy while enhancing staff and patient satisfaction.
MASCC-0313
Osteomyelitis of the jaws following chemotherapy
S. Elad 1, M. Findler2, M. Findler3
1Division of Oral Medicine, Eastman Institute for Oral Health University of Rochester, Rochester, USA, 2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, 3Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
Introduction: Necrosis of the jaws in oncologic patients was associated with bisphosphonates. However, alveolar bone necrosis may develop due to other factors, unrelated to bisphosphonates use.
Objectives: To increase awareness of a chemotherapy-induced osteomyelitis and to encourage clinicians and patients to ensure complete elimination of oral-dental foci of infection prior to the initiation of chemotherapy.
Methods: Case reports of patients with leukemia that developed osteomyelitis of the jaws following chemotherapy.
Results: The patients presented with a generalized form of chronic periodontitis after consolidation chemotherapy. Necrotic alveolar bone was observed clinically. Radiographs showed a pathological process involving the interdental alveolar ridge compatible with sequesta. Histopathological evaluation showed acute and chronic osteomyelitis with sequestrated bone, and an inflammatory response with reactive fibrous connective tissue. Microbiological cultures were positive for gram negative bacteria. Patients had no history of bisphosphonate therapy. The patients were diagnosed with chronic suppurative osteomyelitis. Patients were treated with broad-spectrum antibiotics and surgery; they responded well and remained inflammation free during the long follow-up period.
Conclusions: Chemotherapy may promote the development of osteomyelitis with alveolar bone necrosis in the hemato-oncologic patient population. Elimination of local periodontal irritants prior to chemotherapy is essential, and may prevent development of the condition. Patients should be monitored closely for oral complications, even after the end of induction chemotherapy. A combination of local antiseptics, systemic antibiotics and surgery should be considered for treatment of chronic suppurative osteomyelitis of the jaws.
MASCC-0314
Biomarkers and early detection of late onset anthracycline-induced cardiotoxicity in children
L. Sherief 1, A. Kamal1, E. Khalek1, N. Kama2, A. Soliman3, A. Esh4
1Pediatric Hematology and Oncology, Zagazig, Zagazig, Egypt, 2Pediatric, Cario, Cario, Egypt, 3Pediatric, Zagazig, Zagazig, Egypt, 4Clinical Pathology, Zagazig, Zagazig, Egypt
Introduction: The main strategy for minimizing anthracycline cardiotoxicity is early detection of high-risk patients.
Objectives: To investigate the role of cardiac biomarkers; cardiac troponin T (cTnT) and N-terminal probrain natriuretic peptide (NT-pro-BNP), and tissue Doppler imaging (TDI), as early predictors of chronic cardiotoxicity in survivors of acute leukemia.
Methods: We carried a retrospective study on 50 asymptomatic survivors of acute leukemia who received anthracycline in their treatment protocols. All patients underwent blood sampling to determine the levels of NT-pro-BNP and cTnT along with conventional echocardiography and TDI.
Results: None had abnormal cTnT levels. About 20 % had abnormal NT-pro-BNP levels. Diastolic dysfunction of the left ventricle was the most significant in conventional echocardiography. TDI was superior as it detected myocardial affection in 10 % more than echo. TDI demonstrated global myocardial damage with significant aberrations in peak myocardial velocities and ratios.
Conclusions: NT-pro-BNP can be used as a sensitive cardiac biomarker in monitoring of anthracycline-induced cardiotoxicity. Follow up is essential to validate the role of NT-pro-BNP as an early marker for late onset anthracycline-induced cardiotoxicity. Tissue Doppler is marvelous as it could detect early cardiac dysfunction even in those with normal study by conventional echocardiography.
MASCC-0315
Antimicrobial use in patients with advanced cancer: experience of the palliative care unit (PCU) of the national cancer institute of Brazil (INCA)
L. Ramadas 1, P.F. Barroso2
1Nosocomial Infection Control Committee, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Brazil, 2School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
Introduction: The benefits of antibiotic use in palliative care are not clear. Decisions to treat infections in end-of-life care are difficult.
Objectives: To describe the characteristics of antibiotic use in patients with advanced cancer at a PCU in Rio de Janeiro, Brazil.
Methods: This was a retrospective cohort study of patients referred to INCA during the period of July to December of 2010. Main variables, abstracted from charts, included demographics, site and type of cancer, Karnofsky Performance Status(KPS), devices use, survival time and antimicrobial use.
Results: Six hundred fifty-five subjects were included. Median age was 62 years. 344(53 %) were women. Median survival time was 34 days (0 to 477). Head and neck(25 %), gastrointestinal (18 %) and gynecologic (15 %) cancer were the most prevalent. 39 % used at least one invasive device, nasoenteric probe being the most prevalent (16 %). 239 (36 %) patients were prescribed at least one antimicrobial, adding up to 390 courses with a medium 1,6 course per patient (medium time of use of 8,5 days). Clavulanic acid/amoxicillin was the most prescribed antibiotic (38 %), followed by metronidazole (17 %) and ciprofloxacin (10 %). Oral or gastroenteric route was used in 57 % occasions and 61 % were in-hospital prescriptions. Most common KPS found was 40 %(27 %). 325(83 %) courses had clinical indication reported. 162(42 %) as infection treatment and 158(41 %) as symptoms control. Respiratory tract infections (13 %) or symptoms (18 %), urinary tract infections (9 %) or symptoms (6.4 %) and odor control (9 %) were the most reported reason.
Conclusions: Antibiotic use was highly prevalent. Clear definitions of treatment goals and indications of antibiotic use in these growing populations are a challenge.
MASCC-0316
Feasibility study of a daily diary for assessing the prevalence of radiation induced emesis (RIE)
H. Chung 1, V. Haid2, K. Kumar2, E. Al Duhaiby1, J. Pang2, C. DeAngelis3, M. Pasetka3, Y. Ko2, J. Nguyen1, K. Dennis4, E. Chow1
1Radiation Oncology, Odette Cancer Center Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada, 2Medical Oncology, Odette Cancer Center Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada, 3Pharmacy, Odette Cancer Center Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada, 4Radiation Oncology, Ottawa Hospital Research Institute and The Ottawa Hospital and University of Ottawa, Toronto, Canada
Introduction: Despite radiation-induced emesis (RIE) being relatively common, it remains under-appreciated by many physicians for a variety reasons. To address this, a number of patient-reported QOL instruments have been proposed. Yet no consensus has been reached with regards to frequency, format and wording. This prompted us to develop our own self-assessment RIE tool.
Objectives: To evaluate the feasibility of using this daily diary amongst patients undergoing radiotherapy.
Methods: This was a single-institution prospective pilot study including adult patients receiving radiotherapy to the abdomen, cranium or esophagus. The RIE tool was composed of a 2 page self-assessment daily diary containing a symptom assessment based on the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool (MAT) and a medication log. Patients completed the daily diary at baseline, during treatment and post-radiotherapy for 15 days. A 7-point Functional Living Index – Emesis (FLIE) self-assessment tool was completed twice a week during and post-treatment. A debriefing questionnaire was also completed.
Results: Thirty-five patients were accrued; 16 patients did not have any results, 3 had very minimal data, and only 16 patients (46 %) had analyzable results. Of these 16 analyzed patients, only four completed the entire study. During treatment, nine patients (56 %) experienced nausea, and two patients (12.5 %) experienced vomiting. Post-treatment two (22 %) patients experienced nausea and vomiting.
Conclusions: Compared to other studies, compliance was poor in our cohort. Possible reasons include the lack of a call-back program, prolonged study period, and need for more patient-friendly formatting.
MASCC-0317
Factors related to changes of physical fitness during one course of chemotherapy in adult acute leukemia patients: a preliminary study
P.H. Lee 1, S.C. Shun2, Y.H. Lai2, J.L. Tang3, J.Y. Tsauo4
1Nursing, National Taiwan University Hospital, Taipei City, Taiwan, 2Nursing, National Taiwan University, Taipei City, Taiwan, 3Internal Medicine, National Taiwan University, Taipei City, Taiwan, 4Physical Therapy, National Taiwan University, Taipei City, Taiwan
Introduction: Many acute leukemia patients decrease their physical activity during treatment since diagnosed. However, decreasing physical activity for a long time might worse the physical fitness, and there were no studies to examine the factors related to changes of physical fitness during one course of chemotherapy in leukemia patients.
Objectives: To explore the factors related to changes of physical fitness in leukemia patients during chemotherapy.
Methods: Eligible participants were acute leukemia patients, who were going to receive chemotherapy in first week during hospitalization, in a teaching hospital in northern Taiwan. Data was collected twice at admission and discharged by physical fitness examine including 6-minutes walking test (6MWT), grip strength of dominant hand, and 30-sec chair stand test (30-sec CST). Generalized estimating equations (GEE) were used to analyze the important factors affecting physical fitness.
Results: A total of 36 patients were recruited and 30 patients completed the survey. The distance of 6MWT, the grip strength of dominant hand, and the times of 30-sec CST were no significant change, but worse than health people. Those patients were female, diagnosed with ALL, longer hospitalized days, lower level of hemoglobin, and higher status of depression had worse level of physical fitness.
Conclusions: The physical fitness were no significant difference prior and post one course of chemotherapy, but this study revealed important factors to physical fitness in leukemia patients during hospitalization. For those with high risk factors, health providers should encourage them to exercise to maintain the physical fitness in following treatment.
MASCC-0318
Effects of physical activity on the quality of life in Taiwanese lung cancer patients receiving active treatment or off treatment
C. Lin 1
1College of Nursing, Taipei Medical University, Taipei, Taiwan
Introduction: Lung cancer is the leading cause of cancer deaths in the world. Physical activity can enhance the quality of life (QOL) of cancer patients. However, the best timing according to cancer therapy to implement physical activities for lung cancer patients is not yet clear.
Objectives: The purpose of our study was to examine the relationship between physical activity and QOL in different cancer-treatment periods among lung cancer patients.
Methods: This study used a cross-sectional design. Instruments included the Functional Assessment of Cancer Therapy-Lung Cancer and the Godin Leisure-Time Exercise Questionnaire.
Results: In total, 185 patients participated in this study, and results showed that only 25 % of participants achieved recommended physical-activity guidelines. Of all patients, 50.3 % engaged in light physical activity, such as walking. During active-treatment periods, lung cancer patients who engaged in light or moderate activity had significantly higher scores for the overall QOL than did those who were completely sedentary. However, during off-treatment periods, there were no significant differences in the overall QOL with different activity levels.
Conclusions: The QOL may be improved by engaging in light or moderate physical activity during active-treatment periods among lung cancer patients. It is important for healthcare providers to consider promoting physical activity based on different cancer treatments to improve the QOL of Taiwanese lung cancer patients.
MASCC-0319
Assessment of preference for hormonal treatment-related health states among patients with breast cancer
X.Y. Tan1, M.M. Aung1, M.I. Ngai2, F. Xie3, Y. KO 1
1Pharmacy, National University of Singapore, Singapore, Singapore, 2Pharmacy, National University Hospital, Singapore, Singapore, 3Clinical Epidemiology & Biostatistics, McMaster University, Hamilton Ontario, Canada
Introduction: Despite significant reduction in disease recurrence and death for the management of estrogen-receptor-positive breast cancer, hormonal therapies are often associated with adverse effects on patients’ quality of life.
Objectives:(1) to obtain preference scores from breast cancer patients for different stages of breast cancer and hormonal therapy-related adverse effects, and (2) to determine the association of patient demographic and clinical characteristics with those preference scores.
Methods: A total of 22 health states were used to elicit preference values from 64 patients with breast cancer. At each interview, 14 health states were randomly selected and rated by the patient using the visual analogue scale (VAS) and standard gamble (SG) Methods to derive health state preference scores, which were recalibrated to the scale of 0 (death) and 1 (perfect health).
Results: Mean adjusted VAS scores ranged from 0.25 (no recurrence with ischemic cerebrovascular events) to 0.82 (no recurrence with no side effects). Mean adjusted SG scores ranged from 0.31 (distant recurrence with chemotherapy-related side effects) to 0.80 (no recurrence with no side effects). Side effects ischemic cerebrovascular events and spine fracture resulted in the greatest decline in health state preference scores. Age, ethnicity, education level, and prior chemotherapy experience were associated with the preference scores.
Conclusions: Taking into account disease progression and hormonal therapy-related adverse effects as well as their impact on HRQoL, this study quantifies patients’ preference for various breast cancer-related health states. The findings offer valuable information for future cost-utility analysis of breast cancer treatments.
MASCC-0320
The empowerment process for the terminal hepatocellular carcinoma patient
Y. Chen 1, S.F. Cheng1
1Nursing, Changhua Christian Hospital, Changhua County, Taiwan
Introduction: Hepatocellular carcinoma is the most common male cancer and the leading cause of cancer deaths in Taiwan. Patients in terminal cancer not only experience physical discomfort, but also psychological-spiritual distress. It is noteworthy that the psychosocial and spiritual needs of patients with terminal cancer patients often are neglected by families and healthcare providers in Taiwan. However, psychosocial and spiritual well-being for cancer patients near the end of life is urgently important.
Objectives: The objectives of this study were to explore experiences and the psycho-spiritual empowering process of the terminal hepatocellular carcinoma patient.
Methods: The author presented a case report of a middle-aged terminal hepatocellular carcinoma patient who experienced the psychosocial and spiritual distress.
Results: Psychosocial and spiritual distress in the middle-aged hepatocellular carcinoma patient were included loss control and powerlessness resulted from the rapidity of disease progression; disrupted family relationships resulted from loss the main source of income and burdens on families; loneliness and worthlessness resulted from the caducity of life. The author used empowering process to encourage the patient emotional expression, strengthen families’ relational connectedness, reconstruct belongingness, find the meaning of life and ultimately achieve personal empowerment.
Conclusions: By sharing the experience of care, it provided important information that healthecare professionals must be strongly sensitive to psychosical and spiritual needs. In addition to ongoing psychological, social and spiritual support, meaning-making process in terminal stage is the central part of palliative care. It’s expected to the best quality of life and psycho-social-spiritual well-being will be reached.
MASCC-0321
Influence of P. gingivalis and other oral bacteria on oral wound healing in vitro
A. Laheij 1, J.J. de Soet1, E.C.I. Veerman2, J.E. Raber-Durlacher3, J.G. Bolscher2, C. van Loveren1
1Preventive Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands, 2Oral Biochemistry, Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands, 3Periodontology, Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands
Introduction: Porphyromonas gingivalis, a gram-negative anaerobic bacterium associated with periodontitis, was identified as a positive predictor for ulcerative oral mucositis (OM) in patients undergoing hematopoietic stem cell transplantation. The role of microorganisms in the pathogenesis of OM is not clear, however bacteria may contribute to OM severity and duration.
Objectives: The present study was aimed to explore the hypothesis that P.gingivalis inhibits wound healing in vitro. The oral bacteria Prevotella nigrescens, Prevotella intermedia, Tannerella forsythia and Streptococcus mitis were studied as well.
Methods: Human oral epithelial cells (HO1N1) were grown in a confluent single cell layer and a standardized scratch was made. The epithelial cells were challenged with bacteria, medium containing various molecules secreted by the bacteria or lipopolysaccharide (LPS) from P.gingivalis in several concentrations. Closure of the scratched area was measured after 17 h and compared to control medium using an inverted phase contrast microscope.
Results: P.gingivalis, P. nigrescens and secreted molecules from P.gingivalis strongly inhibited relative closure of the scratch. Weaker inhibitory effects were found for the other bacteria. LPS from P.gingivalis did not inhibit relative closure of the scratch (Figure 1).
Conclusions: P.gingivalis and P. nigrescens inhibited relative closure of the scratch in this in vitro wound healing model more strongly than the other bacterial species. This supports our hypothesis that P.gingivalis may be involved in delayed mucosal wound healing. LPS was not responsible for this effect. Our results warrant further experimental and clinical investigations to elucidate the role of bacterial mechanisms in the pathogenesis of OM.
MASCC-0322
‘Kinecting’ the rehabilitation of breast cancer patients through digital technologies
C. Golby1, K. Debattista2, K. Yap 3,4
1Institute of Digital Healthcare WMG, University of Warwick, Coventry, United Kingdom, 2Visualisation Group WMG, University of Warwick, Coventry, United Kingdom, 3Department of Pharmacy, National University of Singapore, Singapore, Singapore, 4Academic Informatics Office, National University Health System, Singapore
Introduction: Breast cancer patients tend to experience lymphedema and joint/bone pain as a consequence of their surgeries and hormonal therapies. Patients are encouraged to exercise as part of their rehabilitation, but there is currently no standard exercise regime or method of monitoring their improvements.
Objectives: We aimed to develop a prototype rehabilitation tool for them using digital technologies.
Methods: Two Microsoft ‘Kinect for Windows’ sensors were used to track a range of movements and increase monitoring accuracy through its Software Development Kit (SDK v1.6). Skeletal tracking from both sensors was combined. Filtering algorithms were used to define and evaluate a range of upper body movements. Additionally, the depth sensing functionality was used to assess the degree of lymphedema by recording a human model’s arm diameter at each point between the elbow and shoulder. Such tracking would enable an exercise routine to be generated for basic rehabilitation of patients.
Results: The range of upper body movements that were tracked included the raising of the arm (abduction/adduction) and bending of the elbow (flexion/extension)
Results showing a breakdown of motion ranges at each joint throughout the exercises were shown to the user. Additionally, the model’s upper arm diameter (representing lymphedema) was determined through a smoothing algorithm of 200 visual capture measurements taken from both cameras when he raised his arm ~40° laterally.
Conclusions: A Kinect-based prototype tool has been developed to monitor arm movements and degree of lymphedema of breast cancer patients. Additional modules exploring other limb motions (e.g. legs) are intended.
MASCC-0323
Implementing the Dutch guideline cancer rehabilitation seems feasible: an analysis of current practice
M. Velthuis 1, S. Lunter2, M. Van der Pol3, B. Gijsen4
1Quality improvement, Iknl, Utrecht, Netherlands, 2Quality improvement, Iknl, Enschede, Netherlands, 3Networking, Iknl, Utrecht/Leiden, Netherlands, 4Quality improvement, Iknl, Maastricht, Netherlands
Introduction: In 2011 IKNL published the Dutch guideline Cancer rehabilitation1. We expect that implementing the guideline requires three important changes: 1) structural detection of complaints and referral by medical specialists or nurse(s) (practitioners) 2) tailored rehabilitation based on a structured intake 3) extension of rehabilitation programmes, also during curative treatment and in the palliative phase.
Objectives: Prior to implementation, we performed a diagnostic analysis to get more insight into 1) the actual cancer rehabilitation care in perspective of the guideline, 2) suggestions for organising recommendations in daily practice and 3) barriers and facilitators for implementation.
Methods: Qualitative analyses consisting of 1) an online survey (218 professionals), an investigational conference (13 cancer patients) and 3) in-depth interviews by telephone (19 professionals and managers).
Results: Professionals and patients consider the guideline recommendations partly as usual care. As expected, special attention is needed for implementation of screening instruments, intake and rehabilitation programmes in the whole cancer trajectory. The majority of the respondents consider implementation of these recommendations feasible.
Facilitators and barriers for implementation are individual (for example knowledge and time), organisational (for example collaboration) and external (for example reimbursement and rehabilitation budget of organisations) factors.
Conclusions: This analysis provides useful recommendations on specific parts of the guideline, such as: 1) detection of complaints, 2) referral to cancer rehabilitation, 3) intake, 4) modular rehabilitation programs during all the stages. Specific recommendations for implementation in daily practice are currently used in a national implementation project Cancer rehabilitation coordinated by IKNL.
References: 1. http://www.oncoline.nl/
MASCC-0324
Feasibility of creative art therapy as a supportive care modality for patients with metastatic lung cancer treated with chemotherapy
B. ETIENNE-MASTROIANNI 1, L. Natoli1, J.F. Cordier1, N. Girard1
1Pneumologie, Hôpital Louis Pradel, Lyon, France
Introduction: Creative art therapy (CAT) consists in the use of artistic activities to help patients manage physical and emotional problems in a therapeutic setting. In oncology, CAT has mostly been practiced in palliative-care units. CAT has not been used in lung cancer patients so far, especially when chemotherapy treatment is still delivered.
Objectives: To prospectively assess the feasibility of integrating CAT in the management of patients with metastatic lung cancer treated with chemotherapy.
Methods: From 2011/11 to 2012/10, CAT was offered to all consecutive in- and out-patients who received chemotherapy for metastatic lung cancer in our department. Creative activities included the production of paintings, drawings, and/or sculptures. Patients were assessed by a registered art therapist for anxiety levels, self-awareness and satisfaction, before and after each art session
Results: Seventy-four patients were included in the study, among whom 41 (55 %) accepted CAT and received a mean number of 3 sessions. In this cohort of 13 men and 28 women, 31 (75 %) and 17 (41 %) patients reported improvements in anxiety levels and cancer-related symptoms after the art session, respectively. CAT gave satisfaction to 37 (90 %) patients. These benefits were transient in all cases. Main reasons for refusing CAT in the remaining 33 patients included fatigue and lack of interest for arts.
Conclusions: Our study reports on the feasibility of CAT in lung cancer patients receiving chemotherapy. CAT may be considered part of the multimodal supportive care management of lung cancer patients.
References
This study was supported by an unrestricted grant from Hoffmann-La Roche.
MASCC-0325
Evaluation of the quality of life in iron deficiency anemia and zinc insufficiency
S. Daghbashyan1, V. Khachatryan 2, K. Israelyan3
1Chef of Haematology center, Center of Haematology, Yerevan, Armenia, 2Outpatient department, Center of Haematology, Yerevan, Armenia, 3Senjor Scientific Staff, Center of Haematology, Yerevan, Armenia
Introduction: Iron deficiency anemia is a national problem for health care system of many countries and Armenia in this respect is not an exception. According to WHO data and results of cohort analysis conducted in the Hematology Center of the Republic of Armenia the incidence of anemia is constantly rising.
Objectives: The aim of this study has been to study the quality of life of patients with iron deficiency anemia among Armenian population, which is often accompanied with zinc insufficiency.
Methods: For estimation of the quality of life, we used an international questionnaire—Short Form Medical Outcomes Study (SF-36). The analysis was conducted between a control and two groups of patients with iron deficiency anemia with various degrees of zinc insufficiency (in group 1—zinc content in serum was <13 mmol/l, in group—2 > 13 mmol/l).
Results: The obtained results have revealed a statistically significant decrease of the pooled estimate for all scales of life quality, which did not exceed 42 % among the patients of both groups. However, it should be stated that in group 1 patients the index of emotional functioning (RE) and mental health (MH) was lower than in group 2 patients
Conclusions: Thus according to the results of the conducted survey among patients with iron deficiency anemia combined with zinc deficiency there are observed more expressed changes of some indices of the quality of life, which is important for choosing the optimal treatment strategy for these patients.
MASCC-0326
Renin inhibition protects from doxorubicin (an anti cancer drug) induced cardio-renal toxicity
A.K. Najmi 1, M. Azhar1, K.K. Pillai1, M. Akhtar1, M. Mujeeb2, M. Aqil3
1Pharmacology, Jamia Hamdard, New Delhi, India, 2Pharmacognosy, Jamia Hamdard, New Delhi, India, 3Pharmaceutics, Jamia Hamdard, New Delhi, India
Introduction: Doxorubicin (DXR) is a quinone-containing anthracycline antibiotic that is highly effective to treat different type of malignancies. Unfortunately, its clinical use is restricted by the side effects, cardiomyopathy and nephropathy.
Objectives: The present study aimed to investigate the possible protective effects of aliskiren against doxorubicin (DXR)-induced cardio-renal injury and to identify the mechanisms involved.
Methods: Rats were divided into seven groups of eight rats each. DXR (15 mg/kg, i.p.), as acute dose was given to toxic control group on tenth day. Aliskiren and telimisartan in different doses was administered by oral route, for 14 days. On 14th day Caspase-3, LDH, albumin, angiotensin I, blood urea nitrogen (BUN) and creatinine were estimated. Animals were sacrificed and heart and kidney tissues were collected for biochemical and ultra structural evaluation. Oxidative stress biomarkers {malondialdehyde (MDA), superoxide dismutase (SOD), and reduced glutathione (GSH)} were also estimated in heart and kidney tissues.
Results: Oral administration of aliskiren (100 mg/kg, for a period of 14 days) significantly prevented all these DXR-induced adverse effects and maintained the rats near to normal status. However, telmisartan (10 mg/kg) pretreatment partially protected the rats in DXR-induced renal injury as evidenced by broadening of podocyte foot process and narrowing of slit pore diameter.
Conclusions: These results suggest that aliskiren has protective effects against acute model of DXR-induced cardiotoxicity and nephrotoxicity; implying that plasma renin activity plays a role in DXR-induced cardio-renal toxicity.
References: Octavia Y, Tocchetti CG, Gabrielson KL, Janssens S, Crijns HJ, Moens AL. Doxorubicin-induced cardiomyopathy: from molecular mechanisms to therapeutic strategies. J Mol Cell Cardiol. 2012;52(6):1213-25
MASCC-0327
Cancer relating symptoms in homecare patients
J. Giuliani 1, L. Andreetta1, A. Busatto1, O. Zanardi1, B. Borese1
1Palliative Care Unit, ULSS 21, Legnago (VR), Italy
Introduction: According to the World Health Organization (WHO), palliative care is defined as the active total care of patients whose disease is not responsive to curative treatment
Objectives: The aim of this study was to assess the impact of different cancer relating symptoms in homecare cancer patients in daily clinical practice.
Methods: A retrospective analysis of homecare patients with advanced cancer disease in palliative care, referred to our Local Unit Social Health and followed by our homecare service (ADI), was examined by 01/01/2012 to 31/12/2012. The symptom assessment was performed with a board called “Symptom distress scale” (SDS), which was administered to patients weekly by the Nursing Staff. A univariate analysis for survival (calculated from the date ADI started), considering each cancer related symptoms, was estimated.
Results: We have evaluated 28 patients. At the time of last follow-up (January 2013), 13 patients (46.4 %) were alive and 15 patients (53.6 %) were deceased. Median follow-up time was 35 days (range: 7–138). By the univariate analysis, only the intestinal activity (p = 0.003) and cough (p = 0.034) seemed to statistically influence survival. The other cancer related symtomps (pain-frequency, pain intensity, nausea-frequency, nausea intensity, appetite, breath, fatigue, insomnia, concentration, appearance, mood) did not seem to have a prognostic significance
Conclusions: We can consider how useful the intervention of the palliative homecare team in all cancer patients and we encourage a carefull and regular evaluation of the cancer related symptoms, in order to improve quality of life.
MASCC-0328
Extravasation due to access of a fully rotated implantable port
G.A. Goossens 1, I. Kerschaever2, E. Despierre3, M. Stas4
1Nursing Centre of Excellence, Universtity Hospitals Leuven, Leuven, Belgium, 2Surgery, Regional Hospital Tienen, Tienen, Belgium, 3Gynecologic Oncology, University Hospitals Leuven, Leuven, Belgium, 4Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
Introduction: Implantable ports consist of a catheter and a subcutaneously placed chamber that may be sutured to the pectoral fascia. However port rotation can occur independent of device fixation
Objectives: Our objective is to report a case of extravasation due to mistaken access of a completely rotated port.
Methods: An unusual incident is presented as a case report
Results: A cancer patient was referred to our Venous Access Team. She presented with erythema due to chemotherapy extravasation, following difficult port access in another hospital. A clinical nurse specialist nurse inserted a new Huber needle. A similar feeling as puncturing the silicone septum of the reservoir was felt, however she was unable to hit the chamber bottom. Injection was easy, blood aspiration however, was impossible. New attempts to access the port failed. The chest radiograph showed a fully rotated port chamber. We presume that the needle has been placed in one of the chamber’s “suture holes” filled with silicone, what provides the same feeling as puncturing the chamber septum
Conclusions: Needle placement in a silicone-filled suture hole is possible whether the port is in a correct position or fully rotated. Two signs might indicate incorrect needle placement: (1) absence of needle tip abutting the chamber bottom and (2) no brisk blood return. Chest radiography should confirm correct port position and a brisk blood aspiration ability is mandatory before chemotherapy administration.
References: Goossens GA, Kerschaever I, Despierre E, Stas M. Access of a fully rotated implantable port leads to extravasation. JVascAccess. 2013 Jan 21. DOI:10.5301/jva.5000136
MASCC-0329
Toward digital melanoma follow-up: a qualitative exploration of melanoma patients’ attitudes towards the use of technology in follow up
P. Murchie 1, S. Hall1
1Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
Introduction: People treated for melanoma traditionally attend structured cancer centre-based follow-up. Attending is costly and inconvenient for those living in remote rural regions. It maybe that novel follow-up models employing digital technologies offer a potential solution. However, the attitudes of potential users toward using digital technologies in their melanoma follow-up is unknown.
Objectives: To explore attitudes of people from remote areas with melanoma toward using digital technologies in their follow-up, and the effect of personal characterisitcs on their attitudes.
Methods: People from rural areas attending a hopsital joint melanoma clinic were purposively recruited. Semi-structured interviews were conducted to explore the patients views on the use of digital technology during follow up any barriers or facilitators perceived. Interviews were transcribed verbatim and subject to framework analysis.
Results: Twenty-one people (aged 30–80) took part.
Participants had a wide range of IT skills. All used a mobile phone, only two had a tablet. Most had heard of telemedicine but few had practical experience. Several had used skype.
Most were positive about the future potential for technology in melanoma follow-up, particularly younger workers. Many felt unable to hold strong views beacuse of limited technological experience. Some were anxious that current technologies were too rudimentary to convey high quality clinical information. Some were concerned about impaired patient:health professional interactions
Conclusions: Rural melanoma patients perceive a future role for digital technologies in follow-up. This is not viewed as an imminent developent however. Further research is required, including practical piloting exercises, to determine the true potential of digital technologies in modern melanoma follow-up.
MASCC-0330
Knowledge, awareness and perception regarding dengue fever among university students of interior Sindh
R. rafaqat 1
1Dow University, Dow Medical College, Karachi, Pakistan
Introduction: Dengue Fever is one of the most common arthropod borne viral disease of humans. It has become a major public health problem worldwide. It is estimated that 50 million cases of dengue fever occur yearly.
Objectives: This study aimed to assess the knowledge and perception of dengue fever among university students of interior Sindh.
Methods: The cross-sectional study conducted among university students of interior Sindh during the period of April to June 2012. Four hundred fifty students were surveyed, 46.5 % were males and 53.5 % were females. A pre tested questionnaire was used to assess the knowledge of dengue fever. The collected data was analyzed using SPSS version 17.
Results: Of all the participants, 43.4 % male and 51 % reported they heard about dengue, 22.1 % male and 36.5 % females (p-value < 0.001) agreed with “Aedes” mosquito as cause for dengue fever. Aedes mosquito is “A small dark mosquito having white stripes on its leg” reported by 54.8 % students. Aedes mosquito breed in the “Flowing dirty water” by 14.1 %, “Flowing clean water” by 19 % (p-value < 0.001), “Standing dirty water” by 38.1 % and “Standing clean water” by 47.6 % (p-value 0.003). Dengue mosquito usually bites at “Dusk” by 44.7 % (p-value 0.002) at “Dawn” by 51 % and at “Night” by 21 % (p-value < 0.001). Regarding symptoms of Dengue fever, “Prolonged high fever” reported by 52.6 %, “Muscular pain” by 39.6 % (p-value 0.009), “Bleeding” by 41.3 % (p-value 0.001), “Headache, nausea and vomiting” by 44.7 % (p-value 0.001).
Conclusions: Due to severe lack of knowledge different educational programs are needed to increase the knowledge and awareness regarding Dengue Fever.
MASCC-0331
From evidence to practice: implementation of bone modified agents (BMA’s) guidelines in patients with solid tumor malignancies
T. Granot 1, M. Shimoni2, S. Ben Ami3, S.M. Stemmer4, A. Sulkes5, A. Morag6
1Breast Cancer Unit, Institute of Oncology Davidoff Center Rabin Medical Center, Petach-Tiqva, Israel, 2Day Care Unit, Institute of Oncology Davidoff Center Rabin Medical Center, Petach-Tiqva, Israel
3Internal Medicine Division, Head Nurse of the Internal Medicine Division Sheba Medical Center, Ramat Gan, Israel, 4Deputy of institute, Institute of Oncology Davidoff Center Rabin Medical Center, Ramat Gan, Israel, 5Head of institute, Institute of Oncology Davidoff Center Rabin Medical Center, Petach-Tiqva, Israel, 6Head Nurse of institute, Institute of Oncology Davidoff Center Rabin Medical Center, Petach-Tiqva, Israel
Introduction: Metastatic bone disease is a common consequence that impairs quality of life, reduces overall survival. BMA prevent, reduce, and delay ancer-related Skeletal Related Events (SRE) prevalence. Missing data regarding side effects, complications and structured follow- up, was the drive to explore this issues by the Israel Oncology Nursing Society (IONS).
Objectives: Aim of the project was to establish and implement guidelines to support health care providers with the BMA treatment process.
Methods: As a national project, several nursing subgroups, reviewed relevant literature on BMA’s. One group established a multidisciplinary comprehensive guideline in one cancer center. BMA’s guideline writing process incorporated few steps: literature review (Aapro 2008, Hillner 2003), multidisciplinary discussions, consensus, writting assessment tools and patient education materials. Guideline was composed of: general information, indications and contraindications, drug-drug interactions, time and course duration, special considerations, complications, administration and patient education. Implementation process included: guideline and related materials approved by management, presentation to all treating staff and discussions with specialists in Oral Medicine in order to assure appropriate patients flow.
Results: Although guidelines were written in one cancer center, products were edited by a pharmaceutical company and disseminated nationwide, with mutual cooperation with the IONS. This process started and ended as a national project. It has very strong safety implications for patients and health providers as well.
Conclusions: The new guidelines enables health care providers to use common and acceptable measures to treat and monitor patients on BMA. Multidisciplinary working process increased staff awareness to the required parameters.
MASCC-0332
Cold cap to prevent chemotherapy-induced alopecia in patients undergoing cancer treatment: integrative review
C. Inocencio Vasques 1, H.C. Seganfredo1, P.E.D. Reis1, G.P.R. Simino2
1Nursing Department, University of Brasilia, Brasília, Brazil, 2Nursing College, Federal University of Minas Gerais, Belo Horizonte, Brazil
Introduction: Chemotherapy-induced alopecia is not an adverse effect that weakens the patient clinically. However, often has been considered a devastating side effect with regard to self-image. The occurrence of alopecia involves the alteration of the patient’s body image.
Objectives: This study aims to identify the main evidence exists in the scientific literature related to the use of hypothermic cap and its relation to the reduction of alopecia in patients with cancer.
Methods: The method used was an integrative review. Thus, we conducted searches of publications in the following databases: Medline, Lilacs and Cochrane, using the following controlled descriptors checked by DeCs and Mesh: alopecia and the following keywords: cold cap, chemotherapy-induced alopecia, hypothermia, induced. Also used descriptors were not controlled. Inclusion criteria were studies that performed the use of hypothermic cap as preventive method of alopecia as a side effect of chemotherapy drugs.
Results: The final sample consisted of eight articles. According to the level of evidence, they were categorized in level 2 (n = 2), level 3 (n = 3), level 4 (n = 2) and level 5 (n = 1). The results indicate that the use of hypothermic cap decreased the degree of alopecia. Furthermore, the time of use the cap can directly influence the result of alopecia.
Conclusions: The results indicate that the use of hypothermic cap has been effective in the prevention of chemotherapy-induced alopecia, as well as reducing the appearance of metastases in the scalp.
MASCC-0333
Palliative care cancer patient reported outcomes assessment using tablets
G. Stukenborg 1, L. Blackhall2, J. Harrison1, P. Read3
1Public Health Sciences, University of Virginia Health Systems, Charlottesville, USA, 2Palliative Care, University of Virginia Health Systems, Charlottesville, USA, 3Radiation Oncology, University of Virginia Health Systems, Charlottesville, USA
Introduction: Recent recommendations for collecting Patient-Reported Outcomes in adult oncology emphasize the need for quick and efficient reporting using electronic data capture technologies. Tablet computers with touch screens are likely to be well suited for collecting patient data in the clinic setting.
Objectives: To develop and assess the feasibility of tablet computer based Patient-Reported Outcomes measurement in the adult oncology palliative care setting.
Methods: The PROMIS (Patient Reported Outcomes Measurement Information System) Assessment Center website is used as a resource for capturing health status assessment data, with access to the study website via wireless internet connection using tablet computers provided to patients during scheduled visits to the clinics. Upon arrival in the clinic, patients use tablet computers to report their experience (over the last 7 days) for the following health domains: anxiety, depression, fatigue, pain interference, pain severity, physical function, instrumental social support, sleep impairment, diarrhea, constipation, nausea, vomiting, anorexia, dyspnea, neuropathy, and spiritual values.
Results: Preliminary testing demonstrates that tablet computers provide secure, reliable, wireless data collection, with instantaneous data storage, and nearly immediate data availability. Tablet computers appear to be well suited for collecting patient data in the clinic setting. Continued evaluation of the devices among patients in the clinic setting is currently underway.
Conclusions: Tablet computers can be used to efficiently and reliably collect patient reported health status measures among palliative care cancer patients presenting in clinics. The use of these devices may support substantial improvements and innovations in making this information available for clinical decision making.
MASCC-0334
Pain progression and analgesic use after skeletal-related events in patients with solid tumors and bone metastases
L.J. Fallowfield 1, C. Cleeland2, R. von Moos3, D. Patrick4, J.J. Body5, B. Egerdie6, A. Stopeck7, J.E. Brown8, G. Marx9, F. Palazzo10, D. Damyanov11, Y. Zhou12, A. Braun12, A. Balakumaran12, Y. Qian12
1Sussex Health Outcomes Research & Education in Cancer (SHORE-C), University of Sussex, Brighton, United Kingdom, 2M.D. Anderson Cancer Center, University of Texas, Houston TX, USA, 3Kantonsspital Graubünden, Chur, Switzerland, 4University of Washington, Seattle WA, USA, 5CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium, 6Urology Associates/Urologic Medical Research, Kitchener ON, Canada, 7Arizona Cancer Center, University of Arizona, Tucson AZ, USA, 8Cancer Research UK Clinical Centre, Leeds, United Kingdom, 9Sydney Adventist Hospital, Wahroonga, Australia, 10Center for the Integral Assistance of Oncology Patients, San Miguel de Tucumán, Argentina, 11National Hospital for Treatment in Oncology, Sofia, Bulgaria, 12Amgen Inc., Thousand Oaks CA, USA
Introduction: Patients with bone metastases frequently experience skeletal-related events (SREs) including pathological fracture (PF), surgery (SB) or radiation to bone (RB), or spinal cord compression (SCC). Pooled results from three clinical trials showed denosumab is superior to zoledronic acid (ZA) for preventing SREs.
Objectives: We assessed the impact of SREs on patient-reported pain and analgesic use.
Methods: Randomized patients received denosumab (120 mg, SC) or ZA (4 mg, adjusted for renal function) monthly. This posthoc analysis includes data from patients with solid tumors in both treatment groups. Pain was assessed with the Brief Pain Inventory, and analgesic use was scored with the Analgesic Quantification Algorithm. Pain and analgesic use were analyzed from 6 months before to 6 months after the first on-study SRE. In patients without SREs, an index time of the median time to each SRE type was used. SRE impact was assessed using a Cox proportional hazards model (HR [95 % CI]).
Results: One thousand nine hundred twenty-five patients had an on-study SRE (923 PF, 829 RB, 119 SCC, 54 SB); 3,618 did not. More patients with SREs reported moderate/severe pain or strong opioid use than those without SREs. All SRE types were significantly associated with a greater risk of progression from no/mild pain at baseline to moderate/severe pain on study (PF 1.29 [1.07, 1.57], P = 0.009; RB 2.51 [2.03, 3.10], P < 0.001; SCC 3.07 [1.83, 5.13], P < 0.001; or SB (2.75 [1.19, 6.33], P = 0.018).
Conclusions: Patients with SREs have increased pain severity and stronger analgesic use. Treatments that prevent SREs can decrease pain and the palliative use of opioid analgesics.
MASCC-0335
Stressful life events before development of colorectal cancer
P. Heras 1, V. Niarou2, A. Bechli2, M. Kostopoulou2
1Internal Medicine, General Hospital of Nafplio, Athens, Greece, 2Internal Medicine, General Hospital of Nafplio, Nafplio, Greece
Introduction: Colorectal cancer is a type of cancer that mostly occurs due to lifestyle and increasing age.
Objectives: The aim of this study was to describe stressful events before development of colorectal cancer.
Methods: Retrospective chart review study of all first time hospitalized patients for colorectal cancer treated at the General Hospital of Nafplio during 3 year period of time. During an average of 4, 1 year follow-up period, patients were assessed using standardized instruments (Holmes & Rahe stress scale).
Results: Forty-one colorectal cancer patients were hospitalized. Stressful life events before the diagnosis of colorectal cancer were found in 44 %. Death of significant other was present in 13 %, separation/divorce 16 % patients, change of job in 29 %, serious illness/operation in 16 % and moving house in 13 % of patients, serious problems in family 22 %, at work 17 %, major journey 16 %.
Conclusions: We found that a large part of our patients had stressful life events before colorectal cancer, so we can conclude that it is an important factor, which can facilitate development of disease.
MASCC-0336
Neurocognitive effects of chemotherapy in Egyptian children surviving acute lymphoblastic leukemia
L. Sherief 1, A. El-hadad2, A. Shebl3, R. Sanad3, E. Atia3, E. Elsafy4, R. Khalek5, N. Kamal6
1Pediatric Hematology and Oncology, Zagazig, Zagazig, Egypt, 2Pediatric Oncology, Cairo-NCI, Cairo, Egypt, 3Pediatric, BanhaI, Banha, Egypt, 4Psychology, Zagazig, Zagazig, Egypt, 5Pediatric Oncology, Zagazig, Zagazig, Egypt, 6Pediatric, Cairo, Cairo, Egypt
Introduction
Objectives: We evaluated neurocognitive effects of chemotherapy in Egyptian children surviving Acute Lymphoblastic Leukaemia (ALL) treated with chemotherapy only with two different protocols.
Methods: One hundred survivors of ALL treated at three Egyptian centres were included in this study. They were divided into 2 groups. Group I: Included 50 children treated with modified CCG 1991 protocol. Group II: Included 50 survivors of ALL treated with Total XIII protocol. Both groups were compared with 40 healthy and matched siblings to serve as a control group.
Results: There was highly significant decrease of full scale scores in leukemic groups. There was no significant differences between ALL survivors regarding verbal I.Q. while there was significant differences in total performance I.Q. scores in early age of onset of ALL except in picture completion and object assembly. Girls did worse than boys in almost all I.Q. parameters except in vocabulary and picture arrangements. Impact of treatment intensity in our study revealed that deleterious effects were observed in children who received intensified treatment (TXIII protocol) and there was negative correlation between duration from the end of the therapy and most I.Q. parameters.
Conclusions: Chemotherapy appears to have subtle effects on neurocognitive functions, most commonly including attention, visual processing and visual-motor functioning which are more prominent in children who are younger at diagnosis, in girls versus in boys and with high treatment intensity.
MASCC-0337
Associations of proteomic profile and clinical measures of fatigue
N. Lukkahatai 1, S. Patel2, M. Gucek2, L. Saligan1
1National Institute of Nursing Research, National Institutes of Health, Bethesda MD, USA, 2National Heart Lung and Blood Institute, National Institutes of Health, Bethesda MD, USA
Introduction: The etiology of fatigue is unknown. Differential expression of APOE and transthyretin were observed in prostate cancer men reporting high fatigue while receiving external beam radiation therapy (EBRT).
Objectives: To examine the associations of serum apoliprotein (Apo) E and transthyretin with fatigue, cognitive function and static fatigue of prostate cancer men and healthy volunteers.
Methods: Healthy men (controls, n = 5) and prostate cancer men who reported high fatigue change from baseline (day0) to midpoint (day21) of EBRT (n = 9) were included in the analyses. Study outcomes obtained at baseline for controls and at day 0 and day 21 for EBRT men included serum samples (ApoE/transthyretin levels), Functional Assessment of Cancer Therapy–Fatigue (FACT-F) score (low score = high fatigue), STROOP reaction time (cognitive function), and hand dynamometry (static fatigue). Western Blot analyses measured serum proteins. Linear regressions determined associations.
Results: High levels of transthyretin were correlated (p < .05) with low FACT-F scores (β = −.41) and static fatigue (β = .55) among EBRT men. Low ApoE levels were correlated (p < .01) with low FACT-F scores (β = .98) and long STROOP reaction times (β = −.98) among controls.
Conclusions: The significant correlation of transthyretin with reported fatigue and static fatigue suggests that fatigue during EBRT may be physical in nature and transthyretin may serve as a correlate of physical fatigue in this population. Significant correlation of ApoE with fatigue score and STROOP reaction time suggests that fatigue reported by healthy men may influence cognitive function and ApoE may serve as a correlate of mental fatigue. Further investigation and intervention development are warranted.
MASCC-0338
Sann-Joong-Kuey-Jian-Tang could inhibit human pancreatic carcinoma BXPC-3 cells through decreasing Mcl-1 and TCTP expression
C. Su 1
1Surgery, Changhua Christian Hospital, Changhua, Taiwan
Introduction: Sann-Joong-Kuey-Jian-Tang (SJKJT), a traditional Chinese medicinal prescription, has been used for lymphadenopathy and solid tumors, with therapeutic potential in many human malignant tumor cell lines. However, the efficacy of SJKJT in human pancreatic cancer have not been elucidated.
Objectives: In the present study we evaluated the anticancer effects of SJKJT in human pancreatic carcinoma BxPC-3 cells.
Methods: The cytotoxicity of SJKJT was measured by MTT assay. The protein expressions of Mcl-1, TCTP, Fas, TNF-α, Caspase-8, Caspase-3, Bax and Bcl-2 family were measured by Western blotting. The cell cycles were analyzed by flow cytometry (FACS). The protein expression of Caspase-3 was also detected by immunocytochemical staining (I.C.C)
Results: The results showed that SJKJT could inhibit the proliferation of BxPC-3 cells with time and dose dependent. The protein expressions of TNF-α, Caspase-8, Caspase-3 and Bax were increased, but Mcl-1, TCTP, Bcl-xl were decreased in BxPC-3 cells were treated with SJKJT. The results also showed that SJKJT can increase the sub-G1 phases in BxPC-3 cells. In addition, ICC staining showed that BxPC-3 cells were treated with SJKJT can up-regulate the protein expression of Caspase-3
Conclusions: SJKJT can inhibit the proliferation of BxPC-3 cells through extrinsic and intrinsic pathway to induce apoptosis in vitro. SJKJT has chemotherapeutic potential for human pancreatic cancer BxPC-3 cells. It is warrants further study in the future
References: Cheng CY, Lin YH and Su CC: Sann-Joong-Kuey-Jian-Tang increases the protein expression of microtubule-associated protein II light chain 3 in human colon cancer colo 205 cells. Mol Med Rep 2: 707–711, 2009.
MASCC-0339
Pathological and clinical characteristics of elderly patients with breast cancer: multicenter study (Anatolian Society of Medical Oncology)
A. inal 1, T. akman2, S. yaman3, S. ozturk4, C. geredeli5, M. bilici6, I. mevlude7, H. harputoglu8, U.M.U.T. demirci9, O.Z.A.N. balakan10, H. cinkir11, S. alici12, O. sonmez11, H. engin13, U. olcun14, G. gokoz dogu15, G. goksel16, T. tamozlu3, S. buyukberber4, C. boruban17, A. isikdogan18
1Department of Medical Oncology, Dicle University, Diyarbakir, Turkey, 2Department of Medical Oncology, Dokuz Eylül University, Izmir, Turkey, 3Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey, 4Department of Medical Oncology, Gazi University, Ankara, Turkey, 5Department of Medical Oncology, Secuk University, Konya, Turkey, 6Department of Medical Oncology, Atatürk University, Erzurum, Turkey, 7Department of Medical Oncology, Erciyes University, Kayseri, Turkey, 8Department of Medical Oncology, Inönü University, Malatya, Turkey, 9Department of Medical Oncology, Ataturk Education and Research Hospital, Ankara, Turkey, 10Department of Medical Oncology, Gaziantep University, Gaziantep, Turkey, 11Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Education and Research Hospital, Ankara, Turkey, 12Department of Medical Oncology, Goztepe Medikal Park Hospital, Istanbul, Turkey, 13Department of Medical Oncology, Zonguldak Karaelmas University School of Medicine, Zonguldak, Turkey, 14Department of Medical Oncology, Dokuz Eylül University Department of Medical Oncology, Izmir, Turkey, 15Department of Medical Oncology, Pamukkale University School of Medicine, Denizli, Turkey, 16Department of Medical Oncology, Celal Bayar University, Manisa, Turkey, 17Department of Medical Oncology, Secuk University, Kanya, Turkey, 18Department of Medical Oncology, Dicle University, Diyarbakir, Turkey
Introduction: There is very little information about breast cancer characteristics, treatment choices, and survival among the elderly patients
Objectives: The purpose of this multicenter retrospective study was to examine the clinical, pathological and biological characteristics of 620 breast cancer patients age 70 years or older.
Methods: Between June1991 and May 2012, 620 patient with breast cancer, recruited from 16 institutions, were enrolled into the retrospectively study.
Results: Patients had smaller tumors at diagnosis, only 15 % of patients had tumors larger than 5 cm. The number of patients who had no axillary lymph node involvement was 203 (32.7 %). Ninety-three patients (15.0 %) had metastatic disease at diagnosis. Patients were characterized by a higher fraction of pure lobular carcinomas (75.3 %). The tumors of the elderly patients were also were more frequently ER positive (75.2 %), and PR positive (67.3 %). The local and systemic therapies for breast cancer differed according to age. An association between age and OS has not been demonstrated in elderly patients with breast cancer
Conclusions: In conclusion, the biological behaviour of older patients with breast cancer is different from in younger patients, and older patients receive different treatments.
MASCC-0340
The prevalence of type D personality among colorectal cancer survivors
P. Heras 1, V. Niarou2, M. Kostopoulou2, A. Bechli2, E. Andrikopoulos2, M. Hera1
1Internal Medicine, General Hospital of Nafplio, Athens, Greece, 2Internal Medicine, General Hospital of Nafplio, Nafplio, Greece
Introduction: Type D personality is defined as the joint tendency towards negative affectivity and social inhibition.
Objectives: We aimed to investigate the prevalence of type D personality among colorectal cancer (cc) survivors and to obtain insight into its effect on health status, impact of cancer and health care utilization.
Methods: We selected 47 patients diagnosed with cc from 2000 to 2011. W e asked them to complete a questionnaire containing Type D Personality Scale (DS14), Impact of Cancer Questionnaire (IOC) and SF-36 and 80 % responded.
Results: 22 % survivors were classified as type D. They reported a clinically and statistically significant worse general health (57.9 vs 75.4), social functioning (73.2 vs 89.1), mental health (62 vs 81), more emotional role limitations (67.2 vs 89.1) and less vitality (54.6 vs 73) than non-type D patients. Additionally, they reported a statistically and clinically relevant higher impact of cancer on body changes, negative self-evaluation, negative outlook on life, life interferences and health worry. No differences were found in health care utilization.
Conclusions: Our study provided insight into the role of type D personality on health status and impact of cancer among cc survivors 1–10 years after diagnosis. The type D scale has proven to be a useful screening tool in cc survivors to identify subgroups at risk for impaired health status and impact of cancer.
MASCC-0341
Lung cancer stigma and its potential impact
P. Heras 1, V. Niarou2, A. Bechli2, M. Kostopoulou2
1Internal Medicine, General Hospital of Nafplio, Athens, Greece, 2Internal Medicine, General Hospital of Nafplio, Nafplio, Greece
Introduction: Lung cancer patients have long reported feeling stigmatized however little research exists about the stigma and its potential impact.
Objectives: This survey of the general public, lung cancer patients and oncologists explores the impact of stigma from the perspectives of three distinct groups.
Methods: The general population interviews were conducted by phone using a random digit dial sample. Lung cancer patient interviews were conducted by telephone and online, those with oncologists online only. The average survey length was 15 min.
Results: A majority of all three groups agree there is a stigma associated with lung cancer. Nearly a third of the general population, oncologists and nearly half patients feel lung cancer patients are treated differently. Significant differences were found in the general population’s support of lung and breast cancer organizations and in feelings regarding which cancer deserves stronger research support. Similarly less than a quarter of both lung cancer patients and oncologists rated the support given to lung cancer organizations as excellent/very good compared to more than half of patients and 79 % of doctors who felt the same way about breast cancer organizations. Two out of ten lung cancer patients rated the research conducted to find new treatments ‘highly’ vs more than half who rated that for breast cancer as such. Nearly a third of oncologists rated the amount of lung cancer research funding as excellent/very good compared to almost three fourths who highly rated the amount to breast cancer.
Conclusions: This survey confirms that the stigma associated with lung cancer is real and impacts patients at the individual, familial, medical and societal level.
MASCC-0342
Psychosocial care and quality of life in cancer patients
P. Heras 1, V. Niarou2, M. Kostopoulou2, A. Bechli2, M. Hera1
1Internal Medicine, General Hospital of Nafplio, Athens, Greece, 2Internal Medicine, General Hospital of Nafplio, Nafplio, Greece
Introduction: Depressive symptoms and deficits in mental well-being among cancer patients often go untreated even if psychosocial care can allay patient distress and improve psychosocial outcomes. However, the use of care services is not detailed among patients prior to chemotherapy.
Objectives: The present study sought to describe patterns of utilization of supportive care and the relationship to quality of life outcomes in cancer patients. It has hypothesized that patients experiencing greater depression and poorer mental well-being prior to chemotherapy probably had utilized psychosocial services.
Methods: Two hundred thirty-two adults participated (M = 58 year, SD = 11.7, 94 % Caucasian, 37 % male). Breast 34 %, lung cancer 34 %, stage III 28 % or IV 37 % were most common. Use of psychosocial care (SSQ), depressive symptoms (CES-D) and mental well-being (SF-36 MCS) were assessed via self-report prior to chemotherapy.
Results: Twenty-seven percent of participants (n = 62) had used psychosocial care within the previous 3 months. Most utilized services were: spiritual counseling/support (14 %), social work (10 %), mental health counseling (5 %), support groups (4 %), psychologists (3 %) and psychiatrists (3 %). As expected, use of psychosocial care was significantly related to patient reports of poorer mental well-being (r = −0.27) and greater depressive symptoms (r = 0.23), ps < 0.001. Additionally, 63 participants (27 %) met clinical cutoffs for depression (CES-D ≥ 16). Among these patients, 41 % had used psychosocial services; correspondingly, the other 59 % had not used psychosocial services, x 2 = 9.19, p < 0.01.
Conclusions: Patients prior to chemotherapy who reported poor mental well-being and greater depression possibly have used psychosocial services in the past 3 months. This suggest that patients in need of services probably receive them. However, findings indicated that most of patients experiencing clinically significant depressive symptoms had not received psychosocial services. Future research should examine this more by evaluating whether implementation of recommended procedures for routinely assessing psychological well-being in cancer patients results in greater use of psychosocial services and improved psychosocial outcomes.
MASCC-0343
Long-term use of fentanyl pectin nasal spray in the management of breakthrough pain in cancer
L.M. Torres 1, D. Taylor2, L. Radbruch3, J. Revnic4, J.E. Ellershaw5, M. Perelman6
1Anesthesia Resuscitation and Pain Therapy, Hospital Universitario Puerta Del Mar, Cádiz, Spain, 2Anesthesiology, Georgia Center for Cancer Pain Management and Palliative Medicine, Marietta, USA, 3Klinik für Palliativmedizin, Universitäsklinikum Bonn, Bonn, Germany, 4Palliative Care Unit, Hôpital Jean Jaurès, Paris, France, 5University of Liverpool, Marie Curie Palliative Care Institute, Liverpool, United Kingdom, 6Archimedes Development Ltd, Archimedes, Nottingham, United Kingdom
Introduction: As patients with cancer are living longer, treatments for palliative care need to be well tolerated and effective for long-term use.
Objectives: To investigate fentanyl pectin nasal spray (FPNS) as long-term treatment for breakthrough pain in cancer (BTPc) in patients taking regular opioid therapy (≥60 mg/day oral morphine or equivalent).
Methods: Adult patients (N = 401) averaging 1 to 4 episodes of BTPc/day, who had newly enrolled, or completed an FPNS randomized controlled trial, entered an open-label study (NCT00458510). Of these, 171 patients continued into an extension period. Up to 4 episodes of BTPc/day were treated with FPNS (100–800 μg doses). Patients visited the clinic every 4 weeks for assessment and reporting of adverse events (AEs)
Results: In total, 163 patients had documented FPNS use, with mean duration of 325 days; 46 patients used FPNS for ≥1 year; maximum duration was 3 years, 8 months. Two percent of patients withdrew from the study due to lack of efficacy. Seventy four percent did not change FPNS dose. The most common AEs, excluding disease progression, were insomnia, 9.9 %; nausea, 9.4 %; vomiting, 9.4 %; and peripheral edema, 9.4 %. The overall incidence of treatment-related AEs was 11.1 %, the most common being constipation (4.1 %), with no apparent dose relationship. Ten patients (5.8 %) experienced treatment-related nasal AEs; most of which were mild or moderate.
Conclusions: FPNS appeared to provide sustained benefit and was well tolerated during the long-term treatment of BTPc.
References: Research supported by Archimedes Development Ltd.
MASCC-0344
Palliative care and spirituality. A survey on specific needs of health workers in Italian hospices
S. Serpentini 1, S. Baro2, E. Pasquin3, I. Spano4, E. Capovilla5
1Palliative Care Unit/Psychoncology Unit, Azienda ULSS 3/IOV-IRCSS, Bassano del Grappa/Padova, Italy, 2Dept. of Psychology, University, Padova, Italy, 3Palliative Care Unit, Azienda ULSS 3, Bassano del Grappa, Italy, 4Dept. of Sociology, University, Padova, Italy, 5Psychoncology Unit, IOV-IRCSS, Padova, Italy
Introduction: In the last decade the spiritual dimension of the operators working in Palliative Care has taken a growing interest.
Objectives: To understand the importance of spirituality in healthcare operators working in Hospice and to evaluate their sense of adequacy and the need for a specific training in this field.
Methods: A structured questionnaire was sent to seven Hospice of the Veneto Region (Italy), one for each of the seven provinces. The data collected were analyzed by SPSS.
Results: The sample includes 82 healthcare workers (57 F, 25 M), 50 nurses and 32 health care assistants. The age group most represented is 41–50 year. The 52.4 % has a length of service in Hospice between 5 and 10 years. The 82,1 % attributes importance to spiritual training; no one believes to have an adequate preparation to face the spiritual needs of patients and the 63.6 % admits to feeling little or any preparation in this area. The 66.7 % affirm that they had not received a specific training, the 41.3 % participated to advanced courses on this subject; the 77.3 % searched by their own specific alternative. The 90.69 % believes that the spiritual dimension should be included in the training planning.
Conclusions: Our sample shows awareness about the limits existing regarding the spiritual dimension of the care. They recognize the importance of a specific training in this field in order to provide adequate skills and tools necessary to assist the patients and their families with a global approach, particularly in the process of death and dying.
MASCC-0345
Study in the town of Orikum, about the knowledge that women have for breast cancer
Y. Bilushi 1, M. Meminaj1, R. Luci1
1Public Health Care, University of Vlora, Vlore, Albania
Introduction: Breast cancer is a major public health problem in terms of frequency, with which meets, as well as the correct diagnosis and treatment of it. This study was conducted to assess the knowledge on breast cancer that women have in this area.
Objectives: The aim of this study was to evaluate the basic knowledge about the prevention of breast cancer and to analyze the behavior of females related to the breast cancer risk factors
Methods: This study is realized, throw the analysis method where as the main tool was used a questionnaire. The questionnaire was with questions just for breast cancer. In this study attend about 60 women. The manner of distribution the questionnaire was met each of the female and giving them the paper where, were played the questions
Results: All the women in this area knew something about breast cancer. Fifty-eight percent of the women participator of this study knew how to realise self-examination, whereas 42 % of them never haven’t made a self-examination. When this women where asked related with mammography 58 % of them knew what it was, but 42 % haven’t done never a examination with it.
Imagine 1: Knowledge for mammography
Imagine.2: Self-examination
Conclusions: In the end of this study we noticed that exist a deficit in the knowledge that the women of this area have for breast cancer. And the most disturbing thing was that they didn’t know a lot of things for risk factors about this pathology
References: Breast cancer, knowledge, mammography, examination.
MASCC-0346
Post-traumatic growth among elderly breast cancer survivors
P. Heras 1, V. Niarou2, A. Bechli2, M. Kostopoulou2
1Internal Medicine, General Hospital of Nafplio, Athens, Greece, 2Internal Medicine, General Hospital of Nafplio, Nafplio, Greece
Introduction: Growthing numbers of elderly people survive cancer and live their final years coping with long-term effects. Research in psycho-oncology has recognized the resilience of survivors who find benefits from their cancer experience and who exhibit posttraumatic growth (PTG). Yet, there has been only limited focus on factors associated with PTG among the elderly.
Objectives: This study considered manifestations of PTG and demographic and stress related factors associated with PTG in a non-clinical population of elderly cancer survivors.
Methods: Semi-structured interviews were conducted with 171 elderly people who reported a cancer diagnosis while participating in a prior survey of health communication (mean age = 80.37;SD = 7.57). Participants in this representative sample of community residents reported diverse cancer diagnoses and ranged from the recently diagnosed to long-term survivors. PTG was assessed using a 12-item version of Tedeschi and Calhoun’s (1996) measure (Cronbach;s alpha = 0.93 in this sample). Demographic and stress-related predictors were measured using interview questions.
Results: Increased compassion and appreciation of life were the PTG items most frequently endorsed by elderly cancer survivors, thus focusing on existential aspects of PTG in this group. Based on linear regression analysis, younger age and minority status significantly predicted PTG. Furthermore, perceiving cancer as a traumatic experience and using religious coping, resulted in significantly greater PTG. Findings support the view that PTG emerges, even in late life, in the aftermath of suffering from life-threatening illness. Personal characteristics and resources and appraisals of cancer as stressful shaped the extent of PTG reported.
Conclusions: Experiencing illness off-time (younger respondents), having endured cumulative disadvantage (minorities), appraising the illness experience as more stressful and religious coping all contribute to cognitive restructuring reflected in PTG.
MASCC-0348
Dental protocol for prevention and management of mucositis in patients undergoing bone marrow transplantation
S. Gallego Zapata 1, R. Carvajal Reynaldo2, M. Urrego Marcela3, L. Aluma Luis4, C. Portilla Carlos5
1Odontologia General y Especializada, Centro Medico Imbanaco, Cali, Colombia, 2Epidemiology, Centro Medico Imbanaco, Cali, Colombia
3Hematooncology, Centro Medico Imbanaco, Cali, Colombia, 4Urology-Oncology, Centro Medico Imbanaco, Cali, Colombia, 5Pediatric Hematooncology, Centro Medico Imbanaco, Cali, Colombia
Introduction: Mucositis is a frequent complication of chemotherapy. In occasions, due to its severity, it causes the interruption of the treatment, dose diminution, and prolonged hospital stay with its consequent raise in costs or complications such as sepsis.
Objectives: At Centro Medico Imbanaco, Mucositis incidence was compared in two groups: one with and the other without the implementation of a protocol for prevention and management of mucositis before chemotherapy. The purpose was to observe the incidence and severity of mucositis.
Methods: During 2011–2012 the protocol was implemented in 83 patients requiring bone marrow transplantation. These results were compared to those of 66 patients undergoing transplantation during 2009–2010 not receiving any dental treatment. The protocol consisted in the initial assessment with RX, odontogram, bacterial plaque index, general stomatological health condition and photographic records. Infectious focuses were treated as an initial step and control during the transplantation term. Antibacterial toothpaste and mouthwashes were used. The comparison of the incidence between the two groups was made based on the Fisher’s exact test.
Results: Global incidence (%) of mucositis was 43.8 %. In patients with dental sanitation it was 39 % vs without sanitation 50.9 % (p value ~0.120). This translated into an absolute risk reduction of 11.9 %. In the group not undergoing a dental treatment, grade II and III mucositis was 32.2 %. In the group with a dental treatment it was 10 % (p value ~0.001). Absolute risk reduction of 22.1 %.
Conclusions: The Dental protocol used in patients undergoing bone marrow transplantation reduces the incidence and severity of mucositis.
MASCC-0349
Clinical characteristics of elderly patients with non-small cell lung cancer (NSCLC)
M.M. Vaslamatzis 1, A. Laskarakis1, N. Alevizopoulos1
1Clinical Oncology, “Evaggelismos” General Hospital, Athens, Greece
Introduction: Considering risk-benefit, chemotherapy in elderly patients is promising
Objectives: To document side effects & mortality in elderly patients admitted in our Department (1-2007 – 11-2011).
Methods: A retrospective study carried out in 50 non small cell lung cancer (NSCLC) patients, stage ≥IIIA. Median age was 71 (65–82) ys in 42 (84 %) m & 8 (16 %) f pts, ECOG 1 (0–4). Active smokers (≥60 pack/years) were 46(92 %) pts, while passive 4(8 %). According to symptoms: cough 17(34 %), thoracic pain 9(18 %), fatigue 6(12 %), fever 5(10 %), hemoptysis 3(6 %), dyspnea 3(6 %), & hoarsenes 2(4 %) were respectively reported. Histologically :adenocarcinomas, squamous & large cell were 30(60 %), 17(34 %) & 3(6 %), respectively. Comorbidities reported were hypertension, ischemic disease, diabetes and chronic obstructive pulmonary disease in 20(40 %), 9(18 %), 9(18 %) and 7(14 %) pts. Median creatinine was 1.7 mg/dl (1.2–1.9) & median Ejection fraction was 50 % (40 %–60 %). All pts received 1st line therapy with Paclitaxel—Carboplatin ± bevacizumab, supported with G-CSF in prophylaxis base.
Results: Side effects : Neutropenia (18 cases - 5 febrile), thrombocytopenia (7 cases), anemia (12 cases) & 1 case acute renal failure. All events were anticipated with G-CSF, Erythropoietin, blood, platelets transfusions & antibiotics intravenously. Post 3 chemo-cycles 44 patients (88 %) were reevaluated. Partial response was stated in13 (30 %), SD in 5 (11 %) & PD in 26 (59 %). Median PFS was 4 (1–14) mo.PD in 27 pts was followed by 2nd line therapy & reevaluation in 20, revealed 2 PR &18 PD. Median OS was 6 (1–68) mo. Partial response was stated in13 (30 %), SD in 5 (11 %) & PD in 26 (59 %). Post 3 chemo-cycles 44 patients (88 %) were reevaluated. Partial response was stated in13 (30 %), SD in 5 (11 %) & PD in 26 (59 %).
Conclusions:
1. Cardiac, renal function and co-morbidities should be evaluated in elderly patients
2. Supportive growth factors were mandatory in elderly patients.
3. Prolonged intervals in chemo rotation & variable reductions were often necessary measures of toxicity avoidance.
MASCC-0350
Cancer patients’ needs in integrative oncology to help them manage side effects : a prospective study
C. Brami 1, N. Jovenin2, B. Fache1, P. Viaux1, J. Volet1, Q.H. Le1, L. Petit1, C. Lesage1, F. Ramiandrisoa1, O. Bouché1
1Oncology Hematology UMA-CH, University Hospital Reims, Reims, France, 2Oncology, Institut Jean Godinot, Reims, France
Introduction: Supportive care associates pharmacologic and non-pharmacologic measures. Integrative oncology measures are defined as complementary modalities that have known-efficacy in adjunct to standard treatment to reduce symptoms. The interest in integrative oncology is increasing however in France there is not any integrative oncology unit yet.
Objectives: Before establishing our integrative oncology model, we wanted to know cancer patients’ needs to help them to manage their side effects.
Methods: In a prospective analytic study between August and December 2012, cancer patients in an oncology day unit at the University Hospital in Reims answered a multiple choice questionnaire about their treatment side effects and their needs in integrative oncology.
Results: One hundred seventy-eight patients answered the questionnaire (gastrointestinal cancer: n = 91, lung cancer: n = 37, malignant hemopathies: n = 44, skin cancer: n = 6). Characteristics of patients were: 64 % male, 94 % PS:0–1, 68 % metastatic. Only 6 patients were asymptomatic. They suffered from fatigue (44.6 %), stress and anxiety (29 %), nausea (20 %), and pain (n = 6,4 %). About 88 % of patients were interested in integrative medicine to help them manage their side effects. The most requested terms were mind and body therapy such as massage therapy (31.5 %), yoga and relaxation (21.9 %), music therapy (19.1 %), hypnosis (3.9 %). Patients need more information about diet (20.8 %), supplement and aromatherapy (16 %), aesthetic (10.7 %) and physical activity (7.9 %).
Conclusions: In 2013, cancer patients still suffer from treatment side effects. Integrative oncology modalities may help them when combined with mainstream treatment. According to patient’s need, starting an integrative oncology unit in France would be interesting as it has already been realized in the United-States.
MASCC-0351
Experiences of parents for the physical care needs at home of children with cancer: a qualitative study
H. Yildirim Sari1, M. Yilmaz 1, S. Ozsoy2, M. Kantar3, N. Cetingul3
1Health Sciences Faculty Nursing Department, Izmir Katip Çelebi University, Izmir, Turkey, 2Faculty of Nursing, Ege University, Izmir, Turkey, 3School of Medicine, Ege University, Izmir, Turkey
Introduction: Children diagnosed with cancer are admitted to the oncology clinic and receive treatment. Between the two treatment protocols, children who have not developed any complications, neutropenia and who are deemed suitable by the health team are sent home until the start of the next treatment protocol.
Objective: The objective of this study was to determine the experiences of families for care at home of children who had been recently diagnosed with cancer and was continuing cancer treatment of children who had been released from hospital between the treatment protocols.
Methods: The study was carried out at the Ege University, Turkey. The sampling of the study, was composed of the mothers of 12 children between the ages of 0–18 years of age. The study was carried out with the qualitative research method, data was collected with the in-depth interview method. The data were analyzed according to Dorothea Orem’s Self-care Theory.
Results: The data were explained under three main themes: Basic situational factors, self-care agency and self-care requisites. It was determined that some families changed cities where they lived due to treatment, that they focused on the recovery of the child, that they experienced fear, anxiety and perception difficulties, and experienced difficulties related to self -care needs.
Conclusions: In this study, Mothers and their children have difficulties extremism and dilemma in maintaining their daily routines of life for fear of infection’s capture and they have difficulties in especially to experience in feeding.
MASCC-0352
Elderly patients with thoracic esophageal carcinoma undergoing esophagectomy: resource utilization and complications in intensive care unit
A. Chao 1
1Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Introduction: Esophageal carcinoma is one of the deadliest diseases that developed mainly in elderly men. Increasing elderly patients receive esophagectomies and are admitted to intensive care units (ICUs) after surgery in the aging world.
Objectives: To examine the complications and resource utilization in the elderly patients undergoing esophagectomy and compare them with their younger cohorts during the ICU stay.
Methods: Demographic, morbidity, mortality and resource utilization were collected retrospectively from the records of 248 patients undergoing Ivor Lewis esophagectomy between Jan 2003 to Sept 2008. The patients were divided into four groups according to age: Group I (age £ 54 years, n = 31), II (55–64 years, n = 92), III (65–74 years, n = 95), and IV (3 75 years, n = 30).
Results: The mean age of the patients was 64.4 years old, with male predominant (87.5 %). The incidence of preoperative pulmonary dysfunction was 0 %, 7.6 %, 11.6 % and 20 % (p < 0.04) as well as the preoperative abnormal electrocardiography of 3.2 %, 5.4 %, 16.8 % and 16.8 % (p < 0.02), respectively, in Group I, II, III, and IV. Complications of postoperative pulmonary, cardiac, wound infection and mortality were not different among the four groups. Resource utilization including postoperative hospital stay, time to extubation, tracheostomy, blood transfusion were insignificant.
Conclusions: Outcomes and resource utilization in patients 3 75 years old were not significantly different from the younger patients. Elderly patients should not denied surgery solely due to age. Careful patient selection and meticulous perioperative management are essential for good patient outcome.
MASCC-0353
Carer satisfaction survey of a palliative care consultative service in a teaching hospital in Sydney, NSW, Australia
S. Kanathigoda 1, G. Aggarwal2, M. Butler2
1Palliative Medicine, Calvary Health Care Sydney, Kogarah, Australia
2Palliative Medicine, Concord Repatriation General Hospital, Concord, Australia
Introduction: The ultimate goal of palliative care is to provide services that mirror patients’ and family members’ goals of care.
Measuring carers’ perceived satisfaction with services is crucial if services are going to continually improve their responsiveness to the needs of those they serve.
Objectives: The primary aim of the survey was to evaluate the effectiveness of the Palliative Care Consultative Service at Concord Repatriation General Hospital (CRGH) by measuring carer satisfaction.
Methods: The tool used to measure the carer satisfaction was the FAMCARE-2 scale which is a validated tool for assessing carers’ perceptions and satisfaction on the care for their loved ones in a variety of palliative care settings throughout Australia.
The questionnaire was administered to all consenting carers over a period of 4 1/2 months.
Results: The mean score obtained for each question was almost on par with the mean scores obtained for the FAMCARE-2, Australian Palliative Care Outcomes Collaboration (PCOC) data. Further, the sub scales including questions relating to Control of physical symptoms and comfort, Provision of information and Psychological care had higher mean scores when compared with questions relating to Family support. It was found that the re-referred patients were slightly more satisfied with the services provided, than the newly referred patients
Conclusions: From the responses received for the questions throughout the 4 sub scales of FAMCARE-2, it was revealed that most of the carers of both new and re-referred patients were satisfied with the care provided by the Palliative Care Consultative Service at CRGH.
MASCC-0354
Collaborating to develop palliative care in low & middle income countries (LMIC)—project “Shanthi”-Sri Lanka
S. Kanathigoda 1
1Palliative Medicine, Calvary Health Care Sydney, Kogarah, Australia
Introduction: Presently Sri Lanka has two hospices run by NGO’s and has no Community Palliative Care.
There is no formal training in Palliative care for Doctors, Nurses or Allied Health Professionals.
With the help of the WHO, Sri Lanka has developed a National Cancer Control Program with four key areas. They are: Screening, Early detection, Treatment and Palliative Care
Objectives: Australian Palliative Link International (APLI), is collaborating with other WHO Collaborating Centres (WHOCC) to develop Palliative Care in Sri Lanka, within their National Cancer Control Program, through “Project Shanthi”
Methods: A Palliative Care physician from Australia attended the first ever Palliative Care Symposium and workshop conducted in Sri Lanka in 2011.
APLI will now collaborate with the Trivandrum Institute of Palliative Sciences (TIPS) (WHOCC) in India to conduct palliative care courses for doctors and nurses from each district in Sri Lanka.
APLI will provide “Shanthi” scholarships to the doctor/nurse teams to attend these courses in India.
Another WHO Collaborating Centre -The Pain and Policy Studies Group (PPSG) of the University of Wisconsin in USA has awarded the 2012 International Pain Policy Fellowships (IPPF) to two doctors nominated by APLI and the NCCP of Sri Lanka to improve opioid availability in Sri Lanka
Results: After the teams return to their respective districts, mentor teams from Australia through APLI will visit them in Sri Lanka to mentor them in their own environments.
Conclusions: Collaborating with regional and international centres is important to develop palliative care in LMICs.
MASCC-0355
The effectiveness of thymus honey on radiation induced mucositis and xerostomia for head and neck cancer patients: preliminary findings of a RCT
A. Charalambous 1, M. Charalambous2, V. Raftopoulos2, E. Lambrinou2
1Nursing, Cyprus University of Technology, Limassol, Cyprus, 2Nursing, Cyprus University of Technology, Limassol, Cyprus
Introduction: Oral mucositis and xerostomia are among the most severe and persistent side effects that head and neck cancer patients can face during and after radiotherapy, impairing their quality of life. Honey has been studied for the management of various treatment-related side effects and holds a prominent place in the relevant literature.
Objectives: To evaluate the effectiveness of thymus honey on radiation induced-oral mucositis and xerostomia
Methods: This is a randomised controlled trial (NCT01465308) with 80 patients equally assigned either to the intervention (honey) group (IG) or the control (saline) group (CG). Patients of both groups are clinically assessed (visually) on a weekly basis (8 measurements) with a xerostomia (NCI-CTCATE) and an oral mucositis scale (RTOG). Additionally, three self-administered questionnaires that evaluate Quality of Life (EORTC QLQ C30, H&?35) xerostomia (XQ) and oral mucositis (OMWQ) are used. Statistical evaluation was performed using the χ(2) test.
Results: The analysis included 30 patients (preliminary recruitment). Out of the 15 patients included in the IG, only two demonstrated Grade 3 xerostomia (RR = 0.13) and four Grade 3 oral mucositis (RR = 0.26) indicating that honey is effective for both symptoms. The proportion of patients with intolerable oral mucositis and xerostomia was lower in the IG and this was statistically significant (p = 0.000).
Conclusions: Safe Conclusions cannot be drawn on these preliminary findings. However, the analysis shows a prospective benefit from the use of honey in irradiated patients. Honey is readily available, affordable and well accepted by patients making it useful for improving their quality of life.
MASCC-0356
Supportive care in long term cancer cervix survivor
M. Sharma 1, A. Sharma2
1Radiation Oncology, Maulana Azad Medical College, New Delhi, India, 2Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
Introduction: Late stage complications ware well known in post radiation therapy long-term survivors of cancer cervix. Undesirable Methods of treatments such as surgical intervention—cystectomy, colostomy and cauterization of bleeders has increased the misery.
Objectives: Study of Pattern of Care in late Sequaellae in post radiation cancer cervix.
Methods: Retrospective analysis was carried out with regards to sequellae in the cancer cervix patients who are coming for 5 years and more. The pattern of care was studied under following headings:
1- Intravesical formalin bladder irrigation under spinal anesthesia.
2- Steroid rectal enema, in extreme cases shortterm colostomy.
3- Guided abdominal massage for woody fibrosis.
4- Urethral or anal dilatation as and when required
5- Vaginal dilatation
Results: Post radiation hemorrhagic cystisis was treated with 100 % success, prior cystoscopic and imaging diagnosis was assured.
Post radiation proctitis treated with steroid enema had 80–90 % success and advice on constipation preventive diet.
Regular follow up and vaginal dilatation was 100 % successful in patients having vaginal sealing
Simple urethral or rectal dilatation was more effective than any radical surgical intervention
Conclusions: Followup in Indian setting is important to treat these very late sequaellae in these cancer survivors.
Intravesical formalin instillation under spinal anesthesia is an OPD procedure with 100 % success. With minor percentage resulted in reduced bladder volume
Betamethasone enema for 6 day with a few repetitions is effective in late radiation proctitis. Advice on laxative diet has to go together.
Vaginal, urethral and rectal dilatations are simple alternatives to radical surgical intervention often mistakenly taken by surgeons.
MASCC-0357
Care and management of radiation/chemotherapy induced skin and mucosal reactions by injectable placenta extract (injection placentrex) 15 years study
M. Sharma 1, A. Sharma2
1Department of Radiation Oncology, Maulana Azad Medical College, New Delhi, India, 2Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
Introduction: Treatment disruption due to Mucosal Toxicity shall affect treatment, survival results.
Objectives: Observation on Placentrex on recovery from Radiation or Chemotherapy induced skin, mucosal reactions.
Methods: Study: Patients receiving 1-Radiation, 2-Chemoradiation, 3-Chemotherapy, received Inj. Placentrex as programmed therapy. Controls received: GV paint or Oral soothers for skin/mucosal reaction. Sucralflate, antacids H2 inhibitors for GIT. Observation till the resolution of the reaction at different, radiation, chemotherapy cumulative dose levels
Results: Placentrex (Human Placenta Extract) shows 50 % faster recovery when compared to standard therapy for reaction. Compliance for EMA-CO/CAF Regimen was 100 % with programmed Placentrex rescue when compared to controls.
Chemoradiation therapy goes uninterrupted when patients continue with Placentrex .50 % breast radiation controls were paused for 7–10 days at cumulative therapeutic doses. Post therapy control of reaction was 23 % better when compared to non Placenrex group
Conclusions: Placenta extract through it multitudes of factors, offers economical, effective therapy for all sites when compared with Amifostin with its limitations.
This seems to offer a special role in mucotoxic chemo regimen such as EMA Co and CAF and Multiple chemosensitizing regime involving Cis platinum, 5 Fu and Bleomycin.
It is Intramuscularly administered and is devoid of side effects, serological infection transmission, or anaphylaxis in Indian patients.
MASCC-0358
Profile of the patients assigned for supportive therapy in poor socio economic settings in India
M. Sharma 1
1Department of Radiation Oncology, Maulana Azad Medical College, Ghaziabad, India
Introduction: The compliance to supportive/palliative therapy in Indian patients is unacceptably low
Objectives: To improve awareness and compliance to palliative therapy in deserving patients.
Methods: Patients requiring supportive therapy are classified into four groups:
1-Terminally ill patients
2-Curable patient with no family support.
3-Geriatric Patients.
4-General patients requiring supportive therapy.
Patients were given therapy as per protocol for curable and incurable cancers. The acceptance/non acceptance by the patient was recorded.
Further investigative follow up in order to study compliance for advised treatment. Extensive investigational study with regards to intellectual and financial status vis-a-vis family related acceptance, psychological, emotional attachment or distancing was also carried out
Results: Acceptance for palliative/supportive care in the incurable cases is very poor at first recommendation in Delhi. Option for, costlier medicine, expensive medical care is seen in some section of patients not realizing poor prognosis of the case.
Acceptance for admission in terminal care home was only 5–10 % in various socioeconomic classes with special reference to their family circumstances and emotional attachments to the suffering patient
Conclusions: Inadequate awareness, among patients, doctors, illiteracy, lack of initiative from the oncologist is main cause of low acceptance for palliative care.
Misguidance by corporate sector hospitals, pharma companies and their sponsored doctors is another cause of insisting for wasteful, exorbitant cost curative Methods on the patients suitable for palliative therapy. Even at the cost of selling property and valuables. And this is crippling the economy of the patient and the nation.
MASCC-0359
An evaluation of the impact of a specialist palliative care team on the symptomatology of a heterogeneous group of hospital inpatients
A. Davies 1, K. Smith1, J. Fryer1
1Palliative Care, St. Luke’s Cancer Centre, Guildford, United Kingdom
Introduction: The MSAS-SF is a validated tool for the assessment of physical and psychological symptoms, and has been integrated into the holistic assessment undertaken by our specialist palliative care team (SPCT)
Objectives:
1. To assess the impact of the SPCT on the symptomatology of a heterogeneous group of hospital inpatients (using the MSAS-SF).
2. To assess the utility of the MSAS-SF in this setting
Methods: This service evaluation examined 200 consecutive patients referred to the SPCT; 104 patients were able to complete the MSAS-SF on first assessment, and 55 patients completed a further MSAS-SF at 1 week or on discharge (if sooner).
Results: Data will be presented on the frequency of symptoms, the distress caused by the symptoms, and the change in symptoms over time. 83 % patients reported pain on first assessment, and 78 % of patients reported an improvement in pain after 1 week (of at least one point on the categorical scale). The mean Physical Symptom Subscale score improved from 1.74 to 1.15; 45 patients had an improvement in this score, 2 patients had no change, and 8 patients had a worsening in this score. Data for Psychological Symptom Subscale scores, and the Global Distress Index scores, will also be presented.
Conclusions: This service evaluation confirms that the specialist palliative care team does improve the symptomatology of a heterogeneous group of hospital inpatients, and that the MSAS-SF can be a useful tool in this setting (although many patients are unable to complete such tools due to cognitive impairment/poor performance status).
MASCC-0360
Treatment of depressive symptoms in breast cancer patients undergoing adjuvant therapy
R. Navari 1
1Medicine, Indiana University School of Medicine South Bend, South Bend, USA
Introduction: Women with breast cancer may have a high risk of depression and may develop a high level of depressive symptoms at the time of initial diagnosis.
Objectives: Newly diagnosed early stage breast cancer patients were screened for depressive symptoms prior to the initiation of adjuvant therapy
Methods: Patients with depressive symptoms were randomized in a double blind fashion to daily oral fluoxetine (20 mg) or placebo. Patients were followed for 6 months and evaluated for quality of life, completion of adjuvant treatment, and depressive symptoms. Patients with stage I disease at initial diagnosis were subsequently assessed for disease recurrence and survival at 5 years
Results: Two hundred three of 357 screened patients with newly diagnosed early stage breast cancer were found to have depressive symptoms prior to the initiation of adjuvant therapy. One hundred ninety-three patients were randomized to fluoxetine or placebo. The use of fluoxetine for 6 months resulted in a significantly (p < 0.01) higher number of patients with an improvement in quality of life, a higher completion of adjuvant treatment (chemotherapy and/or hormonal therapy,) and a reduction in depressive symptoms compared to patients who received placebo. At 5 years, there was a significant (p < 0.01) improvement in survival for patients with Stage I disease who received fluoxetine, possibly related to a higher completion of adjuvant treatment
Conclusions: An antidepressant should be considered for early stage breast cancer patients with depressive symptoms who are receiving adjuvant treatment.
MASCC-0361
Can we improve survival and mortality in the unfavorable type of endometrial Carcinoma
D. Boll 1
1Gynecology, Tweesteden Ziekenhuis, Tilburg, Netherlands
Introduction: Malignancy of the corpus uteri is the fifth most common cancer in women. The most common type is endometrial carcinoma (EC), of which 20 % occur with unfavorable tumour characteristics namely grade 3 EC, advanced-stage EC and non EC endometrioide (NEEC).
Objectives: These tumour types are responsible for the majority of deaths from EC. In order to improve survival for women with EC and decrease their mortality treatment strategies have been proposed in addition to the standard surgery and radiotherapy, such as extensive cytoreductive surgery and adjuvant chemotherapy, this has however not yet been proven in randomized trials.
Methods: The aim of this review is to discuss the recommended aggressiveness of therapy to improve survival and reduce mortality in this vulnerable group of older patients.
Results: The unfavorable tumor characteristics of EC and the NEEC tumors mainly occur in patients aged 75 +, who frequently suffer from multimorbidity and who are more vulnerable. The survival and mortality is clearly influenced by patient characteristics.
Conclusions: Caring for the patient, as well as her cancer, requires an evolving response and measures to preserve or enhance the quality as well as the quantity of life.
Reference List
MASCC-0362
Assessment of the disease subjective experience of suffering in women with breast cancer
S. Remondes-Costa 1, M. Rocha1, F. Jiménez2, J.O.S.E. Pais-Ribeiro3
1Educacion and Psychology, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal, 2Department of Personality Assessment and Psychological Treatments, University of Salamanca, Salamanca, Spain, 3Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
Introduction: The presentation of the cancer diagnosis to a patient is one of the situations where it is more noticeable the suffering experience. The presence of suffering in a current disease experience is a bio psychosocial phenomenon, which it is not limited to the pain, but affects several personal dimensions: bodily dimension, identity, family and social relationships and the work and the spiritual areas.
Objectives: The current study goal is to assess the subjective experience of suffering in women with breast cancer. It is intended to perform variance analyses in order to comprehend if the subjective suffering dimensions vary according to some sociodemographic and clinical variables.
Methods: The sample comprises 104 women with breast cancer that were in treatment at the data collection moment, aged 29 to 82 years (M = 55.22; SD = 13.07).
Data were collected by means of self-report questionnaires, namely by answering to a sociodemographic and clinical questionnaire build especially for the study, and to the Inventory of Subjective Experiences of Suffering in the Disease (ISESD, McIntyre & Gameiro, 1999). The instrument allows the assessment of the physical, psychological, relational, existential, and the positive suffering experiences.
Results: The results indicate that the relational and the psychological suffering experiences present the highest scores. Another important finding is that the suffering experience varies depending on the women’s level of education.
Conclusions: We think that more studies are needed and can alter the state of the art concerning the relation between both variables.
MASCC-0363
Psychopathological symptomatology assessment in women with breast cancer
S. Remondes-Costa 1, M. Rocha1, F. Jiménez2, J.O.S.E. Pais-Ribeiro3
1Educacion and Psychology, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal, 2Personality Assessment and Psychological Treatments, University of Salamanca, Salamanca, Spain, 3Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
Introduction: The presence of psychological symptomatology happens very often, and it is well documented in the literature. The simptomatology screening and treatment is essential in oncology, since the symptoms cause suffering, they don’t allow for effective coping, they interfere with the patients’ treatments adhesion and they undermine the patients’ quality of life
Objectives: This study as goals to assess the psychopathological symptomatology of women with breast cancer, identifying the most frequents symptoms, investigating if the symptomatology varies accordingly with some sociodemographic and clinical variables
Methods: The sample comprises 104 women with breast cancer that were in treatment at the data collection moment, aged 29 to 82 years (M = 55.22; SD = 13.07).
Data were collected by means of self-report questionnaires, namely by answering to a sociodemographic and clinical questionnaire build especially for the study, and to the Brief Symptoms Inventory (BSI, Derogatis, 1975; Portuguese adaptation by Canavarro, 1999, 2007)
Results: The results indicate that those anxious, obsessive-compulsive and depressive symptomatologies are the most prevalent pathologies, even though without any clinical relevance. The obsessive-compulsive and depressive symptoms’ present the highest levels of severity among the three most frequent
Conclusions: The obsessive-compulsive symptoms should be further investigated, since little is referenced in the literature.
MASCC-0364
Prognostic factors of invasive pulmonary aspergillosis in patients with acute leukemia
O. Mishcheniuk 1, Z. Mart?na1, A. Tovstohan1, S. Kravchenko1, I. Dyag?l1
1Hematology and Transplantology, SI “NRCRM of NAMS of Ukraine”, Kiev, Ukraine
Introduction: Despite, recent advances in the diagnosis and management of invasive pulmonary aspergillosis (IPA), the latter is associated with significant mortality in acute leukemia (AL) patients. Determination of clinical variables and AL associated factors to prognosis of IPA is useful for optimization of patients management
Objectives: An objective of the study was to analyze outcomes and prognostic factors in AL patients with IPA.
Methods: We studied all verified IPA cases in AL patients (109 subjects) from 2009 to 2012 years at a department of hematology and transplantology of NCRM of NAMS of Ukraine. The diagnosis of IPA was established by 13 (11.9 %) AL patients, all of them had neutropenia (<0.5 × 109/L) for a median of 18 days (range 13–78) at a time of diagnosis. The median delay from diagnosis to start of therapy was 1 days (range 0–3)
Results: Five (38.4 %) patients died. Five (38.4 %) and two (15.3 %) of patients were assessed as having a partial and complete response to specific therapy, respectively. IPA associated mortality was greater in group of patients with hepatic and/or renal failure (3 from 5 vs. 0 from 7, p = 0.03). Refractory and relapsed AL was associated with an unfavorable response to IPA therapy and elevated risk of 12-week mortality to 6.4 –fold (relative risk [RR]; 95 % confidence interval [CI], 1.1–36.4; p = 0.032)
Conclusions: IPA remains as a poor therapeutic outcome, especially in patients with comorbidity and refractory/relapsed AL.
MASCC-0365
Development of a nurse-led survivorship intervention for long-term survivors of Hodgkin lymphoma
P. Gates 1, J.F. Seymour2, M. Krishnasamy3
1Late Effects Service, Peter MacCallum Cancer Centre, Melbourne, Australia, 2Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia, 3Cancer Nursing Practice and Research, Peter MacCallum Cancer Centre, Melbourne, Australia
Introduction: The increasing numbers of Hodgkin Lymphoma (HL) survivors, has raised awareness of the need to optimise long-term health outcomes and quality of life for this group.
Objectives: To develop and pilot-test the feasibility and potential of a nurse-led survivorship intervention to enhance HL survivors’ awareness of health risks and adoption of healthy lifestyle behaviours.
Methods: A pre-post test. Thirty survivor participants and 30 healthy controls were recruited to receive the intervention at 4 time points. Data were collected using the General Health Index and the Health Promoting Lifestyle Profile II. The intervention included: i) exploration of knowledge of health risks and lifestyle behaviours; ii) delivery of a tailored education package; iii) screening for unmet supportive care needs and iv) development and delivery of a tailored survivorship care plan
Results: Statistically significant improvements were reported for physical activity (p = 0.014); nutrition (p = 0.0005); stress management (p = 0.002) and health promoting lifestyle (p = 0.005) from baseline to 6 months. 57 % of survivors reported some level of fatigue for most of the time in the last 2 weeks; 47 % reported feeling a lot of worry; 37 % reported sleep problems; and 23 % reported feeling depressed
Conclusions: The intervention was shown to be feasible and demonstrated potential to improve survivors’ health status. A randomised controlled trial is needed to further test the efficacy of the intervention; determine optimal dose and the best time to deliver the intervention to prevent the considerable levels of physical and emotional need reported by this study group.
MASCC-0366
Evaluation of ‘patient-oriented’ cover makeup products for patients with skin changes related to cancer therapy
T. Wakeda 1, K. Nishioka1, E. Tsuji1, K. Tada1, K. Nemoto2, S. Nagai2, Y. Kataoka2, E. Otomo2, T. Ogawa1, Y. Heike3
1Department of Breast Surgery, The University of Tokyo, Tokyo, Japan, 2Nursing Department, The University of Tokyo, Tokyo, Japan, 3Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
Introduction: Cancer therapy often causes unsightly skin changes; operative scars and pigmentation on faces or fingers due to chemotherapy. In our previous study, we found that patients did not willingly accept their skin changes even though they were inevitable for treatment. We also showed that cover makeup satisfied patients with skin changes. However, patients weren’t satisfied with the cover foundation cream itself, ‘Not easy to use’, ‘Stuck to the clothes’, ‘Came off easily’ and ‘Weak to water’. Therefore, we developed the ‘patient-oriented’ products overcoming patients’ claims and conducted the study to evaluate whether they could contribute to the patients’ Quality of Life.
Objectives: Any patients with skin changes related to cancer treatment.
Methods: Skin reactions are concealed with mainly 2 types of the novel products, cream in a ‘compact’ or a ‘tube’. The compact type cream is used for skin changes on faces, just as usual makeup. As to the tube type cream, patients only have to spread the cream on the changed region to get strongly water-resistant cover effect.
Results: Though our study is going on, the novel products covered pigmentation and scars related to treatment almost perfectly (cf. pictures), and made most cancer patients feel satisfied so far. The water-resistant cream could respond the patients’ senses, ‘I’d like swimming’.
Conclusions: It seems that the ‘patient-oriented’ products would be important to deliver quality patient care.
MASCC-0367
Multivariate analysis of correlations between incidence of delirium and delirium-initiating factors in advanced cancer patients in a palliative care unit
N. Mizukami 1, M. Yamauchi1, A. Watanabe1, K. Koike2, M. Yamakage1
1Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan, 2Division of Palliative Medicine, Higashi-Sapporo Hospital, Sapporo, Japan
Introduction
Introduction: Delirium is one of the most frequent symptoms in cancer patients. It not only impairs cognition and patient’s quality of life but also causes anxiety for the patient’s family. Although many delirium-initiating factors have been considered, there are still few reports showing significant delirium-related initiating factors in advanced cancer patients.
Objectives: We retrospectively investigated the correlation between incidence of delirium and each initiating factor by multivariate analysis.
Methods
Methods: Seventy-six patients in a high-performance palliative care unit were divided into a delirium group and a non-delirium group. Delirium was diagnosed using the confusing assessment method by our medical staff. Delirium-initiating factors included existence of brain tumor, epilepsy, hyperammonemia, hypercalcemia, hyponatremia, medication with a steroid, narcoleptic, opioid, anticholinergic, antiemetic or antibiotic drugs, radiation therapy, infection, anemia, malnutrition, age over 60 years, cerebral infarction and Alzheimer’s disease. The prevalence of each factor, Spearman’s rank-correlation coefficient and multivariate analysis were performed for statistical analysis.
Results
Results: Delirium occurred in 27 (36 %) of the patients. Hypercalcemia (Correlation coefficient: 0.324) and medication with a narcoleptic (0.322) had significant correlations with incidence of delirium (p < 0.05). Multivariate analysis also demonstrated that Hypercalcemia (p = 0.006; odds ratio: 12) and the use of a narcoleptic (p = 0.003; odds ratio: 5.2) were significant initiating factors for delirium.
Conclusions
Conclusion: Despite highly professional palliative care, delirium was observed in 36 % of the patients with end-stage cancer. We should pay more attention to calcium metabolism and medication with narcoleptics in end-stage cancer patients in order to decrease the incidence of delirium.
MASCC-0368
The effectiveness of the NK1 receptor antagonist, aprepitant for gynecologic cancer chemotherapy -induced nausea and vomiting
M. Ikeda 1, H. Kan-no1, T. Narayama1, C. Narayama1, M. Yasaka1, T. Tajima1, M. Shida1, T. Hirasawa1, M. Mikami1
1Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
Introduction: Chemotherapy induced nausea and vomiting (CINV) is one of the side effects frequently happened. While the standard therapy (dexamethasone + 5-hydroxytriptamine-3(5-HT3) receptor antagonist) is highly effective for CINV on acute phase, the effectiveness to delayed period is poor.
Objectives: To examine the effectiveness of the additional administration of the neurokinin (NK)1 receptor antagonist, aprepitant for patients with CINV.
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Methods: Between July 1, 2010 and March 31, 2012, in Tokai University Hospital, 173 patients who are scheduled moderately and highly emetogenic chemotherapy were enrolled. We underwent the additional administration of aprepitant to standard antiemetic therapy for patients had CINV Grade 2 or more in CTCAE ver. 4.0. The primary endpoint was complete response (CR) during the acute and delayed phase.
Results: By the combination of standard antiemetic therapy and aprepitant, reducing effect of CINV comparable to those patients who do not require the additional administration of aprepitant were observed. In Cisplatin (CDDP) regimen with aprepitant, a significant improvement was observed in acute and delayed period. In Carboplatin (CBDCA) regimen, CR on the acute phase with standard therapy had been obtained, a significant improvement with aprepitant was observed in the delayed period. By looking at the changes in CINV, CDDP regimen showed improvement around the fourth day from the first day. On the other hand, with CBDCA regimen showed improvement after the second day, in the third and fourth day in particular. The improvement of CINV by administering aprepitant positive correlation was observed.
Conclusions: Addition of aprepitant to standard antiemetic therapy was effective for gynecologic cancer chemotherapy.
MASCC-0369
Cisplatin intraperitoneal administration for treatment of symptomatic malignant ascites in patients with advanced gastric cancer
S. Hamauchi 1, H. Yasui1, Y. Onozawa1, A. Fukutomi1, K. Yamazaki1, N. Machida1, T. Yokota1, A. Todaka1, T. Tsushima1
1Gastrointestinal Oncology, Shizuoka Cancer Center, Sunto-gun, Japan
Introduction: Symptomatic ascites is a most common complication of advanced gastric cancer (AGC), and impair a patient’s quality of life. The treatment for these patients is limited.
Objectives: The objective of this study was to review the safety and efficacy of cisplatin intraperitoneal administration (CDDP i.p.) in Japanese patients with AGC.
Methods: The subjects were 59 patients with AGC who received CDDP i.p. for symptomatic malignant ascites between September 2002 and October 2012 at the Shizuoka Cancer Center. Intraperitoneal CDDP was administered once a week at 200 mg/body with thiosulfate 10 g/body bolus and continuous infusion after drainage almost ascites. Drainage free survival (DFS) was counted from the date of treatment initiation to the date of re-drainage or death.
Results: Of the 59 patients, 40 (68 %) were male, 36 (61 %) were ECOG PS of 3 and the median age was 58 years. Fifty five patients (93 %) have received prior chemotherapy with a median number of regimens of 2 (range: 0–5).
The median DFS was 30 days, and the median survival time was 90 days. The median length of hospitalization was 16 days.
Ascites response was 47 % and the rate of PS improvement was 27 %. Twenty seven patients (46 %) could increase dietary intake and eight patients (14 %) became to be able to withdraw intravenous infusion. The most commonly CDDP i.p. related adverse events were fever (Grade1/2 34 %) and abdominal pain (Grade1/2 27 %).
Conclusions: The CDDP i.p. for symptomatic malignant ascites of AGC patients is well tolerated and may be one optional treatment.
MASCC-0370
Transcriptome profiling of peripheral leukocytes to identify potential biomarkers for oxaliplatin induced neuropathy
M. Morales 1, L. Boronat1, M.L. Soriano1, R. Gonzalez-Fernandez2, J. Avila2, P. Martin-Vasallo2
1Medical Oncology, Hospital Universitario Ns Candelaria, SANTA CRUZ DE TENERIFE, Spain, 2Biochemistry & Molecular Biology, University of La Laguna, LA LAGUNA, Spain
Introduction: Peripheral neuropathy is an important side effect of oxaliplatin, greatly affecting function and quality of life.
Objectives: The aim of the study is the differential gene expression induced by FOLFOX chemotherapy (CT) in leucocytes.
Methods: Peripheral leukocytes from patients before and after three FOLFOX cycles were isolated with Ficoll-Hypaque gradient. We isolated mRNA from leukocytes from ten patients with 2–4 grade neuropathy and differential transcriptome were analysed.
Results: Differential transcriptomics showed a series of genes expressed at variable number of mRNA copies. Comparison between both series (post- and pre-CT) gave a list of about 1,200 genes, from those, we selected all expressed, at least, twice as much as their correspondent. 270 genes were selected. This list includes genes coding for metabolic proteins (mitochondrial and cytosolic), transcription factors, cellular dynamics and enzymes involved in drug resistance mechanisms.
Conclusions: These results show that FOLFOX chemotherapy varies the expression of some genes that, ultimately, drives the cell to two opposite fates: apoptosis or survival and mitosis. Along with this effects on cancer cells, cytotoxicity produces non-desirable effects on normal healthy tissues, some of these variations could be causative CT unwanted effects. Is our propose to get the trascriptome of patients suffering from peripheral neural toxicity induced by FOLFOX in order to know what genes are involved in such non-desirable effect and through what specific signal transduction ways.
References:
1. Eur J Cancer 2008: 44; 1507–1515.
2. J. Peripher. Nerv. Syst. 2008: 13; 27–46.
3. Eur. J. Cancer 2007: 43; 2658–2663.
MASCC-0371
Interregional guideline of the role of complementary therapies in supportive care in oncology
S. Trager 1, M. Rodrigues2, F. Farsi3, D. Alimi4, I. Krakowski5
1Oncology, Groupe Hospitalier Public du sud de l’Oise, Senlis, France, 2Oncology, Institut Curie, Paris, France, 3Oncology, Réseau Espace Santé Cancer Rhône-Alpes, Lyon, France, 4Centre de Traitement de la Douleur, Institut Gustave Roussy, Villejuif, France, 5Oncology, Centre Alexis Vautrin, Vandoeuvre les Nancy, France
Introduction: Complementary and alternative medicines are used worldwide by cancer patients. Those practices are now taking a significant place in the health services though they still represent a divisive issue in France. The French public authorities have recently launched a global reflection on this subject.
The French association for supportive care in cancer (AFSOS) has organized a survey in partnership with the French National Academy of Medicine and a guideline to offer to caregivers information on complementary therapies.
Objectives: To elaborate a guideline for professionals to better inform cancer patients about the use of complementary therapies.
Methods: In accordance with the AFSOS1 procedure, an interregional working group including physicians, oncologists, nurses, supportive care specialists, and other professionals involved in complementary therapies has been created.
This group achieved the following tasks:
- An analysis of the literature published on this topic.
- Several phone meetings allowing circumscribing the question, defining the methodology and elaborating a work plan.
- This work has been presented and discussed during the “national supportive care guidelines sharing days”, which were organized by AFSOS in December 2012. As a result of the working session, the modifications were integrated and a complete validation was obtained by consensus in plenary session
Results: cf
Conclusions: This French interregional and multidisciplinary guideline is a very useful tool to help teams informing patients on risks and benefits of these therapies, aiming at getting rid of prejudices and reminding the regulatory framework. The final goal is to enhance the relationship and the dialog between patients, complementary medicine practitioners and caregivers.
MASCC-0372
Factors contributing to a good cancer death—findings from a study of hospital and home deaths in Cape town
C. Manicom 1
1Social Work, GVI Oncology, Cape Town, South Africa
Introduction: A study of hospital and home deaths from patients of a private oncology practice in Cape Town provided insight into the survey respondent’s observations about the dying process.
Objectives: The objectives were to establish whether or not a Good Death was possible in a hospital context, and what other factors contributed to the respondent’s perception of a Good Death. To quantify these objectives, the study listed components that family members believed contributed to a Good Death, and assessed how many family members thought the death they experienced was a Good Death.
Methods: The postal survey yielded 24 respondents from the Hospital Death (HospD) category and 34 from the Home Death (HD) category who were requested to provide their own wording to describe a Good Death and were additionally asked whether they believed the death to have been a Good Death.
Results: Basic demographic details of the deceased are provided as a backdrop to survey results. The ten most commonly mentioned themes formed the list of components of a Good Death which will be presented. 50 % of the HospD and 56.7 % of the HD group believed this was a Good Death, with 25 % and 40 % respectively being unsure. 25 % of the HospD group and 3.3 % of the HD group responded that this had not been a Good Death.
Conclusions: Good Death is possible in an acute care hospital setting, and dying at home does not always guarantee a Good Death. Suggestions for assisting the dying patient to a better death are provided.
MASCC-0374
The brief cope in cancer research
M. Hankins 1, C. Foster1, N. Hulbert Williams2, M. Breckons1
1Faculty of Health Sciences, Macmillan Survivorship Research Group, Southampton, United Kingdom, 2Department of Psychology, University of Chester, Chester, United Kingdom
Introduction: The need to understand the problems faced following treatment and how they are resolved is becoming increasingly important for cancer survivors and service planners. The Brief COPE is used in research to assess coping strategies used by cancer patients at various stages; it comprises 28 items covering 14 domains of coping and is reported to have acceptable reliability and validity.
Objectives: To explore the reliability and factor structure of the Brief COPE for cancer research using data from three separate studies
Methods: Brief COPE data were collected in three separate studies (N = 182; N = 160; N = 130). Reliability of subscales was assessed cross-sectionally within each sample using Cronbach’s Alpha. Factor structure was examined using exploratory and confirmatory factor analysis on pooled data (N = 472).
Results: Scale reliability varied widely across scales and samples (0.40 to 0.96), equating to measurement error of between 4 % (good) and 60 % (unacceptable). Scales with low reliability were Acceptance, Self-distraction, Behavioural Disengagement, Venting and Denial. Scales with high reliability (Alpha > 0.80) were Emotional Support, Substance use, Religion and Humour. The proposed structure of 14 subscales was not supported by the pooled data
Conclusions: The Brief COPE measures coping strategies with varying reliability, with some scales falling far below acceptable thresholds. The proposed structure of 14 subscales was not supported by analysis of the pooled data,
The kinds of coping strategies used by people with cancer should be clarified with more detailed qualitative research and new, more reliable measures developed with greater patient involvement if the concept is to retain any utility in cancer research.
MASCC-0375
Vaginal dryness in haemato-oncological patients prevention and treatment decision tree
C. Eeltink 1, O. Visser1
1Haematology, VU University Medical Center, Amsterdam, Netherlands
Introduction: Haemato-oncological patients can suffer from vaginal dryness causing itching, burning, irritation, and pain, and as a result sexual activity can be compromised. Despite the various safe and effective options only a minority of the patients will seek help.
Objectives: To present a decision tree in which basic information on the differential diagnosis can decide which treatment should be used.
Methods: Relevant published literature was used to identify the etiology and the available strategies for vaginal dryness in haemato-oncological female patients.
Results: In haemato-oncological patients vaginal dryness can be caused by different reasons, e.g. sexual problems, or by vaginal atrophy as a result of (premature) menopause, or by pain due to (chronic) graft versus host disease. The decision tree differentiates between prevention and treatment. Each risk factor needs a particular intervention: topical or systemic estrogen therapy for vaginal atrophy, non-hormonal moisturizer to hydrate the vaginal mucosa, or a vaginal lubricant to minimize dryness and pain during sexual activity.
Conclusions: With help of the decision tree, healthcare providers are able to distinguish between the various options to treat and prevent vaginal dryness. Women should be educated about the need of the various strategies, such as vaginal lubricants, moisturizers and estrogen therapy.
MASCC-0376
Early evaluation predicts pain relief of irradiated bone metastases: a single-center prospective study
P. Truntzer 1, D. Atlani2, M. Pop1, J.B. Clavier1, S. Guihard1, C. Schumacher1, G. Noel1
1Radiotherapy, Centre Paul Strauss, STRASBOURG Cedex, France, 2Radiotherapy, Centre Hospitalier Pasteur, Colmar, France
Introduction: Radiation therapy is an effective modality used for palliative care. Most studies completed to date have endpoints of 1 month or greater after treatment completion.
Objectives: This study analyzed the response rates at different time points during the first month after treatment
Methods: From May 2010 to November 2011, 61 patients treated for 74 metastases were included in the study. The end points were defined as the completion of treatment (CT) and d8, d15 and d30 after the completion of treatment. The response rate was measured by the worst pain in the last 24 h and the administered opioid dose. Patient assessment was performed during consultations and phone appointments.
Results: The overall response rate significantly improved from the CT (38 %) to d8 (53.8 %), d15 (53.8 %) and d30 (57.1 %) (respectively p < 0.001; p < 0.001 and p = 0.001). The improvement peaked at d8. Patients responding to the treatment at d8 had a significative longer pain relapse free survival (PRFS) compared to patients not responding (3.38 weeks vs 0.3 weeks; p < 0.001). However, the pain decrease did not result in a performance status improvement, which declined over time (p < 0.001).
Conclusions: Radiation therapy is an efficient treatment method for providing pain relief. This relief continues until d8 after treatment, and the response at d8 is predictive of the response at 4 weeks. Pain management alone is not enough to improve performance status, further studies are need to evaluate a more global supportive care approach.
MASCC-0377
Content validation of the brain symptom and impact questionnaire (BASIQ) in patients and health-care professionals to assess quality of life in patients with brain metastases
G. Bedard1, S. Ray2, L. Zhang1, L. Zeng1, D. Cella3, E. Wong1, C. Danjoux1, M. Tsao1, E. Barnes1, A. Sahgal1, L. Holden1, N. Lauzon1, E. Chow 1
1Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada, 2Health Economics & Outcomes Research (HEOR), Abbvie, North Chicago, USA, 3Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
Introduction: Brain metastases specific questionnaires are lacking.
Objectives: To validate the content items of the Brain Symptom and Impact Questionnaire (BASIQ) for brain metastases.
Methods: Patients with brain metastases and their health care professionals (HCPs) assessed the relevance of each item of the BASIQ on a 0–10 scale with 10 as extremely relevant.
Results: Fifty two patients and 20 HCPs participated in this study. 95 % of HCPs and 85 % of patients found all items on the BASIQ to be relevant. Balance and walking ability were rated relevant by 100 % of patients and HCPs. Headache, nausea, energy, memory, and ability to do housework were also rated relevant by 100 % of HCPs. Over 95 % of patients determined the items of ability to do housework, tiredness, energy, vision, memory, and putting ideas into words as relevant. There were no items rated below 7 by patients or below 5 by HCPs. Balance (8.4) and walking ability (8.3) were rated the most relevant items by patients, while headache (8.4) and nausea (8.3) were rated the most relevant by HCPs. No new issues were consistently identified, and no item was consistently rated as being inappropriate, upsetting or irrelevant. When comparing patients with HCPs, there was no significant difference in the determination of whether or not an item was relevant.
Conclusions: The BASIQ encompassing symptom and impact designed specifically for use in the brain metastases population has undergone successful content validation. Its psychometric validation is ongoing.
References
Acknowledgement: We thank the sponsor of Abbvie and the survey participants
MASCC-0378
Efficacy and cost-evaluation of web-based guided self-help targeting psychological distress in cancer survivors
I. Verdonck-de Leeuw 1, A.M. Krebber1, H.F.E. Smit2, B.I. Witte3, R. de Bree4, P. Cuijpers2, A. van Straten2, G.M. Eeckhout5, A.T.F. Beekman5, C.R. Leemans4
1Otolaryngoloy/Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands, 2Clinical Psychology, VU University, Amsterdam, Netherlands, 3Epidemiology and Biostatistics, VU University, Amsterdam, Netherlands, 4Otolaryngology/Head and Neck Surgery, VU University, Amsterdam, Netherlands, 5Psychiatry, VU University, Amsterdam, Netherlands
Introduction: Cancer survivors often suffer from psychological distress. Information on cost-effectiveness of psychosocial intervention among cancer survivors with distress is scarce.
Objectives: To develop and evaluate efficacy and costs of a web-based guided self-help intervention targeting psychological distress in head and neck cancer survivors
Methods: In a randomized clinical trial, patients with distress in the intervention group followed a stepped care model: 1. Watchful waiting 2. Guided self-help. In the control group, patients received care as usual. Outcome measures were the HADS, EORTC QLQ-C30, QLQ-HN35, and QLQ-PATSAT and were evaluated before and direct and at 3 months after intervention. Effect sizes were calculated and linear mixed models and t-tests were used to assess differences between the groups regarding the course of the outcomes from baseline to follow-up. A cost utility analysis was performed using data on EQ-5D and health care utilization and work loss (TIC-P and PRODISQ).
Results: Forty-five patients were randomized into the intervention group (24 % preferred to use the Internet format) and 36 in the control group. Intervention was beneficial with effect sizes ranging from 0.80 (HADS-total), 0.73 (HADS-A), and 0.75 (HADS-D) post-treatment to 0.72, 0.64, and 0.67 at follow-up. At follow-up, mean HADS differences were no longer statistical significant. Several QOL domains improved significantly, especially at follow-up. The incremental costs were €438 (SE = 372) and the incremental effect utility was 0.06 (SE = 0.045)
Conclusions: This pilot RCT reveals that among distressed cancer survivors, guided self-help speeds up recovery of distress with beneficial effects on quality of life in the longer term, but to additional costs.
MASCC-0379
Development and validation of a new tool for functional evaluation in cancer patients: the cancer functional assessment set (CFAS)
C. Miyata 1, T. Tsuji1, K. Honaga1, A. Ishikawa1, A. Tanuma2, M. Liu1
1Rehabilitation, Keio University School of Medicine, Tokyo, Japan, 2Rehabilitation, Shizuoka Cancer Center, Shizuoka, Japan
Introduction: Over the past several years, the demand for cancer rehabilitation services has increased. Rehabilitation specialists must properly evaluate the neuromuscular, musculoskeletal, and functional status of patients in order to deliver more effective rehabilitation. Such a measurement tool should be a single assessment that is both usable in daily clinical practice and suitable for various stages of cancer.
Objectives: The purpose of this study was to develop and evaluate psychometric properties of a new measurement tool, the Cancer Functional Assessment Set (cFAS).
Methods: This study took place in four phases: 1) item generation, literature search, and a round table discussion with three rehabilitation specialists; 2) item reduction and selecting appropriate items from the first item pool; 3) validity testing involving 69 cancer inpatients at the Shizuoka Cancer Center to assess construct validity and concurrent validity; and 4) responsiveness, in which standardized response mean values were calculated.
Results: The cFAS consists of 24 items. Factor analysis identified six factors: maximal ability for daily living activity (factor 1); muscle strength (factor 2); balance (factor 3); ankle ROM (factor 4); sensory function (factor 5); and shoulder ROM (factor 6). Significant correlations were found between the total cFAS score and existing scales (ECOG-PS, KPS, and FIM). The cFAS was more responsive to changes than the other tools, regardless of the treatment regimen.
Conclusions: The cFAS was developed and found to have good validity and responsiveness. It can be a useful tool in clinical trials and contribute to development of cancer rehabilitation.
MASCC-0380
Reliability of the newly developed cancer functional assessment set (CFAS)
C. Miyata 1, T. Tsuji1, K. Honaga1, A. Ishikawa1, A. Tanuma2, M. Liu1
1Rehabilitation, Keio University School of Medicine, Tokyo, Japan, 2Rehabilitation, Shizuoka Cancer Center, Shizuoka, Japan
Introduction: A new tool for functional evaluation in cancer patients, the Cancer Functional Assessment Set (cFAS), was developed. It is based on the World Health Organization model of ICIDH and ICF and is useful for planning a more effective rehabilitation program and modifying goals in accordance with patients’ conditions.
Objectives: The purpose of this study was to evaluate the reliability of the cFAS.
Methods: Cronbach’s alpha was calculated for a sample of 69 cancer inpatients to determine the degree of internal reliability of the 24 items of the cFAS. Inter-rater reliability testing was conducted in 20 inpatients. Two raters evaluated each patient with cFAS independently within a 24-hour period. To estimate inter-rater reliability, weighted kappa statistics were used for the 24 items, and the intra-class correlation coefficient, the ICC (2,1), was used for the total cFAS score.
Results: Cronbach’s alpha coefficient for the cFAS exceeded Nunnally’s criterion of 0.7. The ICC (2,1) for the total cFAS score was 0.97. Using the weighted kappa for scale items, agreement between investigators ranged from substantial (0.74) to almost perfect (1.00).
Conclusions: Cronbach’s alpha coefficient for the cFAS demonstrates acceptable internal consistency. The weighted kappa statistics for the 24 items of the cFAS and the ICC for the total cFAS score demonstrated sufficient inter-rater reliability. These results indicate that the cFAS is a reliable instrument.
MASCC-0381
Development of a self-management portal for patients after total laryngectomy
I. Verdonck-de Leeuw 1, I.C. Cnossen1, C.F. van Uden-Kraan1, S.E. Eerenstein1, R. de Bree1, C.R. Leemans1
1Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands
Introduction: After total laryngectomy patients have to deal with altered speech, swallowing and smell function.
Objectives: We aim to develop a self-management portal to support patients in their rehabilitation process. To ensure sufficient adoption, a participatory process design is followed.
Methods: A patient’s needs assessment (N = 9) was conducted through a focus group interview. Care professionals (N = 11) discussed the intervention content and structure. A plan of requirements was formulated. Usability of the intervention prototype was tested by patients (N = 6). Speech therapists (N = 10) participated in cognitive walkthroughs.
Results: A self-management portal was build including information about 1) flexibility exercises for neck and shoulders, 2) nutrition, 3) olfactory rehabilitation, 4) tracheostomy care, 5) voice prosthesis care, 6) speech rehabilitation. Based on the usability tests the user interface was adjusted. Speech therapists appreciated the completeness of information and the way the information was offered (multimedia). All expressed the intention to implement the intervention in regular care when available
Conclusions: Study results give insight into the characteristics needed to design a useful e-health portal, with a guided web-based intervention to provide information and support patients after a laryngectomy during the rehabilitation process. A booklet with DVD will be made available for patients without internet access.
References: www.verderzonderstembanden.nl
MASCC-0382
The utilization of telephone follow-up in the advanced cancer population: a review of the literature
R. Chow 1, M. Zhou1, E. Chow1, G. Bedard1, L. Zeng1, H. Lam1, D. Chu1, N. Lao1, N. Lauzon1, L. Holden1
1Radiation Oncology, Odette Cancer Centre, Toronto, Canada
Introduction: Telephone follow-up is becoming more frequently used as an adjunct to clinical follow-up
Objectives: To review the literature, examine the utility and effectiveness of telephone follow-up in the advanced cancer population
Methods: A literature search was conducted on Medline (1980—April week 4 2012), Embase (1980—2012 week 17), Cochrane Central Register of Controlled Trials (April 2012) and CINAHL (1981—July 31 2012)
Results: A total of 11 studies were identified that were published between 2001 and 2011. Follow-up at week 4 (month 1) was the most common interval for patient contact. Information collected during the contact varied with the study, however the most commonly used tool was the ESAS. Other information included analgesic diary, patient feedback, satisfaction with the care, post treatment side effects, along with a variety of quality of life questionnaires. Some studies provided information to the patient about protocols for care, advice and coping strategies. Attrition was common even with the use of telephone contact in place of clinical follow-up.
Conclusions: Telephone follow-up is a feasible alternative to traditional hospital follow-ups for assessment of symptom palliation. There are fewer burdens on the patient allowing for a better maintenance of quality of life and lower rates of attrition in clinical trials. Patients had an overall positive opinion of the use of this alternate approach with no common disadvantages. A combination of follow-up strategies, such as clinic follow-up and telephone contact for those not attending, may result in a more comprehensive assessment.
MASCC-0383
Palliative radiotherapy in the treatment of lung metastases or advanced lung cancer
J. Nguyen 1, D. Chu1, G. Bedard1, E. Wong1, F. Jon1, C. Danjoux1, E. Barnes1, M. Tsao1, L. Holden1, E. Chow1, E. Lauzon1
1Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: In patients with advanced lung cancers or lung metastases, an improvement or maintenance of quality of life (QOL) is a primary endpoint for treatment. External beam radiotherapy (EBRT) is effective in palliating numerous debilitating symptoms in this population; however, the side-effects of the treatment itself have yet to be adequately examined.
Objectives: This case series aims to assess whether the palliative benefits of EBRT outweigh its acute toxicities in patients with advanced primary lung cancers or lung metastases.
Methods: Five cases in which patients were diagnosed with advanced lung cancers or lung metastases and treated with palliative EBRT were appraised. Every day from baseline until 10 days post-treatment, the patients filled out diaries, which noted their medications and evaluated their perceived severity of the following symptoms: coughing, hemoptysis, dysphagia, chest pain and dyspnea. In conjunction with the diaries, two QOL questionnaires, the EORTC QLQ-C15 PAL and the EORTC QLQ-LC13, were completed.
Results: The patients’ QOL assessments revealed that two patients had an improved QOL, another two experienced no change in QOL and one had a worsened QOL. Analysis of the patients’ diaries showed that three patients noticed symptom palliation, one perceived no change in symptoms, and another patient recognized multiple acute side-effects post-treatment.
Conclusions: Due to the limited number of cases and time of assessment, it remains unclear whether EBRT provides benefits that supersede its acute side-effects. Further research is recommended in order to guide future modifications in EBRT treatment for patients with advanced primary lung cancers and lung metastases.
MASCC-0384
An update of the quality of life measurements in advanced lung cancer patients receiving palliative radiotherapy: a literature review
D. Chu 1, J. Nguyen1, K. Koo1, L. Zeng1, G. Bedard1, H. Lam1, E. Wong1, M. Popovic1, E. Chow1
1Department of Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: Lung cancer is the leading cancer-related cause of death in both men and women. As lung cancers tend to be diagnosed in its advanced stages, their treatments are mainly palliative in intent; therefore, quality of life (QOL) should be used to assess overall well-being, rather than traditional endpoints, such as survival rate
Objectives: To conduct a systematic review of validated instruments used to assess QOL in patients with advanced primary or metastatic lung neoplasms.
Methods: A literature search was conducted in the EMBASE (1950–2012 week 30) and MEDLINE (1946–2012 week 3 July) databases. All compiled studies utilized QOL or symptom palliation as a primary or secondary outcome for patients with advanced lung cancer.
Results: A total of 17 studies met the criteria required for inclusion. Four questionnaires were most commonly used: the EORTC QLQ-C-30, the EORTC QLQ-C-13, the Rotterdam Symptom Check-list (RSCL), and the Hospital Anxiety and Depression Scale (HADS). Eleven of seventeen (65 %) studies evaluated symptom palliation. Nine of the seventeen (53 %) studies evaluated QOL in their cohorts; of those nine, seven (77 %) utilized a lung-specific tool
Conclusions: The limited number of studies assessing QOL in patients with advanced lung cancers suggests that QOL is still an uncommon endpoint for this patient population. Thus, physicians should focus more on QOL assessment as symptom palliation tools can potentially show inconsistencies between the physician and the patient. It is also encouraged that lung-specific QOL questionnaires be used in tandem with general questionnaires within this cohort.
MASCC-0385
Elderly survivors reflect on coping with their cancer journey
E. Kahana 1, B. Kahana2, B. Kahana3
1Sociology, Case Western Reserve University, Cleveland OH, USA, 2Psychology, Cleveland State University, Cleveland OH, USA, 3Radiation Oncology, Marshfield Clinic, Marshfield WI, USA
Introduction: This paper focuses on perspectives of elderly cancer survivors on their experiences of coping with cancer during various phases of their illness career (Charmaz, 1991)
Objectives: Anchored in the sociology of the life course this study explores the meaning of living with cancer as reflected in narratives of elderly cancer survivors.
Methods: A nonclinical sample of 174 older adults who reported a cancer diagnosis were selected from a panel study of successful aging (Kahana et al., 2009). In depth interviews with respondents focused on perceived stressors and coping strategies at different phases of their cancer experience. Themes were derived from narratives based on consensus by three raters
Results: Elderly patients accepted the diagnosis without dismay. Most respondents (62 %) expressed determination to fight the disease. Less than 10 % expressed fear after diagnosis. Resolve and determination during the diagnosis phase was followed by assuming a more passive ‘sick role’ during the treatment phase, relying on expert medical care (Parsons, 1951). Elderly patients reported confidence and trust in their doctors and satisfaction with communications. During the longer term survivorship phase older adults looked back at the adaptations they found most useful. The majority reported valuing active coping styles. These include seeking social support and instrumental orientations to dealing with the illness followed by religious or spiritual approaches.
Table 2 Coping Strategies in the Post Survivorship Phase
1. The number one ranking coping strategy referred to marshaling social support. This included turning to others for emotional or instrumental support (35 responses). We refer to respondents using this type of coping asa “The Neworkers”. Response examples include: “My wife was supportive and I am still trying to get help from my doctors” and “I moved in with my daughter, she knows what to do”. |
2. The second highest ranking focused on instrumental coping strategies whereby patients took active steps to manage their illness (25 responses). We refer to this group as the “Take Charge Patients”. Examples include: “I choose self-reliance, if you have a problem, take care of it” and “I consistently kept doctor appointments, I tried an organic diet, read pertinent articles and shared my experiences with others.” |
3. The next highest ranking included religious coping (24 responses). This included turning to religion, praying, or spirituality. We refer to this group as the “Pious Copers”. Examples include: “I used my spiritual self to cope” and “I had a belief God was looking after me and he did. Religion and spirituality, prayer has been a big help.” |
4. The next group of responses relate to intra-psychic coping strategies including reappraisal of the situation and making positive comparisons (23 responses). We referred to this group as “Stay Positive Patients” examples include: “Acceptance helped me by seeking the inspiration and consolation. I kept a positive attitude” and “Forgetting about it and live your life every day, just be positive”. |
5. Number five included coping strategies that reflected “keeping busy” and keeping one’s mind off the challenges of the cancer experience (14 responses). We referred to this group as the “Busy Bees”. Examples include: “Keeping up routines as much as possible and continuing to focus on other areas of my life as well, giving is a therapeutic environment for me” and “It wasn’t a challenge for me I didn’t have time… I had teenagers at home”. |
6. The next group felt there was no need to enact coping strategies as the treatment they received cured them of their cancer (12 responses). We referred to this group as the “Get Treated and Forget It” patients. Examples include: “I didn’t have to cope, he cut it out and that was it” and “the cancer was eliminated and I led my life as it should”. |
7. This group included people who went on their lives and chose not to dwell on their cancer experience. This group realized that they were living with cancer, but made a conscious decision to not focus on their illness. We referred to this group as the “The Passers By” (11 responses). Examples include: “There was no coping, I did what had to be done and that’s it” and “I have inner strength, I am a fatalist, what will be, will be”. |
8. This group was characterized as dependent copers, in the sense that they left the coping to someone else. We referred to this group as “Dependent Copers”. This orientation is reflected in the following statement, “My spouse dealt with my cancer for me” (5 responses) |
9. This group consisted of the emotional copers, or people who referred to crying or becoming very sad in response to their cancer. We referred to this pattern as the “Emotionally Afflicted” It is notable that there were only 3 people who reported engaging in this coping strategy. |
10. This group referred to post-traumatic growth or transformation. We referred to them as the “Benefit Fiders” (3 responses). Examples include, “Some priorities have changed—you know what is important”. |
Conclusions: The ‘on time’ interpretation of having a cancer diagnosis in old age may diminish the stressfulness of the diagnosis and may enhance the patients’ ability to proactively deal with the reality of their illness.
MASCC-0386
Screening for distress in community-based cancer support organizations
M. Fitch 1, A. McAndrew2, K. Pang2
1Oncology Nursing/Patient & Family Support Program, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada, 2Oncology Nursing, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada
Introduction: Distress is recognized as the 6th vital sign. Distress screening is used in clinical settings to identify what patients are most concerned about and guide discussion about interventions that would be helpful. Recently questions have been raised from community–based cancer support volunteer organizations about the relevancy of screening for distress for them.
Objectives: The purpose of this project was to develop and field-test an approach to distress screening in community settings.
Methods: A literature review was conducted to identify relevant screening tools for a community-based volunteer setting. Focus groups with patients/survivors, volunteers, and staff members of community-based agencies were held to review tools and explore ideas for distress screening in their setting. Based on the focus group results, a new standardized approach to distress screening was designed and pilot-tested at three community organizations.
Results: The literature contains many tools to identify distress. During focus group discussions, participants emphasized the need to tailor the approach to distress screening to be suitable for use in the community-based setting, especially given their philosophy of creating an inviting, supportive and home-like environment. The new distress screening approach is embedded in a conversation rather than a paper-based or computer generated survey. A standardized tool is used by a trained individual during a discussion with the patient/survivor.
Conclusions: The new approach allows for the identification of relevant patient issues and quantification of distress. This presentation will highlight the literature and focus group findings, describe the new approach to screening, and outline the experience with the new distress screening approach.
MASCC-0387
Implementing programmatic screening for distress: rapid identification of physical symptoms and emotional psychosocial concerns
M. Fitch 1, J. Myers2, S. Burlein-Hall3
1Oncology Nursing/Patient & Family Support Program, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada, 2Palliative Care Consult Team, Sunnybrook Health Sciences Centre, Toronto, Canada, 3Oncology Nursing, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada
Introduction: Distress is commonly experienced as patients cope with the consequences of cancer. Identifying those individuals who would benefit from supportive care intervention remains a challenge in busy ambulatory settings.
Objectives: We designed a concrete approach for early identification of patient distress related to both physical and psychosocial issues.
Methods: We implemented a programmatic approach that includes a standardized tool to screening for distress, a brief assessment conversation with the patients, a subsequent dialogue for deeper assessment as required, and intervention or referral based on the assessment. Education, quality improvement cycles, evidenced-based practice guidelines and inter-professional team algorithms were introduced. Evaluation included pre- and post-measures.
Results: Staff report that conversations with patients unfold differently than before the implementation and more psychosocial issues are being identified. The assessments provide a basis for tailoring the care plan with the patient. Referrals have increased as most of the issues are handled by the primary oncology team. Referrals are considered to be appropriate and require the intervention by professionals with additional psychosocial expertise. Staff members report it took time to gain confidence and comfort in using the standardized screening tool in routine practice.
Conclusions: Successful implementation of distress screening requires a programmatic approach. Screening must be followed by appropriate assessment and intervention at the primary team level and referral if additional expertise is required. Staff members require education to perform successfully and relevant clinical tools and supports must be available to assist the members of the inter-professional team.
MASCC-0388
Identification of emotional distress: reflections on using the Edmonton symptom assessment system (ESAS) and the Canadian problem checklist (CPC) as screening tools
M. Fitch 1, A. McAndrew2, S. Burlein-Hall2, T. Lilien3
1Oncology Nursing/Patient & Family Support Program, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada, 2Oncology Nursing, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada, 3Palliative Care Consult Team, Sunnybrook Health Sciences Centre, Toronto, Canada
Introduction: In busy ambulatory cancer clinics, concrete strategies are needed for documenting symptom-related distress and supportive care needs, and identifying the individuals who would benefit from intervention.
Objectives: The purpose of this study was to identify the types of concerns reported by patients attending a comprehensive ambulatory cancer clinic.
Methods: The Edmonton Symptom Assessment System and the Canadian Problem Checklist were implemented in a standardized approach to screening for distress in our ambulatory cancer clinic. Collation of data allows identification of patient concerns at an individual patient level as well as at a population level. Descriptive statistical analysis facilitates targeted intervention and program planning.
Results: 2,627 patient screenings with ESAS and 1,431 screenings with the CPC were completed in 1 month. The most frequently identified issues at the severe level on the ESAS were tiredness (13.2 %), anxiety (10 %) and well-being (10 %). The most frequently identified issues at the moderate level were tiredness (24.4 %), well-being (23.6 %), appetite (18.2 %) and anxiety (13.7 %). On the CPC, the most frequently identified issues included sleep (31.4 %), fears/worries (30.7 %), worry about family and friends (23.6 %), weight (23.5 %) and understanding illness/treatment (20.8 %).
Conclusions: Patient distress can be related to physical, psychosocial or practical issues. Rapid identification of issues in these domains is facilitated in a busy clinic using standardized instruments. Using both ESAS and CPC is helpful in capturing relevant patient issues in the three domains and setting the stage for meaningful dialogue with patients. Collation of data at a population level facilitates the identification program gaps and areas for improvement.
MASCC-0389
Patient experience with percutaneous endoscopic gastrostomy tubes
M. Fitch 1, A. McAndrew2, E. Poslins3, E. Stokes3, J. Kwong4, K. Vandenbussche4
1Oncology Nursing/Patient & Family Support Program, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada, 2Oncology Nursing, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada, 3Clinical Nutrition, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada, 4Clinical Nutrition, Sunnybrook Health Sciences Centre, Toronto, Canada
Introduction: Percutaneous endoscopic gastrostomy (PEG) tubes are an established part of the management for head and neck cancer patients with impaired nutritional and functional status. Limited research has explored the impact of this potentially distressing intervention from a patient perspective.
Objectives: The purpose of this study was to document the experiences of advanced head and neck cancer patients living with a PEG tube.
Methods: The study was conducted using a descriptive qualitative design. A convenient sample of 16 participated in an in-depth interview about living with the PEG tube. Interviews were audio-recorded, transcribed verbatim, and subjected to a content and theme analysis.
Results: Difficulty swallowing and weight loss emerged as the primary factors in influencing the PEG tube insertion. Fear and uncertainty characterized the initial reaction to the tube insertion. Although participants became accustomed to living with the tube, there were challenges to overcome in managing it on a daily basis. Resuming an oral diet required a gradual approach and engendered its own set of challenges. All participants recognized the value of the tube and considered it necessary for their survival—‘it was a life raft’.
Conclusions: Living with a PEG tube was not seen as negative by these participants as has been described in the literature. How the discussion occurs at the onset of the decision-making about the insertion of the tube, the education patients received about the tube and its management, and the on-going support provided by health care professionals contributed to the positive experience.
MASCC-0390
Qualitative exploration of families’ experience caring for loved ones with advanced ovarian cancer
M. Fitch 1, T. DasGupta2, A. McAndrew3, M. Sapsford4, S. Moura5, K. Stilos6, K. Barrow6, L. Faltl3
1Oncology Nursing/Patient & Family Support Program, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada, 2Professional Nursing, Sunnybrook Health Sciences Centre, Toronto, Canada, 3Oncology Nursing, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada, 4Ontario Region, Ovarian Cancer Canada, Toronto, Canada, 5PMH Nursing Administration, University Health Network/Princess Margaret Hospital, Toronto, Canada, 6Palliative Care, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada
Introduction: Ovarian cancer is physically and psychologically challenging because of the advanced nature of the disease at diagnosis, side effects of the treatment, and impact on roles and responsibilities. The family plays an integral role in providing physical and emotional support. Research exploring the family experience is essential to inform practice and develop processes that foster family centered care.
Objectives: The purpose of the study is to explore family members’ experiences of caring for a loved one with advanced ovarian cancer.
Methods: The research question for this qualitative study was, ‘What are the experiences and challenges of individuals while caring for a family member with advanced ovarian cancer?’. Eligible patients were invited to participate until data saturation was reached. In-depth interviews were audio recorded, transcribed verbatim and subjected to standardized qualitative descriptive content and theme analysis. Thirteen interviews were conducted with family members.
Results: Participants described an intensely emotional experience from diagnosis to end of life. Family members experienced on-going challenges with access to information, management of advanced symptoms, and the transition from active medical management to end of life care. All described a point when they recognized their family member was ‘truly dying’ and felt the need to be present on a 24-hour basis. Lack of information about what was happening and what would happen created distress for family members.
Conclusions: Insight regarding families’ experiences has implications for nurses and physicians caring for women and their families at end of life in terms of providing relevant information, supportive communication, and anticipatory preparation.
MASCC-0391
Low bacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia
M. van de Wetering 1, E. van Dalen2, A. Mank3, E. Leclercq2, R. Mulder2, M. Davies4, M.J. Kersten5
1Paediatric Oncology, Academic Medical Center, Amsterdam, Netherlands, 2Cochrane Childhood Cancer Centre, Academic Medical Center, Amsterdam, Netherlands, 3Internal Medicine, Academic Medical Center, Amsterdam, Netherlands, 4Haematology and Transplant unit, NHS Manchester, Manchester, United Kingdom, 5Internal Medicine, Academic Medical Center, Amsterdam, Netherlands
Introduction: It is thought that a low bacterial diet (LBD) can prevent the occurrence of infections in cancer patients receiving chemotherapy causing episodes of neutropenia, but much remains unclear.
Objectives: To determine the efficacy of an LBD versus a control diet in preventing the occurrence of infection and to decrease (infection-related) mortality in cancer patients receiving chemotherapy.
Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (DARE)) PubMed EMBASE (and CINAHL (from 1981 to 20 October 2011) selection criteria; Randomised controlled trials (RCTs) comparing the use of an LBD with a control diet with regard to infection rate, (infection-related) mortality in cancer patients receiving chemotherapy. Two review authors independently performed the study selection, ‘Risk of bias’ assessment and data extraction. Analyses were performed according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions.
Results: Three RCTs were identified assessing different intervention and control diets in 192 patients (97 intervention diet; 95 control diet). Pooling of results of included studies was not possible. All 3 studies did not show a significant difference in infection rate between the intervention and control diet; None of the studies mentioned infection-related mortality.
Conclusions: There is no evidence from individual RCTs in patients with cancer that underscores the use of an LBD for the prevention of infection. Based on the currently available evidence, we are not able to give recommendations for clinical practice. More high-quality research is needed.
References:
Gardner 2008, Journal of Clinical Oncology; 26(35); 5684–8
Moody 2006, Journal of Paediatric Hematology and Oncology;28(3): 126–33.
van Tiel 2007; Annals of Oncology 2007;18:1080–4
MASCC-0392
Assessing client satisfaction among patients receiving hematopoietic stem cell transplantation at a designated transplant facility within the United States department of veterans affairs
J. Toro 1, R. Alonzo1, F. Gushiken1, D. Haile1, C. Freytes1
1Medicine, South Texas Veterans Health Care System, San Antonio, USA
Introduction: Hematopoietic stem cell transplantation (HSCT) is a complex and labor intensive procedure that requires specialized personnel and facilities. The United States Department of Veterans Affairs (VA) has developed regional, specialized centers where transplant candidates are referred.
Objectives: The purpose of this project was to assess the satisfaction of patients who underwent HSCT at a designated VA transplant facility.
Methods: The CSQ-8 was sent to 442 patients and 277 (63 %) completed and returned the questionnaire. Ninety-nine percent of respondents rated the quality of service received as ‘good’ or ‘excellent.’ The same proportion reported receiving the kind of ‘service they wanted’ and would ‘recommend the services’ to a friend. Only 4 % of respondents were dissatisfied with the ‘amount of help they received.’
Results: The CSQ-8 was sent to 442 patients and 277 (63 %) completed and returned the questionnaire. Ninety-nine percent of respondents rated the quality of service received as ‘good’ or ‘excellent.’ The same proportion reported receiving the kind of ‘service they wanted’ and would ‘recommend the services’ to a friend. Only 4 % of respondents were dissatisfied with the ‘amount of help they received.’
Conclusions: An overwhelming majority of patients were satisfied with the quality of service they received, felt that their needs were met and indicated that they would recommend or return if needed. Studies utilizing other instruments should be performed as there is limited information regarding client satisfaction after HSCT.
References: Nguyen TD, Attkisson CC, Stegner BL. Eval Program Plann. 1983;6(3–4):299–313.
MASCC-0393
A randomized trial of oral cryotherapy, saline solution and Caphosol for the prevention of high-dose melphalan-induced oral mucositis followed by autologous hematopoietic stem cell transplantation
J. Toro 1, D. Schneider1, R. Alonzo1, A. Hasan1, S. Lee1, F. Gushiken1, D. Haile1, C.O. Freytes1
1Medicine, South Texas Veterans Health Care System, San Antonio, USA
Introduction: Oral mucositis (OM) is a frequent complication of high-dose melphalan (HDM) followed by autologous hematopoietic stem cell transplantation (AHSCT).
Objectives: To compare the efficacy of 3 interventions to prevent HDM-induced OM in patients with multiple myeloma (MM).
Methods: One hundred seventeen MM patients who received HDM were randomized to 3 groups: oral cryotherapy (CT), saline solution rinses (SS) or Caphosol® (calcium phosphate). Patients were assessed daily for OM until resolution or hospital discharge using the World Health Organization (WHO) mucositis scale. We also evaluated pain level, use of narcotics and OM duration.
Results
Table 1. Baseline Patient characteristics
Total | Caphosol | Cyrotherapy | Saline Solution | |
Patients, n | 117 | 39 | 40 | 38 |
Age, median (range) | 62 (39–75) | 62 (45–68) | 62 (39–75) | 61.5 (43–70) |
Gender, n (%) | ||||
Male | 110 (94) | 36 (92) | 38 (95) | 36 (95) |
Female | 7 (6) | 3 (8) | 2 (5) | 2 (5) |
Race/Ethnicity, n (%) | ||||
Caucasian | 56 (75) | 23 (59) | 16 (40) | 17 (45) |
African Americans | 40 (34) | 11(28) | 15 (37) | 14 (37) |
Hispanic | 21 (18) | 5 (13) | 9 (23) | 7 (18) |
Karnofsky score, median (range) | 90 (70–90) | 90 (80–90) | 90 (70–90) | 90 (80–90) |
Total Bilirrubin, mean (SD) | 0.64 (0.22) | 0.65 (0.21) | 0.61 (0.19) | 0.66 (0.25) |
Body Mass Index, mean (SD) | 30.87 (5.73) | 29.48 (4.52) | 31.72 (6.63) | 31.40 (5.70) |
Serum Creatinine, mean (SD) | 1.12 (0.67) | 1.28 (0.93) | 1.00 (0.29) | 1.09 (0.63) |
Diabetes, n (%) | ||||
Yes | 32 (27) | 9 (23) | 13 (32) | 10 (26) |
No | 85 (73) | 30 (77) | 27 (68) | 28 (74) |
Dentures, n % | ||||
Yes | 32 (27) | 9 (23) | 13 (32) | 10 (26) |
No | 85 (73) | 30 (77) | 27 (68) | 28 (74) |
Only 10 % of patients in the CT group experienced OM ≥ grade 1, compared to 64 % and 66 % in the Caphosol® and SS groups, respectively (P < 0.0001). None of the CT patients experienced grade 3–4 OM. There was a significant decrement in duration of OM in the CT group compared to the Caphosol® group (mean duration [MD] in days 0.8 vs. 4.77; p < 0.001) and the SS group (MD 5.55 days; p < 0.001). Duration of OM was shorter in the CT group compared to the SS group (MD .9 days vs. 3.38 days; p = 0.004) and the Caphosol® group (MD 2.97 days; p = 0.020). Patients in the CT group required less use of analgesics when compared with the SS group (p = 0.007).
Conclusions: CT significantly reduced OM frequency, duration and severity in MM patients who received HDM when compared to Caphosol® or SS rinses. Patients who received CT had lower analgesic requirements than patients who received SS.
MASCC-0394
Influence of oral mucositis on the quality of life of patients treated with high-dose melphalan and autologous hematopoietic stem cell transplantation
J.J. Toro 1, D. Schneider1, R. Alonzo1, A. Hasan1, S. Lee1, F. Gushiken1, D. Haile1, C.O. Freytes1
1Medicine, South Texas Veterans Health Care System, San Antonio, USA
Introduction: The influence of oral mucositis (OM) on the quality of life (QoL) of patients with multiple myeloma (MM) treated with high-dose melphalan (HDM) and autologous hematopoietic stem cell transplantation has not been rigorously studied.
Objectives: To assess the influence of mucositis on the QoL of MM patients treated with HDM.
Methods: We analyzed parameters associated with QoL as part of a randomized study evaluating 3 interventions to prevent OM: cryotherapy (CT), saline solution rinses (SS) or Caphosol®. (calcium phosphate) The ‘Patient-Reported Oral Mucositis Symptom’ (PROMS) scale, a validated instrument to assess QoL, was utilized daily from HDM administration to OM resolution.
Results: Patients in the CT cohort experienced less mucositis than the other cohorts based on established clinical criteria. Sixty-eight percent of study patients reported changes in taste. There was a significant difference in parameters associated with patient well-being among the 3 groups in favor of the CT cohort (see table). Patients who received CT had significantly less mouth pain than the other cohorts. Difficulty and restriction of speech, eating and drinking was significantly higher for the SS and Caphosol® cohorts.
Table. PROMS variables reported at any point during the study
Variables | Caphosol n = 39 | Cryotherapy n = 40 | Saline solution n = 38 | P value |
Yes | Yes | Yes | ||
Mouth pain | 21 (54 %) | 6 (15 %) | 23 (61 %) | <.0001a |
Difficulty speaking because of mouth sores | 8 (21 %) | 2 (5 %) | 15 (39 %) | 0.0009b |
Restriction of speech because of mouth sores | 8 (21 %) | 2 (5 %) | 15 (39 %) | 0.0008b |
Difficulty eating hard foods because of mouth sores | 16 (41 %) | 8(20 %) | 21 (55 %) | 0.0055a |
Difficulty eating soft foods because of mouth sores | 12 (31 %) | 2 (5 %) | 14 (37 %) | 0.0007b |
Restriction of eating because of mouth sores | 15 (38 %) | 2 (5 %) | 19 (50 %) | <.0001b |
Difficulty drinking because of mouth sores | 15 (38 %) | 3 (8 %) | 15 (39 %) | 0.0007b |
Restriction of drinking because of mouth sores | 13 (33 %) | 4 (10 %) | 18 (47 %) | 0.0008b |
Difficulty swallowing because of mouth sores | 20 (51 %) | 6 (15 %) | 20 (53 %) | 0.0005a |
Change in taste | 29 (74 %) | 21 (53 %) | 29 (76 %) | 0.0431a |
aChi-Square
bFisher’s Exact Test
Conclusions: Patients in the CT cohort experienced better QoL after HDM based on the PROMS scale. Since the CT cohort experienced less OM, this study suggests an important influence of mucositis on the QoL of patients treated with HDM.
References: Krusher JA et al. J Can Dent Assoc. 2008; 74(1):59
MASCC-0395
High dose Asian Ginseng, (Panax Ginseng) for cancer related fatigue (CRF): a preliminary report
S. Yennu 1, A. Reddy1, N. Tannir2, R. Lee3, G. Lopez3, C. Escalante4, E. Manzullo4, S. Frisbee-Hume1, J. Williams1, S. Palla5, L. Cohen6, B. Eduardo1
1Palliative Care and Rehab Medicine, University of Texas MD Anderson Cancer Center, Houston, USA, 2GU Oncology, University of Texas MD Anderson Cancer Center, Houston, USA, 3General Oncology, University of Texas MD Anderson Cancer Center, Houston, USA, 4Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, USA, 5Biostatistics, University of Texas MD Anderson Cancer Center, Houston, USA, 6Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
Introduction: CRF is a common and severe symptom in patients with cancer. There are limited useful treatments available.
Objectives: The objective of this preliminary study was to assess the safety of high dose Panax Ginseng (PG) on CRF.
Methods: In this prospective open labeled study, 30 patients with cancer and fatigue ≥4/10 (0 = no fatigue, 10 = worst possible fatigue) received high dose PG 800 mg orally daily for 29 days. Functional Assessment of Cancer Therapy- fatigue (FACIT-F), Edmonton Symptom Assessment System (ESAS) (0 = best, 10 = worst), and Hospital Anxiety Depression Scale (HADS) were assessed at baseline and day 29.
Results: Results in 24/30 (80 %) evaluable patients were as follows (Table 1). The median age was 58 year, 50 % were females, 84 % were white. The most common cancer type was genitourinary cancer (31 %). ESAS well-being improved from 4.67 (2.04) to 3.50 (2.34) (p = 0.01374), appetite improved from 4.29 (2.79) to 2.96 (2.46) (p = 0.0097). 21/24(87 %) patients had an improved FACIT-F fatigue score by day 15. Global Symptom Evaluation score of PG for fatigue was better in 15/24 patients (63 %) with median improvement of 5 (1 = hardly any better, 7 = very great deal better). No ≥ grade 3 adverse events related to the study drug were reported.
Conclusions: 1) PG is safe and rapidly improved ESAS fatigue and FACIT-F fatigue scores; 2) overall quality of life (FACT-General), appetite, and sleep at night also improved. Randomized controlled trials of PG are justified in CRF.
Table 1. Change in Symptoms after treatment with High Dose Ginseng
Symptom | Baseline, mean (SD) | Day 29, mean (SD) | p value |
Fatigue (ESAS) | 6.2 (1.82) | 3.75 (1.62) | <0.0001 |
Drowsiness (ESAS) | 3.21 (2.21) | 2.42 (2.28) | 0.0948 |
Sleep at night (ESAS) | 5.38 (2.37) | 3.54 (2.02) | 0.0012 |
Depression (ESAS) | 1.29 (2.22) | 1.29 (2.03) | 0.999 |
Depression (HADS) | 6.50 (3.34) | 6.09 (3.86) | 0.6088 |
FACIT-F Fatigue Subscale (primary outcome) | 24.58 (8.9) | 32.90 (11.01) | <0.0001 |
FACIT-G | 71.42 (17.54) | 77.29 (17.79) | 0.0104 |
FACIT-F physical | 17 (5.82) | 19 (4.79) | 0.002 |
MASCC-0396
The mIAS scale: a scale to measure mTOR inhibitor-associated stomatitis
C. Boers-Doets 1, R.V. Lalla2
1Clinical Oncology, Leiden University Medical Center, Leiden, Netherlands, 2Department of Oral Health and Diagnostic Sciences MC1605, University of Connecticut Health Center, Farmington CT, USA
Introduction: mTOR inhibitor-associated stomatitis (mIAS) is a dose-limiting toxicity of mTOR inhibitors. Even small ulcerations can cause significant pain and affect quality of life. Scales developed for conventional oral mucositis are currently used to assess mIAS. These scales are mainly driven by ulceration size and the resulting impact on diet. Since the morbidity of mIAS results from persistence of lesions and associated pain, these scales may not be appropriate to measure mIAS
Objectives: To develop a scale specifically designed for mIAS, so that decisions on dose-modification can be made based on an accurate assessment of the toxicity
Methods: A comprehensive literature review was performed in PubMed, to determine important features of mIAS that influence its morbidity. Keywords were assessment, questionnaire, tool, stomatitis, mucositis, and mTOR inhibitor. Commonly used oral mucositis scales were examined to identify suitable components for mIAS measurement
Results: A new scale was generated with a subjective component measuring pain and an objective component measuring duration of lesions. The subjective grading criteria range from 0 for no pain to 3 for a pain score of 6 or higher on a 0–10 scale. The objective grading criteria range from 0 for no visible lesion to 3 for lesion(s) persisting for more than 7 days. It is suggested that dose-modification be considered only when both subjective and objective grades are 3, representing persistent lesions with significant pain, despite analgesic use
Conclusions: Measurement of mIAS using this scale should facilitate the optimal management of the underlying malignancy, resulting in improved outcomes.
MASCC-0397
Toxicity profile of rituximab in Indian patients
C. Basu 1, B. Basu2
1Gyn Oncology & Clinical Trial, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India, 2Screening, Cancer NOCK, Kolkata, India
Introduction: The chimeric anti-CD20 monoclonal antibody rituximab (R) is increasingly being used for treating lymphoproliferative disorders. While life threatening toxicities like infusional, tumour lysis syndrome, Severe Mucocutaneous Reactions, Progressive Multifocal Leuko encephalopathies are very rare there is paucity of such toxicity study in Indian literature
Objectives: In our tertiary cancer care centre in last 4 years (Jan 2009 to Jan 2013) we have experience of 125 lymphoma cases and 500 doses of Rituximab either alone or in combination with CHOP
Methods: Hence, we are presenting this observational study on Indian patients
Results: Outcomes were reported for only rituximab and addition of R with CHOP (cyclophosphamide, doxorubicin [hydroxydaunorubicin], vincristine [Oncovin], and prednisolone). In common this included 87 males and 38 females. The median age was 46 years (range 17 to 78 years). One-fourth of patients were above 60 years. The histology was aggressive NHL in 86, indolent NHL in 39. 32 were in early stage (I/II) and the remaining 93 were in advanced stage (III/IV) of disease. Total toxicity profile in our series was as follows:
Infusional reaction 10 cases, Hypotension 12 cases. They are mostly in first infusion. Leucopenia in 30 occasions. Febrile neutropenia in four cases Secondary prophylaxis was not necessary in them. Peculiar thing was hyperglycemia which was constantly present in about forty percent cases (n = 48). Bleeding piles developed for the first time in two cases. There were reactivation of hepatitis and development of pneumonitis in two cases each
Conclusions: We did not find any other toxicity and found R is reasonably safe.
MASCC-0398
Current status and issues with psychosocial support for patients with recurrent colorectal cancer
E. Shindo 1, N. Yamagishi1, M. Chaen1, H. Komatsu1
1Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
Introduction: Recently, colorectal cancer has been increasing in Japan. Rapid advances have improved the survival of patients with recurrent colorectal cancer, but treatment creates physical, psychological, and social burdens. We previously demonstrated that patients with recurrent colorectal cancer live with a fear of self-dissolution. However, such programs for patients are not yet sufficient in Japan. We should investigate a customized support program.
Objectives: To review the literature on current status and issues with psychosocial support programs for patients with recurrent colorectal cancer undergoing the treatment.
Methods: Between 2009 and 2011, we searched Pubmed and CINAHL for studies on support programs for colorectal cancer patients using the keywords “colorectal cancer”, “patient”, and “support (supporting) program”, as well as studies on psychosocial support for cancer patients using the keywords “cancer survivor” and “psychosocial support”. Thirty articles were selected for analysis.
Results: Few intervention studies on support for colorectal cancer patients were available, and we found no intervention study on support for patients receiving treatment after recurrence. The intervention Methods included group therapy, nurse-initiated customized support packages, and lifestyle education. Most interventions were tested as support for breast cancer survivors, and no study investigated patients with recurrent colorectal cancer.
Conclusions: There have been few studies on support for patients with recurrent colorectal cancer. Unlike breast cancer patients, those with recurrent colorectal cancer are less likely to receive support. In the future, we will determine the needs of patients and investigate a customized support program.
MASCC-0399
Single fraction palliative radiotherapy in the treatment of bone metastases with soft tissue mass
N. Lao 1, M. Poon1, L. Probyn1, M. Popovic1, R. Chow1, N. Lauzon1, E. Chow1
1Rapid Response Radiotherapy Program Department of Radiation Oncology, Sunnybrook Health Sciences Odette Cancer Centre, Toronto, Canada
Introduction: Pain associated with bone metastases can substantially decrease quality of life (QOL) in cancer patients. Single or multiple fraction radiotherapy is commonly used to treat uncomplicated bone metastases; however, debate exists concerning the optimal fractionation scheme for palliative cancer patients.
Objectives: The purpose of this present case report is to discuss the efficacy of single and multiple fraction radiotherapy in the treatment of bone metastases with soft tissue mass.
Methods: A 56-year old female breast cancer patient was referred to Odette Cancer Centre, Sunnybrook Hospital. She presented with a right femur bone metastasis with soft tissue mass. She received a single 8Gy fraction of radiotherapy.
Results: The patient responded well to treatment with good pain relief. A post-radiation CT scan was performed on the right femur. The soft tissue mass had substantially decreased in size, and new endosteal and periosteal bone had formed in the femur.
Conclusions: The response of this patient to single fraction radiotherapy indicates the efficacy of this treatment for the palliation of bone metastases. Further evaluation for the benefits of using single fraction radiotherapy for soft tissue masses in patients with poor performance status should be considered.
MASCC-0400
Supportive care needs and quality of life among Chinese breast cancer survivors
K.C. Choi1, W.K.W. So1, S.S.M. Ho 1, C.W.H. Chan1, S.S.S. Mak2, R.W.M. Wan2, S.Y. Chair1
1The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China, 2Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China
Introduction: Despite advanced cancer treatments prolong survivors’ lives, studies have been reported that cancer survivors experience poorer quality of life (QoL) than general populations. Identifying their needs is crucial to develop relevant follow-up health services for them.
Objectives: To examine supportive care needs of Chinese breast cancer survivors and investigate its relationships with participants characteristics and their quality of life (QoL)
Methods: One hundred and sixty-three participants were recruited from an out-patient oncology department of a local public hospital. They completed a self-report questionnaire: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy.
Results: The five most commonly reported unmet needs were all in the health system information domain (range: 55–63 %). In fact, most of the participants (84 %) reported at least one unmet need in relation to health care information. Stepwise multivariable regression analyses revealed that time traveling from home to hospital, physical and psychological unmet needs were independently associated with QoL among the breast cancer survivors.
Conclusions: Breast cancer survivors perceived various unmet needs, and the health system information is the most common one. Those who have more unmet needs in the physical and psychological domain were more likely to perceive a poorer QoL.
MASCC-0401
Inpatient palliative care consultation for patients with glioblastoma in a tertiary hospital
E. Lin 1, M.A. Rosenthal2, B.H. Le1, P. Eastman1
1Palliative Care, The Royal Melbourne Hospital, Parkville, Australia, 2Medical Oncology, The Royal Melbourne Hospital, Parkville, Australia
Introduction: Glioblastoma (GBM) is an uncommon disease with significant mortality and morbidity, but there is a lack of published evidence on palliative care involvement in this population.
Objectives: To describe characteristics and outcomes of inpatients with GBM who are referred to the palliative care consultation service.
Methods: This retrospective audit used data from The Royal Melbourne Hospital (RMH); a tertiary hospital and a major provider of neuro-oncology services in Victoria, Australia. Data were available for all GBM inpatients discharged between 1 July 2009 and 29 February 2012. From this group, the medical records of those who had their first palliative care involvement during the admission were extracted. Information collected included patient demographics, symptoms, reasons for referral to the palliative care consult service, use of allied health, length of stay and patient outcome.
Results: A high symptom burden is experienced by GBM patients, with almost 75 % experiencing three or more symptoms. There were high levels of involvement from physiotherapy, occupational therapy and social work, but surprisingly little from pastoral care. The median time from diagnosis of GBM to palliative care consultation service referral was 111 days.
Conclusions: This audit highlights the heavy symptom burden, extensive allied health involvement and discharge outcomes of GBM inpatients referred to the palliative care service. These data provide an important framework upon which further research can be built, and also support the vital role multidisciplinary palliative care services can and should play in the care of patients with GBM.
MASCC-0402
A systematic review on quality of life among patients at 1 year after treatment for head and neck cancer
W.K.W. So 1, R.J. Chan2,3, D.N.S. Chan1, B.G.M. Hughes2,4, S.Y. Chair1, K.C. Choi1, C.W.H. Chan1
1The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China, 2Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 3School of Nursing and Midwifery, University of Queensland, Australia, 4School of Medicine, University of Queensland, Australia
Introduction: Although advances in treatment modalities have improved the survival of head and neck (H&N) cancer patients over recent years, survivors’ quality of life (QoL) could be impaired for a number of reasons. The investigation of QoL determinants can inform the design of supportive interventions for this population.
Objectives: To examine the QoL of H&N cancer survivors at 1 year after treatment and to identify potential determinants affecting their QoL
Methods: A systematic search of literature was done in December 2011 in five databases: Pubmed, Medline, Scopus, Sciencedirect and CINAHL, using combined search terms ‘head and neck cancer’, ‘quality of life’, ‘health-related quality of life’ and ‘systematic review’. The methodological qualities of selected studies were assessed by two reviewers using predefined criteria. The study characteristics and results were abstracted and summarized.
Results: Thirty-seven studies met all inclusion criteria with methodological quality from moderate to high. The global QoL of H&N cancer survivors returned to baseline at 1 year after treatment. Significant improvement showed in emotional functioning while physical functioning, xerostomia, sticky/insufficient saliva, and fatigue were consistently worse at 12 months compared with baseline. Age, cancer sites and stages, social support, smoking, presence of feeding tube are significant QoL determinants at 12 months.
Conclusions: Although the global QoL of H&N cancer survivors recover by 12 months after treatment, problems with physical functioning, fatigue, xerostomia and sticky saliva persist. Regular assessment should be carried out to monitor these problems. Further research is required to develop appropriate and effective interventions for this population.
MASCC-0403
Medical expenditure and customer satisfaction degrees in independent hospice ward
B. Kim 1, S. Nam1, T. Lim1, M.S. Kim2, K.S. Yoon2, D.J. Lee2
1Internal Medicine, VHS Medical Center, Seoul, Korea, 2Hospice Care Unit, VHS Medical Center, Seoul, Korea
Introduction: Ward type in palliative hospice therapy may contribute to reduce economic medical costs as well as to more specific total care for terminal cancer patients (Am J Hosp Palliat Care. 2013;30:50–2). We expanded hospice care program and established the independent Hospice Ward (HW) in 2011.
Objectives: This study compared medical expenditures between HW and other hospice care types in VHS Medical Center. In addition, we investigated customer satisfaction degrees every years.
Methods: We set up the independent HW and intergated candidates into this hospice care facility. Medical expenditures in terms of daily general medical costs, analgesic costs, antibiotic costs, nutritional costs, laboratory test costs and transfusion costs were compared between the independent HW (2012) and other two types of hospice care (2011). The third party conducted the customer satisfaction survey to family members.
Results: A total of 93 patients were enrolled into WT (n = 29) and ST (n = 64) in 2011. Seventy-seven patients were enrolled into HW in 2012. There is no significant factors except for laboratory test cost between WT and ST in 2011. But average daily medical cost and daily costs of antibiotics, parenteral nutrition, laboratory blood tests and blood products were significantly lower in HW than ST as well as WT. There were no cases for ICU in HW and WT, but fourteen (22 %) in ST had yet been experienced to admit in ICU. Customer satisfaction scores in were improved in 2012 than in 2011(from 4.74 to 5.00)
Conclusions: For hospice care in terminal cancer patients, we can reduce medical expenditures in independent HW without loss of customer satisfaction.
MASCC-0404
Ultrasonographic evaluation of therapeutic effects after complex decongestive therapy in lymphedema
S.I. Park 1, Y.J. Sim1, G.C. Kim1, H.J. Jeong1
1Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
Introduction: Breast cancer related lymphedema (BCRL) is a chronic, progressive and multifactorial process. Ultrasonography is one of the diagnostic tools in BCRL. We investigated the usefulness of ultrasonography in complex decongestive therapy (CDT) in BCRL as a follow up tool.
Objectives: To evaluate the usefulness of ultrasonography as a follow up tool for investigating of CDT in BCRL.
Methods: Twenty patients with BCRL were enrolled in this study. All patients were taken therapies with CDT program for 2 weeks. Soft tissue thickness of both affected and unaffected upper limbs were measured before and after CDT. It was measured by 3 points (midpoint between the medial and lateral epicondyles at the elbow level, 10 cm proximal and distal to elbow) with or without pressure. And we calculate the compliance of soft tissue before and after CDT. The circumference of both affected and unaffected upper limb were measured before and after CDT.
Results: Twenty patients examed by 1 sonographer. We compared 3 values (Soft tissue thickness, Compliance and circumference). After 2 weeks of CDT program, the soft tissue thickness and circumference of unaffected upper limb did not show significant changes between before and after CDT. But on affected upper limb, there was significantly reduced compared measurements taken prior to treatment.
Conclusions: Our results suggest that circumference measurement and the soft tissue thickness measured by ultrasonography was useful for follow up tools for investigating therapeutic effects of CDT.
References: Waren A, Borson H, Borud LJ, Slavian SA. Strength of materials. lymphedema: a comprehension review. Ann Plastic Surgery 2007; 59: 464–472
MASCC-0405
Community interventions for reducing breast health myths and promoting breast cancer screening: from Korean experience
W. Hong 1, K. Park2
1Nursing, Kyungnam University, Changwon-si, Korea, 2Cancer Information and Education Branch, National Cancer Center, Goyang, Korea
Introduction: The Korean government provides biennial mammograms for Korean women over 40 years of age through the National Cancer Screening Program (NCSP). However, only 49.5 % of women undertakes in accordance with these guidelines. There are mythical health beliefs and different community participations related to breast cancer screening for women in Korea.
Objectives: This study was to identify mythical health beliefs related to breast cancer and promote to take a breast cancer screening test free provided by the Korean NCSP. The researchers conducted a multicomponent community intervention trail to correct breast cancer myths and promote a breast cancer screening test for early detection for Korean women
Methods: A 6-month, 2-city community intervention trial was conducted. In the intervention city, 480 women were surveyed at baseline and 7 months later to evaluate the effects of the intervention program. Strategies implemented in the intervention city included community outreach and clinic and pharmacy-based in-reach strategies.
Results: This study showed a 20.4 % decrease in myths about the link between cancer and breast size, a 19.2 % decrease in myths concerning mammography costs, and a 14.1 % increase in intention to take screening mammography. The study also revealed a 23.4 % increase in the proportion of women at the action stage of the trans-theoretical model in the intervention city
Conclusions: This study showed the value of the strategies aimed at reducing mythical beliefs in breast cancer for Korean women. The invention also stimulated women more likely to undertake breast cancer screening through mammography in the future.
MASCC-0406
First report on the contribution of metaphorical music therapy in supportive care of cancer patients
C. JOURT PINEAU 1, C. Chargari1, B. Ceccaldi1, S. Le Moulec1, L. Védrine1
1Oncology, H.I.A. du Val-de-Grâce, Paris, France
Introduction: Recent studies have validated the physiological and psychological benefits of both music therapy and art therapy as supportive cares in the management of patients with cancer.
Objectives: Metaphorical music therapy is an emerging individual method that combines the benefits of music with those of artistic and narrative creation.
Methods: This original method was applied to a 32 year old female patient with metastatic esophageal carcinoma.
She was suffering from acute chest pain related to an extended tumor and was receiving chest radiation therapy.
The pain was resistant to high doses of morphine and generated psychological withdrawal.
From two words “magic” and “spell” given by the therapist at the beginning of the session, the patient, following a musical induction, achieved a metaphorical tale in the form of a collage and a short story. According to her musical tastes, she chose a sequence of music therapy known as “U-based”. As she was wearing headphones and listening to the music, she was asked to select cut/tear fragments of images in magazines. At the end of the musical sequence, she performed a narrative and composite collage using selected elements.
Results
The patient produced a collage and a narrative story externalizing her clinical situation, emotions, fears and hopes, as she had never done before.
At the same time, morphine doses could be partially reduced
Conclusions: This single case suggests that metaphorical music therapy could be beneficial in selected patients suffering physically and psychologically, when verbal communication is not efficient. This clinical relevance will be prospectively assessed.
MASCC-0407
HPV high/risk molecular epidemiology in Belarus
V. Eremin 1, G.I. Vergeichik2, E.L. Gasich1, E.A. Shishkin1
1Clinical Virology, Republican Research & Practical Center for Epidemiology & Microbiology, Minsk, Belarus, 2Oncology, Gomel State Medical University, Gomel, Belarus
Introduction: 897 cases of a neck uterus cancer and 358 women death are registered in Belarus for 2008.
Objectives: 1,080 urogenital samples, HPV-16,18, 31, 45 DNAs.
Methods: PCR, sequencing.
Results: As the results showed in the territory of Belarus circulate, generally the European and East Asian HPV-16 type. Average p-distances between samples from Brest, Mogilyov and Vitebsk equaled 0.000 that points to a uniform source of an origin of these viruses and their long circulation in population of the people infected with HPV-16. In the analysis of HPV-16 DNA fragments received from the Gomel region, it was shown that the majority of samples also treat the European and Asian HPV-16 options, average p-distances between samples equaled 0.000, and with African 0.013–0.017. In the Grodno region all samples clastered round the “European” and “Asian” reference samples. Average p-distances between samples were 0.000–0.003, and with samples from Africa p-distances varied from 0.010 to 0.013. The exception was made by one sample, which on a phylogenetic tree clastered together with samples from Africa. Average p-distances of a sample No.8 with the African reference sequences were 0.000, and with the European and Asian varied from 0.010 to 0.013.
Conclusions: Thus, use of molecular epidemiology Methods allows to give the qualitative characteristic to epidemiological process, to define the directions and time of virus drift to the country, to supervise virus circulation in population, at last to make recommendations about vaccines application.
References: 1. Prevalence of high- and low-risk oncogenic human papillomaviruses in patients with external genital pathology. Vergeichik GI, Stribuk ZhA, Eremin VF. Vopr Virusol. 2011 Mar–Apr;56(2):26–8.
MASCC-0408
Assessing the use of wiki based clinical practice guidelines for lung cancer
I. Olver 1, J. von Dincklage2, A. Garrett2, L. Holliday2, C. Vuletich2
1CEO, Cancer Council Australia, Sydney, Australia, 2Guidelines Group, Cancer Council Australia, Sydney, Australia
Introduction: The challenge for clinical practice guidelines is regularly updating with new evidence.
Objectives: To develop and trial an internet based wiki platform for guidelines.
Methods: Using lung cancer, the key steps in guideline development of identifying questions, literature searching, appraisal of papers, experts writing evidence-based recommendations and wide public consultation and dissemination were integrated in an access-protected wiki. Google web analytics were used to monitor usage. Authors updated the guidelines as new papers became available.
Results: Sixty-seven clinical questions resulted in 2076 articles being critically appraised. Public acceptance of the wiki was demonstrated by 1,055 visits in the consultation month and 2,955 visits in the following 5 months. Access was from a mobile in up to 11 % visits. Wiki guidelines were internationally accessed, 80 % from Australia, 6 % New Zealand, 4 % USA and 2 % UK. In the consultation period the site was found by organic searches in 56 %, 31 % directly accessed it and 13 % were referred. Subsequently 72 % came from searches, 19 % direct and 11 % referrals. Australian government and Cancer Council websites were the major referral sources. Highlighting a role for social media in accessing guidelines, Facebook was responsible for 6–8 % of referrals. The average highest visit duration by a country was 9.06 min in the consultation month (Australia) and 7.24 for Canada. Bounce rates vary widely from 20 % (Germany) to above 70 % (USA, UK, India).
Conclusions: Both clinicians and the public will engage with wiki guidelines and they reach a wide international audience.
MASCC-0409
The need to enhance quality of life in palliative care hepatocellular cancer patients. Review of differences based on etiology and available therapeutic options
C. Teresa 1, J.S. Vilallonga1, A. Chandía1
1Hepatologia, Hospital Universitari Bellvitge-IDIBELL, Hospitalet de Llobregat, Spain
Introduction: Hepatocellular Carcinoma (HCC) is increasingly diagnosed worldwide, with significant differences related to etiology, culture and therapeutical options. Nowadays, there are more therapeutical options available. Nevertheless, curative therapies are restricted to a select group of patients (approximately 20 %).
Objectives: To review the literature to study the management of patients with chronic liver disease and HCC in different countries and quality of life (QOL) assessment.
Methods: We searched for ‘Hepatocellular carcinoma and QOL’ on Pubmed database, finding 19 studies that matched our purpose (Group A). We then reviewed our personal database consisting of 11 studies on QOL in patients with chronic liver disease and/or liver transplantation with or without HCC (Group B). We assessed the different characteristics within these 30 studies.
Results: Group A: 8 out of 19 (42 %) HCC studies were carried out in Asia; 5 (26 %) in Europe and 6 (32 %) in America. The most used instruments for the assessment of QOL were FACT (in 8 studies: 42 %) and EORTC (in 6 studies: 31 %). Group B: None of the studies on other chronic liver diseases and liver transplantation were made in Asia; 6 (54 %) were made in Europe and 5 (46 %) in America. 8 of them used SF-36 (73 %), and 2 (18 %) used Karnofsky.
Conclusions: The etiology and available therapies of liver disease in each country highlight the differences in therapeutic strategies and the assessment of quality of life. More patient oriented studies are needed in order to better understand QOL burden in HCC patients, clinicians and researchers.
MASCC-0410
Phase III clinical trials with anamorelin HCL, a novel ghrelin receptor agonist for the treatment of NSCLC cachexia
A. Abernethy 1, J.S. Temel2, D. Currow3, L. Gleich4, J. Friend5
1Medicine/Medicine - Oncology, Duke University School of Medicine, Durham, USA, 2Hematology/Oncology Department of Medicine, Massachusetts General Hospital, Boston, USA, 3Palliative and Supportive Services, Flinders University, Adelaide, Australia, 4Oncology, Medpace, Cincinnati, USA, 5R&D, Helsinn Therapeutics Inc., Bridgewater, USA
Introduction: Cancer anorexia/cachexia, a multifactorial condition involving loss of appetite and lean body mass (LBM), is associated with increased morbidity and mortality and may occur in up to 80 % of advanced cancer patients. Anamorelin HCl (ANA) is a ghrelin receptor agonist that demonstrated significant increases in LBM, physical strength and body weight in Phase II trials. Through its ghrelin and growth hormone secretagogue activity, it displays anabolic and appetite stimulating properties—two aspects vital to treating cancer anorexia/cachexia.
Objectives
Methods: HT-ANAM-301 (NCT01387269) and HT-ANAM-302 (NCT01387282), also known as ROMANA1 and ROMANA2, are double-blind, placebo-controlled, randomized (2:1 ANA vs. placebo) Phase III trials in patients with non-small cell lung cancer (NSCLC) cachexia. Eligible patients must have unresectable Stage III or IV NSCLC and cachexia (≥5 % weight loss within prior 6 months or BMI < 20 kg/m2). Patients receive once daily oral doses of ANA (100 mg) or placebo for 12 weeks. Co-primary endpoints are the change from baseline in LBM and in muscle strength (measured by DXA and handgrip strength, respectively). Secondary endpoints include change in body weight, overall survival, and quality of life (FACIT-F and FAACT). For HT-ANAM-301 only, population pharmacokinetics are tested at Week 6. After 12 weeks of treatment, patients may continue in a 12-week safety extension study (HT-ANAM-303 [ROMANA3] NCT01395914). At their last meeting (August 2012), the Independent Data Monitoring Committee suggested no safety issue and allowed the trials to continue as planned.
Results
Conclusions
MASCC-0412
Salivary flow rate in chemotherapy receiving cancer patients
T. Davidowitz 1, S. Stemmer2, I. Kaplan3
1Oral Medicine, SHEBA medical center, Ramat Gan, Israel, 2Institute of Oncology, Rabin medical center, Petach Tikva, Israel, 3Institute of Pathology, Rabin medical center, Petach Tikva, Israel
Introduction
Objectives: To Investigate early and delayed chemotherapy- induced effects on salivary flow in patients with breast and colon cancer.
Methods: Thirty-nine patients completed the study. Patient were evaluated before chemotherapy treatment, and again at 1, 3 and 6 months. Resting and stimulated salivary flow rates were measured (spit method). Questionnaires evaluated subjective symptoms and function (Fox and UKU adapted questionnaires).
Results: The study population included 34 F, 5 M, 28–70 years old (median 52 years). 14 (32.5 %) patients with colon cancer, 35 (67.5 %) with breast cancer. In comparison with pre-chemotherapy flow rates, unstimulated salivary flow decreased at 1 and 3 months and stayed low at 6 months (mean 3.28, 2.87, 2.86, 2.85 ml/10 min. respectively). The stimulated flow rate showed a similar trend (mean 4.32, 3.58, 3.08, 3.34 ml/10 min. respectively). In the questionnaires, the proportion of complaint- free patients decreased with time (67.5 %, 45 %, 32.5 %, and 30 % respectively in the Fox and 70 %, 40 %, 22.5 % and 42.5 % UKU questionnaire, p < 0.05).
Conclusions: Chemotherapy for breast and colon cancer caused significant decrease in stimulated and unstimulated salivary flow rates. This effect lasted for at least 6 months after treatment, and correlated with an increased level of patient discomfort.
Patients receiving chemotherapy should get counseling and supportive treatment to deal with the decrease in salivary flow. In view of limited number of patients completing this study, larger numbers of patient are needed to further validate these findings.
MASCC-0413
Monitoring instruments for nutritional status in head and neck cancer patients
J. Büntzel 1, H. Buentzel2, C. Donner3, K. Meyer4
1Otolaryngology, Südharz Klinikum, Nordhausen, Germany, 2Palliative Medicine, Südharz Klinikum, Nordhausen, Germany, 3Palliative Medicine, Palliative Care Network, Nordhausen, Germany, 4Home Care, Südharz Klinikum, Nordhausen, Germany
Introduction: Weight, body mass index, screening and assessment tools are well established in the diagnosis of malnutrition. We need more detailed information about the value and practicability of such instruments in the follow up of our cancer patients.
Objectives: What are the best diagnostic instruments for nutritional monitoring of advanced head neck cancer patients?
Methods: We have included 30 patients (23 men, 7 women) to this observational study. We have registered body weight, body mass index, nutritional risk screening tool, bioimpedance vector analysis (BIVA), bioimpedance phase angle (BIA) and RTOG dysphagia classification about 12 month. At the end of observation the nutrition team had to categorize the used instruments regarding their information value, practicability, and therapeutic impact.
Results: Regarding the information value we observed following categorization: BIA > body weight > NRS-2002 > BMI > RTOG dysphagia scale > BIVA. Following therapeutic impact was seen: BIA > RTOG dysphagie scale > body weight > BIVA > NRS-2002 > BMI. The practicability was categorized: body weight > BIA > RTOG dysphagia scale > BMI/BIVA > NRS-2002.
Conclusions: Body weight and bioimpedance analysis should be used to monitor the nutritional status of head neck cancer patients. RTOG dysphagia scale should registered as additional information of daily nutritional problems.
MASCC-0414
Randomized, double-blind, phase iii trial of palonosetron versus granisetron in the triplet regimen for preventing chemotherapy-induced nausea and vomiting (CINV) after highly emetogenic chemotherapy (HEC)
T. Yamanaka 1, T. Yanai2, Y. Honma3, K. Arata4, R. Matsui5, K. Goto6, N. Yasumori7, W. Okamoto8, M. Takase9, K. Shibata10, M. Sano11, N. Haga12, N. Seki13, K. Suzuki4, N. Yamamoto14
1Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan, 2Division of Pharmacy, National Cancer Center Hospital, Tokyo, Japan, 3Division of Gastrointestinal Oncology, National Cancer Center Hospital, Tokyo, Japan, 4Department of Pharmacy, Shizuoka Cancer Center, Shizuoka, Japan, 5Department of Pharmacy, National Cancer Center Hospital East, Chiba, Japan, 6Division of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan, 7Department of Pharmacy, National Kyushu Cancer Center, Fukuoka, Japan, 8Department of Medical Oncology, Kinki University Hospital, Osaka, Japan, 9Department of Pharmacy, Kouseiren Takaoka Hospital, Toyama, Japan, 10Department of Medical Oncology, Kouseiren Takaoka Hospital, Toyama, Japan, 11Department of Pharmacy Services, Saitama Medical University, Saitama, Japan, 12Department of Digestive Tract and General Surgery, Saitama Medical University, Saitama, Japan, 13Division of Medical Oncology, Teikyo University School of Medicine, Tokyo, Japan, 14Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
Introduction: Standard antiemetic care for preventing CINV due to HEC is a combination of 5-HT3 receptor antagonist (RA), dexamethasone, and NK1 RA.
Objectives: To compare the efficacy of two 5-HT3 drugs, palonosetron and granisetron, within the triplet regimen for preventing HEC.
Methods: Patients with a malignant solid tumor who were receiving HEC containing 50 mg/m2 or more cisplatin were eligible. They were randomly assigned to either Arm A (palonosetron 0.75 mg, i.v.) or Arm B (granisetron 1 mg, i.v.), before chemotherapy on day 1, both arms with dexamethasone (9.9 mg on day 1 and 6.6 mg on day 2–4, i.v.) and aprepitant (125 mg on day 1 and 80 mg on day 2–3, p.o.). The primary endpoint was complete response (CR) at the overall (0–120 h) phase. Secondary endpoints included CR at the acute (0–24 h) and delayed (24–120 h) phases, and complete control (CC) and total control (TC). Planned sample size was 840. The exact Cochran-Mantel-Haenszel (CMH) test was performed at a significance level of 0.05.
Results: Between July 2011 and June 2012, 842 patients were registered from 20 centers and 827 patients were evaluable. The median CDDP dose was 76.1 mg/m2 in Arm A and 75.7 mg/m2 in Arm B. Baseline characteristics were well-balanced. Efficacy results are summarized in the Table.
Table
Arm A, N = 414 | Arm B, N = 431 | Odds Ratio (95 % CI) | P-value | ||
CR % | Overall | 66 % | 59 % | 1.35 (0.99, 1.82) | 0.0539 |
Acute | 92 % | 92 % | 1.00 (0.58, 1.71) | 1.00 | |
Delayed | 67 % | 59 % | 1.45 (1.07, 1.96) | 0.0142 | |
CC % | Overall | 64 % | 56 % | 1.41 (1.05, 1.90) | 0.0234 |
Acute | 90 % | 90 % | 1.01 (0.61, 1.65) | 1.00 | |
Delayed | 65 % | 56 % | 1.51 (1.12, 2.04) | 0.0053 | |
TC % | Overall | 48 % | 41 % | 1.36 (1.01, 1.82) | 0.0369 |
Acute | 81 % | 81 % | 1.00 (0.69, 1.45) | 1.00 | |
Delayed | 49 % | 41 % | 1.36 (1.02, 1.83) | 0.0369 |
Conclusions: The primary endpoint was not met (P = 0.0539). However, the overall study results have shown the clinical utility of palonosetron in the triplet regimen. Palonosetron is a more preferable 5-HT3 RA than granisetron for preventing CINV due to HEC
References: Registered with UMIN-CTR (http://www.umin.ac.jp/ctr/). Study ID: UMIN000004863
MASCC-0415
Changes of care and nursing after DNR decision making in oncology units
L.E.E. SOON HAENG 1, Y.A.N.G. yunjung2, P.A.R.K. jungyun3
1ICU Care Nursing, Asan Medical Center, Seoul, Korea, 2Asan Cancer Center, Asan Medical Center, Seoul, Korea, 3Clinical Nursing, University of Ulsan, Seoul, Korea
Introduction: Do-not resuscitate (DNR) in the event of cardiac arrest is the most common and important discussion between a patients’ family and physicians among the end-of-life decision-making process. To observe the performance of a DNR order in critically ill patients, we analyzed the incidence of DNR orders, the change in therapeutic level after DNR orders, and the cases of violated DNR codes in patient who had died in Korean Medical oncology unit between July 2011 and December 2012.
Objectives: To evaluate treatments at the end of life care for terminal cancer patients during their last admission.
Methods: Medical records of terminal cancer patients during their last admission at a district academic hospital were evaluated.
Results: Total 585 patients were included. The median patients age was 58.5 years. The median length of admission was 17.3 days (rang: 1 ~ 367).
Patients characteristics, 360 males and 225 females in total were enrolled. Lung cancer (30.4 %) accounted for the most common premorbid diagnosis during their last admission and on patients’ day of death. Ninety percent of the patients (92.3 %) had formal DNR orders. Fifty-four percent of the patients with a DNR order had received the order within 3 days death. Decrease in their tests (ABGA, culture, x-ray, fluid analysis, blood sample, CT, MRI, sono) number after implementing the DNR decision about thirty-two percent, but on patients’ day of death the average of four tests were conducted.
Conclusions: DNR orders are initiated when patient death is imminent.
However, on patients’ day of death tests were conducted.
MASCC-0416
Unemployment correlates and association with quality of life in cervical cancer survivors
S. Yoo 1, Y. Yun1, S. Park2, Y. Kim3, S. Park3, D. Bae4, J. Nam5, C. Park6, C. Cho7, J. Lee8
1Department of Medicine, Seoul National University College of Medicine, Seoul, Korea, 2Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea, 3Research Institute and Hospital, National Cancer Center, Goyang, Korea, 4Department of Obstetrics and Gynecology, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea, 5Department of Obstetrics and Gynecology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea, 6Department of Obstetrics and Gynecology, Kangnam Cha Hospital College of Medicine Pochon CHA University, Seoul, Korea, 7Department of Obstetrics and Gynecology, School of Medicine Keimyung University, Daegu, Korea, 8Department of Obstetrics and Gynecology, East–west Neo Medical Center Kyung Hee University, Seoul, Korea
Introduction: Little is known regarding cervical cancer survivors’ employment status, which represents social integration of cancer survivors as a pivotal domain of long-term quality of life.
Objectives: We enrolled 858 cervical cancer survivors from the gynecological oncology departments in South Korea.
Methods: Factors associated with unemployment were identified using multivariate logistic regression analyses. We assessed different HRQoL domains with multivariate-adjusted least-square means between cervical cancer survivors who currently work and those who do not.
Results: After diagnosis and treatment, the percentage of unemployed survivors increased from 50.6 % to 72.8 %. Lower income (adjusted odds ratio [aOR] 1.97, 95 % confidence interval [CI] 1.38–2.81), medical aid (aOR 1.58, 95 % CI 1.05–2.38), two or more comorbidities (aOR 1.80, 95 % CI 1.12–2.90), current alcohol drinkers (aOR 2.33, 95 % CI 1.54–3.52), and employed at the time of diagnosis (aOR 10.72, 95 % CI 7.10–16.16) were significantly associated with unemployment. Non-working groups showed significant differences with respect to physical functioning, role functioning, depression, and existential well-being
Conclusions: The proportion of unemployed cervical cancer survivors seems to increase, with low-income status and the presence of medical aid negatively associated with employment, in addition to other comorbidities and previous working status. Effort should be made to secure the financial status of cancer survivors.
MASCC-0417
Intravenous methadone for severe cancer pain. Presentation of 10 cases
D. Lossignol 1, I. Libert1, B. Michel1, C. Rousseau1, M. Obiols-Portis1
1Supportive care, Institut Jules Bordet, Brussels, Belgium
Introduction: We present our preliminary experience with intravenous (IV) methadone in 10 cancer patients with advanced disease and severe cancer pain already treated with high doses of opioids.
Objectives: To study the effectiveness of IV methadon in refractory cancer pain
Methods: We followed 10 consecutives cancer patients with severe pain, treated with IV methadone. All had advanced disease and were already received strong opioids, some in association with ketamine. Pain was assessed at T0, T24 h, and at the end of treatment.
Results: All patients benefited from the switch to IV methadone with a reduction of pain on VAS after 24 h (median: 4/10-range, 0–5) until the end of treatment (all cases < 3/10). The median starting dose was 100 mg/day (range, 20–400) and the final dose remained stable with a median of 100 mg/day (range, 27–700). The median duration of IV methadone was 11 days (range, 2–59). No cardiac toxicity had been observed.
Conclusions: IV methadone is an effective pain relieving alternative for the treatment of severe cancer pain, especially in refractory pain syndrome. No toxicity (neurological or cardiac) or any other major side effects were observed and the treatment were overall well tolerated. More extensive comparative studies should be planned.
References:
Lawlor PG, Turner KS, Hanson J et al (1998) Dose ratio between morphine and methadone in patients with cancer pain: a retrospective study. Cancer, 82:1167–1173
Shaiova L, Berger A, Blinderman CD et al. (2008) Consensus guideline on parenteral methadone use in pain and palliative care. Palliat Support Care 6:165–176
MASCC-0418
Comparison of different methods for measuring the nutritional status and the identification of malnutrition in patients with cancer
C. Diemar 1, J. Rüssel1, F. Güntsch1, T. Behlendorf1, M. Wass1, H.J. Schmoll1, K. Jordan1
1Klinik für Innere Medizin IV Hämatologie/Onkologie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
Introduction: Cancer patients are under risk to develop malnutrition due to disease and side effects of the therapy. However, there is neither an uniform definition of malnutrition nor a gold standard for the assessment of malnutrition which complicates the diagnosis and a timely intervention to counteract the loss of body mass.
Objectives: We conducted a prospective study to analyze the feasibility and comparability of 3 different Methods for measuring the nutritional status and the identification of malnutrition in patients with cancer.
Methods: The nutritional status of 50 cancer patients was assessed by the Nutritional Risk Screening (NRS-2002), a bioimpedance-analysis (BIA) and the measurement of albumin, prealbumin and retinol-binding protein (RBP) which are indicators of visceral proteins in serum. For statistical analysis the ANOVA-method was used to make a statement about the variance between well- and malnourished patients.
Results: According to NRS-2002, 14 patients were at high risk of malnutrition, 7 patients were classified to be at moderate risk and 29 patients were not at risk of malnutrition. Albumin classified 28 patients as not well-nourished, prealbumin 7 patients and RBP 5 patients.
Results of BIA measurements are still under investigation. Patients identified as malnourished by prealbumin and RBP showed significant lower values of albumin and prealbumin or respectively RBP and were at risk to develop malnutrition by NRS-2002.
Conclusions: For diagnosis of malnutrition in patients with malignancies we preliminary suggest a well-defined screening according to NRS-2002 in each hospital patient and the determination of prealbumin or RBP as short-lived proteins.
MASCC-0419
Changes in nutritional status and body composition in childhood cancer patients: a prospective cohort study
A. Brinksma 1, E. Sulkers1, P.F. Roodbol2, W.A. Kamps3, A.M. Boot4, J.G.M. Burgerhof5, R.Y.J. Tamminga3, W.J.E. Tissing3
1Department of Pediatric Oncology and Hematology/School of Nursing and Health, University Medical Center Groningen University of Groningen, Groningen, Netherlands, 2School of Nursing and Health, University Medical Center Groningen University of Groningen, Groningen, Netherlands, 3Department of Pediatric Oncology and Hematology, University Medical Center Groningen University of Groningen, Groningen, Netherlands, 4Department of Pediatric Endocrinologie, University Medical Center Groningen University of Groningen, Groningen, Netherlands, 5Department of Epidemiology, University Medical Center Groningen University of Groningen, Groningen, Netherlands
Introduction: Since malnutrition and obesity have adverse outcomes during and after childhood cancer treatment, it is essential to gain insight in timing of weight loss and weight gain and in contributing factors.
Objectives: To determine (1) in which period of treatment changes in nutritional status and body composition occurred, and (2) which factors contributed to those changes.
Methods: We performed a prospective cohort study of 133 newly diagnosed cancer patients with hematological, solid, and brain malignancies. Anthropometric data and related factors were assessed at 0, 3, 6 and 12 months after diagnosis.
Results: Despite initial weight loss in the first weeks after diagnosis in patients with hematological and solid malignancies, body mass index (BMI) and fat mass (FM) increased within 3 months with 0.13 SDS (P < 0.001) and 0.05 SDS (P = 0.021) respectively. Increase continued during the next 9 months, and resulted in doubling of the number obese patients. Fat free mass (FFM), already low at diagnosis, remained low. During the whole study period about 17 % of the patients were malnourished according to low FFM. Tube feeding and diminished activity level were related to increase in respectively BMI and %FM. No relationship was found between energy intake or corticosteroids and increase in BMI or %FM.
Conclusions: Alarming increase of BMI and FM already started within the period of intensive treatment and continued thereafter, while FFM remained low. Improvement of nutritional status and body composition might be accomplished by prevention of overfeeding and improvement of physical activity in children on treatment.
MASCC-0420
Impact of high-level laser therapy on the weight of oncological patients affected by oral mucositis after radiotherapy of the head and neck region
M. Gobbo 1, G. Ottaviani1, F. Ciriello2, S. Zacchigna3, R. Di Lenarda1, A. Beorchia2, M. Biasotto1
1Dental Science - Oral Medicine and Pathology, University of Trieste, Trieste, Italy, 2Radiotherapy, Ospedale Maggiore, Trieste, Italy, 3Molecular Medicine, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
Introduction: Weight loss is frequently noted among head and neck cancer patients during and after radiotherapy
Objectives: To evaluate the capacity of High-level laser therapy to improve the nutritional status of patients affected by oral mucositis due to radiotherapy of the head and neck region during oncological treatment.
Methods: Sixty-three oncological patients were retrospectively included in this study. All patients were affected by solid tumors of the head and neck and had developed oral mucositis following radiotherapy. 42 patients had been treated by High-level laser therapy in addition to traditional medications, whereas 21 patients had received traditional medications only. Weight (Kg) and BMI (mass(kg)/(height)(m)2) at the first and last day of radiotherapy, site and stage of tumor, and kind of oncological treatment, were considered for this study.
Results: Laser-treated patients experienced a lower decline in BMI during radiotherapy. Patients treated by combined oncological treatment underwent a higher weight loss during radiotherapy. Multivariate regression analysis indicated that the only variable, which significantly influenced BMI decrease, was the execution of High-level laser therapy
Conclusions: Laser therapy is actually considered one of the recommended therapies to improve the healing of oral mucositis in oncological patients, by reducing pain and increasing chewing and swallowing capacities. It significantly improve the feeding capacity of patients, prevent excessive weight loss and reduce the costs for hospitalization and supportive care. Laser therapy should become part of nutritional interventions in oncological patients affected by oral mucositis
References: Ehrsson YT et al. Nutritional surveillance and weight loss in head and neck cancer patients; Support Care Cancer. 2012 Apr;20(4):757–65.
MASCC-0421
Adequacy of energy intake in childhood cancer patients
A. Brinksma 1, E. Sulkers1, P.F. Roodbol2, W.A. Kamps3, W.J.E. Tissing3
1Department of Pediatric Oncology and Hematology/School of Nursing and Health, University Medical Center Groningen University of Groningen, Groningen, Netherlands, 2School of Nursing and Health, University Medical Center Groningen University of Groningen, Groningen, Netherlands, 3Department of Pediatric Oncology and Hematology, University Medical Center Groningen University of Groningen, Groningen, Netherlands
Introduction: Despite a widespread belief that adequate energy intake is needed to maintain weight during childhood cancer treatment, consensus on how to define adequate energy intake is lacking, and the impact of energy intake on weight has never been tested.
Objectives: To evaluate which criterion is the best to determine the adequacy of energy intake during treatment for childhood cancer.
Methods: Prospective cohort study of 115 newly diagnosed cancer patients assessing energy intake at diagnosis, 3, 6, and 12 months. Intake was compared to recommended daily allowances (RDA), healthy controls, individual energy requirements (IR) based on Schofield formula, and weight changes.
Results: Energy intake was lower than RDA and lower than in healthy Dutch children (according to a food consumption survey 2008/2011) (FCS) at all measurement points. About 41–56 % of the patients had insufficient intake (<80 %) according to RDA or FCS. Energy intake matched IR at diagnosis and 6 months. However, energy intake was higher than IR at 3 months (P = 0.020) and lower at 12 months after diagnosis (P = 0.044). According to IR, intake was insufficient in 13–30 % of the patients.
During the study period, weight-for-age (WFA) increased from .01 SDS to .34 SDS (P = 0.001). Energy intake was not associated with increase of weight.
Conclusions: Despite energy intake being lower than RDA and FCS, weight increased. Obviously, childhood cancer patients need less energy than RDA or than healthy children. Instead of using RDA or FCS, adequacy of energy intake can better be evaluated with IR.
MASCC-0422
Inadequate treatment of pain: time for the courts/legislature to redress these human rights violations?
R. Jansen 1
1Private Law, University of the Free Sate, Bloemfontein, South Africa
Introduction: “Of patients with advanced cancer, 70 % have pain and 70–90 % of those with advanced AIDS have uncontrolled pain … suffering on this scale is … unnecessary … Every individual has the right to pain relief.”[1].
In 90 % of patients pain can adequately be relieved, but in 80 % of cases this is not done, despite the fact that effective pain medication is available. Morphine, one of the most effective painkillers, has been known to mankind for approximately 3 000 years.
Objectives: Over the last few decades the spotlight has fallen on the under-treatment of pain. Although attempts have been made to address this unnecessary human suffering, there are a number of reasons why too little progress has been made. In some countries, like the USA, fear of the regulatory authority has been mentioned. In South Africa this is not the case, but still people suffer needlessly. A lack of knowledge and archaic views have resulted in a so called “opiophobia” and a standard practice of giving no pain medication or as little medication as possible.
Methods: Diverging views on whether the health care system’s failure to treat patient pain adequately needs corrective action by the judiciary, will be discussed. Other possible solutions such as recent legislative developments will also be considered.
Results: Ideally the fear of lawsuits should not guide medical care.
Conclusions: The basic ethical principle is that human dignity requires and demands that treatable pain be relieved. Simultaneous initiatives in medicine, law and ethics are required.
References: [1] Korea Declaration 2005
MASCC-0423
Off label use of laser therapy for the treatment of radiodermatitis in breast cancer patients
S. Zacchigna 1, F. Ciriello2, M. Gobbo3, G. Ottaviani3, M. Biasotto3, R. Di Lenarda3, A. Beorchia2
1Molecular Medicine, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy, 2Radiotherapy, Ospedale Maggiore, Trieste, Italy, 3Dental Science - Oral Medicine and Pathology, University of Trieste, Trieste, Italy
Introduction: Dermatitis is a common and distressing side effect of radiotherapy in patients with cancer. Swelling, redness, and ulceration of the skin are often associated to itching, pain and burning sensation. There is no convincing evidence supporting any single practice in the prevention or management of radiodermatitis.
Objectives: To evaluate the effectiveness of High-level laser therapy (HLLT) in reducing the severity of radiodermatitis in breast cancer patients.
Methods: Ten patients affected by severe radiodermatitis at the grade 3 or 4, according to Common Terminology Criteria for Adverse Events scale, were treated by 2 consecutive HLLT sessions, 3 times a week for 2 weeks. HLLT was applied to the intramammary fold and underarm. Follow up recalls were performed at 7, 14 and 30 days after the last laser session, by evaluating general discomfort, hitching, bleeding and subjective satisfaction. Before enrollment, all patients were asked to interrupt any medication.
Results
A general improvement in pain sensation and hitching was seen both during laser session and follow up. Bleeding was stopped immediately after treatment. All patients referred to be highly satisfied, immediately after treatment as well as during follow up. Objective examination showed in all cases a noteworthy improvement of inflammation, oedema, erythema and swollenness. All patients underwent complete regression of all lesions in the treated areas.
Conclusions: Our results suggest that HLLT might significantly contribute to the healing of radiodermatitis, thereby improving quality of life of cancer patients.
References: Kumar S et al. Management of skin toxicity during radiation therapy: a review of the evidence. J Med Imaging Radiat Oncol. 2010 Jun;54(3):264–79.
MASCC-0424
The effect of modafinil on fatigue, cognitive functioning and mood in primary brain tumor patients: a multi-center RCT
F. Boele 1, L. Douw2, M. Groot de2, H. Thuijl van2, W. Cleijne1, J. Reijneveld2, J. Heimans2, M. Taphoorn3, M. Klein1
1Medical Psychology, VU University Medical Center, Amsterdam, Netherlands, 2Neurology, VU University Medical Center, Amsterdam, Netherlands, 3Neurology, Medical Center Haaglanden, the Hague, Netherlands
Introduction: Fatigue, cognitive deficits, and depression are frequently reported, but often undertreated symptoms that can profoundly affect daily life in patients with primary brain tumors (PBTs).
Objectives: To evaluate the effects of the psychostimulant modafinil on fatigue, depression, health-related quality of life (HRQOL) and cognitive functioning in PBT patients, we performed a multi-center, double-blind placebo-controlled crossover trial.
Methods: Patients randomly received either 6 weeks of treatment with modafinil (up to 400 mg/day) or 6 weeks with placebo. After a 1 week washout period, the opposite treatment was provided (6 weeks of placebo or 6 weeks of modafinil). Assessments took place at baseline, and immediately after the first and second condition. Patients completed self-reported questionnaires on fatigue (CIS), depression (CES-D), HRQOL (SF-36), and self-perceived cognitive functioning (MOS). They also underwent comprehensive neurocognitive testing.
Results: Thirty-seven PBT patients participated. Relative to baseline, patients reported lower fatigue severity (CIS) and better motivation (CIS) both in the modafinil (p = 0.010 and p = 0.021, respectively) and placebo condition (p < 0.001 and p = 0.027, respectively). The same held for physical health (SF-36 PCS score; p = 0.001 and p = 0.008, respectively), working memory (p = 0.040 and p = 0.043, respectively) and information processing capacity (p = 0.036 and p = 0.040, respectively). No improvement in depressive symptoms was found in either condition.
Conclusions: Modafinil did not exceed the effects of placebo with respect to symptom management. Patient accrual was slow and relatively many patients dropped out during the trial, mostly due to experienced side-effects. Other, preferably non-pharmacological intervention studies should be considered to improve symptom management of PBT patients.
MASCC-0425
Incidence and management of aspiration pneumonia in patients treated with radiotherapy for head and neck cancer
S. Cousin1, M. Reich2, M. Degardin1, A. Mailliez1, V. Leclercq2, G. Lefebvre 1
1Head and Neck Cancerology, Centre Oscar Lambret, Lille, France, 2supportive Care Department, Centre Oscar Lambret, Lille, France
Introduction: Aspiration pneumonia (AP) has been reported as a frequent complication in patients treated with radiotherapy for head and neck cancer.
Objectives: The aim of this study was to investigate the incidence, the mortality and the management of AP in unselected head and neck cancer patients consecutively treated by radiotherapy, independently of the other associated anti cancer treatments.
Methods: We have carried out a retrospective analysis in our institution. Data about patients, tumors and treatment characteristics were recorded.
Results: A total of 273 consecutive patients treated from December 2011 to December 2012 were included. AP occurred in 9 (3,2 %) patients, corresponding to an incidence rate of 33 [95 % CI 11–54] per 1,000 person-years. Seven episodes were hypoxemic pneumonia which required oxygenotherapy. At the time of the AP, 8 patients had a performance status ≥3, 5 had a gastrostomy and none had a feeding tube. They all received a probabilistic antibiotherapy: 8 penicillin-based, 1 by levofloxacin. Seven had a respiratory kinesitherapy but only 2 were treated by nebulization. The median time of hospitalization was 9 days [3–14]. One patient with AP died from this complication.
Conclusions: In our population, the incidence of AP was lower than expected. The majority of our patients had a supportive care management with nutritional assessment before the beginning of the anti cancer treatment and an intensity-modulated radiation therapy, which can in part explain the low rate of AP.
References: Eisbruch A, Lyden T, et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2002;53:23–8
MASCC-0426
Telephone versus face to face palliative care consults
K.J. Weru 1
1Medicine, Aga Khan University Hospital, Nairobi, Kenya
Introduction: Palliative care aims at ameliorating patients and families suffering when faced with life-limiting illnesses. It involves symptom management and psychosocial, spiritual support. Proper communication between clinicians is important for this. Studies show that errors in communication are common.
Objectives: The aim was to assess the adequacy of information given in telephone versus face to face consults.
Methods: Twenty-five consults received in 2 months; 16 telephone 8 face to face. Team did not ask any questions but recorded information given during the consultation. This was assessed for following details: I) name II) age, III) gender, IV) longevity of illness, V) location, VI) diagnosis, VII) reasons for referral, VIII) current treatments, IX) knowledge of diagnosis, X) family involvement XI) knowledge of referral.
Results: Ninety percent of the telephone consults missed at least 5 parameters. These were, I, XI, IX, II, VI in that order.
No face to face missed 5 or more parameters but 20 % missed 2–3 of the parameters which were: I, X and IX. Of note is 88 % of the cases had the patient’s name not mentioned. This is a case of...... was the commonest starting statement.
Conclusions: Telephone consult is less informative than face to face. It is important to have a discussion after telephone consultation. Doctors are poor in the aspects of communicating with patients, families, colleagues.
References:
ISABEL, D; ET AL; 2012. Errors in Palliative Care: Kinds, Causes and Consequences
PEREIRA, J; and BRUYERE, E; 2011. The Pallium Palliative Pocketbook
MASCC-0427
Associations between men’s experiences of prostate cancer care and health-related quality-of-life and psychological wellbeing: findings from a national study
M. Hennessy 1, H. Comber1, F.J. Drummond1, L. Sharp1
1Research, National Cancer Registry Ireland, Cork, Ireland
Introduction: Prostate cancer is the most commonly diagnosed cancer in men in developed countries. The care experience of cancer patients has been investigated in various countries. These studies show significant variations between patients in experiences of care, with prostate cancer patients reporting significant problems and dissatisfaction. The extent to which these experiences impact on health-related quality-of-life and psychological wellbeing is not well understood
Objectives: The PiCTure 2 study aims to assess the care experiences of men recently diagnosed with prostate cancer and investigate associations between experiences and health-related quality-of-life and psychological wellbeing.
Methods: Men diagnosed with invasive prostate cancer (ICD10 C61) 5–20 months prior to study commencement were identified through the National Cancer Registry. The study questionnaire was based on the Prostate Care Questionnaire (Baker et al. 2007), modified for Ireland and pre-tested using cognitive interviewing. Health-related quality-of-life and psychological well-being were assessed using the ED5D-5 L and DASS. The questionnaire was administered by post to >2,200 men during January-February 2013.
Results: More than 950 completed questionnaires have so far been received. Men’s experiences will be compared by time since diagnosis, age at diagnosis, treatments received and socio-demographic factors. Factors which contribute to positive/negative experiences will be highlighted and the extent to which these are associated with health-related quality-of-life (utility) and psychological wellbeing (depression, anxiety and distress) described.
Conclusions: If care experiences are associated with health-related quality-of-life and psychological wellbeing, this provides further rationale for initiatives to improve quality of care.
MASCC-0428
Men’s experiences of prostate cancer care: qualitative findings from cognitive interviews
M. Hennessy 1, H. Comber1, F.J. Drummond1, L. Sharp1
1Research, National Cancer Registry Ireland, Cork, Ireland
Introduction: Prostate cancer is the most common cancer in men in developed countries. Incidence in Ireland is the highest in Europe. Patients’ experiences of care are an important indicator of quality of care, but remain poorly understood
Objectives: The PiCTure 2 study aims to assess the care experiences of men recently diagnosed with prostate cancer in Ireland
Methods: A questionnaire was developed from the Prostate Care Questionnaire (PCQ; Baker et al., 2007). To modify as appropriate for Ireland, it was pre-tested using cognitive interviewing. Seventeen interviews were conducted with prostate cancer patients (managed by all major treatment modalities) recruited by Urologists and/or Clinical Nurse Specialists at three hospitals during September 2012–January 2013. Men were invited to ‘think-aloud’ whilst completing the survey; the interviewer used prompts to understand how respondents interpreted survey questions. Interviews lasted 20–90 min. Interview recordings were transcribed and analysed thematically
Results: Emergent themes included: breaking the bad news; support (both informational and emotional) from doctors, nurses and spouses/partners; growth in knowledge throughout the diagnosis-treatment trajectory but a reliance on ‘experts’ at the outset and how this impacted on their ability to participate in care and decision-making; and altruism. Key revisions were made to the survey so that it will accurately capture experiences of patients in Ireland.
Conclusions: As well as informing survey development, cognitive interviews provided rich qualitative data which will add to the interpretation of the survey findings. The PiCTure 2 results will be of value to policy-makers, service providers, health professionals and patient support organisations.
MASCC-0429
Increase of life quality and toxicity decrease in patients with the ovarian cancer who’s taking adjuvant chemical therapy
A.I. Rybin 1, V.G. Dubinina1, O.V. Kuznetsova1, O.V. Lukyanchuk1
1Oncology, Odessa National Medical University, Odessa, Ukraine
Introduction: In Ukraine 75 % cases of ovarian cancer are diagnosed in late stages and need adjuvant chemotherapy. But in 30–40 % of cases there are platinum resistant forms of ovarian cancer or the treatment should be stopped owing to toxicity of this drug.
Objectives: The aim of this work is to study the clinical effectiveness of L-arginine in treatment of patients with ovarian cancer at later stages by assessing quality of life and toxicity of chemotherapy.
Methods: Fifty patients with ovarian cancer at stage IIIA-IIIC were divided into 2 groups: in the first group on the background of traditional postoperative chemotherapy (cisplatin + paclitaxel) patients carried L-arginine: 500 mg per os twice a day during 10 days. In the second (control) group the patients received traditional adjuvant chemotherapy.
Results: The results of L-arginine use clinical efficacy in complex treatment of patients with the ovarian carcinoma investigation are presented in the article. It was established that L-arginine use in parallel with postoperative chemical therapy improves indices of patient’s life quality and also decreases chemical drugs toxicity. The cause of such results is that L-arginine is donator of the nitric oxide. And one of the of nitric oxide effects is stimulation of tissue sanogenesis.
Conclusions: Use of L-arginine in complex treatment of ovarian cancer increases patients’ life quality and reduces platinum drugs toxicity.
References: Philip J. DiSaia, William T. Creasman. Clinical Gynecologic Oncology. Seventh edition. - Elsevier, 2011.
MASCC-0430
Prevalence of advanced directives and information needs of cancer patients during radiotherapy
B. van Oorschot 1
1Department of Radiation Oncology, Interdisciplinary Center Palliative Care, Würzburg, Germany
Introduction: Advanced directives (living wills, AD) are becoming increasingly widespread.
Objectives: We examined prevalence and information needs concerning ADs during radiotherapy.
Methods: A standardized questionnaire was handed out to all cancer patients on 4 random days between June 2009 and July 2010.
Results: Of 470 questionnaires, 276 returned completed (58.7 %). 69 respondents had already an AD (25.6 %) and 143 thought they were likely to sign an AD (53.0 %). The concept of AD was unknown for 10 respondents (3.7 %). 28 respondents did not want to sign an AD (10.4 %). Patients with an AD were significantly older than 65 years. 82.0 % of all respondents, agreed with the statement that patients should be asked about an AD in context of every admission. Among them 93.1 % of all patients had an AD and 83.6 % of all respondents were likely to sign an AD. 94.4 % agreed with the statement that counselling concerning ADs is useful; among them, there were significantly more patients likely to sign an AD than patients with ADs (p = .000). 60.4 % wanted for themselves expert advice on Ads. Among them significantly more patients were likely to sign an AD than patients who already had ADs (66.0 % vs 57.3 %, p = .000). Among the patients who wanted expert advice 59.9 % wanted a consultation with their general practitioner, 25.7 % with a physician in charge in hospital and 6.7 % with another medical specialist.
Conclusions: ADs are relevant and especially patients likely to sign an AD want expert advice. To optimize patients support communication about ADs in the context of oncological treatment should be improved.
MASCC-0431
Development of a multidisciplinary, evidence based symptom management tool for oral care in cancer therapy
I. Harle1, D. Saunders 2, K. Bak3, V. Jarvis4, P. Argier5, A. Cheung6, A. Knight7, T. Murphy-Kane8, C. Root9, S. Wales Arnold10, S. Tierney11
1Dental Oncology, Health Sciences North North East Cancer Center, Sudbury, Canada, 2Palliative Care Medicine Program, Queen’s University, Kingston, Canada, 3Oncology Nursing Psychosocial and Palliative Care, Cancer Care Ontario, Toronto, Canada, 4Palliative Care Medicine Program, University of Ottawa the Ottawa Hospital Cancer Center, Ottawa, Canada, 5Supportive Care, R.S McLaughlin Durham Regional Cancer Center, Oshawa, Canada, 6Pharmacy, Cancer Care Ontario, Toronto, Canada, 7Palliative Care Medicine Program, Health Sciences North North East Cancer Center, Sudbury, Canada, 8Palliative Care Medicine Program, Princess Margaret Hospital, Toronto, Canada
9NSMPCN Palliative Resource Team, North Simcoe Muskoka Palliative Care Network, Orillia, Canada, 10Supportive Care, Peel Regional Cancer Center, Mississauga, Canada, 11Palliative Care, Elisabeth Bruyere Hospital SCOHS, Ottawa, Canada
Introduction: Cancer Care Ontario developed Symptom Management a series of evidence-based tools for oral care to assist healthcare professionals in the assessment and appropriate management of a patient’s cancer-related symptoms. The tools consist of a comprehensive Guide-to-Practice, quick reference Pocket Guides and two-page Algorithms.
Objectives: The overall goal of the oral care symptom management tools is to promote an interdisciplinary model of care, enabling earlier identification, assessment, communication and documentation of symptom, and optimal non-pharmacological and pharmacological management of symptoms, ranging from basic to palliative oral care. In order to reach a wide audience, the oral care tools were intended to be user-friendly and available in print, web and smart phone applications.
Methods: The tools were developed by an interdisciplinary panel, using the ADAPTE guideline adaptation approach that includes identifying existing guidelines using a systematic search strategy, appraising guideline quality using the AGREE tool, selecting recommendations for inclusion and obtaining expert feedback.
Results: The tools offer recommendations, based on the best available evidence and expert consensus, for the assessment, etiology and diagnosis of oral care. As well interventions for the following: general oral care (from basic to intensified to palliative oral care), oral mucositis, xerostomia and salivary gland dysfunction, dysgeusia, and intraoral infections, with specific reference to pharmacological and non-pharmacological interventions.
Conclusions: Following the trends in user-friendly guideline development (eg using algorithms or smart phone applications), the primary goal was to develop a evidence based tools for oral care in cancer that were accessible to practitioners in a manner that suits their clinical needs.
MASCC-0432
Novel all-oral combination of netupitant plus palonosetron (NEPA) for preventing CINV with highly emetic chemotherapy: a randomized study exploring maximally convenient and effective regimens
R. Gralla 1, G. Rossi2, G. Rizzi3, M. Palmas4, A. Alyasova5, I. Drobner6, P. Hesketh7
1Oncology, Albert Einstein College of Medicine, Bronx NY, USA, 2Clinical Operations, Helsinn Healthcare S.A., Lugano, Switzerland, 3Statistics & Data Management, Helsinn Healthcare S.A., Lugano, Switzerland, 4Corporate Clinical Development, Helsinn Healthcare S.A., Lugano, Switzerland, 5Oncology, Federal State Institution Privolzhsky District Medical Center under the Federal Medical-Biological Agency of Russia, Nizhny Novgorod, Russia, 6Oncology, Regional Oncology Center, Khmelnytsky, Ukraine, 7Thoracic Oncology, Lahey Hospital & Medical Center, Burlington MA, USA
Introduction: Antiemetic goals are to provide maximally convenient approaches with safe and effective treatment.
Objectives: This study was conducted to explore NEPA, an all-oral combination of netupitant (long-acting NK1 receptor antagonist) plus palonosetron to determine proper netupitant doses with palonosetron so that single-dosing formulations could be further investigated.
Methods: This randomized, double-blind study included 694 chemotherapy-naïve patients receiving cisplatin. It compared 3 netupitant doses plus oral palonosetron 0.50 mg with oral palonosetron (PALO) 0.50 mg, all given on day 1. A fifth exploratory group received IV ondansetron (O) 32 mg plus aprepitant [days 1–3]. All patients received oral dexamethasone (D) on days 1–4. The primary endpoint was complete response (CR: no emesis, no rescue) during the overall (0–120 h) phase.
Results: Treatment groups were similar: male (57 %), median age 55. Most frequent cancers: lung (27 %); head & neck (21 %). Median cisplatin dose: 75 mg/m2. While results were similar in all NK1-arms, the highest NEPA dose studied (netupitant 300 mg/palonosetron 0.50 mg) demonstrated the best overall CR, acute CR, and no significant nausea rates. All NK1 regimens had superior overall CR rates compared with palonosetron + dexamethasone; side effects were similar in all groups.
CR Rates | PALO + D | NEPA 100 + D | NEPA 200 + D | NEPA 300 + D | APREP + O + D |
Patients | 136 | 135 | 137 | 135 | 134 |
Overall | 76.5 % | 87.4 %* | 87.6 %* | 89.6 %* | 86.6 %* |
Acute | 89.7 % | 93.3 % | 92.7 % | 98.5 %* | 94.8 % |
Delayed | 80.1 % | 90.4 %* | 91.2 %* | 90.4 %* | 88.8 %* |
*p ≤ 0.05 vs PALO + D
Conclusions: The NEPA all-oral combination is convenient and highly effective in patients receiving cisplatin. NEPA300 was associated with the best results and is particularly suited for further trials using maximally convenient single-dosing strategies.
MASCC-0433
Phase 3 study of NEPA, a fixed-dose combination of netupitant (NETU) and palonosetron (PALO), versus PALO for prevention of CINV following moderately emetogenic chemotherapy (MEC)
M. Aapro 1, G. Rizzi2, M.E. Borroni3, M. Palmas3, S. Grunberg4
1Oncology, Clinique de Genolier, Genolier, Switzerland, 2Statistics & Data Management, Helsinn Healthcare S.A., Lugano, Switzerland, 3Corporate Clinical Development, Helsinn Healthcare S.A., Lugano, Switzerland, 4Division of Hematology/Oncology, Fletcher Allen Health Care, Burlington VA, USA
Introduction: Targeting multiple molecular pathways is important for control of CINV. Novel agents are necessary for optimization of CINV control, particularly with regard to delayed nausea. NEPA is a fixed-dose combination of NETU, a highly-selective NK1 receptor antagonist (RA) and PALO, a pharmacologically distinct 5-HT3 RA.
Objectives: This was a multinational, randomized, double-blind, parallel-group study assessing the efficacy and safety of a single oral dose of NEPA (NETU 300 mg + PALO 0.50 mg) versus a single oral 0.50 mg dose of PALO in 1,455 chemotherapy-naïve patients receiving anthracycline-based chemotherapy.
Methods: Patients in the NEPA and PALO arms received 12 mg and 20 mg dexamethasone on Day 1, respectively. After completion of the first cycle, eligible patients were allowed to continue into an unlimited multicycle extension. The primary efficacy endpoint was complete response (CR: no emesis, no rescue medication) during the delayed (25–120 h) phase. The primary analysis is a two-sided Cochran-Maentel-Haenszel test including treatment, age, and region as strata. NEPA will be declared superior to PALO if the p-value is less than or equal to 0.050 and favoring NEPA. Secondary efficacy endpoints include CR rates during the acute (0–24 h) and overall (0–120 h) phases, and proportion of patients with no emesis, no significant nausea and complete protection (no emesis, no rescue medication, and no significant nausea) during all phases. Key safety assessments include adverse events, ECGs, left ventricular ejection fraction, and cardiac troponin level.
Results: The primary analyses are expected to be complete by March 15, 2013 and fully available as a late-breaking submission in May.
Conclusions
MASCC-0434
Phase 3 study of NEPA (fixed-dose combination of netupitant and palonosetron) for prevention of CINV following repeated moderately (MEC) and highly (HEC) emetogenic chemotherapy cycles
K. Jordan 1, G. Rizzi2, M.E. Borroni3, M. Palmas3, R. Gralla4
1Oncology/Hematology, University of Halle, Halle, Germany, 2Statistics & Data Management, Helsinn Healthcare S.A., Lugano, Switzerland, 3Corporate Clinical Development, Helsinn Healthcare S.A., Lugano, Switzerland, 4Oncology, Albert Einstein College of Medicine, Bronx NY, USA
Introduction: NEPA is a fixed-dose combination of netupitant (NETU), a highly selective NK1 receptor antagonist (RA) and palonosetron (PALO), a pharmacologically distinct 5-HT3 RA. Recent trials were conducted to establish the superiority of NEPA over PALO in preventing CINV following a single cycle of HEC and MEC.
Objectives: This study was designed to examine the tolerability and efficacy of NEPA over multiple cycles of HEC and MEC.
Methods: This was a multinational, randomized, double-blind, phase 3 study evaluating a single oral dose of NEPA (NETU 300 mg + PALO 0.50 mg) administered on day 1 of each cycle, and given with oral dexamethasone (day 1: MEC; days 1–4: HEC) prior to repeated cycles. A standard 3-day oral aprepitant + PALO + dexamethasone arm was included as a control with an unbalanced 3:1 (NEPA:aprepitant) randomization ratio. The number of cycles was not limited. Safety was the primary objective as assessed by adverse events; secondary variables included ECGs, left ventricular ejection fraction, and cardiac troponin levels. Efficacy was assessed as proportion of patients with complete response (no emesis, no rescue medication). No formal statistical comparisons are planned; data will be summarized descriptively.
Results: Four hundred thirteen patients were randomized. Analyses will be completed by March and submitted as late-breaking.
Conclusions: Few large randomized trials have documented safety and antiemetic control over multiple cycles of chemotherapy, especially HEC. The safety profile will provide new information over multiple cycles. NEPA is designed to provide maximal convenience with high degrees of antiemetic control throughout the patient’s full course of chemotherapy.
MASCC-0435
Mandibular osteoradionecrosis in squamous cell carcinoma (SCC) of the oral cavity and oropharynx : incidence and risk factors at the Lausanne University Hospital, Switzerland
K. bouferrache 1, C. Madrid1, M. Abarca1, Y. Monnier2
1Oral surgery Oral medicine and Hospital Dentistry, Department of Ambulatory Care and Community medicine, Lausanne, Switzerland, 2Otolaryngology Head and Neck surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Introduction: Osteoradionecrosis (ORN) is defined as an area of exposed devitalized irradiated bone that fails to heal over a period of 3–6 months in the absence of local neoplastic disease. Its reported incidence in the literature is variable, from 0.4 % to 56 %.
Objectives: To analyse the incidence and risk factors for mandibular ORN in SCC of the oral cavity and oropharynx.
Methods: A monocentric retrospective study of 73 patients was conducted at the Lausanne University Hospital, between January 2000 and December 2007, with a minimum follow-up of 2 years. Different variables (age, sex, dental extraction before and after radiotherapy (RT), alcohol/tobacco consumption…) were taken into consideration to evaluate patient-related risk factors for mandibular ORN.
Results: The incidence of mandibular ORN in the reported patient group was 40 % at 5 years. Two peaks of incidence were founded. All patients developing ORN had received radiation doses above 66 Gy, most of them (92 %) had undergone mandibular surgery. No patient-related risk factor was statistically significant in the present study. Mandibular surgery prior to radiotherapy was the only independant risk factor associated ORN.
Conclusions: Mandibular ORN is a frequent long-term complication of RT of oral cavity and oropharynx cancer. The reported incidence rate is high compared with most published data. The reason for this difference is most likely multifactorial. Interestingly, pre-irradiation dental extraction and poor oral and/or dental hygiene (before RT) were not statistically significant risk factors. Mandibular surgery proved to be the most important risk factor.
References: Monnier, 2011
MASCC-0436
Vascular endothelial growth factor inhibitors (VEGFIS) and cognitive impairment: evidence and controversies
T. Ng 1, Y.T. Cheung1, Q.S. Ng2, A. Chan1
1Department of Pharmacy, National University of Singapore, Singapore, Singapore, 2Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
Introduction: It is suggested that vascular endothelial growth factor (VEGF) induces neurogenesis in the brain and provides neuroprotective effects; hence there are concerns that the use of VEGF inhibitors (VEGFIs) may induce cognitive disturbances in cancer patients. However, current evidence on VEGFI-induced cognitive impairment is limited.
Objectives: The aim of this review is to summarize and critically evaluate the evidence and controversies surrounding the cognitive issues associated with the use of VEGFIs.
Methods: A literature search was performed; articles and meeting abstracts evaluating the association between VEGFIs and cognitive disturbances were included from January 1995 to December 2012. Both preclinical and clinical studies were assessed. Studies that have evaluated the effects of VEGFIs on brain tumors were excluded.
Results: A total of 4 articles and meeting abstracts were included in this review (2 clinical studies, 1 case-series and 1 preclinical study). Drugs being evaluated were bevacizumab, sunitinib, sorafenib and a non-commercially available VEGFI (PTK787/ZK222584). With the exception of a clinical study that reported a lack of association between VEGFIs and cognitive functioning, other studies have demonstrated that VEGFIs have a negative impact on cognitive functioning commonly in the memory domain
Conclusions: This review has brought attention to the potential cognitive issues associated with the use of VEGFIs and has added a new, unexplored dimension to the problem of cancer treatment-related cognitive changes. However, due to conflicting results and a lack of substantial data, more well-designed longitudinal studies are required to ascertain this association.
MASCC-0437
Natural history of insomnia in breast cancer patients
L. Fleming 1, E. Stewart1, C.A. Espie2, D. Morrison1, J. Paul3
1Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom, 2Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom, 3Cancer Research UK Trials Unit, Beatson Institute for Cancer Research, Glasgow, United Kingdom
Introduction: Sleep disturbance is highly prevalent in breast cancer patients. The onset of sleep disruption commonly occurs at diagnosis and often becomes persistent. Despite its prevalence, and considerable evidence that Cognitive Behaviour Therapy (CBT) is an effective treatment, insomnia remains a neglected problem, due partly to the uncertainty around when CBT should be implemented.
Objectives: To track the natural history of insomnia in breast cancer patients and report on the optimal time to provide CBT within cancer settings.
Methods: This on-going study tracks 250 newly diagnosed breast cancer patients, gathering data on sleep, cancer-related and stress-response symptoms. This interim analysis reports data from the first 92 participants. Median age of the sample is 60 years. 52 % have a stage 1 tumour (X1), 37 % have X2, 9 % have X3 and 2 % have X0. 95 % of the sample has undergone radiotherapy and 48 % have had chemotherapy.
Results: Preliminary analyses reveal pre-diagnosis median ISI score of 1.5, increasing to 9.0 at diagnosis. Scores remained in sub-clinical ranges at months 3 (9.0) and 6 (8.0), improving at month 9 (7.0). Baseline, ISI scores were significantly correlated with fatigue and depression but not with anxiety. Post-diagnosis ISI scores were associated with worsening fatigue, depression and anxiety.
Conclusions: Early results suggest significant deterioration in sleep pattern/quality occurring around diagnosis. This pattern remains consistent throughout active treatment and sleep does not return to pre-diagnosis status after treatment completion. This study will provide important information about the natural history of sleep disturbance in this population, with implications for treatment and prevention.
MASCC-0438
Effectiveness of pegfilgrastim prophylaxis for reducing the risk of febrile neutropenia in patients with advanced stage solid tumors
J. Crawford 1, M. Reiner2, D. Dale3, P.K. Morrow4, E. Abella4, G.H. Lyman5
1Department of Medicine, Duke University Medical Center, Durham, USA, 2Global Biostatistical Science, Amgen Inc., Thousand Oaks, USA, 3Department of Medicine, University of Washington, Seattle, USA, 4Hematology/Oncology, Amgen Inc., Thousand Oaks, USA, 5Comparative Effectiveness and Outcomes Research – Oncology, Duke University School of Medicine and the Duke Cancer Institute, Durham, USA
Introduction: Patients with advanced cancer receiving chemotherapy are at risk for developing febrile neutropenia (FN), which is associated with substantial morbidity.
Objectives: To determine the impact of pegfilgrastim prophylaxis on grade 3/4 FN in patients with advanced stage solid tumors.
Methods: Patients were pooled from three Amgen-sponsored placebo-controlled trials (placebo versus pegfilgrastim prophylaxis): a phase 3 trial in breast cancer patients (Vogel 2005) and a phase 2 and a phase 3 trial in CRC patients (Hecht 2012, Pinter 2013). Patients with advanced disease (stage III, IIIA, IIIB, IV) at baseline were included (N = 1823). Grade 3/4 FN definition: ANC <1.0 × 109/L and either a temperature of ≥38.2 °C or sepsis, infection, or neutropenia-related hospitalization. The Chi-square test was used to evaluate the association between pegfilgrastim and grade 3/4 FN; the OR for treatment effect on the incidence of grade 3/4 FN was estimated from a multivariate logistic regression model with the inclusion of type of cancer and age at baseline.
Results: Patient characteristics in the placebo (n = 915) and pegfilgrastim (n = 908) groups: median age, 57 and 57 years; ≥ 65 years, 252 (28 %) and 260 (29 %); breast cancer, 390 (43 %) and 375 (41 %); CRC, 525 (57 %) and 533 (59 %). Pegfilgrastim significantly reduced the incidence of grade 3/4 FN versus placebo four-fold (p < 0.001; OR for pegfilgrastim versus placebo = 0.18 [95 % CI:0.11, 0.28]).
Conclusions: Pegfilgrastim prophylaxis reduced the risk of FN in patients with advanced stage cancer. Assessment of FN risk is essential in the advanced/metastatic treatment setting.
MASCC-0439
Using the internet to assess lymphedema in breast cancer survivors: agreement between face-to-face and telerehabilitation system
N. Galiano Castillo 1, A. Ariza García2, C. Fernández Lao2, I. Cantarero Villanueva2, M. Legeren Alvarez3, M. Arroyo Morales2
1Physiotherapy. Fellow FPU AP2010-6075, Faculty of Health Sciences, Granada, Spain, 2Physiotherapy, Faculty of Health Sciences, Granada, Spain, 3Oncology, University Hospital San Cecilio, Granada, Spain
Introduction: Lymphedema is a lifetime complication of breast cancer survivors that can limit their participation in recreational or sports activities. Follow-up of lymphedema using an Internet application could help patients to determine the influence on their condition of these activities and adapt them accordingly. We aimed to determine the level of agreement between lymphedema assessment by telerehabilitation and by the traditional face-to-face method.
Objectives: The main objective of this study was to determine the level of agreement between lymphedema assessment by telerehabilitation and by the traditional face-to-face method in breast cancer survivors.
Methods: Thirty breast cancer survivors participated in a descriptive study of repeated measures using a cross-over design. Patients attended a session for a clinical face-to-face and real-time online telerehabilitation assessment of lymphedema. There was a 120-min interval between these two sessions. The order of sessions was randomly selected for each patient. A caregiver (husband, sister or friend) conducted the telerehabilitation assessment using a system that includes a specific tool based on an arm diagram for measuring the participant’s arm circumferences via a telehealh application.
Results: All outcome measures showed reliability estimates (α) ≥0.90; the lowest reliability was obtained for the total volume non-affected side (α = 0.90). The diagnosis of lymphedema by the two Methods also showed a good inter-rater reliability (Rho = 0.89).
Conclusions: These preliminary findings support the use of an Internet-based system to assess lymphedema in breast cancer survivors, offering carers a useful role in helping patients to follow up this lifetime health problem.
MASCC-0440
Delivering better supportive care to people with lung cancer: an exploration of the use of a patient-reported outcome measure in clinical nursing practice
R. Maguire 1, G. Kotronoulas1, C. Papadopolou1, M.F. Simpson2, J. McPhelim2, I. Lynn2
1School of Nursing and Midwifery, University of Dundee, Dundee, United Kingdom, 2Cancer Directorate, NHS Lanarkshire, Lanarkshire, United Kingdom
Introduction: Supportive care needs (SCNs) of people with lung cancer (LC) are highly prevalent, yet, are often unrecognised and unmet. Patient Reported Outcome Measures (PROMs) are a way of identifying the SCNs of people with lung cancer in clinical practice.
Objectives: To explore the use of PROM’s by lung cancer nurse specialists (LCNS) in the delivery of supportive care to people with LC.
Methods: A mixed-Methods study design was used. Patients (N = 20) were recruited from 3 sites in Scotland and took part in the study over 3 time-points: baseline (T1), 1 month (T2), 2 months (T3). At each time point, patients completed the Sheffield Profile for Assessment and Referral to Care (SPARC) and used the PROM to direct consultations with their LCNS (N = 3). End of study interviews explored patients’/clinicians’ experiences of using the SPARC in the delivery of supportive care.
Results: SCNs were highly prevalent at baseline. A significant reduction in overall psychological and spiritual needs from T1–T2, and family/social and treatment concerns from T1–T3 was recorded. The use of the SPARC resulted in patients disclosing needs that they would not have previously raised and promoted them to ask questions about their condition/care. LCNSs perceived that using the SPARC to guide consultations resulted in patients discussing a wider array of SCNs particularly sensitive issues such as death/dying, concerns regarding family/carers, and sexuality.
Conclusions: Our findings demonstrate the feasibility and acceptability of the use of PROMs in the delivery of supportive care to people with LC in clinical practice.
MASCC-0441
Rolapitant and its major metabolite do not affect the pharmacokinetics of midazolam, a sensitive cytochrome P450 3A4 substrate
A. Poma 1, J.C. Christensen2, H.P. Pentikis3, S.A. Arora4, M.L.H. Hedley5
1Medical Department, Tesaro, Waltham, USA, 2Program Management, Tesaro, Waltham, USA, 3Clinical Pharmacology, SAJE Consulting, Baltimore, USA, 4Statistics, Arora Consulting, North Oaks, USA, 5President & CSO, Tesaro, Waltham, USA
Introduction: Rolapitant is a highly selective and potent (Ki = 0.66 nM) neurokinin-1 receptor antagonist (NK-1RA). Other NK-1RA are known inducer/inhibitors of cytochrome P450 3A4 and may require dose-adjustment of concomitantly administered drugs.
Objectives: Evaluate potential effects of rolapitant on the PK of midazolam.
Methods: Phase1 study in healthy subjects (16 M, 10 F) who received midazolam 3 mg on D1. D3, all subjects administered rolapitant 200 mg followed by midazolam. D8 and D11, subjects received midazolam. Comparisons in PK of midazolam and 1-OH-midazolam on D3, D8, and D11 versus D1 were made to evaluate the potential time-dependent effects of rolapitant on the PK of midazolam.
Results: No significant PK interactions observed upon co-administration of rolapitant and midazolam. On D3, the geometric mean (90%CI) for Cmax and AUC were 0.86 (0.78, 0.94) and 0.98 (0.93, 1.03), respectively. Similarly, no significant PK interactions between SCH 720881 and midazolam observed as the Cmax and AUC of midazolam were 0.96 (0.88, 1.05) and 1.07 (1.01, 1.13), respectively on D8. Prolonged exposure to rolapitant did not demonstrate induction of the metabolism of midazolam as the Cmax and AUC were 1.04 (0.95, 1.14) and 1.18 (1.12, 1.24), respectively on D11. Additionally, no changes in the PK of 1-OH-midazolam in the presence of rolapitant or SCH 720881 were seen.
Conclusions: These results demonstrate that neither rolapitant nor its major metabolite inhibits or induces the metabolism of midazolam. This suggests the administration of rolapitant, unlike other NK-1RA, does not require dose adjustment of concomitantly administered drugs, which are metabolized by CYP3A4. Rolapitant was safe and well tolerated in this study.
MASCC-0442
Depressed mood in breast cancer survivors: associations with physical activity, cancer-related fatigue, quality of life and fitness level
N. Galiano Castillo 1, I. Cantarero Villanueva2, C. Fernández Lao2, L. Díaz Rodriguez3, C. Sánchez Salado4, M. Arroyo Morales2
1Physiotherapy. Fellow FPU AP2010-6075, Faculty of Health Sciences, Granada, Spain, 2Physiotherapy, Faculty of Health Sciences, Granada, Spain, 3Nursing, Faculty of Health Sciences, Granada, Spain, 4Breast Oncology Unit, University Hospital Virgen de las Nieves, Granada, Spain
Introduction: Close to 20 % of cancer survivors suffer depression after oncology treatment.
Objectives: The aim of this study was to examine the relationship between quality of life, cancer-related fatigue, physical activity level, health-related fitness and salivary flow rate with depression in breast cancer survivors.
Methods: One hundred and eight breast cancer survivors in the year after treatment is finished were included in this cross-sectional study. Demographic and clinical relevant information, cancer-related fatigue (Piper Fatigue Scale), quality of life (QLQ-Br23 module), pain intensity VAS scale, salivary flow rate, physical activity level (Minnesota Leisure Time Physical Activity Questionnaire) and health-related fitness (force handgrip, multiple sit-to-stand test and vertical jump performance) were assessed. Depressed mood was measured with the Profile of Mood state Depression subscale. Correlation and regression analyses were performed to determine the association among variables and to determine the proportions of explained variance in depressed mood.
Results: Significant positive correlations between depression and fatigue, systemic side effects, perceived shoulder pain, breast and arm symptoms (r ranged between 0.57 and 0.28; p < 0.001). Furthermore, significant negative correlations between depression and body image, future perspective, force handgrip and physical activity level (r ranged between −0.41/−0.19; p < 0.05). Regression analyses revealed that cancer-related fatigue, physical activity level, systemic side effects and body image were significant predictors of depression and when they are combined, they explained 39.6 % of the variance in depression scores (F = 14.43; p < 0.001).
Conclusions: In conclusion, cancer-related fatigue, physical activity level and quality of life correlates explain partially the variability of depression in breast cancer survivors.
MASCC-0443
Operable lung cancer patients experiences of rehabilitation and supportive needs at diagnosis. A qualitative study
M. Missel 1, J.H. Pedersen2, C. Hendriksen3, M. Tewes4, L. Adamsen5
1Dept. of thoracic surgery, Copenhagen University Hospital, Copenhagen, Denmark, 2Dept. of thoracic surgery, University Hospital of Copenhagen, Copenhagen, Denmark, 3Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, 4The Heart Centre, University Hospital of Copenhagen, Copenhagen, Denmark, 5University Centre for Nursing and Care research, University of Copenhagen, Copenhagen, Denmark
Introduction: Lung cancer is one of the most frequently occurring cancers, and the cancer site with the highest mortality rate. Lung cancer patients have complex problems through the disease trajectory and they are considered as disadvantaged when compared with other cancer patients. There are limited intervention studies. These studies have demonstrated promising results, but lung cancer patients’ needs during treatment trajectory still remains to be identified systematically. Present study is part of a PhD study’ Four critical moments in everyday life during disease and treatment trajectory in operable lung cancer patients and relatives, and the significance of participation in an intervention consisting of physical exercise’.
Objectives: The objective is to explore lung cancer patients’ challenges, needs and problems at diagnosis in order to expose diagnosis interference in everyday life.
Methods: A sample of 19 patients has been included. Inclusion criteria are diagnosis of non small cell lung cancer referred for surgery at department of thoracic surgery, Rigshospitalet and age above 18. Individual in-depths interviews combined with validated questionnaires with a phenomenological approach are conducted 5 days following diagnosis. Focus is the present and deals with themes of patients’ experiences with the diagnosis and everyday life. Follow-up interviews and questionnaires has been collected 14 weeks post surgery focusing on the patients return to everyday life.
Results: Data are being analyzed and results are expected to be published spring 2013.
Conclusions: Findings are expected to contribute to the development and initiation of further interventions for lung cancer patients early in the treatment trajectory.
MASCC-0445
Designing and testing of a new radiation therapy patient supportive care screening tool
J. Maamoun1, M.I. Fitch 2
1Radiation Therapy, Odette Cancer Centre Sunnybrook Health Sciences Centre, Toronto, Canada, 2Oncology Nursing, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: To enable Radiation Therapists to quickly identify their patients’ unmet supportive care needs and allow for early intervention and/or timely referral, the need for a new screening tool was anecdotally identified.
Objectives: A screening tool was designed and tested for psychometric properties to facilitate the provision of in-depth quality patient centred supportive care by Radiation Therapists.
Methods: A comprehensive/itemized screening tool was designed to identify the patient distress level and concerns, and to capture the patient desire for assistance. The tool was administered to 115 patients simultaneously with the EORTC QLQ-30 instrument; days 5, 7 and 16 of their radiation therapy treatments, and then tested for reliability, sensitivity and validity by analyzing the patient responses on both tools.
Results: Comparing days 5 and 7, McNemar’s test and the Simple Kappa Coefficient both showed high agreement between item scores. Comparing days 5 and 16 the former test showed a shift from high agreement to lesser agreement across the item scores. The latter showed a shift in over 97.7 % of the items from a higher agreement to a lesser agreement. Data from the EORTC QLQ-C30 showed a similar change over time; the Pearson Product Moment Correlation Coefficient fell on average from 0.75 to 0.58 for the first and the second comparisons respectively with all p-values < 0.0001. Concurrent validity was acceptable.
Conclusions: The new tool was found to be reliable and sensitive with acceptable validity. It is anticipated that it will enable Radiation Therapists to standardize and formalize their approach to patient supportive care.
MASCC-0446
Clinical impact of febrile neutropenia treatment with G-CSF: a retrospective analysis
A. Chan 1, Q.X. Wong1, M. Wong2, L.Y. Hsu3
1Pharmacy, National University of Singapore, Singapore, Singapore, 2Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore, 3Medicine, National University of Singapore, Singapore, Singapore
Introduction: The use of Granulocyte-Colony Stimulating Factor (G-CSF) for febrile neutropenia (FN) prophylaxis is well-documented in the literature, however, the use of G-CSF in established FN remains controversial.
Objectives: The objective of this study was to assess the efficacy of G-CSF in treatment of established FN by evaluating clinical outcomes.
Methods: This was a single-center, retrospective cohort study at the largest cancer center in Singapore. Adult patients who had received chemotherapy and manifested FN between January 2009 to January 2012 were included in this analysis.
Results: Forty-hundred and thirty patients were included in this study, with majority being Chinese (72.6 %) and a mean age of 52.0 (14–81) years. Majority manifested lymphoma (31.6 %), breast cancer (25.3 %) and genitourinary cancers (11.6 %). Almost half (45.4 %) received primary prophylaxis with G-CSF. Mean MASCC risk score was 22.6 (11–26) and infections were documented in 57.4 % patients. Therapeutic G-CSF was given to majority of the patients (77.9 %). Patients receiving therapeutic G-CSF manifested a shorter duration of hospitalization and fever resolution than those who did not receive therapeutic G-CSF. However, patients receiving G-CSF experienced a longer duration of grade 4 neutropenia and antibiotics use.
Treatment Outcomes | With Therapeutic G-CSF ( n = 335) | Without Therapeutic G-CSF ( n = 95) | p-value |
Duration of hospitalization (days) | 3.5 | 3.7 | 0.41 |
Duration to fever resolution (days) | 3.5 | 4.2 | 0.066 |
Duration of grade 4 neutropenia (days) | 2.5 | 2.0 | 0.011 |
Duration of antibiotics use (days) | 16.2 | 14.0 | 0.11 |
Conclusions: In this cohort, there was a lack of clinical benefit with the use of therapeutic G-CSF in established FN.
MASCC-0447
The effect of ginger (zingiber officinale roscoe) in patients with the anorexia cachexia syndrome (ACS)
R. Bhargava 1, A. Burns1, P. Enright1, M. Chasen1
1Palliative Care, Elisabeth Bruyere Research Institute, Ottawa, Canada
Introduction: ACS can present with a wide range of dyspeptic symptoms including nausea and vomiting. Ginger root has been used to treat a number of medical conditions, including those affecting the digestive tract such as dyspepsia, flatulence and nausea. This study is primarily exploratory as there is no data on pattern of Gastric Myoelectrical activity (GMA) in response to Ginger in patients with ACS.
Objectives: (1) To determine the effect of oral Ginger administration on GMA (2) To evaluate the symptoms as measured by the Dyspepsia symptom severity index (DSSI), Edmonton symptom assessment scale (ESAS), the patient generated subjective global assessment form (PGSGA) (3) To correlate the level of inflammatory markers and Ghrelin in patients with ACS and impaired GMA.
Methods: Fifteen Patients with ACS will be recruited to document a baseline and post water load Electrogastrography (EGG) after oral ingestion of Ginger capsule (1,650 mg) once daily, for 14 days. DSSI, ESAS, PG-SGA and Blood test to assess the level of Ghrelin, albumin and CRP will be done pre and post intervention. Descriptive statistics of EGG findings will be presented reflecting the categories of dysfunction. Correlations between types of GMA, gastrointestinal symptoms, Gherlin and inflammatory markers will be performed.
Results: This study is active and the results will be analyzed in late spring 2013.
Conclusions: Ginger enhances gastric motility as correlated by GMA measured by EGG. By increasing gastric emptying, ginger may improve a range of GI symptoms that can affect oral intake and quality of life.
MASCC-0448
Spiritual care rating scale, translation and cultural adaptation to Portuguese nurses
A. Martins1, S. Caldeira2, F.L. Pimentel 3
1Clinic., Cliria., Aveiro, Portugal, 2Health Sciences Institute, Catholic University, Lisboa, Portugal, 3Health Sciences Department, Lenitudes SA. Universidade de Aveiro, Aveiro, Portugal
Introduction: Spirituality in nursing in Portugal isn’t a significant reality. Nurses consider this field as subjective and difficult to interpret. The Spirituality and Spiritual Care Rating Scale (SSCRS) allows us to evaluate the perception nurses have of spirituality and spiritual care and has been used in international studies.
Objectives: Analyze the psychometric properties of the SSCRS, in Portugal
Methods: Linguistic and conceptual equivalence was established for the SSCRS. Portuguese version was applied to a sample of 94 nurses working at Palliative Care. In the validation process the same methodology of the author of the original scale was followed. The nurses who participated in this study were asked for their written consent
Results: Ninety-four nurses participated, (15—male; 79—female); age was between 21 and 39 years, had a full-time schedule, worked in shifts, and had 2 to 6 years of experience. 2 items were suppressed, resulting in an instrument with l5 items. Cronbach alpha was 0.76, which indicates that this instrument as adequate psychometric characteristics for this sample. Nurses recognized the importance of the spiritual needs, although 60.8 % of them mentioned the fact that they have not identified any diagnosis related to the spiritual sphere and 46.7 % of the nurses classify their formation regarding spirituality and/or spiritual care as insufficient.
Conclusions: SSCRS Portuguese version is reliable and valid scale. The nurses acknowledge their role in spirituality and spiritual care, although the clear need to include these dimensions in nurses syllabus remains.
References: McSherry W, et al: The construct of a rating scale… IntJNursing Studies 41;2003:151–161.
MASCC-0449
Identifying and addressing the unmet supportive care needs of radiation therapy patients in radiation therapy treatment settings: a role for radiation therapists
J. Maamoun1, M.I. Fitch 2
1Radiation Therapy, Odette Cancer Center Sunnybrook Health Sciences Centre, Toronto, Canada, 2Oncology Nursing, Odette Cancer Center Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: To date, little attention has been paid to implementing an approach that enables radiation therapists (RTs) to identify and address the unmet supportive care needs of their patients in radiation therapy treatment settings.
Objectives: To explore the ease of use of a new radiation therapy patient supportive care needs screening tool in routine clinical practice following its previous psychometric evaluation. Also, to determine the level of unmet supportive care needs within the patient population, and to quantify the requirement for assistance and/or referral of patients to other services for unmet supportive care needs identified by the new tool.
Methods: Sixteen RTs used the new tool over 6 weeks with 70 patients in their fourth week of their radiation treatments. Descriptive statistics for the patient responses on the screening tool and content analysis for the information on feedback forms completed by the RTs were compiled.
Results: The 70 patients identified 407 concerns or unmet needs with an average score of 2.8 on the ten point Distress Thermometers. Patients wanted help with 32.2 % of their identified concerns. RTs found the new screening tool easy to use as did their patients. RTs were able to address 90.8 % of patient identified concerns when help was wanted.
Conclusions: Given the right tools, RTs are able to identify the unmet supportive care needs of their patients and to address the vast majority of those needs. Screening for such needs should be part of RTs routine clinical practice and repeated throughout radiation therapy treatment delivery.
MASCC-0450
The role of human factors engineering in the development of self-administration drug delivery systems for patients requiring therapeutic and supportive care
R. Ahmed 1, R. Whelton1
1Medical Affairs, BD Medical - Pharmaceutical Systems, Franklin Lakes NJ, USA
Introduction: Self-injection drug delivery systems offer the potential to reduce the burden of care in patients requiring supportive care. However, when selecting a drug delivery system, it is imperative that the patient can successfully use the device, with different degrees of physical limitations and co-morbidities impacting treatment adherence and compliance. To attain the highest levels of therapeutic benefit, a patient-centric design with a strong focus on human factors should be utilized to ensure the creation of successful self-injection devices.
Objectives: To identify specific human factors that influence the usability, adherence, and compliance of self-injection pharmaceutical preparations in patients requiring supportive care, including anti-emetic, anti-inflammatory, and pain-relief options.
Methods: Multiple human factors studies were conducted to assess all aspects of performance safety, efficiency, pain perception, ease-of-use, and patient acceptance of disposable autoinjectors vs. prefilled syringes. Participants simulated use of each device following individual instructions for use, with observation of how patients reacted, capturing their initial response on a variety of human factor parameters, including tactical, visual, quality, and durability.
Results: The studies provided essential insights regarding the patient-product interface and demonstrated that patients had strong and positive input into product features and design. Specific human factor issues raised included dialing click sound, height/color of dosing fonts, visibility of drug reserve, needle size/attachment/positioning, capping/storage instructions, and tactical feel.
Conclusions: To maintain high standards in human factors, drug delivery system manufacturers must work in close partnership with patients to identify the widest possible range of issues to improve user experience, therapeutic compliance, and overall patient care.
MASCC-0451
Assessment of psycho-social and communication needs in Romanian oncology patients (APSCO)
C.L. Dégi 1
1Sociology and Social Work, Babes Bolyai University, CLUJ-NAPOCA, Romania
Introduction: Romania has one of the fastest growing aging populations of all countries in Eastern Europe. This trend will continue to increase age-specific cancer rates. Cancer is an unmet psychosocial challenge to patients and to the specialized services, regardless of care type (Dégi, 2012).
Objectives: This is the first extensive interdisciplinary research in Romania focusing on psychosocial aspects of adult cancer patients in oncology hospitals, in supportive cancer care groups and in palliative care services, including data from multi-centre questionnaire screening, survey and multivariate data analysis.
Methods: According to the tumour location, a heterogenic, mixed sample of oncology patients will be screened; a sample of 300 patients suffering from cancer diseases. Data collection will be performed in the largest oncologic institutions, chosen based on recommendations from Ministry of Health, and in the best-practice cancer-care services. Also we intend to obtain direct information from the persons involved in the investigated phenomenon with 60 semi-structured interviews. Measurement of psychosocial factors includes: Functional Assessment of Cancer Therapy–General (FACT–G 4.0), Beck Depression Inventory (BDI), Social and Emotional Loneliness Scale (SELSA), and llness Intrusiveness Rating Scale (IIRS).
Results: First results will be presented and the urgency of psychosocial screening in the Romanian cancer care system will be highlighted.
Conclusions: APSCO will encourage implementation of new perspectives, practical and policy ideas in this very important field of psycho-oncology in Romania.
References: Dégi, Csaba L. (2012). In search of the sixth vital sign: cancer care in Romania. Supportive Care in Cancer, 1–8. doi:10.1007/s00520-012-1657-7.
MASCC-0452
Evaluation of an education program for patients with cancer suffering from chemotherapy-induced peripheral neuropathy
C. Cranston 1, R. Bhargava2, M. Chasen1
1Palliative Care, Bruyere Research Institute, Ottawa, Canada, 2Pallliative Care, Bruyere Research Institute, Ottawa, Canada
Introduction: The incidence of chemotherapy-induced peripheral neuropathy (CIPN) for patients with cancer is increasing and many patients report that it disrupts their functioning and their quality of life. (Kautio et al. 2011) CIPN can lead to falls and other accidents and can disrupt any activity which involves handling objects. (Driessen et al. 2012; Tofthagen 2010).
Objectives: The objective of this study is to evaluate the effectiveness of a brief education program for patients suffering from CIPN.
Methods: This one-hour education session addresses three topics: preventing harmful secondary effects, compensating for CIPN in order to improve functioning, and non-pharmacological Methods of reducing the distress caused by CIPN.
Questionnaires will be used to evaluate the effectiveness of the education in reducing the interference of CIPN for these patients.
Results: The results will be analyzed and presented.
Conclusions: An education program will help patients to address the effects of CIPN.
References:
Driessen, C. M., de Kleine-Bolt, K. M., Vingerhoets, A. J., Mols, F., & Vreugdenhil, G. 2012, ‘Assessing the impact of chemotherapy-induced peripheral neurotoxicity on the quality of life of cancer patients: the introduction of a new measure’, Support. Care Cancer, vol. 20, no. 4, pp. 877–881.
Kautio, A. L., Haanpaa, M., Kautiainen, H., Kalso, E., & Saarto, T. 2011, ‘Burden of chemotherapy-induced neuropathy—a cross-sectional study’, Support. Care Cancer, vol. 19, no. 12, pp. 1991–1996.
Tofthagen, C. 2010, ‘Patient perceptions associated with chemotherapy-induced peripheral neuropathy’, Clin.J. Oncol. Nurs., vol. 14, no. 3, p. E22–E28.
MASCC-0453
Symptom clusters and demographic characteristics in advanced cancer
A. Aktas 1, D. Walsh1, L. Rybicki2, A. Fitz1
1Department of Solid Tumor Oncology Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA, 2Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, USA
Introduction: Little is known about demographic variations in cancer symptom clusters.
Objectives: To determine whether clusters are associated with age, gender, race, primary cancer site group (PSG), or performance status (PS).
Methods: Symptoms from 922 advanced cancer patients were analyzed with hierarchical cluster analysis. Comparisons were made between patients with and without each cluster using the chi-square test (<65 vs. ≥65 years; female (F) vs. male (M); Caucasian vs. African American; 10 PSG, or Wilcoxon rank sum test (ECOG PS 0–4); p < 0.05 indicated statistical significance.
Results: 83 % Caucasian, 52 % ≥65 years, 56 % male, 55 % PS 3–4. Most common PSG: lung (25 %), genitourinary (18 %), gastrointestinal (GI) (11 %). 7 clusters identified. ‘Fatigue/anorexia-cachexia’ associated with Caucasian race (p = 0.032) and PSG (pancreas) (p = 0.012). ‘Neuropsychological’ associated with older age (p < 0.001) and Caucasian race (p = 0.001). ‘Upper GI’ associated with female gender (p = 0.035) and PSG (pancreas) (p = 0.035). ‘Nausea/Vomiting’ associated with younger age (p = 0.01) and female gender (p < 0.001). ‘Aerodigestive’ associated with male gender (p = 0.01) and PSG (pancreas) (p < 0.001). ‘Debility’ associated with Caucasian race (p = 0.016) and poor PS (p < 0.001). ‘Pain’ associated with younger age (p = 0.028).
Conclusions:
1. We identified 7 clusters whose prevalence were influenced by age (nausea/vomiting, neuropsychological, pain), gender (aerodigestive, upper GI, nausea/vomiting), race (fatigue/anorexia-cachexia, neuropsychological, debility), PSG (fatigue/anorexia-cachexia, upper GI, aerodigestive) or PS (debility).
2. Our findings support the clinical relevance of the symptom cluster concept in palliative and supportive care.
3. Demographic characteristics may warrant different clinical approaches to patient care. Identification of these differences may help develop more effective symptom management strategies.
MASCC-0454
Using a patient navigation program to overcome health care disparities in cancer treatment in a multicultural setting
T. Elrafei1, K. Alexis1, M. Strakhan1, L.J. Reed1, B. Shaker1, B. Stanise1, M. Marquez1, M. Castaldi1, R.J. Gralla 1
1Medical Oncology, Albert Einstein College of Medicine Jacobi Medical Center, New York, USA
Introduction: Treating patients of differing cultures reveals barriers to good cancer care. Additional health disparities affect lower-income patients and are well documented. Causes of poor outcomes include treatment delays coupled with social and financial barriers. Navigation interventions have been more commonly applied in cancer screening and early diagnosis programs than in promoting adherence to treatment.
Objectives: This report examines the early impact of patient navigation (PN) on adherence to prescribed cancer treatment.
Methods: We initiated a PN program as a pilot project (supported by an Avon Foundation grant). Health care coverage: 58 % Medicaid—public assistance, 15 % uninsured or undocumented. Navigator duties included care coordination, appointment reminders, patient education, translations, and transportation arrangement. During a 4 month period new medical oncology patients at high risk received PN. Data collected prospectively included patient characteristics, cancer type, and compliance with visits; this was compared with usual care case controls in the same period
Results: PN program patient characteristics: N = 52 patients (22 breast cancer, 6 prostate cancer, 5 lung cancer and 19 patients other cancers). Mean age = 55; 48 % Black, 38 % Hispanic, 8 % Asian, 6 % White. Adherence to visit results are in the table:
Navigated Care Adherence | Usual Care Adherence | |
Physician Visits ( n = 2021) | 86 % | 97 % |
Infusion Visits ( n = 1656) | 79 % | 90 % |
Conclusions: In its first 4 months, this PN program has been associated with observed improvements in adherence to chemotherapy appointments and follow up physician visits. These results document that a PN program can help overcome barriers to good cancer care while identifying areas for further improvement.
MASCC-0455
Caphosol, a therapeutic option in case of cancer therapy-induced oral mucositis in children? Results from a prospective multicenter double blind randomized controlled trial
M.F. Raphael 1, A.M. den Boer1, F.C.H. Abbink2, G.J.L. Kaspers2, W.J.W. Kollen3, H. Mekelenkamp3, K. Zomer-Kooijker4, B.H.W. Molmans5, W.J.E. Tissing6
1Pediatric Hematology and Oncology, Wilhelmina Children’s Hospital University Medical Center Utrecht, Utrecht, Netherlands, 2Pediatric Hematology and Oncology, VU University Medical Center, Amsterdam, Netherlands, 3Pediatric Hematology and Oncology, Leiden University Medical Center, Leiden, Netherlands, 4Pediatrics, Wilhelmina Children’s Hospital University Medical Center Utrecht, Utrecht, Netherlands, 5Hospital and Clinical Pharmacy, Beatrix Children’s Hospital University Medical Center Groningen, Groningen, Netherlands, 6Pediatric Hematology and Oncology, Beatrix Children’s Hospital University Medical Center Groningen, Groningen, Netherlands
Introduction: Oral mucositis (OM) is a common side effect associated with severe morbidity in pediatric patients during cancer therapy. Caphosol, a calcium phosphate mouth rinse, is proven effective in reducing incidence, degree and duration of OM in adult patients undergoing hematopoietic stem cell transplantation.
Objectives: To study the effect of Caphosol when used therapeutically in cancer therapy-induced mucositis in pediatric oncology patients.
Methods: Hospitalized children who received chemotherapy and/or radiotherapy with a considerable risk to develop mucositis were enrolled. When first signs of mucositis appeared, patients rinsed daily with study rinse (Caphosol) or placebo rinse (sodium chloride 0.9 % (NaCl)), allocated according to randomization. Patients and observers were blinded. Trained nurses determined mucositis degree and pain scores daily.
Results: Fifteen patients received Caphosol rinse, 14 patients received placebo rinse. The number of days with mucositis > grade 1 was not significantly different in the intervention group compared to the control group (9.93 vs.6.36 days; p = 0.154). Caphosol rinse did not affect peak level of mucositis or pain compared to placebo rinse (2.20 vs. 2.43; p = 0.317 and 6.33 vs. 6.29; p = 0.964 respectively). A longer period of pain (11.33 vs. 7.29 days; p = 0.043) and use of analgesics (15.53 vs. 9.14 days; p = 0.035) was observed after using Caphosol rinse. Caphosol was well tolerated. No adverse effects were reported.
Table 1. Characteristics of the patients
Caphosol | Placebo | |
Variable | (n = 15) | (n = 14) |
Male gender | 10 (66.7 %) | 9 (64.3 %) |
Mean age (SD) | 11.3 ± 3.9 | 9.9 ± 4.7 |
Disease | ||
Hematologic malignancies | 6 (40.0 %) | 9 (64.3 %) |
Solid tumors | 3 (20.0 %) | 0 (0.0 %) |
Benign hematologic diseases | 5 (33.3 %) | 4 (28.6 %) |
Other | 1 (6.7 %) | 1 (7.1 %) |
Treatment regimen | ||
Chemotherapy | 5 (33.3 %) | 5 (35.7 %) |
HSCT (conditioning: chemo) | 9 (60.0 %) | 7 (50.0 %) |
HSCT (conditioning chemo + TBI) | 1 (6.7 %) | 2 (14.3 %) |
Neutropenia at start a | ||
Severe | 12 (80.0 %) | 14 (100.0 %) |
No | 2 (13.3 %) | 0 (0.0 %) |
Unknown | 1 (6.7 %) | 0 (0.0 %) |
Grade of mucositis >1 at start | 5 (33.3 %) | 9 (64.3 %) |
aSevere neutropenia defined as neutrophil count < 0.5 × 109/L or leukocyte count < 0.5 × 109/L (severe), determined on day 0, day −1 or day 1 of study. No neutropenia defined as neutrophil count > 1.0 × 109/L. on day 0, day −1 or day 1 of study.
Table 2. Comparisons of outcomes between Caphosol and placebo
Variable * | Caphosol ( n = 15 ) | Placebo ( n = 14 ) | P-value |
Days of mucositis | 15.8 (10.0) | 10.2 (4.7) | 0.069 |
Days of mucositis > grade 1 | 9.9 (8.1) | 6.4 (4.3) | 0.154 |
Peak level of mucositis | 2.2 (0.7) | 2.4 (0.5) | 0.317 |
Peak level of mucositits (functional) | 2.7 (0.5) | 2.4 (0.8) | 0.418 |
Days of pain | 11.3 (5.2) | 7.3 (5.1) | 0 . 043 |
Peak level of pain | 6.3 (2.5) | 6.3 (3.1) | 0.964 |
Days of analgesic use | 15.5 (9.5) | 9.1 (5.3) | 0 . 035 |
Morphine use | |||
Morphine required | 10 (66.7 %) | 9 (64.3 %) | 0.893 |
Peak dose (mg/kg) | 0.89 (0.53) | 0.77 (0.39) | 0.583 |
Days of use | 10.9 (8.6) | 9.0 (2.7) | 0.534 |
Tube feeding | |||
Tube feeding required | 14 (93.3 %) | 9 (64.3 %) | 0.080 |
Nr of days during study period | 13.2 (6.8) | 12.1 (41.4) | 0.670 |
Parenteral feeding | |||
Parenteral feeding required | 6 (40 %) | 4 (28.6 %) | 0.700 |
Nr of days during study period | 14.7 (14.9) | 10.5 (5.8) | 0.601 |
Blood cultures | |||
Taken | 11 (73.3 %) | 13 (92.9 %) | 0.330 |
Positive if taken | 6 (54.5 %) | 2 (15.4 %) | 0.082 |
*Mean values (±SD) or numbers (%) of subjects are given
Conclusions: Caphosol therapy neither reduces duration or severity of mucositis nor its associated pain in pediatric patients with cancer therapy-induced OM compared to placebo, although it is difficult to reach valid Conclusions with this small sample size.
MASCC-0456
Relationship of race to cancer symptom profiles in advanced cancer
A. Aktas 1, D. Walsh1, L. Rybicki2, A. Fitz1
1Department of Solid Tumor Oncology Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA, 2Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, USA
Introduction: Racial influences in advanced cancer symptoms are unknown.
Objectives: To determine whether symptom prevalence, severity, and survival differed between African Americans (AA) and Caucasians.
Methods: Thirty-eight symptoms assessed in 1,000 consecutive advanced cancer patients. Age compared between 167 AA and 803 Caucasians with t-test. Gender and primary site groups (PSG) compared with chi-square test. Performance status (PS) and symptom severity compared with Wilcoxon rank sum test. Kaplan–Meier method estimated post referral survival; p ≤0.05 indicated statistical significance.
Results: Age, gender, PS, and PSG did not differ between AA and Caucasians (p ≥ 0.36). AA had less edema (21 % vs. 30 %, p = 0.02), depression (27 % vs. 44 %, p < 0.001), anxiety (14 % vs. 26 %, p = 0.001), tremors (1 % vs. 6 %, p = 0.018), anorexia (57 % vs. 67 %, p = 0.022), dry mouth (48 % vs. 59 %, p = 0.01), but more headache (17 % vs. 11 %, p = 0.035). Severity of 5 symptoms lower in AA: edema (p = 0.038), depression (p < 0.001), anxiety (p < 0.001), tremors (p = 0.048), dry mouth (p = 0.021). AA had more moderate/severe weight loss (24 % vs. 16 %, p = 0.024), but less depression (12 % vs. 23 %, p = 0.002), anxiety (3 % vs. 13 %, p = 0.001). AA had longer post referral survival (median 2.4 vs. 1.6 months, p = 0.006).
Conclusions:
1. We identified 7 symptoms whose prevalence and/or severity associated with race.
2. AA had higher prevalence of headache and more moderate/severe weight loss.
3. AA had less prevalent (edema, depression, anxiety, tremors, anorexia) and less severe (edema, depression, anxiety, tremors, dry mouth) of some important cancer symptoms.
4. Our findings may stimulate research to evaluate racial variability in the provision of supportive and palliative care services.
MASCC-0457
The value of serial blood cultures during the same febrile neutropenic episode in pediatric oncology patients
M.F. Raphael 1, L. Spanjaard2, M.D. van de Wetering3
1Pediatric Hematology and Oncology, Wilhelmina Children’s Hospital University Medical Center Utrecht, Utrecht, Netherlands, 2Medical Microbiology, Academic Medical Center, Amsterdam, Netherlands, 3Pediatric Oncology, Emma Children’s Hospital Academic Medical Center, Amsterdam, Netherlands
Introduction: Infection remains an important cause of morbidity and mortality in neutropenic oncology patients. During febrile neutropenia most pediatric oncology centers obtain serial blood cultures.
Objectives: To study the necessity to obtain repeatedly blood cultures during one febrile neutropenic episode while empiric antibiotic therapy is already initiated.
Methods: An 8 year retrospective chart review was performed for pediatric oncology patients with fever during neutropenia for whom a blood culture was obtained at admission.
Results: In 323 patients, 420 febrile neutropenic episodes revealed follow up blood cultures taken after the initial blood culture. The initial blood culture was positive in 72 (17 %) of the 420 episodes. In 33 (46 %) of the 72 febrile neutropenic episodes growth during follow-up was found. Of the positive febrile episodes in follow up 55 % showed a change of isolated pathogen. Positive follow-up cultures were associated with longer duration of neutropenia episode. Two patients in this group died of infection related disease.
Of 420 febrile neutropenic episodes, 348 showed negative blood cultures before the start of antibiotics of which 42 (12 %) showed a positive blood culture in follow-up. In this group the neutropenic episodes had a tendency to have a longer mean duration of neutropenia and 6 patients deceased.
Table 1. Characteristics of the patients with febrile neutropenia
No. (%) | |
Patients total | 244 |
Sex | |
Male | 138 (57) |
Female | 106 (43) |
Deceased | 76 (31) |
Type of Malignancy | |
Haematological (lymphoma/leukaemia) | 111 (45.5) |
Solid | 127 (52,0) |
Other* | 7 (2,9) |
Total blood cultures | 1494 |
Total episodes of neutropenia | 420 |
Blood cultures during episode | 2–26 |
Episodes per patient | |
1 | 148 (60,6) |
2 | 51 (20,9) |
3 | 24 (9,8) |
4 | 12 (4,9) |
5 | 5 (4,3) |
6 | 3 (2,0) |
7 | 1 (0,4) |
*e.g. MDS, Aplastic anaemia, Langerhanscell histiocystosis
Table 2. Results blood cultures per febrile episode
Primary blood culture | Follow-up blood culture | ||
Positive | 72 (17 %) | Positive | 33 (46 %) |
Negative | 39 (54 %) | ||
Negative | 348 (83 %) | Positive | 42 (12 %) |
Negative | 306 (88 %) | ||
Total | 420 | ||
Legend Table 2. Every first blood culture in a febrile episode is defined as ‘primary blood culture’. Follow up samples of this primary blood culture are referred to as ‘follow-up blood culture’. The follow-up blood culture is not always the second drawn blood culture. Because some patients suffer more than one neutropenic fever episode, patients can be found more than once in this overview.
Conclusions: After reviewing the results in this study we recommend follow up blood cultures after an initially positive culture during febrile neutropenic episodes when neutropenia remains. And also in the primarily negative blood culture group with a prolonged neutropenic episode, follow-up blood cultures are of importance.
MASCC-0458
Concerns about opioids among young physicians at the University of Belgrade Medical School
J. Dimitrijevic 1, S. Bosnjak1, S. Susnjar1, A. Vujovic1
1Oncology intensive care/Supportive care unit, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
Introduction: Curriculum for undergraduate education at the University of Belgrade Medical School does not include education about cancer pain assessment and management
Objectives: The purpose of this research was to investigate concerns about opioids among young physicians at the University of Belgrade Medical School
Methods: We introduced a questionnaire addressing concerns about: addiction, tolerance, respiratory depression, opioid-induced adverse effects and restrictive regulations for prescribing opioids to a group of 93 young (25–40 years) physicians with less than 5 years (group A) and 5–10 years of work experience (group B)
Results: Majority of young physicians (82/93, 88.17 %) expressed concerns about opioids. Statistically higher proportion of physicians in the group A (61/82, 74.39 %) expressed concerns about opioids than physicians in the group B (21/82, 25.81 %) (chi-square, p = 0.00478). Physicians in the group A did not express any concern about tolerance, while those in the group B did not express any concern about respiratory depression. Among physicians in the group A the most frequent concerns were about respiratory depression (45/61, 73.77 %) and adverse effects of opioids (31/61, 50.82 %), while among physicians in the group B the most frequent were concerns about restrictive regulations for prescribing opioids (18/21, 85.71 %) and adverse effects of opioids (10/21, 47.62 %). Statistically lower proportion of physicians in the group A expressed concern about restrictive regulations than physicians in the group B (chi-square, p = 0.000004)
Conclusions: These results demonstrated inadequate knowledge about opioids among young physicians and the need to include education about opioid analgesics in curriculum for medical students.
MASCC-0459
Complex nursing interventions aimed at reducing chemotherapy-related symptom burden: a systematic review of their characteristics and effectiveness
A. Coolbrandt 1, E. Van der Elst1, H. Wildiers2, B. Aertgeerts3, B. Dierckx de Casterlé1, T. van Achterberg4, A. Laenen5, K. Milisen1
1Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium, 2General Medical Oncology, University Hospitals Leuven, Leuven, Belgium, 3Academic Centre for General Practice, KU Leuven, Leuven, Belgium, 4Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands, 5Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium
Introduction: Ambulatory organization of chemotherapy care leaves patients to deal with symptom burden at home and has challenged the role of nurses in supporting patients treated with chemotherapy to deal with and reduce their therapy-related symptom burden.
Objectives: The aim of this systematic review was to describe the characteristics and to evaluate the effectiveness of complex nursing interventions that target multiple symptoms in patients receiving chemotherapy.
Methods: Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials that compared complex nursing interventions to usual care and that provided data on symptom prevalence, severity, distress or limitations. A narrative description of the interventions provided insight in the interventions’ content. Ratios of means were calculated to estimate and compare the effectiveness of the interventions.
Results: Eleven studies were included in the systematic review. Risk of bias was considerable in several of these studies. The interventions’ content was diverse but generally composed of patient education, symptom assessment and coaching.
Results were mixed, both within and across interventions. However, some interventions produced statistically significant and clinically relevant reductions in symptom burden by 10 to 88 %.
Conclusions: Some complex nursing interventions have shown promising results in reducing chemotherapy-related symptom burden. However, results are inconsistent and available studies do not allow for Conclusions on vital components, circumstances or preferred target populations. The need for high-quality studies as well as for thorough modeling and piloting of such interventions is imperative.
MASCC-0460
Respiratory distress protocol in pediatric palliative care : clinical use
F. Gauvin 1, L. Daoust1, S. Stojanovic1, E. Villeneuve2, N. Humbert1
1Pediatrics, CHU Sainte-Justine Université de Montréal, Montreal, Canada, 2Anesthesia, CHU Sainte-Justine Université de Montréal, Montreal, Canada
Introduction: Recently a respiratory distress protocol was established for pediatric palliative care patients at Sainte-Justine University Hospital (SJUH).
Objectives: The objective of this study was to evaluate the safety and effectiveness of the protocol.
Methods: This epidemiologic descriptive study was based on a retrospective chart review of all the patients for whom a protocol was prescribed between September 2009 and September 2012. The effectiveness of the protocol was assessed using the nurse’s documentation of the patient’s symptoms. The safety of the protocol was evaluated by measuring the time between the administration of the first protocol and the patient’s death.
Results: Over 3 years, the protocol was prescribed for 94 patients. Among those, 80 have died and 14 are still alive. In the former group, 70 of the 80 charts have been reviewed so far. Among these 70 patients, 40 (57 %) were girls; median age was 6,9 years (range:14 days–22 years). The protocol was administered in 57 (81 %) patients, at least once. Forty patients received it more than once, 2 patients up to 16 times. A total of 214 protocol administrations occurred in the 70 patients. According to the ward nurses’ notes, relief of symptoms post protocol was obtained in 66 % of all episodes. The median interval between the administration of the first protocol and death was 9 h (range:1 min–6 months).
Conclusions: At SJUH, the protocol was administered in 81 % of pediatric palliative care patients for whom it was prescribed. Preliminary data show the protocol to be effective in a majority of patients and safe.
MASCC-0461
Respiratory distress protocol in pediatric palliative care: medical and nursing staff’s perceptions
F. Gauvin 1, G. Bidet1, L. Daoust1, M. Duval2, N. Humbert1
1Pediatrics, CHU Sainte-Justine Université de Montréal, Montreal, Canada, 2Hematology & Oncology, CHU Sainte-Justine Université de Montréal, Montreal, Canada
Introduction: Recently a respiratory distress protocol was established for pediatric palliative care patients at Sainte-Justine University Hospital (SJUH). This protocol, after being prescribed by the attending physician, can be initiated by the nurse whenever the patient presents an episode of respiratory distress.
Objectives: The objective of this study was to evaluate the perceptions of the medical and nursing staff towards the use of the protocol.
Methods: This study was done using a survey that was distributed to all physicians and nurses working with pediatric palliative care patients, between September 2010 and September 2012. The answers to the survey were anonymous, done on a voluntary basis, and after consent of the participant.
Results: The response rate to the survey was 46 % (253 answers/548 distributed surveys) and the distribution of respondents was:22 % physicians; 71 % nurses; 7 % residents/fellows. According to the respondents, the protocol was FREQUENTLY (55 %) or ALWAYS (35 %) effective to relieve the patient’s symptoms. The respondents felt SOMETIMES (16 %), FREQUENTLY (34 %) or ALWAYS (41 %) comfortable in giving the protocol. The 2 most important motivations to use the protocol were: 1) speed of efficacy of the protocol; 2) desire to relieve patient’s distress. The 2 most important obstacles were :1) going against the patient’s wishes or patient’s family wishes; 2) improper evaluation of the patient’s distress. The respondents thought the protocol could NEVER (12 %), RARELY (32 %), SOMETIMES (46 %), FREQUENTLY (8 %), ALWAYS (1 %) hasten death.
Conclusions: Data from this survey show that respondents are in favour of using a respiratory distress protocol in pediatric palliative care patients at SJUH and find it effective.
MASCC-0462
Subacute leukoencephalophaty (LE) following high dose (HD) intravenous (IV) and intrathecal (IT) methotrexate (MTX) during treatment of acute lymphoblastic leukemia (ALL) in children
L. Fraquelli 1, M. Onoratelli1, D. Barsotti1, M. Posadas Martínez1, C. Botana Rodriguez1, S. Evangelista1, L. Peralta1, M. Rebollo1, E. Alfaro2, M. Felice2
1Day Care Hospital, Hospital Nacional de Pediatria Prof.Dr. J.P. Garrahan, Buenos Aires, Argentina, 2Hematology-Oncology, Hospital Nacional de Pediatria Prof.Dr. J.P. Garrahan, Buenos Aires, Argentina
Introduction: MTX is an essential drug in ALL treatment and is associated with neurotoxicity. MTX-induced LE can present similar to acute stroke. Abrupt onset of focal neurological signs in a patient with malignancy is a significant diagnostic challenge.
Objectives: Our aim is to alert clinicians to this condition.
Methods: We present a case with neurologic complications during chemotherapy.
Results: We report a 9 years old girl who presented bilateral lower limb pain since 2 months. Bone marrow showed blast cells and immunophenotyping was consistent with B precursor ALL. The cerebrospinal fluid (CSF) was negative for blast cells. She was treated with ALL-BFM therapy protocol that consisted of IV and IT MTX amongst other chemotherapeutic drugs. She achieved complete remission at 33rd day. Ten days after the second cycle of HD IV and IT MTX therapy, she developed sudden onset of right upper limb weakness, ipsilateral facial nerve palsy and aphasia. She was conscious. CSF study revealed no blast cells. Computed tomography and coagulation tests were normal. An electroencephalogram showed right spikes. She recovered within 2 days with no neurological deficits.T2 and FLAIR MRI showed symmetrical bilateral diffuse high intensity areas in corona radiata. The diagnostic was MTX induced subacute LE. She received Protocol II. Four months later, two cycles of IV and IT MTX therapy were given. Follow-up MRI revealed complete resolution. She had no recurrences of neurologic symptoms.
Conclusions: Subacute MTX neurotoxicity occurs 2–14 days after IT or HD MTX. Changes in deep cerebral white matter not necessarily indicate an irreversible cytotoxic injury.
MASCC-0463
Incidence and management of infusion-related hypersensitivity reactions (IRHSRS) following discontinuation of remedications in patients receiving paclitaxel based chemotherapy
C. De Angelis 1, A. Giotis2, C. Folkins2, K. Chandrakumaran2, N. Jamal2, M. Pasetka2
1Pharmacy, Sunnybrook Odette Cancer Centre Leslie Dan Faculty of Pharmacy University of Toronto, Toronto, Canada, 2Pharmacy, Sunnybrook Odette Cancer Centre, Toronto, Canada
Introduction: Paclitaxel administration is associated with IRHSRs including flushing, rash, dyspnea, hypotension, chest pain and tachycardia. To decrease the incidence of IRHSRs, patients are premedicated with dexamethasone, diphenhydramine and a histamine 2 receptor antagonist (H2RA). A recently published pilot study demonstrated that premedications can be successfully discontinued after the second cycle of paclitaxel, if no IRHSRs are experienced.
Objectives: To determine the incidence and management of IRHSRs experienced by patients whose premedications were removed after 2 cycles of IRHSR-free paclitaxel administration.
Methods: All patients scheduled to receive paclitaxel-based chemotherapy between March 2012 and December 2012 (n = 235) were considered for discontinuation of premedications. Patients scheduled for their 3rd cycle of paclitaxel had premedications discontinued if they experienced no IRHSRs during their first 2 cycles with premedications. All premedications were removed with paclitaxel alone while only H2RAs were removed with paclitaxel + platinum treatments. These patients were then monitored for IRHSRs in subsequent cycles.
Results: Fifty-six (23.8 %; 95%CI 18.8–29.7 %) patients experienced IRHSRs during their first 2 cycles of paclitaxel with premedications and were deemed ‘non-eligible’ to have their premedications discontinued. Two of 91 (2.2 % 95 % CI 0.6–7.7 %) patients where only the H2RA was discontinued and 9 of 88 (10.2 % 95 % CI 5.5–18.3 %) patients with all premedications discontinued experienced an IRHSR on subsequent treatments.
Conclusions: No severe IRHSRs occurred in either group. All IRHSRs were managed effectively with rescue medications. Discontinuing premedications for individuals that have not experienced prior IRHSAs to paclitaxel is both feasible and safe.
MASCC-0464
Identification of biomarkers of chemoradiotherapy-induced toxicity in upper gastrointestinal (GI) cancers
J. Bowen 1, I. White2, K. Kristaly2, L. Smith3, S. Thompson3, D. Hussey4, D. Watson4, D. Keefe2
1Medical Sciences, University of Adelaide, Adelaide, Australia, 2Medicine, University of Adelaide, Adelaide, Australia, 3Surgery, University of Adelaide, Adelaide, Australia, 4Surgery, Flinders University, Adelaide, Australia
Introduction: Mucositis is a major clinical problem in oncology which leads to negative patient outcomes. It occurs in roughly half of all patients receiving chemoradiotherapy, however, there is currently no clinical tool to predict which patients are most at risk. We hypothesize that patients most likely to develop severe mucositis will have specific gene expression profiles that can be measured pre-therapy.
Objectives: The aim of this study was to measure immune gene expression in upper GI cancer patients as predictive markers of chemoradiotherapy-induced mucositis.
Methods: Patients were recruited from 2 study sites and followed during 2 cycles of treatment. Patients were classified as toxic or non-toxic based on severity of mucositis data collected by patient questionnaire and clinical records. RNA was extracted from whole blood collected prior to therapy and analysed using an 84-innate and adaptive immunity gene PCR array. Genes identified as upregulated in toxic patients were subsequently confirmed by RT-PCR.
Results: Blood samples were collected from patients diagnosed with oesophageal adenocarcinoma (n = 9), oesophageal squamous cell carcinoma (n = 4), gastro/oesophageal junction adenocarcinoma (n = 4) and gastric adenocarcinoma (n = 7) Mucositis occurred in 15 of 23 patients (65.2 %) receiving chemotherapy/chemoradiotherapy. PCR array found significant upregulation of TNF-a (2.36-fold, p = 0.018), NF-kB (1.80-fold, p = 0.004) and TRAF6 (1.53-fold, p = 0.049) in toxic patients (n = 4) compared to non-toxic patients (n = 5).
Conclusions: This study suggests that baseline expression of key mediators of the innate immune response, including pro-inflammatory cytokines and transcription factors, are measurably different in patients who are at risk of severe mucositis. Analysis is ongoing.
MASCC-0465
Can a predictive model identify hospice patients?
R.M. McCabe 1, J.Z. Ai1, J. Grutsch1
1Clinical and Research Informatics, Cancer Treatment Centers of America, Zion, USA
Introduction: In the United States, generating accurate predictions of 6-month survival has potentially important ramifications in clinical decision making about whether to admit a patient into hospice.
Objectives: To develop a Bayesian network to predict 6-month survival in a heterogenous mix of cancer patients seeking evaluation or treatment of disease in a clinical context using baseline quality-of-life (QoL) and clinical variables.
Methods: Data from 7,187 patients who completed the EORTC QLQ-C30 questionnaire was analyzed. The prognosis for these patients ranged from potentially curable to hospice bound. Nine symptom scales, five function scales, global health, site of origin, stage, newly diagnosed/recurrent, number of comorbidities, demographics and survival were variables used to develop the model. Models were developed, tested, and validated on this dataset using 10-fold cross validation.
Results: In addition to providing probability-based survival predictions, the Bayesian network graphically illustrates underlying relationships among QoL, clinical variables and survival. The resulting model structure indicated that stage, newly diagnosed/recurrent, gender and appetite loss were direct predictors of 6-month survival (figure 1). Fatigue had ‘parent-child’ relationships with stage and 11 QoL attributes but had no direct influence on survival. With a threshold of 0.50, the model yielded: accuracy, 0.76; sensitivity, 0.75; specificity, 0.58; precision, 0.85. Area under ROC curve was 0.74.
Conclusions: Using a large scale dataset, the Bayesian network generated accurate survival predictions and a complex of descriptive relationships. Physical functioning, global health, and fatigue have been routinely associated with cancer survival, however in this analysis appetite loss was the only QoL scale to directly influence 6-month survival.
MASCC-0466
Identification of drivers of quality of life in patients with cancer: the case for fatigue
R. McCabe1, J. Grutsch1, S. Nutakki 1
1Clinical & Research Informatics, Cancer Treatment Centers of America, Zion, USA
Introduction: The Wilson Cleary Quality of Life (QoL) model predicts that symptom-producing pathways (e.g., depression, insomnia) may affect patient health and sense of well being. Currently, it is unclear whether symptoms and functioning domains can accurately explain a patient’s evaluation of overall QoL.
Objectives
Identify determinants of global health–a surrogate variable for patient well being–using baseline symptom and function data from the EORTC QLQ-C30 tool and decision tree algorithms.
Methods: Eight thousand four hundred seventy-eight patients completed the survey. 55 % of patients underwent second or subsequent lines of therapy; 65 % of patients had disease diagnosed in lung, breast, colorectal, prostate and pancreas. Input variables for the classification algorithms included nine symptom and five function scales, site of origin, stage, and demographics. Global health scale data were categorized as Low (<34), Medium, or High (>67) for each patient for classification purposes. 20 experiments were conducted using data subsets stratified by newly diagnosed/recurrent status, site of origin and stage.
Results: Commonly occurring determinants of global health were physical, role and social functioning domains and fatigue, appetite loss and pain (figure 1 and 2). Fatigue was the most commonly occurring decision node (18 of 20 experiments) and root node (14 of 20). 62 % to 74 % of patients in each experiment were correctly classified by the decision tree.
Experimental Subgroup | N | Physical | Role | Emotional | Cognitive | Social | Fatigue | Appetite Loss | Pain | Insomnia | Prediction Accuracy (%) | Root Node | Cut point | |
All Cancers | 8478 | x | x | x | x | x | 67.1 | Fatigue | 28 | |||||
Newly Diagnosed | 3767 | x | x | x | x | x | 68.0 | Fatigue | 28 | |||||
Recurrent Cancers | 47111 | x | x | x | x | x | x | 66.5 | Fatigue | 39 | ||||
Newly Diagnosed | Lung | 730 | x | x | x | 68.0 | Role | 75 | ||||||
Breast | 718 | x | x | x | x | 72.0 | Role | 92 | ||||||
Colocteral | 243 | x | x | 71.2 | Fatigue | 28 | ||||||||
Prostate | 527 | x | x | 73.6 | Fatigue | 28 | ||||||||
Pancreatic | 415 | x | x | x | 69.2 | Fatigue | 47 | |||||||
All others | 1134 | x | x | x | 71.1 | Fatigue | 28 | |||||||
Recurrent Cancers | Lung | 682 | x | 65.8 | Fatigue | 50 | ||||||||
Breast | 1102 | x | x | x | x | x | 69.1 | Fatigue | 28 | |||||
Colorectal | 628 | x | x | 62.3 | Fatigue | 44 | ||||||||
Prostate | 285 | x | x | x | 71.9 | Physical | 90 | |||||||
Pancreatic | 292 | x | x | x | 66.1 | Fatigue | 44 | |||||||
All others | 1722 | x | x | 63.0 | Role | 75 | ||||||||
Newly Diagnosed | Stage 1 | 470 | x | x | x | x | 70.9 | Social | 92 | |||||
Stage 2 | 908 | x | x | x | x | x | x | 73.7 | Role | 92 | ||||
Stage 3 | 644 | x | 66.3 | Fatigue | 28 | |||||||||
Stage 4 | 1434 | x | x | x | x | x | 67.5 | Role | 75 | |||||
Unknown | 311 | x | x | 66.2 | Fatigue | 39 | ||||||||
Conclusions: A set of 20 experiments generating decision trees indicated that fatigue was the most commonly identified domain used to classify global health. This reinforces the conditional importance of fatigue levels in patient evaluation of overall quality of life.
MASCC-0467
Prognostic ability of three performance status measures in patients with advanced cancer
R.W. Jang 1, V.B. Caraiscos2, L.W. Le3, C. Zimmermann2
1Medical Oncology, Princess Margaret Hospital, Toronto, Canada, 2Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada, 3Biostatistics Department, Princess Margaret Hospital, Toronto, Canada
Introduction: Few studies have compared the prognostic ability of different performance status (PS) measures for patients with advanced cancers.
Objectives: To provide estimates of survival by different measures of PS: (1) Eastern Cooperative Oncology Group (ECOG); (2) Palliative Performance Scale (PPS); (3) Karnofsky Performance Scale (KPS), and to compare their ability to predict survival.
Methods: Physicians completed all three measures for consecutive new patients attending the Oncology Palliative Care Clinic (OPCC) from April 2007–February 2010. Survival analysis was performed using the Kaplan-Meier method. For each of the performance measures, the log-rank test for trend was used to test for a difference in survival curves for each level of PS, and the concordance index (C-statistic) was used to test the predictive discriminatory ability.
Results: PS measures were completed for 1,773 patients. PS delineated survival well for all scales. This was significant by the log-rank test for trend (p < 0.0001 for all scales). Survival times were shorter for each worsening performance level. C-statistics were similar for all scales: 0.6398 for ECOG, 0.6329 for KPS, and 0.6294 for PPS.
Survival by ECOG
Survival by PPS
Survival Time According To PS
Median survival (days) | 95 % CI (days) | |
ECOG | ||
0 | 249 | 231–357 |
1 | 192 | 179–214 |
2 | 103 | 89–118 |
3 | 54 | 45–63 |
4 | 25 | 18–50 |
PPS | ||
80–100 | 214 | 189–238 |
60–70 | 113 | 102–128 |
40–50 | 51 | 43–58 |
10–30 | 22 | 13–50 |
Conclusions: Performance status was predictive of survival at all PS levels for patients with advanced cancer attending an outpatient OPCC. ECOG, PPS and KPS had equivalent discriminatory ability.
MASCC-0468
The current status of cancer rehabilitation in palliative care unit and after discharge to home
Y. Izoe 1, S. Minegishi1, M. Uesugi1
1Rehabilitation medicine, Tsukuba Medical Center hospital, Ibaraki Tsukuba, Japan
Introduction: Cancer is the 1st place in Japanese cause of death. Disability in patients with advanced cancer often results from deconditioning, neurologic and musculoskeletal complication of cancers.
Advanced cancer caused them to a limit on activities of daily living, and walking, decrease the quality of their life.
Objectives: Our hospital has started rehabilitation in palliative care unit since 2000. We have investigated the current status of cancer rehabilitation in that unit and outcomes of the patient after discharge to home.
Methods: Seven hundred forty-eight patients admitted to Palliative care unit in Tsukuba Medical Center from April, 2009 to March, 2011. We assessed cancer origin, the term between admission, Dietz’classification, the implementation rate and contents of rehabilitation, the rate of cancer rehabilitation after discharge to home.
Results: The average rate of the patient who underwent rehabilitation in Palliative care unit was 47 %. In the cases who received rehabilitation, 23 % discharged from hospital to nursing home or recuperating at home. Patients who were discharged to home were 19 %. Among them, the patients who had home-visit rehabilitation were 9 %.
Conclusions: Intervention of the rehabilitation in palliative care unit had an effect to the improvement of transfer motion exercises, a range of joint motion exercises, muscle strength exercise, and activities of daily living. There were few rates of home-visit rehabilitation after leaving hospital to home. Home nursing care may partially substitute the need for rehabilitation and reduce the rate of home-visit rehabilitation. The future, we need to analyze in detail the current state of them.
MASCC-0469
Telephone delivered nutrition and exercise counselling for cancer survivors following autologous stem cell transplantation—a pilot, randomised controlled trial
Y. Hung 1, J. Bauer1, P. Horsley2, J. Coll3, J. Bashford4, E. Isenring1
1School of Human Movement Studies, University of Queensland, Brisbane, Australia, 2Nutrition Services, The Wesley Hospital, Brisbane, Australia, 3The Wesley Research Institute, The Wesley Hospital, Brisbane, Australia, 4Haematology & Oncology Clinics of Australia, The Wesley Medical centre, Brisbane, Australia
Introduction: Ongoing nutrition and exercise counselling may help reverse the adverse changes in nutritional status, body composition, and quality of life (QoL) after high dose conditioning and stem cell transplant (SCT).
Objectives: To evaluate the impact of nutrition and exercise counselling provided at hospital discharge on patients’ QoL, nutritional status and body composition up to 100 days post-transplant.
Methods: Consecutive patients from a private haematology clinic in Brisbane, Australia were randomised after transplant. The control group (n = 19) received no intervention after discharge; extended care (n = 18) received fortnightly telephone-counselling from a dietitian and exercise physiologist up to 100 days post-transplant. Nutritional parameters (patient-generated subjective global assessment, and diet history), QoL (EORTC QLQ-C30 version 3), and body composition (Bod Pod, COSMED USA, Inc.) were assessed at pre-admission, discharge, and 100 days post-transplant. Changes at 100 days post-transplant were compared using independent T-test; results were adjusted using analysis of covariance.
Results: Thirty-seven autologous recipients (54 % male; mean age 58.7 ± 9.5 years; median body mass index 26.8 kg/m2 (range 16.4–47.6)) were recruited. Relative to discharge, extended care group exhibited clinically important improvements in protein intake (+9.1 g; CI95% −11.4, 29.6, p = 0.372), cognitive functioning (+12.4; CI95% −5.5, 30.2, p = 0.163), and social functioning (+11.1; CI95% −17.6, 39.7, p = 0.429) compared to control group. Relative to pre-admission, fat loss was significantly higher amongst control group (−3.3 kg; CI95% −6.2, −0.3, p = 0.030); loss of lean body mass was similar between the groups (0.1 kg; CI95% −1.7, 1.8, p = 0.927).
Conclusions: Ongoing nutrition and exercise counselling may encourage greater protein intake, improve certain QoL components, and prevent further weight loss in SCT patients following hospitalisation.
MASCC-0470
The relationship between intensity of symptoms and unbearable suffering studied in end-of-life cancer patients in Dutch primary care
C.D.M. Ruijs 1, A.J.F.M. Kerkhof1, G. van der Wal1, B.D. Onwuteaka-Philipsen1
1EMGO+Institute for Health and Care Research Palliative Centre of Expertise, VU University Medical Center, Amsterdam, Netherlands
Introduction: A certain symptom may be unbearable for one patient, yet bearable for another.
Unbearable suffering hardly is studied in cancer patients
Objectives: To study the relationship between intensity of symptoms and unbearable suffering
Methods: Forty four general practitioners during 3 years recruited cancer patients with an estimated life expectancy of half a year or shorter. Intensity of symptoms and related unbearable suffering were assessed with the State-of-Suffering V, a quantitative instrument with a five point rating scale addressing 69 symptoms in five domains: medical signs and symptoms, loss of function, personal aspects, environment and nature and prognosis of disease
Results: Seventy six out of 148 patients (51 %) requested to participate consented. Sixty four patients were followed up until death. Symptoms of high intensity were unbearable in some 80 %. Symptoms of low intensity were unbearable in a wide range around 25 %. Symptoms with high rated intensity which most frequently were unbearable were: pain (92 %), loss of control over one’s life (92 %), fear of future suffering (89 %), not being able to do the important things (87 %) and not sleeping well (86 %). Symptoms with low rated intensity which most frequently were unbearable were: loss of control over one’s life (80 %), vomiting (73 %), not being able to do the important things (52 %) and not sleeping well (43 %).
Conclusions: Assessment of intensity of symptoms as well as unbearable suffering provides opportunities to improve relief of suffering through combining interventions which diminish the intensity of symptoms with interventions which address the experience of suffering.
MASCC-0471
Irinotecan disrupts occludin in the rat small intestine: implications for chemotherapy-induced mucositis
H.R. Wardill 1, J.M. Bowen1, R. Gibson1
1School of Medical Sciences, University of Adelaide, Adelaide, Australia
Introduction: Chemotherapy for cancer causes significant gut toxicity. Recently there has been renewed interest in the role tight junctions play in the pathogenesis of mucositis.
Objectives: To delineate these underlying mechanisms we aimed to quantify molecular changes in a key tight junction protein, occludin, using a well-established preclinical model of gut toxicity.
Methods: Female tumour-bearing dark agouti rats received irinotecan or vehicle control and were assessed for validated parameters of mucositis including diarrhoea and weight loss. Rats were killed at 6 h, 24 h, 48 h, 72 h, 96 h and 120 h post-chemotherapy. Histopathological damage was assessed using standard staining techniques. Occludin protein and mRNA expression in the ileum and jejunum were assessed using semi-quantitative immunohistochemistry and RT-PCR.
Results: All rats receiving irinotecan developed diarrhoea and significant weight loss. Diarrhoea first appeared 6 h after irinotecan with maximal symptoms seen at 72 h. Peak weight loss occurred at the same time point (p < 0.0001). Marked histological evidence of mucositis was seen in the ileum of irinotecan-treated rats. This was accompanied by significant downregulation of occludin protein expression 24 h and 48 h post-irinotecan in small intestinal crypt epithelia (p < 0.05). Cytoplasmic redistribution of occludin was evident from 24 h post-irinotecan. Occludin mRNA levels remained stable across the time-course of gut toxicity.
Conclusions: Irinotecan causes tight junctional occludin defects which lead to mucosal barrier dysfunction and the development of diarrhoea. Disparate protein and mRNA expression suggest irinotecan indirectly modulates occludin protein expression through post-translational regulation. Detailed research is now warranted to investigate post-translational regulation of tight junction proteins.
MASCC-0472
Expression of TLRS and GFAP in the rat intestine following chemotherapy for cancer and relationship to gut toxicity and central pain behaviour
R.J. Gibson 1, J.K. Coller1, M.R. Hutchinson1, J.M. Bowen1
1School of Medical Sciences, University of Adelaide, Adelaide, Australia
Introduction: Gastrointestinal mucositis (GM) and pain are major clinical problems caused by the cytotoxic effects of chemotherapy. Previous research has indicated that toll-like receptor (TLR) expression may be altered following chemotherapy and correlate with severity of GM and pain.
Objectives: To determine if TLR expression and activation of gut glial cells (GFAP expression) is related to GM and pain behaviour in tumour-bearing rats.
Methods: Female DA rats received irinotecan (175 mg/kg, ip n = 35) or vehicle control (n = 5) Groups of rats (n = 5–8) were killed between 6 and 120 h. Immunohistochemistry for TLRs 2, 4, 5, and 9, and GFAP was conducted on sections of jejuna and colon.
Results: Irinotecan caused bi-phasic GM, with maximal diarrhoea at 72 h. Similarly peak weight loss occurred at 72 h before recovery at 120 h (P < 0.0001). Irinotecan also elevated pain scores peaking at 72 h (P < 0.0001). At 96 and 120 h irinotecan significantly decreased jejuna expression of TLR4 and 5 (both P < 0.001), but TLR2/9 expression was unchanged. Jejunum GFAP expression also increased significantly, with peak expression by 96 and 120 h (P = 0.017). Jejunum expression of TLR4, 5 and GFAP was significantly associated with occurrence of diarrhoea and facial pain scores (P < 0.001), and rats with diarrhoea had higher facial pain scores compared to those without (P < 0.01).
Conclusions: Intestinal innate immunity activation and inflammation caused by chemotherapy potentially modifies central inflammation manifested as pain. As TLR4/5 expression decreased during the GM healing phase, TLR pharmacological inhibition may promote healing in the small intestine following chemotherapy. Impact of tumour-burden on gut TLR expression and glial activation requires further investigation.
MASCC-0473
Health professionals’ knowledge, attitudes and skills in supportive care screening and referral: outcomes of an education program
E. Ristevski 1, M. Regan1
1Rural and Indigenous Health, Monash University, Moe, Australia
Introduction: Education is recognised as a mechanism to facilitate implementation of supportive care screening into routine cancer care. For health services in rural areas, building a workforce with appropriate knowledge and skills in supportive care screening is essential to ensure patients receive best practice care
Objectives: This study examined the impact of an education program on rural health professionals’ knowledge, attitudes and skills in implementing a supportive care screening, assessment, action and referral process into routine care.
Methods: Fifty-five health professionals in Gippsland, Australia completed knowledge, attitudes and skills questionnaires pre and post-training, at 1 month post training, and a case study and interview at 3 months post training. Linear regression, thematic and content analysis were used to analyse the data.
Results: Questionnaire data showed significant increases in participants’ overall knowledge, attitudes and skills in supportive care between pre and post training. Knowledge and skills were maintained at 1 month post training, yet attitudes decreased. Analysis of the case study found participant’s knowledge of supportive care screening and assessment was maintained at 3 months post training, yet skills in action and referral decreased. Themes from the interviews revealed positive attitudes to the supportive care process, yet organisational processes and support mechanisms to implement it into their routine work were lacking.
Conclusions: The educational program was an effective first step in increasing health professionals’ knowledge, attitudes and skills in supportive care. Helping staff and organisations put processes into place to incorporate supportive care into routine care and practice will help to achieve long term sustainability.
MASCC-0474
Risk of arterial (ATE) and venous thromboembolism (VTE) in a population-based cohort of bevacizumab-treated metastatic colorectal cancer (MCRC) patients
W. Cheung 1, I. Yu1, L. Chen1
1Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
Introduction: Bevacizumab potentiates the risk of ATE and VTE in cancer patients who are in a prothrombotic state.
Objectives: Our objectives were to characterize the incidence of ATE and VTE, describe patient and treatment factors associated with thromboembolisms, and examine how ATE and VTE are managed in routine practice.
Methods: Patients diagnosed with mCRC from 2006 to 2008, evaluated at 1 of 5 regional cancer centers, and offered bevacizumab were included. Multivariate regression models were constructed to explore the associations between clinical factors and thromboembolisms.
Results: A total of 500 patients was identified: median age was 61 years, 59 % were men, 62 % had ECOG 0/1, and 8 % reported prior ATE or VTE. Median number of bevacizumab cycles was 11. After receiving bevacizumab, 18 % patients developed 12 ATE and 88 VTE, with 8 patients experiencing >1 event. Baseline characteristics, such as median age (61 vs 61 years), gender distribution (61 vs 58 % men), and ECOG 0/1 (66 vs 58 %) were similar between patients with and without thromboembolisms, respectively (all p > 0.05). In regression models, individuals who experienced ATE or VTE were more likely to have a prior history (14 vs 6 %, p = 0.02), reported greater pre-existing cardiac comorbidities (42 vs 32 %, p = 0.05), and received a higher median number of bevacizumab cycles (13 vs 9, p < 0.01), suggesting a potential dose-related effect. Following ATE or VTE, management varied: bevacizumab was discontinued in 46 %, held temporarily in 14 %, and continued in 40 % of patients.
Conclusions: The risk of thromboembolism is high, especially in patients with pre-existing risk factors and those heavily treated with bevacizumab.
MASCC-0475
Phase II study of aprepitant and granisetron for the prophylaxis of radiotherapy-induced nausea and vomiting (RINV) following moderately-emetogenic radiotherapy for bone metastases: preliminary results
K. Dennis 1, C. De Angelis2, F. Jon3, N. Lauzon3, M. Pasetka2, L. Holden3, E. Barnes3, C. Danjoux3, A. Sahgal3, M. Tsao3, E. Chow3
1Radiation Oncology, Ottawa Hospital Research Institute University of Ottawa, Ottawa, Canada, 2Pharmacy, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada, 3Radiation Oncology, Odette Cancer Centre Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
Introduction: Acute and delayed radiotherapy-induced nausea and vomiting (RINV) are common among patients receiving moderately-emetogenic radiotherapy for bone metastases1.
Objectives: Evaluate the novel combination of Aprepitant and Granisetron for RINV prophylaxis among patients receiving moderately-emetogenic radiotherapy for thoracolumbar bone metastases.
Methods: Single fraction patients (8Gy in 1 fraction) received Aprepitant 125 mg and Granisetron 2 mg on the day of radiotherapy and Aprepitant 80 mg on the first 2 days after the day of radiotherapy. Multiple fraction patients (20Gy in 5 fractions) received Aprepitant 125 mg on the first day of radiotherapy, Aprepitant 80 mg on the third and fifth days of radiotherapy, and Granisetron 2 mg on every day of radiotherapy. Symptoms and medication intake were recorded daily during the Acute Phase (the inclusive period from the first day of radiotherapy until the first day after the last day of radiotherapy), and the Delayed Phase (the inclusive period from the second to tenth days after the last day of radiotherapy). Control was defined as no symptom and no use of rescue antiemetics.
Results:
Symptom control rates:
Acute Phase | Delayed Phase | Combined Phases | ||||
Nausea | Vomiting | Nausea | Vomiting | Nausea | Vomiting | |
Single fraction patients (n = 13) | 100 % | 100 % | 62 % | 85 % | 62 % | 85 % |
Multiple fraction patients (n = 6) | 67 % | 67 % | 83 % | 83 % | 67 % | 67 % |
Conclusions: Aprepitant and Granisetron were efficacious for the prophylaxis of RINV among patients receiving moderately-emetogenic radiotherapy for thoracolumbar bone metastases.
References: 1. Dennis K et al. Prophylaxis of radiotherapy-induced nausea and vomiting in the palliative treatment of bone metastases. Support Care Cancer 2012;20:1673–1678.
MASCC-0476
Population-based patterns of granulocyte colony stimulating factor (GCSF) use in breast cancer (BRCA) patients receiving myelosuppressive chemotherapy
W. Cheung 1, M. Lehmkuhl1, L. Chen1
1Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
Introduction: Prophylaxis with GCSF can reduce hospitalization.
Objectives: Our aims were to characterize patterns of GCSF use, determine the rate of neutropenia and neutropenic fever in those who received and did not receive GCSF, and identify factors associated with appropriate GCSF prophylaxis
Methods: Patients diagnosed with BrCa and treated with chemotherapy protocols that posed >20 % risk of neutropenic fever were reviewed. Using regression models, the relationship between GCSF use and 1) various patient and physician characteristics and 2) treatment outcomes were analyzed
Results: A total of 525 women was included: median age was 51 years, 38 % reported smoking, 50 % used alcohol regularly, 62 % were ECOG 0, and 26 % had private health insurance. In this cohort, 38 % patients were given GCSF. Among those, 39 % and 61 % individuals received GCSF as primary and secondary prophylaxis, respectively. Overall, neutropenia was noted in 56 % cases while neutropenic fever was experienced by 22 % patients. When compared to those who did not use GCSF, patients who used GCSF experienced a lower rate of neutropenia (15 vs 49 %, p < 0.01) and a decreased incidence of neutropenic fever (7 vs 13 %, p < 0.01). In regression models, patients lacking extended medical coverage (35 vs 49 %, p = 0.02), poor performance status (31 vs 53 %, p = 0.03), and those who were evaluated at non-teaching institutions (24 vs 68 % p < 0.01) were less likely to receive GCSF. Patients seen at non-teaching institutions were also given primary GCSF prophylaxis less frequently (15 vs 57 %, p < 0.01)
Conclusions: While GCSF prophylaxis was associated improved neutropenia-related outcomes, use of GCSF was low.
MASCC-0477
Coms eye plaque dosimetry with 125I seeds: heterogeneity effect of plaque components on dose distributions
H. Acar1, G. Yavas 2, C. Yavas3, I. Ozbay1
1Institute of Oncology, Istanbul University, Istanbul, Turkey, 2Radiation Oncology, Selcuk University, Konya, Turkey, 3Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey
Introduction: The eye plaques designed by the Collaborative Ocular Melanoma Study (COMS) group are the most frequently used type for brachytherapy of ocular melanomas.
Objectives: We report the study of the heterogeneity effect on dose distributions in eye phantom for COMS eye plaques with 125I seeds using TLD dosimetry.
Methods: COMS eye plaques, 14, 16, 18 and 20 mm in size, uniformly loaded with 125I seeds were studied. TLDs were positioned in a polystyrene eye phantom above the eye plaque, in two configurations: (1) in the plaque’s central plane, (2) perpendicular to the plaque’s central axis at 5 and 12 mm depth in the eye phantom. The exposure times (from 1.2 to 2.3 h) were adjusted to deliver 100 cGy at 5 mm depth. The TLD dose data were compared with the calculated doses using Plaque Simulator with homogeneous assumption (Homo) and heterogeneity correction (Hetero).
Results: The dose ratio (TLD/Homo) and (TLD/Hetero) values along the central axis are shown in Figure 1. The dose ratio (TLD/Homo) values are substantially lower than unity (mostly between 0.8 and 0.9) for all plaque sizes studied, indicating dose reduction by COMS plaque compared with homogeneous assumption. The dose ratio (TLD/Homo) and (TLD/Hetero) values at 5 and 12 mm depth are shown in Figure 2 and 3 respectively. The TLD dose data agree with the Hetero dose values within the uncertainty of the measurement
Conclusions: We found significant heterogeneity effect on the 125I dose distributions in an eye for COMS plaques using TLD dosimetry.
MASCC-0478
Dosimetric comparison of dose distributions in episcleral plaque brachytherapy
H. Acar1, G. Yavas 2, C. Yavas3, I. Ozbay1
1Institute of Oncology, Istanbul University, Istanbul, Turkey, 2Radiation Oncology, Selcuk University, Konya, Turkey, 3Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey
Introduction: Brachytherapy of intraocular tumors with 125I eye plaques has become a successful treatment modality and a viable alternative to enucleation. Plaque Simulator (PS) is an eye plaque treatment planning system (TPS) that uses TG-43 dosimetry.
Objectives: We aimed to verify the performance of the PS routinely used to plan patients having intraocular tumors.
Methods: Relative dose distributions, including central axis depth dose and off axis dose profiles of Collaborative Ocular Melanoma Study (COMS) plaques with 14, 16, 18 and 20 mm in diameter, loaded with model 125I seeds were measured using 1 × 1 × 1 mm3 Thermo Luminesans Dosimetry (TLD) cubes and computed using MCNP5 Monte Carlo code and PS. Measurements and calculations were compared by normalizing 5 mm distance at the central axis of the plaque.
Results: For the central axis depth doses, the agreement between the measured and calculated dose distributions was within 13 %, whereas deviations up to 22 % were observed in single points far off-axis. For central axis dose distribution, the max difference among the PS, TLD and MCNP5 results was seen at 2 mm from the plaque center for all plaque sizes. For off axis dose distribution the maximum dose difference among the PS, TLD and MCNP5 results were seen at ± 12 mm from the central axis.
Conclusions: The Bebig Plaque Simulator is a reliable TPS for calculating relative dose distributions around realistic multiple 125I seed configurations if one understands its limitations at the first few millimeters around the plaque center and far off axis points.
MASCC-0479
Determining the role of sunitinib and its active metabolite (SU12662) on hand-foot syndrome (HFS) in metastatic renal cell carcinoma (MRCC) patients
Y.L. Teo 1, X.J. Chong1, X.P. Chue1, N.M. Chau2, M.H. Tan2, R. Kanesvaran2, H.L. Wee1, H.K. Ho1, A. Chan1
1Department of Pharmacy, National University of Singapore, Singapore, Singapore, 2Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
Introduction: Both sunitinib and SU12662 contribute to the pharmacological activity in treatment of mRCC. However, their role in HFS has yet to be determined.
Objectives: To compare the HFS-toxicity potential of sunitinib and SU12662, using both in vivo and in vitro approaches.
Methods: Patients receiving sunitinib for the treatment of mRCC were invited to participate. In week 4 of each cycle, HFS was assessed and plasma drug and metabolite levels were quantified using high-performance liquid chromatography. Cell viability assays were conducted on HaCaT keratinocytes to investigate the IC50 of sunitinib and SU12662.
Results: Twenty-four patients were recruited, with 40 drug cycles available for analysis. All-grades HFS was observed in 26 drug cycles (65.0 %). Similar sunitinib, SU12662 and total drug concentrations were observed among patients with and without HFS. Patients with HFS manifested higher median sunitinib:metabolite ratio than those without HFS. A lower IC50 was observed in HaCaT cells treated with sunitinib than SU12662. (Table 1)
Plasma levels (μg/ml) [median (IQR)] | With HFS ( n = 26) | Without HFS ( n = 14) | P |
Sunitinib | 0.08 (0.05, 0.11) | 0.07 (0.06, 0.10) | 0.92 |
SU12662 | 0.01 (0.01, 0.02) | 0.01 (0.01, 0.02) | 0.20 |
Total | 0.09 (0.06, 0.13) | 0.09 (0.07, 0.11) | 0.84 |
Sunitinib:metabolite ratio | 6.69 (5.12, 9.53) | 5.33 (4.86, 7.94) | 0.26 |
Sunitinib | SU12662 | ||
IC 50 (μM) [mean ± SD] | 23.3 ± 1.8 | 35.3 ± 4.9 | 0.02 |
Conclusions: Both clinical and in vitro data suggests that sunitinib is likely more dermatotoxic than SU12662. Patients who are poor metabolizers or receiving drug inhibitors could be at a higher risk for dermatological toxicity.
MASCC-0480
Predictors of fatigue in the year following completion of breast cancer therapies
S. Singh-Carlson 1, C. Alexander2, S. Smith2
1School of Nursing, California State University Long Beach, Long Beach, USA, 2Radiation Oncology, British Columbia Cancer Agency, Victoria, Canada
Introduction: Fatigue adversely affects quality of life in breast cancer survivors
Objectives: To identify patient, tumour and treatment factors that predict for fatigue following completion of breast cancer therapy.
Methods: A survey was designed, validated, and sent to women with non-metastatic, invasive breast cancer who were between 9 and 15 months post-completion of active treatment (last surgery/chemotherapy/radiotherapy). They were asked to rank their level of fatigue in the first year following treatment using a 4 point Likert scale: not at all, a little (mild), quite a bit (moderate), or very much (severe). Responses were linked to disease and treatment information. Multivariate analysis using logistic regression was used to identify factors predicting for fatigue.
Results: 1,065/2,389 (45 %) responses were received. Fatigue was rated as moderate or severe by 56 % of all respondents. On univariate analysis, factors associated with moderate or severe fatigue included younger age, middle income ($35–$100 k/year), node positive disease, high grade disease, axillary dissection, >10 nodes removed, chemotherapy, and type of chemotherapy (more fatigue with taxanes). On multivariate analysis, patients who received chemotherapy (OR 1.96, CI 1.36–2.81, p < 0.0001), and those aged 50–59 at diagnosis (OR 1.80, CI 1.22–2.66, p = 0.003) were more likely to have moderate or severe fatigue. In patients aged 50–59 at diagnosis who receive chemotherapy (n = 156), 74.4 % rated their fatigue as moderate or severe.
Conclusions: Patients aged 50–59 who receive chemotherapy are very likely to experience significant fatigue in the year following therapies for breast cancer.
MASCC-0481
Cervical precancerous lesions and cancer among patients seen in the gynaecology outpatient department at a tertiary hospital in South Africa
M. Hoque 1, E. Hank2
1Graduate School of Business and Leadership, University of KwaZulu-Natal, Durban, South Africa, 2Department of Health, Rahima Moosa Hospital, Johannesburg, South Africa
Introduction: In South Africa, cervical cancer is the second leading cause of death among women. HIV infection and cervical cancer among women in South Africa are both important Public Health concerns.
Objectives: The purposes of this study are to determine proportional rates of cervical precancerous lesions and cancer, and its association with socio-demographic variables, HIV status, and CD4 Cell Count.
Methods: A retrospective comparative study was conducted, targeting the medical records of all women over the age of 18 that were diagnosed histologically through Colposcopy with cervical precancerous lesions and cervical from 01 December 2011 to 30 November 2012
Results: A total of 313 Patient records were used for data analysis. The average age of the patients was 39.06 (SD = 2.04) years. More than a third (37.06 %) of the patients had CIN III or cervical cancer. There was a significant association between Age, CD4 Cell count, HIV status, and cervical lesions (P < 0.05). Age was found to be an influential predictor of cervical lesions (OR = 0.67, 95 % CI: 0.46–0.98).
Conclusions: There exists an association between Age and cervical lesions, indicating the presentation of cervical precancerous lesions and cervical cancer at a younger age among HIV Reactive patients. The National Guidelines should be brought in line with the National HIV Counseling and Testing Policy to offer Pap smears to all sexually active women that test HIV Reactive during routine HIV Testing.
MASCC-0482
Treatment experience of survivors with recurrent colorectal cancer based on interviews
E. Shindo 1
1Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
Introduction: The standardization of treatment for recurrent colorectal cancer has led to extended life expectancy. However, support programs for patients are not yet sufficient in Japan.
Objectives: To examine the experiences of those currently undergoing the treatment and how they are making sense of it.
Methods: A qualitative descriptive study design. The participants were three Japanese females in their 50s and 60s with recurrent colorectal cancer. Data was collected through several continuous semi-structured interviews and analyzed using interpretation of the experiences. IRB of Keio University approved this study.
Results: Interviews were conducted 24–27 times to each over 2.5 years. In continuing chemotherapy, they viewed their bodies as toxic and not their own. The treatment was also seen as an obstacle to being oneself and performing their roles in life. They had mixed feelings about the treatment being something that threatened their bodies but at the same time preserved their lives. They were distressed about whether they should continue with the treatment or not. The harsh experience brought about a fear of self-dissolution, yet they persevered because they hoped it would prolong their lives and let them live in their own ways. They maintained a sense that they were weathering it by carefully controlling both self and disease.
Conclusions: They maintained a sense of controlling both self and disease through suffering by themselves. That was how they were handling the fear of self-dissolution. These results suggested to be more sympathetic to their suffering and to investigate a customized psychosocial support program.
MASCC-0483
The association of TLR2, TLR4 and proinflammatory cytokines with irinotecan-induced gastrointestinal mucositis in an animal model
K. Fakiha 1, R. Logan2, J. Coller3, A. Stringer4, J. Bowen5
1Dscipline of Medicine Faculty of Health Sciences, University of Adelaide, Adelaide, Australia, 2School of Dentistry Faculty of Health Sciences, University of Adelaide, Adelaide, Australia, 3Discipline of Pharmacology Faculty of Health Sciences, University of Adelaide, Adelaide, Australia, 4School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia, 5Discipline of Physiology Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
Introduction: Gastrointestinal mucositis (GIM) is a common side effect of irinotecan administration characterised, in animal studies, by the occurrence of diarrhoea. However, in these studies, rats receiving irinotecan do not always develop diarrhoea. Previous research has shown that TLR2, TLR9 and proinflammatory cytokines are involved in chemotherapy-induced GIM.
Objectives: This study investigated TLR2, TLR4 and proinflammatory cytokine expression following irinotecan administration in rats focusing on diarrhoea occurrence as the marker of GIM.
Methods: Seventeen female DA rats received either single dose of irinotecan (200 mg/kg, n = 11) or vehicle control (n = 6) and were killed at 72 h (irinotecan = 5, control = 3) or 96 h (irinotecan = 6, control = 3) post treatment. Jejunum and colon samples were collected. RT-PCR and immunohistochemistry for TLR2, TLR4, IL-1β, IL-6 and TNF were performed and mRNA and protein expression were compared between groups with and without GIM.
Results: Two-thirds of irinotecan-treated rats developed GIM with peak diarrhoea at 96 h. TLR2, TLR4, TNF and IL-1β mRNA and protein expression increased significantly in the colon of rats that developed diarrhoea at 96 h compared to rats without diarrhoea (P < 0.05). Similarly, protein expression of TLR4 and TNF increased in the jejunum of rats with diarrhoea at 96 h (P < 0.05). No significant differences were observed for IL-6.
Conclusions: Increased TLR2, TLR4, IL-1β and TNF expression correlated with diarrhoea occurrence and severity. These data support previous work indicating the role of inflammatory mediators in rats at 96 h following irinotecan administration. Therefore, they can be considered as possible mediators for irinotecan-induced GIM.
MASCC-0484
Does abiraterone allow pain relief in castration resistant prostate cancer? A real life experience in a French General Hospital
D. Mayeur 1, D. Billard1, C. Abraham1, J.F. Geay1, A. Teillet1
1Haematology-Oncology, Hôpital Mignot, Le Chesnay, France
Introduction: Castration resistant prostate cancer is often associated with moderate to severe pain, especially bone pain.
Objectives: To assess pain relief in patients with castration resistant prostate cancer treated by abiraterone.
Methods: Retrospective study of all the castration resistant prostate cancer patients treated with abiraterone. Using their charts, identification of patients with a pain treatment coprescription at the start of abiraterone. Evaluation of analgesic consumption during abiraterone treatment and the time during which analgesic consumption is decreased by abiraterone, response evaluation to anticancer treatment.
Results: Seventeen patients have been treated by abiraterone. Median age and median PSA at the start of treatment: respectively 71.1 years (57–83) and 354.7 ng/ml (0.1–2108). 5/17 (30 %) patients were pain free. 12/17 (70 %) were treated with analgesics at introduction of abiraterone treatment. No antitumoral effect: 3/17 (18 %) patients. 7 patients out of the 12 (58 %) treated for pain had a decrease of the pain killers during treatment by abiraterone. This decrease lasted 34.3 weeks (8–69.5). Patient 1: decrease of oxycodone from 160 mg/day to 40 mg/day; patient 2: stopped rapid action fentanyl; patients 3, 4 and 5 stopped all analgesic medication; patient 6 decreased transdermal fentanyl from 175 μg/h to 100 μg/h and stopped rapid action fentanyl; patient 7 observed a 50 % decrease in his consumption of tramadol. Increase in pain intensity was, for these entire patients, the first sign of therapeutic loss of efficacy.
Conclusions: Abiraterone is able to provide pain relief and a decrease in analgesic consumption in castration resistant prostate cancer patients.
MASCC-0485
Lymph taping in the head and neck region—first experiences
J. Büntzel 1, G. Danilkina1, H. Büntzel2
1Otolaryngology, Südharz Klinikum, Nordhausen, Germany, 2Palliative Medicine, Südharz Klinikum, Nordhausen, Germany
Introduction: Manual lymph drainage of the head and neck region had been criticized because of possible iatrogenic development of lymphatic metastasis (Herberhold 1993). Elastic lymph taping offers similar anti-edematous effects on the base of patient’s own movements.
Objectives: We evaluated the effects and practicability of lymph taping in head neck cancer patients after radiotherapy.
Methods: We report about our experiences with elastic lymph taping of the head and neck region about at least 21 days. The three-arming tape (15 cm long) was used on both sides of the neck. The self- movement of the neck causes the careful and continuous lymph drainage for each individual. 25 patients (18 men, 7 women, mean 57 years) were treated and observed. All had finished their radiotherapy since at least 3 month. To objectify the anti-edematous effect we have performed bioimpedance analysis of the neck region in selected patients.
Results: 22/25 patients reported positive effects of the elastic lymph taping. 21 patients continued the lymph taping after the planned 3 weeks. The tape was changed every 3–4 days. Acute side effects were not reported. No patient developed any lymphatic or skin metastasis in a time window of 6 month. The bioimpedance analysis has documented the anti-edematous effect as well. The BIA has still to be validated before it is used in clinical practice for this indication.
Conclusions: We offer elastic lymph taping as a comfortable and safe standard in our anti-edematous concept.
References: Herberhold C: Manuelle Lymphdrainage im Kopf-Hals-Bereich? Laryngorhinootol 1993; 72: 580
MASCC-0486
Standard anti-emetic therapy and emend® 7 days after high-dose chemotherapy significantly reduces problems with vomiting for patients undergoing high dose chemotherapy before stem cell transplantation
A. Svanberg 1, G. Birgegård1
1Faculty of Medicin, Inst for Medical Sciences, Uppsala, Sweden
Introduction: Chemotherapy-induced vomiting, acute and delayed, is a problem for patients treated with high dose chemotherapy (HDCT) before stem cell transplantation (SCT). Chemotherapy-induced vomiting impairs compliance with treatment. There has been major improvement to prevent vomiting with the introduction of 5-hydroxytriptamine-3 (5-HT3). This anti-emetic treatment appears to be ineffective against delayed vomiting.
Objectives: To compare the efficacy of standard anti-emetic treatment with standard treatment plus prolonged treatment with aprepitant (Emend®) until 7 days after end of chemotherapy in patients with lymphoproliferative diseases treated with HDCT before autologous SCT at Akademiska University Hospital, Sweden.
Methods: Patients (n = 96) were randomized between 2011 and 2012, to experiment (EXP) group who received Emend® in addition to standard anti-emetics or control (CTR) group receiving placebo plus standard anti-emetics. Emend® or placebo treatment started 1 h before first HDCT dose and was administrated daily until 7 days after chemo. Vomiting was noted by the patient in a diary starting 24 h after HDCT and until day 16 (end of study). Anti-emetic rescue medication was recorded.
Results: Twenty-eight patients in the EXP group compared to 14 in the CTR group experienced complete response (no vomiting) from end of HDCT to end of study regarding vomiting (p = 0.0001). There were no significant differences in use of anti-emetic rescue.
Conclusions: Addition of Emend® to standard anti-emetic treatment during 7 days after chemotherapy gave a significant reduction of chemotherapy-induced vomiting from end of chemotherapy to end of study.
MASCC-0487
Effect of mild exercise program for patients with gynecological cancer undergoing chemotherapy
M. Chaen 1, E. Shindo1, N. Morita1, N. Yamagishi1, M. Kobayashi1
1Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
Introduction: Cancer patients undergoing chemotherapy suffer a reduced overall QOL because treatment side effects result in a decreasing level of activity in daily life. We developed a mild exercise program (MEP) for patients to do easily on the bed or couch whenever they want.
Objectives: To examine the effectiveness of MEP for maintaining/improving QOL of patients undergoing chemotherapy.
Methods: Thirty-two patients, with an average of 49.8 ± 10.2 year, with gynecological cancer undergoing chemotherapy at a university hospital in Japan, were recruited. They were asked to complete the assigned MEP for 4 months at home, to complete SF-36v2 and Hospital Anxiety and Depression Scale (HADS) and measure thigh circumference (TC) before and after the period of study. They also were asked to keep a daily diary documenting whether or not they did MEP, their physical conditions, side effects of chemotherapy, the Borg Index of exercise intensity and their experiences during exercising. Data were analyzed using SPSSver.19. Qualitative data were analyzed using content analysis. IRB approved this research.
Results: In 50.3 % of targeted days, the assigned MEP was done. On these days, the rate of exercise was 68.5 % among patients in good condition; 31.5 % in bad condition. Even in bad condition, they tried to do exercises. Physical functioning and mental health on the SF-36v2 increased significantly, and HADS scores decreased but not significantly. TC increased significantly, and patients reported feeling comfort after doing exercises.
Conclusions: Because of easily access, MEP would be good for cancer patients to keep exercising for improving their QOL.
MASCC-0488
Improving care of patients on oral anticancer therapies
S. Decosterd 1, L. Mercier-Vogel2, E. Lavallière2, N. Blazek2, G. Choupay-Dessard3
1Direction des soins, HUG, Geneva, Switzerland, 2Oncology Service, HUG, Geneva, Switzerland, 3Medical Direction & Quality, HUG, Geneva, Switzerland
Introduction: The development of oral anticancer agents is exponential. It represents a major change with patients being cared for in ambulatory settings and the development of a chronic-disease model of care. To deal with this challenge, experts recommend the development of patient centered educational and support programs, to promote patient adherence to treatment.
Objectives: Improving care of patients on oral anticancer agents.
Methods: In order to develop an adapted ambulatory care program for patient receiving oral anticancer agents, we designed an action-research involving all stakeholders. The data collection was sequential. First we analyzed our prescribing and delivery process for anticancer agents; second we carried out two brainstorming sessions to identify physicians/nurses concerns with oral anticancer treatment; third we carried out three focus groups with patients and relatives to identify their needs.
Results: The content analysis revealed the interest of health professionals for these new treatments, but some worried about the shift of responsibilities toward the patient and the need to have a coherent care process involving all professionals. Patients and their relatives preferred oral anticancer treatments and encountered little practical difficulties. However the illness and its treatment impacted their quality of life. They needed information about the management of medication side effects and support to deal with the different stages of their illness
Conclusions: These results lead to the revision of our process of prescription and delivery of anticancer agents, the development of an educational program for nurses in the ambulatory setting and the introduction of a nursing consultation. These developments will be presented.
MASCC-0489
Expression of matrix metalloproteinase -2 and tissue inhibitor of metalloproteinase-1 in oral mucositis following irinotecan chemotherapy
A.R. Al-Azri 1, R.J. Gibson2, J.M. Bowen2, A.M. Stringer3, D.M.K. Keefe4, R.M. Logan1
1School of Dentistry - Oral Pathology, University of Adelaide, Adelaide, Australia, 2School of Medical Sciences, University of Adelaide, Adelaide, Australia, 3School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia, 4Discipline of Medicine - Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
Introduction: Changes in expression of matrix metalloproteinases (MMPs) subclasses-3 and -9 have been previously reported in the oral mucosa following irinotecan chemotherapy in a rat model of mucositis (MASCC 2012). Subsequently we have also investigated the tissue expression of MMP-2 and tissue inhibitor of metalloproteinases-1 (TIMP-1) in the oral mucosa.
Objectives: To determine whether MMPs may play a role in the pathobiology of irinotecan induced mucositis.
Methods: Eighty-one female Dark Agouti rats were either administered with a single dose of irinotecan (200 mg/kg) or had no treatment. Rats were killed at different time points over a 72 h period. Tongue mucosa was examined histologically. The tissue expression of MMP-2 and TIMP-1 in oral mucosa was characterized by standard qualitative immunohistochemistry.
Results: The study showed an early reduction of oral epithelium thickness after chemotherapy. This was associated with significant up-regulation of MMP-2 and down-regulation of TIMP-1 in various layers of the oral mucosa. The early changes in MMP-2 and TIMP-1 (and the previously reported MMP-3 and-9) coincided with the previously described early up-regulation of mediators of inflammation in oral mucositis, suggesting a relationship between these biological events. Furthermore, the patterns of expression demonstrated by MMPs suggest they are involved in various aspects of the 5-phase model of OM pathophysiology.
Conclusions: This study has provided further evidence of MMPs involvement in the pathobiology of oral mucositis. Further research needs to be directed towards interventional therapies aiming to target MMPs and improve the outcome of cancer treatment.
MASCC-0490
Nutrition impact symptoms in cancer patients: results from a point prevalence study in Australia
J. Loeliger 1, K. Marshall1, L. Nolte2
1Nutrition, Peter MacCallum Cancer Centre, Melbourne, Australia, 2Cancer Strategy, Victorian Department of Health, Melbourne, Australia
Introduction: Malnutrition is an important supportive care need for people with cancer. The Patient Generated–Subjective Global Assessment (PG-SGA) is a validated tool to determine malnutrition in cancer patients. The PG-SGA includes 14 patient-reported Nutrition Impact Symptoms (NIS).
Objectives: This study aimed to determine the prevalence of malnutrition and NIS’s in cancer patients.
Methods: A point prevalence study of adult cancer patients, using the PG-SGA to determine malnutrition and NIS, was conducted in 15 Health Services in Victoria, Australia in March 2012.
Results: A total of 1,693 cancer patients were included with 31 % (n = 523) identified with malnutrition. Malnourished patients reported more NIS than well-nourished patients (3.8 vs 1.2, p < 0.001). Only 8 % of malnourished patients reported ‘no problems eating’ compared to 59 % of those well nourished. The most reported NIS by malnourished patients were ‘no appetite’ (63 %), ‘fatigue’ (49 %), ‘nausea’ (41 %) and ‘feel full quickly’ (41 %). Patients undergoing treatments for upper gastrointestinal, colorectal and gynaecological tumours reported the highest number of NIS. In patients receiving supportive care only (n = 51) reported the highest number of NIS with ‘no appetite’, ‘nausea’, ‘vomiting’ and ‘pain’ the most frequently described.
Conclusions: Malnutrition is highly prevalent in cancer patients and NIS are more commonly reported in those with malnutrition. This study provides valuable insight that can assist to optimise symptom management and direct nutrition interventions in cancer patients.
MASCC-0491
Malnutrition and clinical outcomes in cancer patients: results from a point prevalence study in Australia
K. Marshall1, J. Loeliger 1, L. Nolte2
1Nutrition, Peter MacCallum Cancer Centre, Melbourne, Australia, 2Cancer Strategy, Victorian Department of Health, Melbourne, Australia
Introduction: Malnutrition is an important supportive care need for people with cancer. The Patient Generated–Subjective Global Assessment (PG-SGA) is a validated tool to determine malnutrition in cancer patients
Objectives: This study aimed to (1) determine the prevalence of malnutrition in cancer patients and (2) investigate the association between malnutrition and clinical outcomes
Methods: A point prevalence study of adult cancer patients, using the PG-SGA to determine malnutrition was conducted in 15 Health Services in Victoria, Australia in March 2012. Outcomes were collected at day 30
Results: A total of 1,693 cancer patients were included, with 31 % (n = 523) identified as malnourished. Malnutrition prevalence of inpatients was 57 % (191 of 336) and 25 % of ambulatory patients (332 of 1,357). Malnutrition prevalence was higher in patients with tumours of the upper gastro-intestinal tract (62 %), head & neck (40 %) and lung (37 %) but identified in all tumour streams ranging from 14 % to 62 %. Patients with malnutrition had a significantly higher 30-day mortality (6 % vs 1 %, p < 0.001), length of stay (20.3 vs 15.7 days, p < 0.001) and rate of hospital admission rate (38 % vs 12 %, p < 0.001).
Conclusions: Malnutrition is highly prevalent in cancer patients. Malnutrition is associated with poorer clinical outcomes. This study provides valuable insight and direction for the implementation of evidence-based nutrition interventions to address malnutrition in cancer patients and may allow for further assessment of the economic burden of malnutrition.
MASCC-0492
Development of restore; an online intervention to support self-management of cancer related fatigue (CRF)
C. Foster 1, L. Calman1, M. Breckons2, C. Grimmett1, D. Fenlon3, A. Richardson3, P. Smith4, L. Yardley5, J. Corner3
1Macmillan Survivorship Research Group, University of Southampton, Southampton, United Kingdom, 2Institute of Health & Society, University of Newcastle, Newcastle, United Kingdom, 3Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom, 4Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom, 5School of Psychology, University of Southampton, Southampton, United Kingdom
Introduction: In the UK around 2 million people are living with or beyond cancer, this number is rising by more than 3 % per year. Many survivors experience cancer related fatigue (CRF) following primary treatment. Cancer diagnosis and treatment can leave people feeling vulnerable and lacking in confidence. Self-management can empower patients to act for themselves, increase confidence in their ability to manage problems and enhance quality of life.
Objectives: To develop and user-test an online intervention as a form of self-management support to enhance self-efficacy to manage CRF following primary cancer treatment.
Methods: Informed by the MRC guidance for developing and evaluating complex interventions, self-efficacy theory and Foster & Fenlon’s conceptual model of recovery following primary cancer treatment, the intervention was developed in partnership with survivors, clinicians and academic experts. It underwent two rounds of user testing with survivors. ‘Think aloud’ interviews were conducted as each session was developed. Secondly, the intervention and outcome measures were tested at home and telephone interviews conducted.
Results: The intervention consists of five weekly sessions. Sessions one and two focus on information and goal setting and session three–five home life and work, managing thoughts and feelings and talking to others. Core components include goal setting and evaluation, patient stories, feedback, fatigue diary and assessment of self-efficacy to manage fatigue. User testing revealed the intervention was acceptable and outcome measures not burdensome.
Conclusions: A theoretically driven intervention co-created with services users and acceptable to stakeholders has been developed. A randomised controlled feasibility trial is underway.
MASCC-0493
Oral care in the cancer setting: disseminating best practice—a national project
B. Quinn 1, M. Davies2, J. Horn3, E. Riley4, J. Treleaven5, D. Houghton6, M. Thomson7, F. Campbell7, S. Hoy8, L. Fulman9, K. Mais2
1Cancer, Ashford & St Peter’s NHS Foundation Trust, Surrey, United Kingdom, 2Cancer, Christie Hospital NHS Trust, Manchester, United Kingdom, 3Haematology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom, 4Dentistry, Pennines Acute Trust, Manchester, United Kingdom, 5Haematology, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom, 6Pharmacy, Rivers Hospital, Hertfordshire, United Kingdom, 7Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom, 8Cancer, Royal Marsden NHS Foundation Trust, London, United Kingdom, 9Radiotherapy, Nottingham Universtiy Hospitals NHS Trust, Nottingham, United Kingdom
Introduction: It is widely recognised that oral problems including oral mucositis can be very distressing for the individual, making substantial demands on the person’s health and indeed health care resources. However, some of the distressing symptoms and health risks can be greatly reduced by the correct proactive care and treatment of oral problems.
Objectives: The United Kingdom Oral Mucositis in Cancer Care Group (UKOMIC), a multi-professional group of oral care experts was set up 2 years ago to promote education and address the often under reported impact of oral problems in cancer care. Drawing upon their expertise and the most up to date evidence, the group developed guidance on the prevention and treatment of oral problems secondary to disease and treatments.
Methods: A national educational programme was launched to disseminate best practice in oral care across the United Kingdom. Members of UKOMIC have spent the last year disseminating the guidance in a variety of clinical and non-clinical settings, using a variety of teaching modalities including, clinic based teaching, national study days and internet site resources including an on line module.
Results: Through the education programme the group has engaged with practitioners and professional groups to advance this often neglected aspect of cancer care and the guidance is now being widely used in cancer centres across the United Kingdom to support and update clinical practice.
Conclusions: The work of UKOMIC has also been recognised globally and members of the expert group are working with MASCC, the European Blood and Marrow Transplantation Group and other international organisations to develop best practice.
MASCC-0494
To survey the view of death and hospice education in Chinese cancer patients
J. Rao1, Q. Fu 1, M. Liu1, S. Yu1
1Oncology Department, Tongji Hospital Tongji Medical College Hua Zhong University of Science and Tec, Wuhan, China
Introduction: In China, ‘living will’ has been a controversial topic. The condition of the patients’ view of death is unclear. We tried to discussed the possibility of implementation of living will by the questionnaire.
Objectives: To study the view of death and hospice educational needs in Chinese cancer patients.
Methods: The respondents included medical staff, patients and family dependents accepted a questionnaire survey. The questionnaire consisted of four sections. The first included the respondents’ background information such as sex, age, marital status, etc. In second section, we investigated whether the respondents were willing to talk about death topics. The third showed the views of death. The last was involved hospice educational needs.
Results: A total of 289 (96.3 %) questionnaires were collected. 26.64 % of respondents (11.22 % of medical staff, 27.27 % of patients, 43.29 % of family dependents) were minded talking about death-related issues, half of them (54.55 %) could accept ‘living will’, but 19.48 % could not understand it. and most of them (70.13 %) at the problem of ‘the attitude of treatment of the dying person’ thought that aggressive treatment should be used. ‘The situation of talk’, ‘level of education’ and ‘age’ were correlated with minding to talk about death-related issues. Three groups who didn’t mind talking about death had major differences in the related opinions.
Conclusions: The higher expectation for the hospice educational needs were showed in the medical staff and family members of patients, and patients and families dependents tended to aggressive treatment in end-stage, so ‘Living will’ has been remained to be further discussed.
MASCC-0495
Introduction of palliative care (pc) at nursing education of Tajikistan
G. Samadova 1, N. Abidjonova2
1Family Nursing, Tajik Postgraduate Medical Institute, Dushanbe, Tajikistan, 2Public Health, OSI Tajikistan, Dushanbe, Tajikistan
Introduction: In Tajikistan annually registered 3,000 new cases of cancer, including 60–70 % advanced and 75 % patients want to spend their last days at home
Objectives: Introduction of palliative care in nursing education
Methods: Needs assessment conducted in 2006 showed that education for nurses is important since about ¾ of the population live in rural areas and palliative care will be provided by nurses. Plan of action for implementation of curricula was made on postgraduate level.
Results: Analysis and desk review of case plans showed lack of key issues, the distribution of those on courses and system. Knowledge of basics of Palliative Care of teachers was average 36 %, specialists from PHC level was 56 %, and oncology 68 %. Tajik Institute on postgraduate medical education in 2010 got grant from OSI Tajikistan for introduction PC curriculum for nurses. Prior to implementation of the module “Palliative Care” in the educational process, workshops were held for teachers of final year college/school (result of pre and post tests showed knowledge has grown to 85 % on average). Knowledge and skills graduate students passed the module significantly increased (average 75 %)
Conclusions: Institunalisation of nursing education on post-graduate level with obligatory compulsory objective structured clinical examination will support efforts to make palliative care a sustainable, essential part of public health system and the country will be able to meet the standards of quality of life of patients and their families
MASCC-0496
R1 and R2 for prophylaxis of acute radiation dermatitis: interim results of a randomized multicenter trial (CREAM-1)
P. Naumann 1, D. Krug1, J. Harsch1, T. Wiegel1, A. Hinke1, V. Tarcea1, M. Haefner1, B. Haas-Rassfeld1, P. Niehoff1, J. Debus1, K. Potthoff1
1Radiation Oncology, University Hospital, Heidelberg, Germany
Introduction: Acute radiation-induced dermatitis (ARD) is a common complication in patients with squamous cell cancer of the head and neck (SCCHN) treated by platin-based chemoradiation. Despite ongoing progress in supportive cancer care ARD remains a major adverse side effect with a severe impact on quality of life.
Objectives: Due to convincing clinical experiences with the new lactokine containing topical treatment “R1 and R2” in a pilot case series for management of ARD we launched a multicenter, randomized trial with a recruitment goal of 132 patients in 29 centers to assess its safety and efficacy for prophylaxis of ARD
Methods: Patients with SCCHN were randomized to either receive prophylactic topical “R1 and R2” or the standard skin care of the institution. All patients were treated by concomitant platin-based chemoradiation in curative intention. The primary objective was the amount of patients that experience an ARD grade 3 or 4 (NCI CTCAE v. 4.03). All patients were regularly evaluated and the irradiated skin was photographed and graded according to NCI CTCAE. Additionally, patients completed quality of life (QoL) questionnaires.
Results: As of January 2013, 84 patients were evaluable for safety analysis. Application of R1 and R2 was well tolerated. No allergic reactions occurred and no grade 3 or 4 toxicities were seen. QoL was maintained in patients applying R1 and R2
Results of the interim analysis will be presented
Conclusions: The application of “R1 and R2” is feasible, safe and effective in prophylaxis of ARD. Due to promising initial results active accrual will continue and be completed soon.
MASCC-0497
Participative Management (PM): a dynamic looked for by the French onco-hematology teams
S. Trager 1, G. Nallet2, C. Bauchetet3, C. Préaubert4, V. Tual5, C. Blaizac6, P. Colombat7
1Oncology, Groupe Hospitalier Public du Sud de l’Oise, Soisy sous Montmorency, France, 2Oncology, Reseau Oncolie, Besançon, France, 3Oncology, Retired Health manager, Paris, France, 4Oncology, Clinique du Pont de Chaume, Montauban, France, 5Oncology, Hôpital Européen Georges Pompidou, Paris, France, 6Oncology, Hôpital Ste Musse, Toulon, France, 7Oncology, CHRU Bretonneau, Tours, France
Introduction: Participative Management (PM) is a kind of organization of the departments based on the research of the quality of life at work. This dynamic concept gathers every professional in a common logic of recognition, respect, listening and partnership. It is based on four pillars: caregivers support, project approach, training, and multi-professional meetings
Objectives: To Evaluate the concept of PM in onco-hematology departments
Methods: An anonymous internet questionnaire has been sent to one doctor, one health manager and one caregiver of numerous onco-hematology departments
Results: 144 professionals returned the questionnaire. 67 % of the respondents are aware of the concept of PM. 55 % of the caregivers consider that the organization of the departments is participative. Department’s projects are mainly elaborated by both health managers (86 %) and doctors (81 %) followed by nurses (49 %). Multi-professional meetings are present in 86 % of departments with mainly clinical meetings (88 %) and organization meetings (89 %). According to respondents, speech is sufficiently free (99 %) and taken into account (92 %). 63 % have multi-professional training inside their department. Caregivers support is set up for 50 % of the respondents. 65 % of the respondents are interested in a PM training
Conclusions: A participative dynamic is found in the French onco-hematology department. This course towards the PM is still incomplete in particular for the supporting care professionals and their implication in the project of department. A strong demand in PM is noticed. It will allow the development of this global approach aiming at preventing suffering at work and caregivers burnout syndrome.
MASCC-0498
General health and wellbeing of colorectal cancer patients at diagnosis: characteristics of crew (colorectal wellbeing) cohort and baseline findings
D. Fenlon1, K. Chivers Seymour2, A. Richardson3, P. Smith4, J. Corner3, J. Winter5, L. Calman2, C. Foster 2
1Faculty of Helath Sciences, University of Southampton, Southampton, United Kingdom, 2Macmillan Survivorship Research Group, University of Southampton, Southampton, United Kingdom, 3Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom, 4Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom, 5Southampton Colorectal Unit, Southampton General Hospital, Southampton, United Kingdom
Introduction: Studies suggest most people return to near pre-diagnosis status following surgery for colorectal cancer (CRC). However research has been small scale or narrowly focused. There is a need for a large, longitudinal study exploring the impact of cancer and treatment on everyday life and how this affects recovery
Objectives: CREW is a prospective cohort study established to explore patterns of recovery of health and wellbeing following CRC and what influences this, including: who is at risk of poor/protracted recovery; health service use; and confidence to self-manage.
Methods: Participants were recruited prior to surgery from 30 centres throughout Great Britain. Measures have been completed at baseline, 3 and 9 months and longer term assessments are underway.
Results: Of 1,350 eligible patients 1,055 consented and 911 agreed to complete questionnaires. Demographics 59.2 % men; 71.3 % married/cohabiting; 93.5 % White British; 68.0 % retired; and 3.3 % sick leave. The age range is 32–95 (median 68). Participants reported mean Personal Wellbeing Index total scores of 77.4 (SD 15.9) compared to normative range of 70–80 in Western populations. The Centre for Epidemiologic Studies Depression Scale mean score was 13.2 (SD 8.9). 33.8 % of the sample met a threshold for depressive symptoms (CES-D ≥ 16); compared to 20 % in the general population
Conclusions: CREW participants’ baseline scores for PWI are similar to normative scores. This may reflect that this is prior to surgery or cancer treatment. It is less surprising that we detected a high level of depression at this time. We expect a reduction in personal wellbeing scores after treatment has started.
MASCC-0499
Patient health records for supportive care in cancer
N. Shklovskiy-Kordi 1, B.V. Zingerman1
1Hematology, National Center for Hematology, Moscow, Russia
Introduction: Supportive Care can be effectively realized only in contest of the medical history of the patient. Medical records—the key question of the integrity of Medicine. Doctor has to record the results of his research and reflections—it is the fundament of the continuity and development in Medicine. No one but the patient can collect ALL the records relating to his health.
Objectives: Electron Medical Records and Patient Health Records in particular, becoming widely accepted method of patient care, have to be efficient instrument of interdisciplinary cooperation in medicine and tracing of drugs and other agents of influence interaction
Methods: System of electronic health records, constructed to be patient-driven (patient takes responsibility for the collection, storing, and policies of use of his personal medical records) and comfortable for doctor
Results
Results: Based on our experience in creating the National Standard of Electron Medical Records, developed the Internet-based System for Patient Health Records. The System accepts records in any format. The main features are: 1. ensuring the origin and credibility of records. 2. Integral representation of all data (particular, presentation on a single time axis allows estimation of the real-time correlations of dynamic changes in clinical parameters). This approach is the way to take into account number of curative and supportive interventions addressed to oncology patient in modern medicine.
Fig.1.
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Conclusions: The system of electron medical records permits to track interaction between multiple agents of action, facilitating development of the Integrative Image of Disease.
References: N. Shklovskiy-Kordi, B. Zingerman, «EHR for Blood Count Analysis and Clinical Trials», Platelets 2010, ?.134
MASCC-0500
Rational use of aprepitant based on the individual chemotherapy regimen among highly emetic risk category
H. Fujii 1, H. Iihara1, M. Nishigaki1, A. Suzuki1, M. Ishihara1, Y. Itoh1
1Parmacy, Gifu University Hospital, Gifu-shi, Japan
Introduction: Several clinical practice guidelines recommend the use of antiemetics based on the emetic risk of chemotherapy. However, the emetogenicity appears to considerably vary even among the same emetic risk category
Objectives: For prevention of chemotherapy-induced nausea and vomiting (CINV) associated with high-emetic chemotherapy (HEC), 5-HT3 antagonist, aprepitant and dexamethasone is used in combination before chemotherapy, aprepitant and dexamethasone on the subsequent 3 days. Moreover, several risks for CINV, including age and gender, should be considered for prevention of CINV
Methods: The rate of complete response (no emesis without rescue treatment) was examined among 5 single-treatment HEC (GEM/CDDP for bladder cancer,R-CHOP for non-Hodgkin lymphoma, EPI/CPA for breast cancer,PEM or VNR/CDDP for lung cancer, and ABVd for Hodgkin lymphoma) and 2 repeated-treatment HEC (5-FU/CDDP for head-and-neck cancer and BEP for germ cell cancer), before the introduction of aprepitant. Subsequently, the effect of aprepitant was evaluated in EPI/CPA and 5-FU/CDDP regimens
Results: Based on the rates of complete response during overall period obtained in the absence of aprepitant, which varied ranging from 8 % (ABVd) to 74 % (R-CHOP), we considered that aprepitant should be included as the standard antiemetic therapy in HEC regimens except for R-CHOP and GEM/CDDP. We also found that the emetic control was greatly improved, when aprepitant was administered for 5 but not 3 days in repeated treatment regimens
Conclusions: These findings suggest that appropriate antiemetic medication should be determined based on the individual chemotherapy regimen even among the same emetic risk category.
MASCC-0501
Epidemiology, resistance profile and origin of bacteremia in non-neutropenic patients with solid tumor
M. Merad 1, E. Chachaty2, A. Alibay1, B. Gachot3, M. Di Palma1, S. Antoun1
1Ambulatory Department, Gustave Roussy Institute, Villejuif, France, 2Microbiology, Gustave Roussy Institute, Villejuif, France, 3Infectious Diseases department, Gustave Roussy Institute, Villejuif, France
Introduction: In oncology, and especially for solid tumors, the principal studies describe bacteriema in patients with neutropenia, Few microbiological data are available without neutropenia. Furthermore, bacteria resistance in immucompromised patients is increasingly reported
Objectives: The aim of this study is to describe the bacteremia occurring in solid tumors and to identify a potential association with other sites of infection
Methods: This retrospective study was conducted in patients visiting an emergency oncology department for acute onset symptoms. Urinary, skin and/or sputum samples were analyzed according to clinical symptoms. Central venous catheter infection (CVC) was defined with the differential time to positivity between hub-blood and peripheral-blood cultures
Results: We reported 290 bacteremia, Gram-positive represented 58 %: coagulase-negative staphylococci (CNS) (n = 105), Staphylococcus aureus (SA) (n = 38) (one methicillin-resistant), Streptococcus sp (n = 36). The majority of gram-negative were Enterobacteria (E) (n = 97) and most of them were E coli (n = 62). Only 2 (E coli) developed extended spectrum beta-lactamases resistance. Two ore more microorganisms were found in 41 bacteremia. When CNS, SA and Candida sp. were isolated it was most often related to CVC, and, 25/98 of E bacteremia were also attributed to a catheter infection. It is important to highlight that all the bacteremia were associated with another site of infection
Conclusions: In patients with solid tumors without the context of neutropenia, all the bacteremias are associated with documented sites of infection. Bacteria resistance is the exception (1 %), 58 % of the bacteremia are Gram-positive microorganisms and catheter infection could be with Enterobacteria microorganisms.
MASCC-0502
Development of a multidisciplinary platform for the screening of new preventive and therapeutic drugs against mucositis
B. Vanhoecke 1, J. Bowen2, T. Deryck1, T. Van de Wiele1, D. Keefe2
1Department of Biochemical and Microbial Technology, Ghent University, Ghent, Belgium, 2Mucositis Research Group, The University of Adelaide, Adelaide, Australia
Introduction: Both from ECVAM and worldwide, there is a general call for the reduction, refinement or replacement of the use of laboratory animals. However, while in vivo animal models of chemotherapy and radiotherapy-induced mucositis have been successfully established, alternative Methods such as in vitro tools for mucositis are still missing. These are urgently required to allow a rapid and high-throughput screening of new-generation anti-mucositis candidate molecules
Objectives: The aims of the platform are: 1. Generation of innovative high-throughput in vitro models of mucositis; 2. In vivo validation of the in vitro models using established animal models of chemo/radiotherapy-induced mucositis; 3. Exploration of the in vitro and in vivo tools to identify new biomarkers, risk factors and new drugs
Methods: The generation of in vitro mucositis models will be based on our recently developed full mucosa model that allows long-term coculturing of oral biofilms and the underlying mucosa (Ghent University). Proof-of-concept will be achieved by validating these in vitro models in vivo by means of well-established rat mucositis models (The University of Adelaide). Correlation between in vitro and in vivo endpoints will be estimated.
Results: -
Conclusions: The in vitro and in vivo tools provided by the platform will enable a rapid identification and validation of new biomarkers, risk factors and potential anti-mucositis drugs. Further, the platform generates an opportunity to achieve a substantial reduction of animal experiments in mucositis assessments. -
MASCC-0503
Chronic fatigue development in men treated with localized radiation therapy for prostate cancer
M. Araneta 1, N.L. Lukkahatai1, L.S. Saligan1
1Nursing Research, National Institutes of Health, Bethesda MD, USA
Introduction: Fatigue develops in 80 % of patients during external beam radiation therapy (EBRT). No study reports the association between fatigue development during EBRT and persistent fatigue post treatment.
Objectives: To describe acute and chronic fatigue levels of men treated with EBRT for prostate cancer. To determine the strength of association between the development of chronic fatigue post EBRT from subjects with acute fatigue during EBRT.
Methods: Fatigue was measured in 37 men with prostate cancer, by the Functional Assessment of Chronic Illness-Fatigue (FACIT-F, low score = high fatigue) at baseline, midpoint (day21), completion (day42), and 1 year-post EBRT. Subjects were categorized into high (HF) and low fatigue (LF) groups based on a 3-point change in FACIT-F score from baseline to either day21 or day42 of EBRT. Descriptive statistics using t-tests compared the groups and odds-ratio predicted incidence of chronic fatigue.
Results: FACIT-F scores significantly decreased from baseline (mean = 44.9 ± 7.0) to day21 (mean = 34.9 + 9.0, p < .01) and day42 of EBRT (mean = 35.6 + 9.0, p < .01) in HF subjects (n = 22, mean age = 65.8 + 7.1), while no significant change in FACIT-F scores was noted in LF subjects (n = 15, mean age =63.2 ± 7.5). Sixteen HF men (73 %) developed high fatigue 1 year post EBRT (mean FACIT-F = 38.7 ± 10.9). HF men are 20.8 times (SE = .92, p < .001) more likely to develop high fatigue 1 year post treatment than LF men.
Conclusions: Development of high fatigue during EBRT significantly increases the risk of chronic fatigue development post treatment. Early assessment and management of fatigue during EBRT may prevent development of chronic fatigue.
MASCC-0504
The epidemiology of long-term and short-term survivors in a population based cohort of cancer patients
L. Jarlbaek 1, L. Christensen2, E. Bruera3, D.G. Hansen4
1Danish Knowledge Centre for Palliative Care (PAVI), The Danish National Institute of Public Health (NIPH), Copenhagen, Denmark, 2Department of Oncology, Odense University Hospital, Odense, Denmark, 3Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, Houston, USA, 4National Research Centre for Cancer Rehabilitation Research Unit of General Practice, Institute of Public Health University of Southern Denmark, Odense, Denmark
Introduction: In order to plan rehabilitation and palliative care, it is important for the health care system to rely on estimates based on the epidemiology of the cancer population.
Objectives: To characterise the epidemiology of long-term and short-term survivors in a population based cohort of incident cancer patients.
Methods: All cancer patients, diagnosed in 1993–2003 from a 470.000 large population were identified using registry linkage, and followed individually from diagnosis to death or until 31 December 2008. Long-term survivors were patients, who lived beyond 5 years after the time of the cancer diagnosis (TOCD), and short-term survivors were those, who died less than 5 years after TOCD.
Results: Of 24,162 incident cancer patients, 41 % became long-term survivors (N = 9,813). Short-term survivors’ (N = 14,349) median survival was 0.6 years, and 78 % died less than 2 years after TOCD. The median age at TOCD was 60 years for long-term and 72 years for short-term survivors, and 80 % of short-term survivors were 60+. Females comprised 64 % of long-term, and 46 % of short-term survivors. The proportion of breast and lung cancers differed between the groups: Long-term survivors: 31 % breast cancer, 2.4 % lung cancer. Short-term survivors: 21 % lung cancer, 7.2 % breast cancer.
Conclusions: Long-term and short-term survivors differed with regard to age at TOCD, cancer types and sex. 2-years crude cancer survival could seem as a clinically relevant cut point for estimating ‘denominator-populations’ for rehabilitation or palliative care. Knowledge of the epidemiology of the two groups could help to target the programs of care to the participants.
MASCC-0505
Skeletal muscle radiation attenuation predicts prognosis in metastatic renal cell carcinoma treated by target therapies
S. Antoun 1, E. Lanoy2, R. Iacovelli3, L. Albiges4, Y. Loriot4, M. Merad-Taoufik5, K. Fizazi4, M. DiPalma5, V.E. Baracos6
1Ambulatory care, Institute Gustave Roussy, Villejuif, France, 2Biostatic and Epidemiology, Institute Gustave Roussy, Villejuif, France, 3Oncology and Human Pathology, Sapienza University, Rome, Italy, 4Cancer Medicine, Institut Gustave Roussy, Villejuif, France, 5Ambulatory Care, Institut Gustave Roussy, Villejuif, France, 6Oncology, University Alberta, Edmonton, Canada
Introduction: Previous studies have shown that body components i.e. skeletal muscle (SM) and adipose tissue (AT) are linked to overall survival (OS) and progression free survival (PFS)
Objectives: The aim of our study was to analyze whether SM and AT have a prognostic role in metastatic renal cell carcinoma (mRCC).
Methods: We investigated body mass index (BMI), SM and AT in mRCC patients. Analysis of CT images was used to evaluate cross-sectional areas of SM, AT, and mean Hounsfield units (HU). High level of mean HU reflects high quality of SM. Population was divided in: patients with values <= or > median observed in patients of the same gender. OS and PFS were estimated using Kaplan-Meier method and compared with the log-rank test. Multivariable Cox proportional hazards model were adjusted for modified MSKCC risk group and treatment
Results: In the 149 patients (113 men), the median OS was 21.4 (95%CI: 18.4–23.9) months and was strongly associated with attenuation of SM: the median OS in patients with low mean HU (14 months) was half that in patients with high mean HU (29 months, p = .0011). After adjustment for MSKCC score and for treatment, high mean HU was associated with longer OS (HR = 1.85, 95%CI = [1.22;2.82], p = .004) and longer PFS (HR = 1.81, 95%CI = [1.22;2.65], p = .002)
Conclusions: High muscle quality as measured by high mean HU is independently associated with improved OS and PFS in mRCC. None of the other parameters: SM, AT or BMI was associated with OS or PFS
MASCC-0506
The role of humour during nurse–patient interactions on an adult cancer ward: an ethnographic study
M. Tanay 1, J. Roberts1
1School of Nursing, King’s College London, London, United Kingdom
Introduction: The literature highlights the multi-dimensional value of humour on a person’s well-being. The diagnosis of cancer is extremely stressful and treatments are difficult. Patients and nurses may use humour as a coping mechanism to contend with the stresses caused directly or indirectly by cancer.
Objectives: The study investigated the nature of humour which took place during interactions between patients and nurses in an adult cancer ward. It explored ways of how patients and nurses use humour as a coping strategy.
Methods: This study used an ethnographic methodology that included fieldwork participant observations (30 h), patient interviews (n = 5) and nurse interviews (n = 5). Data were analysed using thematic content analysis.
Results: Results highlighted the importance of humour in nurse–patient interactions. Patients and nurses use humour to reduce tension and stress, to manage negative emotions and to help manage grief. Patients perceive having a sense of humour as a positive attribute for a nurse. Nurses expressed concerns regarding compromising professionalism when using humour and felt the need for guidance from senior staff. Patients consciously use humour during nurse–patient interactions as an attempt to help nurses cope with the stress they encounter in clinical practice.
Conclusions: The benefits of humour are recognised by both cancer patients and nurses. A deeper understanding of patient and nurse perceptions of the use of humour, can inform strategies for its therapeutic use in the clinical setting.
References: Olsson H, Backe H, Sorensen S, Kock M (2002) The essence of humour and its effects and functions: a qualitative study. Journal of Nursing Management 10: 21–26.
MASCC-0507
The situation of oral care in Tohoku University Hospital after national health insurance coverage to oral management
T. Tamahara 1, R. Hosokawa1, E. Yoshida1, N. Tanda2, E. Ito1, T. Koseki1
1Graduate School of Dentistry, Tohoku University, Sendai, Japan, 2Preventive Dentistry, Tohoku University Hospital, Sendai, Japan
Introduction: Oral management including oral care and oral hygiene is efficient to prevent side effects such as oral mucositis during chemotherapy and radiotherapy (CRT). Japanese national health insurance has covered oral management during CRT since April 2012
Objectives: In this report, we report the change of situation in dental management due to national health insurance coverage. And we also report the effect of kanpomedicine, which is a kind of oriental herb in Japan, to the patient who suffering from mucositis.
Methods: We analysis medical record of patients who were in ward of Tohoku University hospital and visited our department dental office at 2011 and 2012, such as 1) medial diagnosis 2) treatment plan, 3) side effect related to oral region. And we apply kanpomedicine, Hangeshashinto (TJ-14) to the patients suffering from mucositis due to radiotherapy in head and neck region.
Results: The number of cancer patients visiting our office was increasing (154 at 2011 and 278 at 2012). Of 278 patients at 2012, 96 was head and neck cancer patients. The patients who had radiotherapy in head region were suffering from oral mucositis, grade 2 or grade 3. Furthermore, there were no patients belonged to grade 3 in the patients group who took Hangeshashinto (TJ-14)
Conclusions: Our date reveal that national health insurance support cancer patients to visit dental office for oral care. And Hangeshashinto (TJ-14) may inhibit oral mucocitis during radiotherapy in head region.
MASCC-0508
Analysis of hydrogen sulfide, methyl mercaptan, and acetaldehyde in oral health care for perioperative patients of lung cancer
N. Tanda 1, N. Ishida2, Y. Hoshikawa3, T. Sato2, N. Takahashi2, R. Hosokawa4, T. Koseki4
1Division of Preventive Dentistry, Tohoku University Hospital, Sendai, Japan, 2Division of Oral Ecology and Biochemistry, Tohoku University Graduate School of Dentistry, Sendai, Japan, 3Department of Thoracic Surgery, Institute of Development Aging and Cancer Tohoku University, Sendai, Japan, 4Division of Preventive Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
Introduction: Importance of oral health care (OHC) for hospitalized patients is widely known. One of the questions to be answered is how oral environment is influenced by the OHC.
Objectives: To analyze the effect of OHC on gases and oral bacteria of perioperative patients of lung cancer.
Methods: Seven hospitalized patients of lung cancer (4 men, 3 women, mean age 73.4 years) agreed with the research. Hydrogen sulfide, methyl mercaptan, and acetaldehyde in breath and in mouth air of the patients were measured by portable gas chromatographs before breakfast on T1 (before OHC), T2 (after OHC but before lung operation), and T3 (1 week after lung operation) in Tohoku University Hospital. Saliva was collected by chewing a paraffin pellet and analyzed for oral bacteria by selective Mitis Salivarius (MS) and non-selective CDC blood agar (CDC) under anaerobic and aerobic conditions. The ratio of colony-forming units on the MS to those on the CDC was calculated.
Results: Hydrogen sulfide, methyl mercaptan, and acetaldehyde were observed only in mouth air. Acetaldehyde was observed in 6 patients on T1 and disappeared in 5 patients on T2. Hydrogen sulfide was observed in 5 patients on T1 and decreased in 4 patients on T2. Methyl mercaptan was observed in 4 patients on T1 and disappeared on T2. The ratio of MS/CDC was highest on T2 in 6 patients.
Conclusions: The OHC for perioperative patients of lung cancer decreased odorous gasses in mouth air and increased the ratio of salivary streptococci, usually known as healthy-associated bacteria.
MASCC-0509
Early palliative care for patients with metastatic non-small-cell lung cancer in Khyber Pakhtunkhwa
S. Salman 1, J. Idrees2, M. Idrees3, M. Anees4, F. Idrees4, A.A. Khattak5
1Department of Pharmacy, University of Peshawar, Peshawar, Pakistan, 2Department of Zoology, Islamia College University Peshawar, Peshawar, Pakistan, 3Department of Chemistry, Islamia College University Peshawar, Peshawar, Pakistan, 4Khyber Medical College, Khyber Medical Institute, Peshawar, Pakistan, 5Pediatric Unit, Lady Reading Hospital Post Graduate Medical Institute, Peshawar, Pakistan
Introduction: Patients with metastatic non-small-cell lung cancer have a considerable symptomatic burden and undergo substantial generalized anxiety and depression
Objectives: The primary objective was to assess the change in the quality of life and mood at baseline till 12th week.
Methods: Quality of life and mood were assessed at baseline and at 12 weeks with the use of the Functional Assessment of Cancer Therapy–Lung (FACT-L) scale and the Hamilton Anxiety and Depression scale were used respectively
Results: Of the 163 patients who underwent randomization assigned to early palliative care had a better quality of life than did patients assigned to standard care (mean score on the FACT-L scale 88.0 vs. 83.5; P = 0.04). Fewer patients in the palliative care group than in the standard care group had depressive symptoms (26 % vs. 47 %, P = 0.02)
Conclusions: Early palliative care provided to metastatic non-small-cell lung cancer led to significant improvements in both quality of life, adherence, compliance and mood as compared to those patients who received standard care
References
1. Anthony J A, Jean G F and Jonathan M S. Epidemiology of lung cancer: ACCP Evidence- based clinical practice guidelines. Chest 2007; 4: 29–55
2. Follwell M, Burman D, Le LW, et al. Phase II study of an outpatient palliative care intervention in patients with metastatic cancer. J Clin Oncol 2009;27:206–13.
3. Zimmermann C, Riechelmann R, Krzyzanowska M, Rodin G, Tannock I. Effectiveness of specialized palliative care: a systematic review. JAMA 2008;299: 1698–709.
MASCC-0510
Are there differences in the therapeutic effects of complex decongestive therapy on edema, quality of life and level of satisfaction between upper- and lower-extremity lymphedema?
S. Noh1, T. Yoon 1, J. Hwang1, J. Kim1, M. Ahn1, H. Chang1, I. Chu1
1Department of Physical and Rehabilitation Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea
Introduction: There is increasing interest in the quality of life (QOL) of patients with lymphedema. Nonetheless, few studies have specifically compared the physical and psychological impacts of complex decongestive physical therapy (CDPT) between upper-extremity lymphedema (UL) patients and those with lower-extremity lymphedema (LL).
Objectives: To compare UL and LL patients for the therapeutic effects of CDPT on edema, QOL, and level of satisfaction.
Methods: One hundred and twenty-one (121) patients with mild to moderate chronic secondary UL (n = 53) or LL (n = 68) undergoing treatment at a physical medicine and rehabilitation outpatient clinic of a university hospital were enrolled in the study. Treatment involved ten sessions of manual lymph drainage, low-stretch bandage, elastic sleeve, and sequential pneumatic pump 90 min per day, 5 days per week, for 2 weeks. The percentage excess volume (PCEV), the Korean version of the Short Form 36-Item (SF-36) Health Survey, the DASH (Disabilities of arm, shoulder & hand) score, and a self-developed satisfaction survey were assessed at baseline, 2 weeks, and 3 months after CDPT.
Results: For the LL patients relative to those with UL, there was a statistically significant improvement in physical functioning and mental health of the Korean version of the SF-36 Health Survey, a degree of improvement of the self-developed satisfaction survey results, as well as a greater PCEV reduction, after CDPT.
Conclusions: The results of this study suggest that PCEV reduction, QOL, and level of satisfaction after CDPT differ between UL and LL; therefore, each condition demands specific management and patient consultation approaches.
MASCC-0511
The prevalence of opioid-related adverse events in cancer pain: analysis of discrepancy between investigator and patient-reported prevalence—this study was funded by Mundipharma Korea Ltd
S.J. Koh 1, Y.S. Hong2, S.W. Shin3, S.Y. Kim4, H.S. Song5, H.Y. Kim6, H.J. Kim6, J.H. Kwon7, K.H. Lee8, D.S. Hong9, Y.J. Choi10, S.J. Sym11, M.Y. Choi12, J.S. Jang13, S.N. Lee14, E.M. Lee15, I.S. Woo16, S.Y. Kim17, H.S. Oh18, J.I. Lee19, Y.J. Yuh20, H.M. Ryoo21, E.K. Song22, K.T. Lee23, J.B. Ahn24, D.R. Choi25, S.Y. Oh26, I.J. Chung27, B.W. Kang28, S.J. Gong29, H.J. Jung30, N. Bahadur31
1Hematology-Oncology, University of Ulsan College of Medicine Ulsan University Hospital, Ulsan, Korea, 2Oncology, Seoul St. Mary’s Hospital, Seoul, Korea, 3Hematology-Oncology, Korea University Anam Hospital, Seoul, Korea, 4Hematology-Oncology, Chungnam National University Hospital, Daejeon, Korea, 5Hematology-Oncology, Keimyung University Dongsan Medical Center, Daegu, Korea, 6Hematology-Oncology, Hallym University Sacred Heart Hospital, Anyang, Korea, 7Hematology-Oncology, Kangdong Sacred Heart Hospital, Seoul, Korea, 8Hematology-Oncology, Yeungnam University Medical Center, Daegu, Korea, 9Hematology-Oncology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea, 10Hematology-Oncology, Busan National University Hospital, Busan, Korea, 11Hematology-Oncology, Gachon University Gil Hosptial, Incheon, Korea, 12Hematology-Oncology, Inje University Busan Paik Hospital, Busan, Korea, 13Hematology-Oncology, Chung-Ang University Hospital, Seoul, Korea, 14Hematology-Oncology, Ewha Womans University School of Medicine, Seoul, Korea, 15Hematology-Oncology, Kosin University Gospel Hospital, Busan, Korea, 16Hematology-Oncology, Yeouido St. Mary’s Hospital, Seoul, Korea, 17Hematology-Oncology, KyungHee University Medical Center, Seoul, Korea, 18Hematology-Oncology, GangNeung Asan Hospital, GangNeung, Korea, 19Hematology-Oncology, Wonju Christian Hospital, Wonju, Korea, 20Hematology-Oncology, Inje University Sanggye-Paik Hospital, Seoul, Korea, 21Hematology-Oncology, Daegu Catholic University Medical Center, Daegu, Korea, 22Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea, 23Hematology-Oncology, Sooncheonhyang University Cheonan Hospital, Cheonan, Korea, 24Oncology, Yonsei University Severance Hospital, Seoul, Korea, 25Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea, 26Internal Medicine, Seoul Medical Center, Seoul, Korea, 27Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea, 28Hematology-Oncology, Kyungpook National University Medical Center, Daegu, Korea, 29Hematology-Oncology, Eulji Medical Center, Seoul, Korea, 30Mundipharma, Seoul, Korea, 31Mundipharma,, Singapore
Introduction: Although opioid therapy has been the mainstay of treatment for cancer pain, the prevalence of opioid-related adverse events (AEs) has not been reported in Korea.
Objectives: The study aimed to investigate the prevalence of opioid-related AEs amongst cancer pain patients and compare the difference in AEs reported by investigators and patients.
Methods: A cross-sectional analysis of patients’ charts and questionnaires from 30 teaching hospitals was performed. Clinical characteristics and prevalence for AEs were assessed.
Results:
Of the 2,395 patients recruited, the most common opioid-related AEs as reported by investigators were constipation (29.7 %), dry mouth (17.2 %), and somnolence (14.7 %). Patients, however, reported common AEs as dry mouth (61.1 %), asthenia (52.2 %), somnolence (49.4 %) and constipation (49.2 %). In addition to the difference in prevalence rates, results indicated a wide discrepancy in reporting of AEs between patients and investigators. Rates of patient-reported AEs which were not reported at all by investigators were as follows: dry mouth 1,054 (44 %), asthenia 1,040(43 %), somnolence 831(35 %), and constipation 489(20.4 %). On the contrary, the differences in rates of AEs reported by investigators and not reported by patients were extremely small. (Figure 1)
Conclusions: The study demonstrates the magnitude of discrepancy in reporting opioid-related adverse events between physicians and patients which highlights the importance of patient-reported outcomes. There is a need for improved assessment of patients’ AEs, not only to actively manage AEs, but also to improve patients’ pain and quality of life pertinent to cancer pain.
MASCC-0512
Embracing life after prostate cancer. a male perspective of treatment and rehabilitation
K.B. Dieperink 1, L. Wagner2, S. Hansen1, O. Hansen1
1Department of Oncology, University Hospital Odense, Odense, Denmark
2Research Unit of Nursing, University of Southern Denmark, Odense, Denmark
Introduction: Rehabilitation after cancer treatment has been in focus recent years, but the majority of studies have evaluated rehabilitation in breast cancer patients.
Objectives: The aim of this qualitative study was to examine experiences of disease and rehabilitation in men treated for prostate cancer with radiotherapy and androgen deprivation therapy. The study explored the male perspective of rehabilitation and the men’s approach to spousal involvement.
Methods: Two focus group interviews were conducted with patients aged 66–77 years. All had completed a rehabilitation programme with individual nursing and physiotherapist counselling. One focus group included men (n = 6) who involved their spouses in the rehabilitation, and one focus group included men (n = 7) who came alone. Meaning condensation inspired by Giorgi was used as analysis.
Results: To be treated with radiotherapy was like having a fulltime work, but the worst adverse effects were due to the androgen deprivation therapy influencing masculinity and identity. The men were grateful, and embraced life with a particular sense of humour. Whether the rehabilitation programme was supportive depended on: the professional’s approach, the patient motivation and effort to contribute to health promotion, and how experiences were converted into coping strategies. The supportive role of the spouse was emphasized, but some men preferred to handle the process alone.
Conclusions: Attention must be drawn to the information presented about adverse effects of androgen deprivation therapy since it severely influenced everyday life. Rehabilitation was a mutual challenge of patient and professionals. Spousal involvement reflected the relationship the couple had beforehand.
MASCC-0513
Risk and benefit of pregabalin for the treatment of chemotherapy-induced peripheral neuropathy
H. Iihara 1, C. Yoshimi1, M. Yamada1, H. Fujii1, M. Nishigaki1, M. Ishihara1, M. Takahashi2, S. Kurahashi2, T. Takahashi3, K. Yoshida3, Y. Itoh1
1Pharmacy, Gifu University Hospital, Gifu-shi, Japan, 2Nursing, Gifu University Hospital, Gifu-shi, Japan, 3Surgical Oncology, Gifu University Hospital, Gifu-shi, Japan
Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is the dose-limiting toxicity of cancer treatment.
Objectives The aim of the present study was to assess safety and efficacy of pregabalin for treatment of CIPN, and to determine the optimal dosage and administration.
Methods: We reviewed retrospectively the medical records of patients treated with pregabalin for CIPN between October 1, 2010 and August 31, 2011 at the outpatient cancer chemotherapy clinic in Gifu University Hospital. The incidence and severity of CINP were compared before introduction of pregabalin and 4 weeks after attainment of the maintenance dose. The symptom severity was assessed as the grade according to the CTCAE v4.0 and as the patients reported Numeric Rating Scale (NRS). The incidence of ADRs associated with pregabalin, including dizziness, edema limbs and headache, was checked from the medical record.
Results: Thirty-two patients were studied. The incidence of grade ≥ 2 CIPN was significantly (P < 0.01) reduced from 59 % to 22 % after pregabalin administration. The average of NRS also decreased significantly (P < 0.01) from 5.5 to 3.6. For initial dose (150 mg/day and <150 mg/day), the effect at 150 mg/day was superior to that at lower doses (grade ≥ 2 symptom: 53 % versus 23 %). For maintenance dose (≥200 mg/day, 150–199 mg/day and <150 mg/day), the therapeutic effect was dose-dependent (grade ≥ 2 symptom: 83 %, 59 %, and 29 %). However, the incidence of ADRs associated with pregabalin was not different among initial and maintenance doses.
Conclusions: Our findings suggest that sufficient initial and maintenance doses of pregabalin are required from the view point of safety and efficacy.
MASCC-0514
Morphine metabolites ability to inhibit lymphocytes proliferation
M. Chojnicki 1, B. Poniedzialek1, P. Rzymski1, A. Kotlinska-Lemieszek2, W. Leppert2, K. Wiktorowicz1
1Department of Biology and Environmental Protection, Poznan University of Medical Sciences, Poznan, Poland, 2Department of Paliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
Introduction: Morphine is the most commonly used opioid medication to relieve moderate to severe acute and chronic pain in patients of all ages. Both active metabolites of morphine, morphine 6β-glucoronide (M6G) and morphine 3β-glucoronide (M3G), play a role in pain relief and probably also in the side-effects of morphine.
Objectives: The following study was undertaken in order to determine whether morphine or its metabolites can be responsible for potential immunosuppresion in patients selected for pain treatment.
Methods: We investigated different concentrations (10–1,000 ng/ml) of morphine, M3G and M6G upon the proliferation of human peripheral blood lymphocytes in vitro
Results: We have demonstrated that moprhine metabolites can inhibit lymphocytes proliferation.
Conclusions: It would therefore appear to be good practice to avoidsuch agents in patients already immunosuppressed by disease orpharmacotherapy. Powerful opioid analgesics without immunosuppressiveproperties can be selected and should be used in such situations and asthese agents can offer additional benefits in addition to theirnon-immunosuppresive analgesia, it should be considered whether to usethem at all times in preference to immunosuppressive opioids.
MASCC-0515
A modified exercise protocol may promote continuance of exercise after the intervention in lung cancer patients—a pragmatic uncontrolled trial
A. Andersen 1, A. Vinther1, L.L. Poulsen2, M. A2
1Department O, Copenhagen University Hospital, Herlev, Denmark, 2Department R, Copenhagen University Hospital, Herlev, Denmark
Introduction: A previous study investigated the effects of a well-documented COPD exercise protocol in lung cancer patients. The study showed improvements in physical fitness, but poor adherence to continued exercise after intervention
Objectives: The aim of the present study was to investigate the effect of an exercise intervention on post intervention adherence, and physical fitness in lung cancer patients
Methods: Fifty-nine patients enrolled in a 9-week exercise program. Eligibility criteria were limited to presence of motivation, and absence of comorbidities that could jeopardize safety. The intervention included 3 times 3 weeks of exercise (3 weeks supervised, 3 weeks home-based and 3 weeks supervised). VO2 max was estimated at baseline, and at the end of intervention. Self-reported quality of life was recorded before and after the exercis program. Post-intervention exercise activity was assessed by telephone interviews 4 weeks after intervention
Results: Fifty-one patients initiated the exercise intervention and 29 patients successfully completed the exercise program. Twenty-six of the 29 were available for follow-up with respect to continuance of physical activity. Among the 26 who completed the 9 week training program, 18 (69 %) continued to be physically active on a daily basis. No change in estimated VO2-max was observed (N = 25). A trend towards increased quality of life and better symptom control was noted
Conclusions: The present study showed an increased level of continuance of physical activity compared to the previous study. The present study could not repeat the improvements in estimated VO2-max from the previous study.
MASCC-0516
A validated questionnaire on end-of-life concerns and preferences of Filipino women with advanced or recurrent gynecologic cancer in a government tertiary hospital
J. Toral 1, N. Castillo-Carandang2, L. Amarillo2, A. Habana2, E. Domingo3, A. Bausa4
1Section of Gynecologic Oncology Department of OB-GYN, University of the Philippines-Philippine General Hospital, Caloocan City, Philippines, 2Department of Clinical Epidemiology, University of the Philippines, Manila, Philippines, 3Section of Gynecologic Oncology Department of OB-GYN, University of the Philippines-Philippine General Hospital, Manila, Philippines, 4Department of Family Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
Introduction: Gynecologic cancers are important causes of mortality among Filipino women. Knowing their concerns and preferences will enable the health provider to give holistic care to them.
Objectives: To develop a valid and reliable questionnaire on the above construct
Methods: A study was conducted among women ages 18–60; with advanced stage/recurrent disease; able to read and understand Tagalog; good performance status; no altered state of consciousness; asymptomatic; with informed consent; with oncological disclosure from their physicians. The qualitative phase involved case studies and focus group discussions with patients and physicians. The scale construction and pretesting (n = 189) ascertained the validity and reliability of the questionnaire.
Results: A 63-item questionnaire was developed with good reliability (Cronbach’s alpha 0.89) and validity. It had discriminatory ability having seen differences between patients according to their age groups, status of disease, educational attainment, and marital status. Factor analysis showed that the items needed to be distributed into a 13-factor structure which better described the patterns of relationships among the variables. The concerns and preferences are put into the following domains: Achieving peace , taking charge , achieving aims and fulfilling roles , fears for self , desires of the sick , health provider issues , decisions at the end of life , matters related to wealth , physical effects of the disease and treatment , fears with external dimension , processing eventual outcome issues , reproductive issues , and letting go .
Conclusions: A valid and reliable questionnaire was created which identified the end-of-life concerns and preferences of Filipino women with advanced or recurrent gynecologic cancer in a government tertiary hospital.
MASCC-0517
Aprepitant (AP) versus dexamethasone (D) for preventing delayed emesis induced by chemotherapy (CT) in breast cancer patients (PTS): a double-blind, multicenter, randomized study
F. Roila 1, E. Ballatori2, A. Fabi3, S. Fatigoni1, S. Chiara4, M.T. Ionta5, M. Aieta6, M. Clerico7, M.A. Palladino8, M. Indelli9, O. Garrone10, S. Bustreo11, B. Ruggeri12
1Medical Oncology, S. Maria Hospital, Terni, Italy, 2Medical Statistics University, University L’Aquila, L’Aquila, Italy, 3Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy, 4Medical Oncology Unit, National Cancer Institute, Genoa, Italy, 5Medical Oncology II, Medical Oncology II, Cagliari, Italy, 6Oncology, Rionero in Vulture, Potenza, Italy, 7Oncology, Ospedale Degli Infermi, Biella, Italy, 8Medical Oncology, Hospital, Piacenza, Italy, 9Medical Oncology, Arcispedale Sant’Anna, Ferrara, Italy, 10Medical Oncology, Santa Croce General Hospital, Cuneo, Italy, 11Medical Oncology, Molinette, Torino, Italy, 12Clinical Government, ASUR Marche, Ascoli Piceno, Italy
Introduction: A combination of AP + a 5-HT3 receptor antagonist + D and AP alone is recommended, respectively, for the prophylaxis of acute and delayed emesis induced by anthracyclines plus cyclophosphamide (AC) CT in breast cancer pts. The role of AP in delayed emesis was not defined in the published studies.
Objectives: Aim of this study was to compare the efficacy of AP versus D in preventing delayed emesis in pts receiving the same prophylaxis of acute emesis
Methods: A randomized double-blind study comparing AP versus D was completed in naive breast cancer pts treated with A+C. Before CT, all pts were treated with intravenous palonosetron 0.25 mg and D 8 mg, and oral AP 125 mg. On days 2 and 3 pts randomly received D 4 mg bid or AP 80 mg qd. Primary endpoint was rate of complete response from days 2–5 after CT.
Results: 580 pts were enrolled; 551 were fully evaluated, 273 in arm D and 278 in arm AP. Day 1 complete response rates were similar: 239/273 (87.6 %) in D arm and 236/278 (84.9 %) in AP arm. From day 2–5, complete response was the same with both antiemetic prophylaxes (79.5 %). During the delayed phase, incidence of insomnia (2.9 % vs. 0.4 %) and heartburn (8.1 % vs. 3.6 %) was significantly superior in D arm.
Conclusions: In breast cancer pts submitted to A+C CT and receiving the same antiemetic prophylaxis for acute emesis, D and AP present similar efficacy and toxicity.
MASCC-0518
Acute inpatient cancer rehabilitation in the oldest patients
K. Shin 1
1Palliative and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
Introduction: The oldest of old or those over the age of 85 is the fastest growing age demographic in the United States. People are living longer and living longer with cancer. They are seeking and receiving more aggressive cancer treatment. These patients can be left with significant functional deficits and acute medical issues which can benefit from acute inpatient rehabilitation. Concerns for geriatric patients receiving inpatient rehabilitation can include decreased tolerance to intensive rehab therapies, fewer functional gains, and frequent discharge to institutionalized settings.
Objectives: To describe cancer inpatients over the age of 85 who were referred and accepted to an acute inpatient rehabilitation unit at a major tertiary national cancer center.
Methods: Retrospective chart review of medical records for age, cancer diagnosis, length of stay, discharge disposition, and functional measure scores.
Results: Between 2007 and 2012, 4,432 patients were referred for inpatient rehabilitation evaluation. 45 of these patients were over the age of 85. 29 were accepted for acute inpatient rehabilitation. For these 29 patients, average age was 87.9. Median age 87. 19 were referred from surgical services, 8 from medical oncology services, 2 from Internal Medicine. Average length of stay was 10.8 days. 22 patients were discharged home, 6 to a long term acute care facility, one patient to an outside rehab facility.
Conclusions: A selected cohort of inpatients over the age of 85 were able to complete an acute inpatient rehabilitation stay and be safely discharged to the home setting.
References: Balducci L. Rehabilitation of older cancer patients. Acta Oncologica 2013; 52: 233–238.
MASCC-0519
Nurses’ assessments of the illness perception of cancer patients with a poor prognosis: association with nurses’ attributes
Y. Izoe 1, M. Mizuno2
1Graduate School of Comprehensive Human Sciences Master’s Program in Nursing Science, University of Tsukuba, Ibaraki Tsukuba, Japan, 2Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki Tsukuba, Japan
Introduction: In order to provide personalized care for cancer patients with a poor prognosis, nurses must understand patients’ specific perceptions regarding their illness.
Objectives: The purposes of this study were to investigate nurses’ Methods for assessing the illness perception of cancer patients with a poor prognosis and identify the nurses’ attributes related to these assessments
Methods: A self-administered questionnaire was completed by 197 nurses (Response rate 70 %) working in wards at general hospitals in Japan. The relationships between the information sources used by preference to assess the illness perception of cancer patients and the nurses’ attributes were statistically examined
Results: Average age of the respondents was 31.6 (SD = 6.7) years. Pancreatic cancer was the most frequently (22 %) imagined disease of patients with a poor prognosis. Patients’ illness perception was least frequently (14 %) assessed using information that nurses directly got from a patient, while dialogue started on patients’own initiative were used most frequently as information to assess (34 %). A significant difference in the mean number of years of cancer nursing experience was observed among nurses’ preference for the information sources using to assess patients’ illness perception
Conclusions: Nurses most frequently imagined pancreatic cancer as having a poor prognosis. When nurses imagine cancer patients with a poor prognosis, younger nurses may infrequently use information that nurse directly got from a patient about their illness perception.
MASCC-0520
Best-practice model for multiprofessional cancer medication management
A. Wilmer 1, A. Tasar2, K. Fleckenstein3, C. Hack3, K. Ruberg2, Y.D. Ko3, U. Jaehde1
1Clinical Pharmacy, Institute of Pharmacy, Bonn, Germany, 2Kronen Pharmacy Marxen, Kronen Pharmacy Marxen, Wesseling, Germany, 3Non-surgical Oncology, Johanniter-Hospital, Bonn, Germany
Introduction: The complex cancer medication is frequently associated with drug-related problems. To improve patient safety an efficient cooperation between all health care professions is crucial.
Objectives: Aim of this project is to enhance patient safety by structured and standardized outpatient cancer care in a multiprofessional best-practice model.
Methods: A module-based model was developed in a multiprofessional quality circle in order to define ‘best practice’. All care modules include evidence-based recommendations for supportive care, written patient information, and an algorithm illustrating the care process. Among others, the effectiveness of the model is evaluated using the patient-reported outcome (PRO) version of the CTCAE criteria. The newly developed instrument was tested in a pilot study.
Results: Care modules were developed for medication review and interaction check, malnutrition, and for the management of four common adverse events: nausea/emesis, mucositis, fatigue, and pain. They can be applied individually for each patient according to medication and toxicity. In the pilot study 30 outpatients with solid tumors were surveyed
Results: show that approximately 73 % of the patients suffered from severe or very severe toxicity according to PRO-CTCAE. Fatigue was the most frequent adverse event (87 %) followed by sleep disorders (70 %) and nausea (57 %).
Conclusions: The efficacy of the model is currently being evaluated in a randomised two-arm interventional trial at the Johanniter-Hospital, Bonn. About 106 patients are allocated either to the control group or to the intervention group receiving modular medication management. Primary endpoint is the time to first occurrence of severe toxicity according to PRO-CTCAE.
MASCC-0521
Nationwide survey on CINV associated with MEC and HEC and primary care medical staffs’ perception on CINV. The CINV study group of Japan survey
K. Aiba 1, K. Tamura2, T. Saeki3, Y. Nakanishi4, T. Kamura5, H. Baba6, N. Yamamoto7, Y. Kitagawa8, K. Yoshida9, J. Furuse10, Y. Kakeji11, G. Wakabayashi12, T. Sugiyama13, Y. Ito14, K. Hatake15, K. Hirata16, Y. Maehara11, M. Kitajima17
1Department of Internal Medicine Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan, 2Division of Oncology Hematology and Infectious Diseases Department of Internal Medicine, Fukuoka University, Fukuoka, Japan, 3Saitama International Medical Center, Saitama Medical University, Hidaka, Japan, 4Institute of Diseases of the Chest, Kyushu University, Fukuoka, Japan, 5Department of Gynecology and Obstetrics, Kurume University, Kurume, Japan, 6Department of Gastroenterological Surgery Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan, 7Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan, 8Department of Surgery, Keio University School of Medicine, Tokyo, Japan, 9Department of Surgical Oncology, Gifu University School of Medicine, Gifu, Japan, 10Department of Medical Oncology, Kyorin University Hospital, Tokyo, Japan, 11Department of Surgery and Science, Kyushu University, Fukuoka, Japan
12Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan, 13Department of Gynecology and Obstetrics, Iwate Medical University School of Medicine, Morioka, Japan, 14Department of Medical Oncology Breast Oncology Center, Cancer Institute Hospital Japanese Foundation for Cancer Research, Tokyo, Japan, 15Department of Medical Oncology/Hematology, Cancer Institute Hospital Japanese Foundation for Cancer Research, Tokyo, Japan, 16First Department of Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan, 17International University of Health and Welfare, International University of Health and Welfare, Tokyo, Japan
Introduction: There has been no nationwide survey on CINV in Japan.
Objectives: An investigation of CINV seen in cancer patients (pts) having chemotherapy for the first time. Medical staffs’ perception on CINV is also studied
Methods: We performed a nationwide survey on CINV in 108 institutions throughout Japan. A 7-day diary for CINV was provided to the pt to record daily occurrence and severity of CINV
Results: A total of 2,068 pts were registered Apr. 2011 through Dec. 2012. 1,536 pts’ diaries and their medical staffs’ reports were obtained by the end of Dec 2012. Underlying diseases were GI (466 pts), lung (400), breast (345), gynecological cancer (185) and hematological malignancy (140). There were 833 females (med. age 58) and 703 males (65), respectively. MEC was given to 608 pts as was HEC to 924. Acute vomiting (AV) was noted in 9(1.5 %) pts with MEC as was in 52(5.6 %) with HEC, while delayed vomiting was seen in 81(13.3 %) with MEC and 84(9.1 %) pts with HEC, respectively. Acute nausea (AN) was experienced in 37(6.1 %) with MEC and in 200 (21.7 %) pts with HEC, while was noted delayed nausea in 243(40 %) with MEC and in 427(46.2 %) with HEC, respectively. Antiemetics were given along the guideline to 402 (66.1 %) with MEC and to 687(74.4 %) pts with HEC. The staff estimated the occurrence of AN and AV in 882(57.4 %) and 204 (13.3 %) pts, while their pts actually experienced 184(20.9 %), and 18(8.8 %), respectively
Conclusions: CINV seems to be well controlled by the guideline. Medical staffs overestimated the incidence of CINV unexpectedly.
MASCC-0522
Impact of a hospital policy to improve use of life sustaining treatments on code status orders at an academic medical center
P. Perez-Cruz 1, D. Finkelstein2, E. Robinson3, S. Brackett4, J. Serna5, P. Montgomery6, E.L. Krakauer7
1Medicina Interna, Pontificia Universidad Catolica de Chile - Facultad de Medicina, Santiago, Chile, 2Biostatistics, Massachusetts General Hospital, Boston MA, USA, 3Optimum Care Committee, Massachusetts General Hospital, Boston MA, USA, 4Surgical Intensive Care Unit, Massachusetts General Hospital, Boston MA, USA, 5Oncologia Medica, Hospital Vall d’Hebron, Barcelona, Spain, 6, Center for Medical Simulation, Boston MA, USA, 7Palliative Care, Massachusetts General Hospital, Boston MA, USA
Introduction: Decisions regarding life sustaining treatments (LST) for patients are difficult. Determination of a patient’s ‘code status’ is used as a way to translate patients’ preferences regarding use of LST into clinical practice. However, not all the hospitalized patients have a code status order (CSO) and physicians usually delay this conversation until patients are in critical condition
Objectives: To describe the impact of a hospital policy to improve use of LST on CSO documentation, time between admission and first CSO, and patient–physician communication regarding use of LST at an academic medical center.
Methods: We retrospectively reviewed charts of patients who died on an intensive care unit or an oncology floor before and after a hospital policy, that included a CSO electronic form, was implemented. We reviewed written CSO for hospitalized patients before the policy implementation and the electronic CSO form after the implementation
Results: 175 patients were analyzed, 88 pre and 87 post policy implementation. There were no differences in patients’ demographics among the groups. The percentage of patients who had a CSO at death increased from 60 % to 86 % (p < .001, chi2). The median time from admission to first CSO decreased from 10 to 3 days post intervention (p = .0053, chi2). The percentage of LSTs received with a prior patient-physician discussion about use of LST increased from 13 % to 32 % (p < .001, chi2).
Conclusions: The implementation of a hospital policy on LST increased documentation of CSO, decreased time to first CSO and increased patient-physician communication regarding use of LST.
MASCC-0523
Clinical implications of malnutrition in childhood cancer patients—infections and mortality
E.A.H. Loeffen 1, A. Brinksma2, K.G.E. Miedema1, G.H. Bock de3, W.J.E. Tissing1
1Department of Pediatric Oncology/Hematology, Beatrix Children’s Hospital University Medical Center Groningen University of Groningen, Groningen, Netherlands, 2UMCG School of Nursing and Health, University Medical Center Groningen University of Groningen, Groningen, Netherlands, 3Department of Epidemiology, University Medical Center Groningen University of Groningen, Groningen, Netherlands
Introduction: In childhood cancer patients, malnutrition has been proposed to increase infection rates and reduce survival. However, little is known about this possible association.
Objectives: We investigated if malnutrition at diagnosis and during treatment is a prognostic factor for infection rates and survival, within a heterogeneous childhood cancer population
Methods: Children ≤ 18 years of age diagnosed between October 2004 and October 2011 were retrospectively included in this study (n = 269). Medical records were searched for prospectively included data regarding BMI, infections and survival. Patients with BMI z-scores at diagnosis lower than −2.0 were classified as malnourished. Weight loss more than 5 % in the first 3 months after diagnosis was considered relevant
Results: At diagnosis, 5 % of all patients were malnourished. These patients showed worse survival than those who were well nourished, independent of expected survival based on diagnosis. Weight loss of more than 5 % in the first 3 months after diagnosis was related to increased occurrence of febrile neutropenic episodes with bacteraemia in the first year after diagnosis. When corrected for intensity of treatment, this association persisted.
Conclusions: Regarding nutritional status of childhood cancer patients at diagnosis, survival differed significantly between malnourished patients and well nourished patients. With regard to infections, we found for the first time that childhood cancer patients who lose weight more than 5 % in the first 3 months after diagnosis experience more febrile neutropenic episodes with bacteraemia in the first year after diagnosis. This underlines the importance of optimal feeding designs in childhood cancer patients.
MASCC-0524
Japanese evidence-based guidelines for cancer rehabilitation
T. Tsuji 1, K. Ikoma2, M. Mizuma3, A. Tanuma4, T. Tsurukawa5, K. Muraoka6, K. Miyakoshi7, R. Saura8, K. Mizuochi9
1Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan, 2Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan, 3Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo, Japan, 4Department of Rehabilitation Medicine, Shizuoka Cancer Center Hospital and Research Institute, Mishima, Japan, 5Department of Rehabilitation Medicine, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan, 6Department of Rehabilitation Medicine, Kawasaki Municipal Hospital, Kawasaki, Japan, 7Department of Rehabilitation Medicine, Kameda Medical Center, Kamogawa, Japan, 8Department of Rehabilitation Medicine, Division of Comprehensive Medicine Osaka Medical College, Takatsuki, Japan, 9Department of Rehabilitation Medicine, Yokohama City University Hospital, Yokohama, Japan
Introduction: Cancer care in Japan is currently lacking in comprehensive support that covers all aspects from treatment aimed at recovery to rehabilitation focusing on quality of life (QOL). This is partly due to the lack of guidelines, which precludes the establishment of evidence-based rehabilitation programs.
Objectives: The objective was to establish Japanese evidence-based guidelines for cancer rehabilitation edited by the Committee on Japanese Guidelines for Cancer Rehabilitation of the Japanese Association of Rehabilitation Medicine (JARM).
Methods: The present project was funded by the Grant for Cancer Control from the Ministry of Health, Labour and Welfare of Japan. Clinical issues related to cancer rehabilitation were classified by primary lesion, treatment objective, and disease stage into the following eight areas. The databases used for literature searching were MEDLINE, Cochrane Library, and PEDro, etc.
Results: A total of 61 clinical questions (CQ) was ultimately selected. Each CQ was reflected in the guidelines by drafting a recommendation and an explanation and gathering public comments from members of the JARM. A total of 427 articles was used as the basis for discussion. Recommendation grades were Grade A (strongly recommended) for 24 CQs, B (recommended) for 27 CQs, and C (may be considered but lacks sufficient scientific evidence) for 10 CQs.
Conclusions: While there were differences by area, a high recommendation grade was obtained for many CQs. We plan to publish the present guidelines in Japan, release it on our website, and widely disseminate it to medical professionals involved in cancer care and rehabilitation medicine, while also promoting their understanding of the guidelines.
MASCC-0525
Promotion of cancer rehabilitation in Japan: effect of a training seminar that targeted rehabilitation staff in hospitals for treating cancer patients
T. Tsuji 1, K. Mizuochi1, T. Koyama1, Y. Takakura1, H. Onoda1, T. Kobayashi1, K. Horaiya1, T. Kanda1, N. Sugimori1, E. Sasaki1, K. Masuoka1, K. Abe1, M. Kurihara1
1The Cancer Rehabilitation Training Committee, a project commissioned by the Ministry of Health Labour and Welfare, Tokyo, Japan
Introduction: Cancer rehabilitation resources are insufficient in Japan. In 2006, the National Cancer Control Act was approved. As part of its measures, the CAREER (Cancer Rehabilitation Educational Program for Rehabilitation Teams), which is a cancer rehabilitation training workshop, was launched in 2007 as a project commissioned by the Ministry of Health, Labour and Welfare.
Objectives: The aim of this study was to evaluate the effect of the CAREER.
Methods: The CAREER has targeted medical professionals at cancer care hospitals. Participants in a team of 4 people include a doctor, a nurse, and rehabilitation therapists. A postal questionnaire was sent to all participants in the CAREER in 2011–2012. The questionnaire was based on items related to the effect of the seminar and included four desirable aspects: reaction (Level 1), learning (Level 2), behavior (Level 3), and results (Level 4) based on Kirkpatrick’s four levels.
Results: Of the 1,320 participants who received the questionnaire, 1,200 (91 %) responded. Of these, 25 % each were doctors and nurses, 28 % were physical therapists, 17 % were occupational therapists, and 5 % were speech language therapists. Most participants were satisfied and obtained the knowledge and skills well (Levels 1 and 2) and had some change in action (Level 3); 60 % reported changes in the workplace (Level 4).
Conclusions: The survey demonstrated that the CAREER was excellent for reaction, learning, and behavior and fair for results. Given the results of this survey, the training curriculum will be improved and efforts will continue to develop specialized cancer rehabilitation professions.
MASCC-0526
Economic analysis of standard therapies in preventing emesis in Chinese patients following highly emetogenic chemotherapy
B. Yu 1, X.L. Xu1, Q. Du1, B. Zhu1
1Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, China
Introduction: Two pivotal phaseIII trials compared the efficacy of palonosetron between ondansetron and granisetron. However, the economic-effectiveness between these three drugs is not clear.
Objectives: To estimate, from the perspective of the Chinese healthcare-system, the economic-effectiveness of four standard strategies among patients following highly-emetogenic chemotherapy
Methods: A Marcov decision-analytic model was developed to simulate the nausea-vomiting disease course following highly-emetogenic chemotherapy (Fig1). The health and economic outcomes of 0.75 mg palonosetro (0.75P) compared to 0.25 mg palonosetron (0.25P) and 32 mg ondansetron (O), and 40 μg/kg granisetron (G) were estimated. The clinical and utility data were taken from published studies. The cost data were estimated from local charge data and current Chinese practices. Sensitivity analyses were used to explore the impact of uncertainty regarding the results.
Results: The base-case analysis (Table1) showed that the 0.75P strategy yielded the maximum health benefits. The marginal cost-effectiveness (ICER, cost per additional hours without emesis) gained was $3.46 (undominated). The probabilistic sensitivity analysis demonstrated that the 0.75P strategy was the most cost-effective approach when the willingness-to-pay threshold was over $10 (0.23 % of per capita GDP of China) (Fig2).
Strategy | Cost ($) | ΔCost ($) | Effectiveness (as hours) | ΔEffectiveness (as hours) | ICER |
G | 89.79 | – | 50.46 | – | – |
0.25P | 119.03 | 29.24 | 65.33 | 14.87 | 1.97 |
O | 152.34 | 62.55 | 48.91 | −1.55 | −40.35 |
0.75P | 153.47 | 63.68 | 68.88 | 18.42 | 3.46 |
Conclusions: Our analysis suggests that 0.75 mg palonosetron therapy is the cost-effective option in the Chinese healthcare setting. In some relatively undeveloped regions, granisetron might be a favorable cost-effective alternative for patients following highly-emetogenic chemotherapy.
References: Lancet Oncol 2009;10:115; Ann Oncol 2006;17:1141
MASCC-0527
Prevalence of iron deficiency in severe anemia for cancer patients visiting the emergency unit for acute onset symptoms
M. Merad 1, R. Miron1, S. De Botton2, L. Zakin3, M. Bertoncello3, A. Alibay1, C. Martin1, M. Di Palma1, S. Antoun1
1Ambulatory Department, Institut Gustave Roussy, Villejuif, France, 2Hematology department, Institut Gustave Roussy, Villejuif, France, 3Research and Development Department, Vifor Pharma, Paris, France
Introduction: Anemia in cancer is a common biological abnormality and etiological research is often not conducted. Iron deficiency is rarely explored
Objectives: The objective is to determine the prevalence of absolute (A) or functional (F) iron deficiency (ID) in severe anemia for cancer patients
Methods: All cancer patients who visited the emergency unit for acute symptoms were included prospectively during 3 months if hemoglobin level was <10 g/dl. Three groups were defined using serum ferritin (SF) and transferrin saturation (TSAT): Absolute ID: TSAT < 20 % and SF < 100; status unknown for ID (UID) or Functional ID: TSAT < 20 % and SF > 100 ng/ml and a group without ID (WID): TSAT >20 %
Results: Severe anemia was observed for 85 patients; 11.8 % of the patients had AID. Asthenia and dyspnea were reported in 76 % and 62 % of the patients, respectively. A gastrointestinal localization was found for only 44 % of the patients with AID. Anemia had another cause than ID in 18.8 %. ID status was difficult to define for 69.4 % of the patients (CS < 20 %, 100 > SF). For 61 % of the patients in UID, inflammatory syndrome (C reactive protein >60 mg/l) might explain the functional ID, but for the remaining patients (39 %), there are probably other explanations for the TSAT less <20 %
Conclusions: Absolute ID was observed in almost 1/10th of cancer patients visiting for acute onset symptoms. There are more than 2/3rd of the patients with an ID status difficult to determine and it might be that the reticulocytosis response after an iron supplementation could be of help for diagnosis.
MASCC-0528
An interprofessional education (ipe) approach to group patient education in the head & neck cancer population
T. Fansabedian 1, A. Gomes2, M. McQuestion3
1Clinical Nutrition, Princess Margaret Cancer Centre, Toronto, Canada
2Speech Language Pathology, Princess Margaret Cancer Centre, Toronto, Canada, 3Nursing, Princess Margaret Cancer Centre, Toronto, Canada
Introduction: Limited human resources to deliver personalized, standardized and timely education to patients with Head and Neck cancer undergoing (chemo)radiation.
Objectives: A group ‘prehab’ class by RD, SLP and CNS to empower patients and caregivers with knowledge on managing acute side effects, maintaining swallow, nutrition and hydration throughout treatment as well as the prevention of late effects
Methods: All patients were booked into a group class within the first 2 weeks of treatment. All participants are provided with patient education material reinforcing the class content. In true IPE format, the class began with three professionals delivering their own portions and has evolved to alternating sessions among professionals with each delivering the full content of the class.
Results: Attendance has been maintained at approximately 50 %. In evaluations 86 % felt the session answered their questions, 83 % felt that they learned something new and 71 % felt it was delivered at the right time. Being open to friends and family members allows for loved ones to also be involved in their care and the group setting allows for a group dynamic and sense of camaraderie to evolve.
Conclusions: Anticipated implications include increased awareness of side effects, improvement in personal symptom management and prevention of associated complications. Future directions include research into identifying differences in outcomes between patients who choose to attend and those who did not.
MASCC-0529
Enhancing the role of carers in the outpatient chemotherapy setting: a participatory action research project
V. Tsianakas 1, A. Richardson2, G. Robert3, R. Verity3, C. Oakley3, E. Ream3
1Florence Nightingale School of Nursing and Midwifery, King’s College London, London, United Kingdom, 2Faculty of Health Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, 3Florence Nightingale School of Nursing and Midwifery, Kings College London, London, United Kingdom
Introduction: Supporting someone through outpatient chemotherapy can be stressful. Evidence suggests that carers are at risk of mental and physical illness if they have unmet needs or perceive themselves ill-equipped to care. However, research has yet to establish the type of support carers require and how to provide this.
Objectives: A participatory action-research approach, Experience-based Co-design (EBCD), was used to develop and test an intervention for carers in the chemotherapy outpatient setting.
Methods: EBCD combines a user-centred orientation (by adopting a filmed, narrative story-telling approach) with a collaborative co-design process. Interviews were conducted with 20 carers and 20 staff, and 30 h of observation was undertaken in two clinical settings. Through a facilitated three-stage process drawing on the fieldwork findings, carers and staff designed components of a carer intervention that took the form of a DVD and leaflet. The delivery and impact of the intervention was tested in a feasibility trial. Forty-three carers were recruited to the trial, randomised between the intervention (n = 21) and control (n = 22) groups. Standardised psychometrically sound measures, completed pre- and post-intervention, provided preliminary evidence of beneficial impact on carer experience. Staff and carer focus groups confirmed the feasibility and acceptability of the intervention.
Results: Carers and staff developed components of the ‘Take Care’ intervention. This was delivered to carers in nurse-led consultations. Feasibility trial results indicated an improvement in carers’ knowledge of chemotherapy and their perceived confidence with their care-giving situation.
Conclusions: These preliminary data are encouraging and support the development of interventions using a co-design process, to improve carer experience.
MASCC-0530
Delirium and symptom distress among cancer patients receiving home hospice care in the last week of life
A. Noguera 1, M. de la Cruz2, M. San Miguel-Arregui2, J. Williams2, G. Chrisholm3, E. Bruera2
1Palliative Care, Hospital Centro de Cuidados Laguna, Madrid, Spain, 2Palliative Care, M. D. Anderson Cancer Center, Houston, USA, 3Statistics, M. D. Anderson Cancer Center, Houston, USA
Introduction: Knowledge of symptom prevalence and adequate assessment of such symptoms at the end of life are important in clinical practice as it enables health care providers to focus, anticipate and address medical issues as they arise.
Objectives: Our objective was to determine the frequency and severity of symptom distress and delirium among patients admitted to hospice in the last week of life. We also sought to determine the clinical utility of the Nu-DESC as scored by the caregiver as a screening tool for delirium.
Methods: We conducted a secondary analysis of the data from a previous randomized controlled trial on parenteral hydration at the end of life of patients admitted to home hospice. We collected the Edmonton Symptom Assessment Scale (ESAS), Memorial Delirium Assessment Scale (MDAS), and Nursing Delirium Screening Scale (Nu-DESC). Sensitivity and specificity of Nu-DESC was calculated.
Results: 78 of 261 patients were included in this study. 62 (80 %) patients have at least 4 moderate to severe symptoms which corresponded to ESAS score ≥ 4. Delirium was diagnosed in 34 (44 %) of patients using the MDAS. Nu-DESC was found to have a sensitivity of 35 %, specificity of 80 %, PPV 58 %, and NPV 61 % when used by caregiver
Conclusions: Hospice patients at the end of life have a high rate of symptom distress. Nu-DESC is not a reliable tool for screening delirium when scoring is conducted by the caregiver. This study illustrates the need for routine use of assessment tools at the end life to improve care.
MASCC-0531
Organization of supportive care in onco-hematology French departments
S. Trager 1, C. Bauchetet2, C. Préaubert3, G. Nallet4, V. Tual5, C. Blaizac6, P. Colombat7
1Oncology, Groupe Hospitalier Public du Sud de l’Oise, Senlis, France, 2Oncology, Retired Health Manager, Paris, France, 3Oncology, Clinique du Pont de Chaume, Montauban, France, 4Oncology, Réseau Oncolie, Besançon, France, 5Oncology, Hôpital Européen Georges Pompidou, Paris, France, 6Oncology, Hôpital Ste Musse, Toulon, France, 7Oncology, CHRU Bretonneau, Tours, France
Introduction: Supportive cares are part of the common health services for cancer patients. Its usefulness has been proven but its organization remains heterogenous.
Objectives: Current situation of the supportive care organization in onco-hematology French departments
Methods: An anonymous Internet questionnaire is sent to one doctor, one health manager and one caregiver of numerous onco-hematology departments
Results: 144 health professionals returned the questionnaire. 44 % of the departments have no internal supportive care coordination. Coordinators are mainly doctors (43 %), nurses (29 %) or health managers (19 %). Supportive care coordination is predominantly requested by patients themselves (66 %), by their relatives (50 %) or their regular doctor (37 %). Supportive care multi-professionnal meetings are held in 25 % of the institutes. The main participants are: doctors (96 %), psychologists (90 %), social workers (79 %), health managers (72 %), nurses (65 %), dietitians (65 %), junior doctors (62 %). 47 % of the institutes or departments have tools to evaluate the needs of supporting care. According to 56 % of the respondents, there are no specific case for supportive care in their department. 54 % of the respondents relate an efficient collaboration with home caregivers
Conclusions: Interdisciplinarity is highly represented. Identification and coverage of the needs are provided by a set of participants. Supportive care meetings have to be developed, particularly for complex care where social workers help is needed. Coordination is underdeveloped: lack of evaluation tools, of traceability and of coordination within the departments. An AFSOS workgroup is studying the possibilities of organization and coordination of supportive care in and outside the hospital
MASCC-0532
A meta-analysis on the interest of exercise in adjuvant breast cancer patients: are the guidelines based on evidence?
M. Carayol 1, C. Delpierre2, G. Ninot1
1Epsylon Laboratory EA4556, University of Montpellier, Montpellier, France, 2INSERM UMR 1027, Paul Sabatier University, Montpellier, France
Introduction: Exercise has been recommended to relieve fatigue as category 1 in cancer patients with active treatment by the National Comprehensive Cancer Network [NCCN, 2011]. A recent meta-analysis reported significant improvements on fatigue, depression and quality-of-life (QoL) in patients with exercise intervention compared to controls [Carayol et al., 2013]. However, significant amount of heterogeneity among pooled randomized controlled trials (RCTs) was observed, suggesting that some characteristics regarding study methodology and/or intervention may influence the effect of exercise interventions
Objectives: To identify methodological and intervention factors that influence exercise efficacy on fatigue, QoL and depression in breast cancer patients receiving chemotherapy and/or radiotherapy
Methods: RCTs testing exercise intervention were systematically identified. Characteristics regarding exercise intervention and methodological quality were coded and tested as moderators of exercise effect estimates in meta-regression models. Psychological outcomes summary effect sizes were then computed by pooling subgroup of RCTs based on categorized identified moderators.
Results: Nineteen RCTs were included. Intervention length, use of intention-to-treat analysis and journal impact factor were significantly and negatively associated with exercise interventions efficacy on the improvement of psychological factors. Number of experimental patients was also negatively related to fatigue and QoL (P < 0.10). Significant impact of exercise intervention on these psychological factors was observed in RCTs with intervention length < 18 weeks, no intent-to-treat analysis, impact factor < 3 and less than 40 experimental patients (see Table 1).
Table 1: Moderators and related summary effect sizes of exercise interventions efficacy on fatigue, quality-of-life and depression
Meta-regression | Subgroup summary effect sizes | |||||||
β | P-value | Group− | Effect estimate* | P-value | Group+ | Effect estimate* | P-value | |
Fatigue | ||||||||
Intervention length (wk) | −0.244 | 0.095 | <18 | −0.47 | 0.012 | ≥18 | −0.09 | 0.542 |
No. of experiment patients | −0.519 | 0.089 | <40 | −0.64 | 0.021 | ≥40 | −0.07 | 0.356 |
Total targeted dose (MET.h) | −0.577 | 0.051 | <150 | −0.65 | 0.006 | ≥150 | −0.03 | 0.725 |
Journal Inpact factor | −0.796 | 0.003 | <3 | −0.96 | 0.002 | ≥3 | −0.05 | 0.417 |
Intent-to-treat analysis | −0.672 | 0.014 | No | −0.80 | 0.004 | Yes | −0.04 | 0.532 |
Quality-of-life | ||||||||
Intervention length (wk) | −0.301 | 0.024 | ≤18 | −0.55 | 0.017 | >18 | −0.17 | 0.127 |
No. of experimental patients | −0.451 | 0.075 | <40 | −0.57 | 0.025 | ≥40 | −0.11 | 0.142 |
No. of sessions/week | −0.484 | 0.077 | ≤4 | −0.48 | 0.002 | >4 | 0.00 | 0.986 |
Intent-to-treat analysis | −0.529 | 0.029 | No | −0.61 | 0.009 | Yes | −0.08 | 0.292 |
Depression | ||||||||
Intervention length (wk) | −0.203 | 0.044 | <18 | −0.47 | 0.000 | ≥18 | −0.06 | 0.561 |
Supervised exercise sessions (%) | −0.145 | 0.097 | <50 | −0.38 | 0.010 | ≥50 | −0.17 | 0.089 |
Individual exercise sessions | 0.319 | 0.094 | No | −0.15 | 0.085 | Yes | −0.46 | 0.002 |
Journal impact factor | −0.343 | 0.049 | <3 | −0.44 | 0.001 | ≥3 | −0.10 | 0.259 |
Intent-to-treat analusis | −0.343 | 0.049 | No | −0.44 | 0.001 | Yes | −0.10 | 0.259 |
Concealed randomization | −0.413 | 0.030 | No | −0.55 | 0.000 | Yes | −0.15 | 0.072 |
*Summary effect sizes were estimated by weighting SMDs by the inverse of their variance based up on random effects models.
Negative effect sizes represent fatigue, quality-of-life of depression improvements.
Conclusions: Exercise evidence and recommendations for improving fatigue, QoL and depression in adjuvant breast cancer patients mainly rely on lowest methodological quality and shortest intervention length RCTs.
MASCC-0533
C-reactive protein and prognosis in solid tumors: a systematic review
S. Shrotriya 1, N. Bennani-Baiti1, S. Thomas1, D. Walsh1
1The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
Introduction: C-reactive protein (CRP) linked to shorter survival in some cancers.
Objectives: Systematic literature review to examine CRP and prognosis in solid tumors. CRP on treatment response and tumor recurrence also determined.
Methods: Related MeSH (Medical Subject Heading) terms used to search electronic databases (PubMed, EMBASE, Web of Science, SCOPUS etc.). Quality Assessment (QA) score devised and utilized. Studies with QA scores <50 % were excluded. Inclusion/Exclusion criteria developed. Two reviewers independently reviewed selected research papers.
Results: Ninety-two articles selected for final review. 70 % prospective; 24 % retrospective. Median (min, max) QA score: 60 (50, 80). 55 % of studies were either in gastrointestinal (GI) malignancies or renal cell carcinoma (RCC). Elevated CRP predicted prognosis; 78 % of studies by multivariate analysis, 13 % univariate analysis, 11 % non-prognostic. CRP predicted prognosis in 80 % of GI and RCC studies. Studies in other solid tumors also positive (high CRP-worse prognosis).
Conclusions
1. High CRP prognostic in 80 % of studies.
2. CRP may help determine treatment response and tumor recurrence.
3. Most studies were in GI malignancies and RCC.
4. CRP be widely used and investigated to determine prognosis.
MASCC-0534
C-reactive protein (CRP) and prognostication in solid tumors
S. Shrotriya 1, N. Bennani-Baiti1, A. Aktas1, B. Estfan1, D. Walsh1
1The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
Introduction: CRP, a non-specific marker of inflammation may help cancer prognostication. CRP is secreted by liver due to interleukin-1 (IL-1), IL-6 and tumor necrosis factor (TNF). It has been linked to shorter survival in some cancers.
Objectives: We examined associations between CRP levels and prognosis in solid tumors.
Methods: Retrospective study of electronic medical records (EMR). Multiple CRP levels at a tertiary cancer center reviewed (2006–2011). Hematological cancer diagnoses excluded. Survival defined from the date with highest CRP to date of death. CRP reported as median (25th, 75th percentile). CRP reference range 0–10 mg/L.
Results: N = 6809 with solid tumors identified. 56 % males. 83 % Caucasian, 15 % African American. Common cancers—genitourinary (GU) 29 %, breast 14 %, gastrointestinal (GI) 14 %, lung 7 %. Highest CRP for GI, GU, lung, breast = 8 (2, 15); 6 (2, 15); 3 (1, 8); 2 (1, 5) respectively. Median survival (months) = 13 (8, 30); 18 (11, 33); 16 (8, 27) and 25 (15, 41) respectively.
Conclusions
1. Higher median CRP in GI, GU, lung and breast cancers.
2. Higher CRP associated with shorter prognosis across primary sites (even within reference range).
3. Inverse relationship between absolute CRP values and survival.
4. High CRP—an adverse prognostic indicator in most solid tumors.
MASCC-0535
Prevalence and incidence of difficulty swallowing in advanced cancer
S. Shrotriya 1, S. Thomas1, R. Trimmer1, D. Walsh1
1The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
Introduction: Difficulty swallowing is an independent predictor of cancer survival. Regular evaluation of swallowing is critical for adequate nutrition and patient care.
Objectives: Our objective was to establish incidence and prevalence of difficulty swallowing in acute palliative medicine unit. Also, to evaluate formal clinical swallow test.
Methods: Electronic medical records (EMR) from acute palliative medicine unit retrospectively reviewed (2008–2011). Formal clinical swallow test comprised: I. Routine swallow screen II. Pre-swallow test questionnaires III. Clinical swallow test.
Clinical swallow test includes:
1. Sip of water without aspiration
2. 3 oz cup of water without aspiration
Results: N = 249 with solid tumors; Mean (±SD) age = 68 ± 13 years; 57 % females. 71 % Caucasians; 25 % African Americans. Common among lung, gastrointestinal (GI), renal cancers. 47 % had metastatic disease. Mean (±SD) length of stay = 10 ± 8 days. Prevalence of difficulty swallowing on admission—6 %. 12 failed routine swallow screen, 3 pre-swallow test questionnaires, and 1 clinical swallow test. Prevalence = 6 % on discharge. Incidence of difficulty swallowing during hospital admission = 21 %. Pneumonia/respiratory symptoms, gastrointestinal problems common among those with difficulty swallowing.
Conclusions
1. 6 % prevalence at admission and discharge.
2. 21 % incidence during the admission.
3. Most who underwent formal clinical swallow test failed routine swallow screen.
4. Pneumonia/respiratory and GI problems common.
5. Formal clinical swallow test critical in acute cancer care.
MASCC-0536
Weight loss: predictors and prognostic importance in solid tumors
S. Shrotriya 1, A. Aktas1, B. Estfan1, L. Rybicki1, D. Walsh1
1The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
Introduction: Large cancer databases provide valuable information on weight changes and clinical parameters. Weight loss (WL) in adults with solid tumors examined.
Objectives: Objective was to determine if demographics, clinical and biochemical indices predicted WL. Examine if WL and related parameters were predictive for survival.
Methods: Outpatients’ Electronic medical records (EMR) from a tertiary cancer center retrospectively reviewed. First visit (V1) within a year after diagnosis compared to last visit (V2) ≥3 weeks after V1. Body weight and other clinical parameters (BMI, BP, REE) at V1 and V2. WL: V2 to V1 categorized as ≤5 %, 5.01–10 %, >10 %. Logistic regression and Cox proportional hazards analysis identified risk factors for WL and prognosis.
Results: N = 5901; 58 % Male; Mean (±SD) age: 61 ± 12 years; 82 % Caucasians; 16 % African Americans. Common cancers: genitourinary (GU) 31 %; gastrointestinal (GI) 16 %; breast 15 %; lung 15 %; head and neck 6 %, others 12 %. Metastatic disease in 18 %. WL: V1 to V2: ≤5 % (73 %), 5.01–10 % (13 %), >10 % (14 %). WL risk factors: multivariable analysis—primary site, metastatic sites, treatment-related variables, BMI category. Median survival >10.0 % = 5.3 months, 5.01–10.0 % = 9.4, not observed ≤5 %; WL prognostic in multivariable analysis (p < 0.001).
Conclusions
1. Major WL ≤ 5 % by V2.
2. Head & Neck and GI cancers (primary)—the greatest risk of WL; breast –lowest.
3. More metastatic sites Λ WL risk.
4. Overweight and obese = Λ WL; underweight = Less WL.
5. ≤5 % WL survival advantage compared to 5.01–10 %, >10 %.
6. WL prognostic after adjustment for other prognostic factors.
MASCC-0537
Literature review on the effectiveness of web-based interventions on health outcomes of caregivers of cancer patients
W.ie.P.Y. Tang1, C.en.W.H. Chan1, S.ne.S.M. Ho 1
1The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China
Introduction: Combating with cancer is a long journey, as caregivers, they are under high level of stress, distress and worries, influencing their physiological and psychological well-being. With advanced technology, Internet becomes an important source of health information and support for the caregivers of cancer patients. Studies reported psychoeducation and psychological interventions were beneficial to cancer caregivers, however, the effects of interventions deliver by web-based format were unclear
Objectives: This review aims to critically review existing literatures related to the effectiveness of web-based interventions in health related outcomes in caregivers of cancer patients.
Methods: Relevant citations were searched from MEDLINE, EMBASE, PsycINFO, Scopus and EBM Reviews from inception to December 2012. Keywords including ‘web-based’, internet, caregiver, cancer were used in each electronic database search. Articles written in English and Chinese were included. Studies focused on only patient outcomes were excluded. The characteristics and the findings of the relevant studies were critically appraised
Results: Nine studies were included in the review. Six of them were experimental studies. All studies were conducted in Caucasian or Western populations. Outcomes examined include quality of life, negative mood, anxiety, perceived mutual support and coping effectiveness.
Conclusions: Preliminary evidence demonstrated web-based intervention approach might be an effective way in delivering health information and support to the caregivers. However, limited randomized controlled studies were done to evaluate the effectiveness of Internet-based interventions. Future studies can employ randomized controlled trials as study method and focus on the impact of web-based interventions in caregivers.
MASCC-0538
Pharmacists-led symptom management program of Asian breast cancer patients: experience at an ambulatory cancer center
K.M. Foo 1, V. Shih2, A. Chan3, R.A. Dent4, Y.S. Yap5
1Pharmacy, National University of Singapore/KK Women’s and Children’s Hospital, Singapore, Singapore, 2Pharmacy, National Cancer Centre Singapore, Singapore, Singapore, 3Pharmacy, National University of Singapore/National Cancer Centre Singapore, Singapore, Singapore, 4Medical Oncology, National Cancer Centre Singapore/Duke NUS GMS Singapore, Singapore, Singapore, 5Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
Introduction: As more cancer patients receive outpatient chemotherapy, it is pertinent to assess their symptom periodically for prompt, effective symptom management which pharmacists play an important role.
Objectives: The study was designed to assess the incidence and severity of symptoms experienced by Asian breast cancer (BC) patients receiving chemotherapy. Secondary objective was to evaluate patient-related characteristics that may predispose patients to chemotherapy-induced symptoms.
Methods: This is a prospective, single institution, cohort study conducted between Jan2012 and Jan2013. Newly diagnosed non-metastatic BC patients receiving chemotherapy at the ambulatory cancer center were recruited. M. D. Anderson Symptom Inventory (MDASI), a validated patient-reported outcome-based multi-symptom assessment tool, was administered by a pharmacist 1 week after every cycle via telephone throughout their entire course of chemotherapy.
Results: Sixty-nine patients were assessed. Majority (82.6 %) were Chinese, 69.1 % had Stage II BC and below and mean age was 49.8 (±9.83) years. The most common symptoms experienced were fatigue (48.7 %), lack of appetite (37.8 %) and disturbed sleep (32.1 %). These lead to interference of general activity (31.8 %), work (29.4 %) and mood (23.4 %). Younger patients (≤50 years) reported higher intensity of pain and nausea (p = 0.023 and p = 0.035 respectively). Patients with higher education had greater tendency for work and relations with others to be affected (p = 0.008 and p = 0.003 respectively). Married patients reported worse mood (p = 0.037).
Conclusions: This pilot study has elucidated common symptoms that afflict BC patients on chemotherapy. Pharmacists can proactively identify patients at higher risk for chemotherapy-induced symptoms and to assist them in effective symptom management.
MASCC-0539
Prophylactic naproxen or loratadine for bone pain in breast cancer patients receiving chemotherapy and pegfilgrastim: a randomized, phase 2 study (NOLAN) AMGEN:20110147 - NCT:01712009
F.D. Vogl 1, A.S. Guinigundo2, C. Maxwell3, L. Vanni4, S. Badre5, P.K. Morrow6
1Global Development, Amgen (Europe) GmbH, Zug, Switzerland, 2Medical Hematology and Oncology, Oncology Hematology Care Inc., Cincinnati OH, USA, 3Infusion Department, Advanced Medical Specialties, Miami FL, USA, 4Pain Management, Providence Hospital, Southfield MI, USA, 5Global Biostatistical Sciences, Amgen Inc., Thousand Oaks CA, USA, 6Global Development, Amgen Inc., Thousand Oaks CA, USA
Introduction: Mild to moderate bone pain is the most commonly reported adverse event (AE) associated with pegfilgrastim. NSAIDs and antihistamines are being used increasingly in the oncology community to reduce this AE; however, there are limited data to support the safety and efficacy of these interventions (Kirshner 2011, 2012). Evidence regarding the effectiveness of these treatments in patients receiving pegfilgrastim and chemotherapy would be of value to both patients and providers.
Objectives: To estimate the difference in cycle 1 bone pain among treatment groups (naproxen, loratadine, or no prophylactic therapy) captured as a part of AE reporting, and secondarily, in patient-reported bone pain surveys across cycles. AEs associated with prophylactic administration of naproxen and loratadine are being evaluated.
Methods: Six hundred patients will be enrolled. Female patients with newly diagnosed, chemotherapy-naïve, stage I–III breast cancer, planning ≥4 cycles of neoadjuvant or adjuvant chemotherapy with pegfilgrastim support are eligible. Exclusions include: ongoing chronic pain or chronic pain treatment; a history of GI bleeding or ulcers. Patients are randomized 1:1:1 to naproxen 500 mg BID versus loratadine 10 mg QD versus no prophylaxis × 5 days starting the day of pegfilgrastim administration. Analyses will be stratified by age (<65 years versus ≥65 years) and chemotherapy received (taxane versus non-taxane). The clinical hypothesis is that an absolute reduction of 10 % in all grade bone pain in the intervention arms as compared to the control arm could suggest a clinical benefit.
Results: Current enrollment (Feb 2013) is 28 patients
Results are expected mid-2014.
Conclusions: Pending results.
MASCC-0540
Concepts and definitions for “actively dying”, “end-of-life”, “terminally ill”, “terminal care” and “transition of care”: a systematic review
D. Hui 1, Z. Nooruddin1, N. Didwaniya1, R. Dev1, M. De La Cruz1, S.H. Kim2, J.H. Kwon3, R. Hutchins4, C. Liem4, E. Bruera1
1Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, USA, 2Family Medicine, Myong Ji Hospital, Gyeonggi, Korea, 3Medical Oncology, Kangdong Sacred Heart Hospital, Seoul, Korea, 4Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, USA
Introduction: The terms ‘actively dying’, ‘end-of-life’, ‘terminally ill’, ‘terminal care’, and ‘transition of care’ are commonly used but rarely and inconsistently defined.
Objectives: We conducted a systematic review to examine concepts and definitions for these terms.
Methods: We searched MEDLINE, PsycInfo, EMBASE and CINAHL for published peer reviewed articles from 1948 to 2012 that conceptualized, defined or examined these terms. Two researchers independently reviewed each citation for inclusion, and then extracted the concepts/definitions when available. We also searched 10 dictionaries, 4 palliative care textbooks and 12 organization websites.
Results: ‘Actively dying’, ‘end-of-life’, ‘terminally ill’, ‘terminal care’ and ‘transition of care’ were defined and/or conceptualized in 1/16, 3/134, 3/44, 2/93 and 4/17 retrieved articles, respectively. ‘Actively dying’ was defined as ‘hours or days of survival’. We identified 2 key defining features for ‘end-of-life’, ‘terminally ill’ and ‘terminal care’: life-limiting disease with irreversible decline and expected survival in terms of months or less. ‘Transition of care’ was discussed in relation to changes in (1) place of care (e.g. hospital to home), (2) levels of professions providing the care (e.g. acute care to hospice), and (3) goals of care (e.g. curative to palliative). Definitions for these 5 terms were rarely found in dictionaries, textbooks and organizational websites. However, when available, the definitions were generally consistent with the concepts discussed above.
Conclusions: We identified unifying concepts for 5 commonly used terms in palliative care, and proposed a preliminary conceptual framework (Figure) toward building standardized definitions.
MASCC-0541
The effect of patient education on reported bone pain in breast cancer patients receiving chemotherapy and pegfilgrastim: a randomized, single-blind study (VINE) AMGEN:20110148 – NCT:01752907
F.D. Vogl 1, A.S. Guinigundo2, C. Maxwell3, L. Vanni4, S. Badre5, P.K. Morrow6
1Global Development, Amgen (Europe) GmbH, Zug, Switzerland, 2Medical Hematology and Oncology, Oncology Hematology Care Inc., Cincinnati OH, USA, 3Infusion Department, Advanced Medical Specialties, Miami FL, USA, 4Pain Management, Providence Hospital, Southfield MI, USA, 5Global Biostatistical Sciences, Amgen Inc., Thousand Oaks CA, USA, 6Global Development, Amgen Inc., Thousand Oaks CA, USA
Introduction: Patient education has been used in many disease states, but it has not been specifically studied in the modulation of pegfilgrastim-related bone pain (Ferrell 1993, de Wit 1997, Oldenmenger 2011). In this single-blind study, patients receiving chemotherapy and pegfilgrastim are randomized to receive one of two educational DVDs, and the effects of these DVDs on reported bone pain will be estimated.
Objectives: Primary: to estimate the difference between arms of mean maximum patient-reported bone pain in cycle 1. Secondary: to evaluate patient-reported bone pain, area under the curve (AUC) for bone pain, analgesic use, and bone pain captured as part of adverse event (AE) reporting across cycles.
Methods: Three hundred patients will be enrolled. Female patients with newly diagnosed, chemotherapy-naïve, stage I-III breast cancer, able to understand English, and planning four cycles of neoadjuvant or adjuvant chemotherapy with pegfilgrastim are eligible. Exclusions include ongoing chronic pain or pain treatment. Patients are randomized 1:1 to receive one of two educational DVDs (either general or bone-pain-specific chemotherapy and pegfilgrastim AE information) to watch twice at the clinic on two separate days, up to and including the first visit for pegfilgrastim administration. Bone pain data are collected using patient-reported surveys and as part of standard AE reporting. The clinical hypothesis is that a difference in mean maximum pain of 0.5 (scale 1–10) in favor of bone pain education is clinically relevant.
Results: Current enrollment (Feb2013) is 2 patients
Results are expected at the end of 2014.
Conclusions: Pending results.
MASCC-0542
Prophylactic subcutaneous fentanyl for exercise-induced breakthrough dyspnea: a preliminary double-blind, randomized controlled trial
D. Hui 1, A. Xu1, S. Frisbee-Hume1, G. Chisholm1, E. Bruera1
1Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
Introduction: Dyspnea is one of the most common and distressing symptoms in cancer patients, and often worsens with breakthrough episodes on exertion. We hypothesized that subcutaneous fentanyl (SCF) given prophylactically before exertion may alleviate breakthrough dyspnea.
Objectives: We examined the effects of SCF on dyspnea, walk distance, vital signs and adverse events in cancer patients before and after intervention.
Methods: In this double-blind randomized controlled trial, we asked ambulatory patients with breakthrough dyspnea to perform a baseline 6 min walk test (6MWT), and then assigned them to either SCF (15–25 % of total daily dose) or normal saline 15 min before a second 6MWT. We documented the change in dyspnea numeric rating scale (NRS), walk distance, vital signs and adverse events between the first and second 6MWTs.
Results: Twenty patients were enrolled (1:1 ratio) without attrition. SCF was associated with significant improvements in dyspnea NRS at the end of 6MWT (mean [95 % CI]: −1.8 [−3.2, −0.4]; P = 0.02), dyspnea NRS at rest 15 min after drug administration (−0.9 [−1.8, −0.04]; P = 0.04), fatigue Borg Scale at the end of 6MWT (−1.3 [−2.4, −0.2], P = 0.04), 6MWT distance (+37.2 m [5.8 m, 68.6 m]; P = 0.03) and respiratory rate (−2.4 [−4.5, −0.3]; P = 0.03). Non-statistically significant improvements were also observed in the placebo arm, with no difference between the two arms. No significant adverse events were observed.
Conclusions: Prophylactic SCF was safe and significantly improved dyspnea, walk distance and respiratory rate. We also observed a non-significant but large placebo effect. Our results justify larger randomized controlled trials to confirm these findings.
MASCC-0543
Designing and testing interventions that address barriers to delivering evidenced based symptom managment
A. O’Mara 1, A. Denicoff2, D. St. Germain1, M. Good1
1Division of Cancer Prevention, National Cancer Institute, Bethesda, USA, 2Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, USA
Introduction: Results from a number of studies have consistently reported high levels of cancer treatment morbidities, while other studies have shown that patients are not receiving evidence based treatments for these morbidities. In response to this gap and recommendations from the Institute of Medicine on improving palliative care, the National Institutes of Health released a request for applications (RFA) in 2004 to encourage research directed at reducing barriers to the delivery of cancer symptom magement (RFA CA/NR-05-013). Interventions were to target (1) patient/family, (2) health care providers, and/or (3) health care system.
Objectives: Summarize the outcomes from the funded RFA projects by describing targeted barriers, types and targets of tested interventions, and highlighting key findings.
Methods: Final progress reports and published data from seminal articles emanating from the funded research projects were reviewed and summarized.
Results: Sixteen intervention studies were funded and all but three completed the projects and provided final reports. Data for this presentation were derived from the 13 completed projects. Approximately 3,000 patients and families and 60 professional and lay health providers participated in the studies. Seven of the thirteen studies reported improvements in patient outcomes as a result of changes to the delivery of symptom management.
Conclusions: All of the projects were labor intensive, with over 10,000 patients and families screened in order to achieve targeted sample sizes. A wide variety of outcome measures were used. Accruing patients and families from hospice settings was very challenging. Implications for future research and practice will be discussed.
MASCC-0544
Evaluation of communication of patients laryngectomized
N. Sawada 1, J.M. Paula1, A.C. Nicolussi1, H.M. Sonobe1, J.A.P. Morero1, V. Andrade1
1General of Specialized, College of Nursing at Ribeirão Preto at University of São Paulo, Ribeirão Preto São Paulo, Brazil
Introduction: The main responsible for the breakdown of social interaction in people laringectomizadas, is the loss of verbal communication. Cancer of the larynx is one of the most common among those who reach the head and neck, representing approximately 25 % of malignant tumors that affect this area, and 2 % of all malignancies.
Objectives: To evaluate the satisfaction of patients’ communication after total laryngectomy.
Methods: Exploratory, cross-sectional, conducted with 50 laryngectomized patients in ambulatory head and neck of the “Hospital of Ribeirão Preto”. Data were collected using the Communication Assessment Questionnaire after Total Laryngectomy and quantitatively analyzed using the Statistical Package of Social Science Program
Results: Analyzing the frequency distribution of the subscales, we found regarding the evaluation of functional communication, 33.6 % are in the maximum score, indicating they were satisfied with the functional issue, which evaluates voice quality in terms of intelligibility, volume, tone, fluency and intelligibility by phone. As for satisfaction assessment, which evaluates the satisfaction of communication after laryngectomy patients reported having a regular communication satisfaction, and most are between scores 3 and 4.
Conclusions: This study showed that despite the patients being satisfied as to the functional assessment, are less satisfied with the new way to communicate. Therefore, the rehabilitation process is essential for laryngectomy patients can return to their daily lives and are able take satisfaction in communicating after surgery.
MASCC-0545
Assessment of health-related quality of life of hematological cancer patients during chemotherapy
N. Sawada 1, V. Andrade1, A.C. Nicolussi1, J.M. Paula1, G.P. Guerrero1, D.A. Saraiva1
1General of specialized, College of Nursing at ribeirão Preto at University of São Paulo, Ribeirão Preto São Paulo, Brazil
Introduction: The cancer diagnosis has affected the Health-Related Quality of Life (HRQoL) of cancer patients, including during chemotherapy.
Objectives: To identify the HRQoL domains affected, and to correlate them with socio-demographic and clinical-therapeutic data of the sample.
Methods: A descriptive and correlational study performed with 61 hematological cancer patients at the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. The instrument Quality of Life Questionnaire-Core 30 (QLQ-C30) was used.
Results: The sample was composed mostly by men, over 40 years. The types of blood cancer were: non-Hodgkin lymphoma (36.07 %), Hodgkin’s lymphoma (31.15 %), leukemia (24.59 %) and others (8.20 %). The general quality of life was considered good (mean = 64.6), the functions ranged from fair to good: physical (61.1), social (54.4), cognitive (53.5), role (49.0) and emotional function (47.3). In symptom scales, loss of appetite, fatigue, pain, insomnia and constipation, the mean ranged from 42.9 to 55.0; nausea and vomiting, diarrhea and dyspnoea the mean ranged from 9.8 to 35.3. The result of Fisher’s exact test indicated that insomnia is associated with age (P = 0.03) nausea and vomiting associated with cancer (P = 0.03). The variable social function was associated with occupation (P = 0.01) and income (P = 0.04).
Conclusions: It is important the knowledge of the healthcare team about the impact that the treatment causes in the lives of onco-hematological patients in chemotherapy, considering the domains of HRQoL affected in the rehabilitation process.
MASCC-0546
Evaluating the effects of denosumab on pain and analgesic use in giant cell tumor of bone (GCTB)
J. Engellau 1, J. Broto2, C. Cleeland3, K. Skubitz4, A. Staddon5, R. Blum6, M. Dominkus7, K. Ganjoo8, A. Feng9, I. Jacobs10
1Department of Oncology, Lund University Hospital, Lund, Sweden, 2COTMES (Comité de Tumores Músculo-Esqueléticos) Sarcoma and Melanoma Units, Hospital Universitari Son Espases, Palma de Mallorca, Spain, 3Department of Symptom Research Division of Internal Medicine, MD Anderson Cancer Center, Houston TX, USA, 4Masonic Cancer Center, University of Minnesota, Minneapolis MN, USA, 5University of Pennsylvania School of Medicine, Philadelphia PA, USA, 6Beth Israel Medical Center, New York NY, USA, 7Medizinische Universitaet Wien, Wien, Austria, 8Stanford University Cancer Center, Stanford CA, USA, 9Biostatistics, Amgen Inc., Thousand Oaks CA, USA, 10Global Develoment-Oncology, Amgen Inc., Thousand Oaks CA, USA
Introduction: GCTB is a rare, osteolytic tumor associated with severe pain. Denosumab inhibits RANKL, which is involved in the pathogenesis of GCTB.
Objectives: To describe pain and analgesic use from a prespecified interim analysis of a phase 2 study of denosumab in GCTB patients.
Methods: Patients (N = 281) received denosumab 120 mg SC Q4W (loading doses, days 8 and 15). The Brief Pain Inventory-Short Form (BPI-SF) (0–10 points) was administered before each denosumab dose for 6 months and then Q3M. Analyses included the proportion of patients with clinically meaningful improvement in worst pain (≥2-point decrease in BPI score in patients with baseline ≥2 points), proportion with no/mild worst pain (≤4 points) at baseline shifting to moderate/severe worst pain (>4 points), proportion with moderate/severe worst pain at baseline shifting to no/mild worst pain, and shift from baseline analgesic score on the Analgesic Quantification Algorithm (AQA) (0:no analgesics–7:strong opioids).
Results: Starting at week 5, >50 % of patients had pain improvement at each visit through month 22. Throughout the study, ≤16 % (range: 0 %–16 %) worsened from no/mild pain to moderate/severe pain. Up to 39 % (range: 4 %–39 %) of patients decreased analgesic use from strong opioids (≥3 points) at baseline to no/low analgesic use (≤2 points) at some time on study; very few (range: 0 %–4 %) increased from no/low analgesic use at baseline to strong opioid use.
Conclusions: Denosumab was associated with clinically meaningful improvement in pain in GCTB patients. Pain improvement did not appear to be associated with increased analgesic use.
MASCC-0547
‘Time to think about carers’ preparing and meeting the needs of family and friends who support people having chemotherapy
R. Verity 1, J. Sturt1, A. Metcalfe1
1Florence Nightingale School of Nursing and Midwifery, King’s College London, London, United Kingdom
Introduction: Most cancer patients receive chemotherapy as outpatients. Family and friends (carers) are relied upon to support them at home through toxic and lengthy treatments. Little is known about how health professionals could intervene to ensure that carers are equipped with the relevant skills and knowledge to support the patient.
Objectives: This study aimed to identify potential interventions and strategies that health professionals could utilise to enhance the support they provide to carers.
Methods: A collaborative, multi-strategy design was utilised, following the initial two iterative phases of the uk mrc (2008) framework for development and evaluation of complex interventions. The pre-clinical phase included a systematic review of carers needs, over 250 h of participatory observation, in-depth interviews exploring the perspectives of health professionals, carers and patients and identification of a theoretical base through a second review. The modelling phase aimed to develop components of an educational intervention for health professionals as well as potential tools that can be used to engage with carers.
Results: The findings from the pre-clinical phase indicate that carers have numerous needs which are largely ignored in practice however health professionals’ needs and numerous challenges to effectively support carers is a neglected area in practice and research. Barriers to supporting carers include included lack of consultation skills and training to manage difficult family dynamics and patient/carer agendas.
Conclusions: This presentation will discuss the barriers that can prevent carers receiving support from clinicians and offer strategies that could enable health professionals to engage and communicate with carers more effectively.
MASCC-0548
A prospective study of thyroid dysfunction following supraclavicular irradiation in the management of carcinoma of the breast
S. Akyurek 1, I. Bablioglu2, S. Yuksel3, S. Cakir Gokce2
1Radiation Oncology, Ankara Üniversity Faculty of Medicine, Ankara, Turkey, 2Radiation Oncology, Ankara Üniversity Faculty of Medicine, Ankara, Turkey, 3Biostatistic, Ankara Üniversity Faculty of Medicine, Ankara, Turkey
Introduction: Thyroid dysfunction is usually underestimated in patients with breast cancer following supraclavicular irradiation.
Objectives: To evaluate the relationship between irradiation and early thyroid dysfunction, focusing on radiation dose-volume factors.
Methods: Twentyone patients with breast cancer received supraclavicular irradiation were evaluated. Thyroid function tests, including serum thyroid stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), were analyzed prior to irradiation and every 3 months the first year and then 18th month after radiotherapy. Dose volume histogram (DVH), mean radiation dose the thyroid and percentages of thyroid volume which received radiation doses 10–60Gy (V10–V60) were considered for statistical analysis
Results: Mean TSH levels before irradiation, at 3, 6, 9, 12 and 18 months were 1.4 μIU/ml, 1.6 μIU/ml, 1.7 μIU/ml, 3.6 μIU/ml, 5.05 μIU/ml, and 5.32 μIU/ml respectively. Serum TSH levels did not change significantly at 3 and 6 months after irradiation (p = 0.1). However, significant elevation was noted at 9 months (p = 0.013). Mean thyroid dose was 32 Gy (19–48 Gy) and mean thyroid volume was 35 cc (24–64 cc). Median values of V10–20–30–40–50–60 were 68 %, 58 %, 55 %, 53 %, 48 % and 0 %, respectively. We could not show significant relationship between the dose-volume factors and development of hypothyroidism. The median follow-up was 18 months (range, 12–24 months). Four patients (19 %) were diagnosed with hypothyroidism, 1 (5 %) developed clinical hypothyroidism and 3 (14 %) had subclinical hypothyroidism
Conclusions: Irradiation of supraclavicular region in breast cancer patients may lead to early thyroid dysfunction. This damage is initially manifested within 9 months after radiotherapy.
MASCC-0549
In vivo monitoring of cisplatin-induced substance P release in the medulla of rats measured by brain microdialysis
K. Yamamoto 1, A. Tasaka1, S. Kim1, A. Yamatodani1
1Graduate School of Allied Health Sciences Faculty of Medicine, Osaka University, Suita Osaka, Japan
Introduction: Neurokinin NK1 receptor antagonists clinically improved antiemetic outcomes in patients receiving cisplatin. Since they act centrally to inhibit the emesis, it has been postulated cisplatin-induced emesis is mediated by a substance P (SP) pathway in the central nervous system, however, the precise etiology remains unclear.
Objectives: To elucidate a role of SP in the central regulation of cisplatin-induced emesis, we investigated the effect of cisplatin on time-dependent changes in SP release in the medulla of rats measured byin vivo brain microdialysis.
Methods: A guide cannula was implanted and fixed into the medulla of rats. After recovery, a microdyalysis probe was inserted through the cannula and it was perfused with artificial cerebrospinal fluid. Following an equilibration period, rats were injected with cisplatin (6 mg/kg, i.p.) with or without 5-HT3 receptor antagonist, granisetron (0.1 mg/kg, i.p.), and dialysate samples were continuously collected for 24 h. SP contents in samples were analyzed by an ELISA assay kit.
Results: Cisplatin significantly increased in medullary SP release after 12 h of the injection and the increase was continued throughout the sampling period. Treatment with granisetron completely inhibited the cisplatin-induced increase of SP release.
Conclusions: We have already found that cisplatin (6 mg/kg) induced pica behavior, which correlates with emesis in humans, in rats within 12 h and the behavior was effectively inhibited by granisetron (0.1 mg/kg) and NK1 receptor antagonist, aprepitant (2 mg/kg)
Results suggest the SP release in the medulla via 5-HT3 receptor and the activation of NK1 receptor are involved in the development of cisplatin-induced emesis in rats.
MASCC-0550
Relationship between shoulder mobility, fatigue and quality of life among post mastectomy patients—results of 6 month surveillance from premiere regional cancer centre in India
S. Madhavan Sasidharan 1, V. Srinivasan1, V. Surendran2, N. Vasumathy1
1Physiotherapy, Cancer Institute (WIA), Chennai, India, 2Psycho-Oncology, Cancer Institute (WIA), Chennai, India
Introduction: Breast cancer is one of the most common malignancies affecting women worldwide. The incidence rate of breast cancer at our Cancer Institute in 2007–08 is 23.5 %. In Chennai the Breast cancer has significantly raised from 14.3 % in 1982 to 24.4 % in 20041. Post mastectomy complications can be a significant factors resulting in discomforts in daily living and decreasing the Quality of Life (QOL).
Objectives: To assess the QOL and Shoulder Range of Motion (ROM) of Mastectomy patients and also to explore the relationship between shoulder ROM, Fatigue, Body image and QOL.
Methods: Post mastectomy female patients (n = 95), age range between 23 and 78, who reported to Physiotherapy OPD from July to December 2012 were assessed for their Shoulder ROM using Goniometer and Cancer Institute-QOL questionnaire2. Data analysed using SPSS 13 Software.
Results: 3.2 % of patients had vey low QOL, 12.6 % of them reported low QOL, 44.2 % had average QOL, 32.6 % found to have high QOL and 7.4 % had very high QOL. 61.1 % achieved full ROM, 57.9 % of patients had fatigue. QOL, Body Image, Physical well being, Psychological well being, Sexual and personal ability were significantly related to Fatigue. QOL, Body image and Physical well being were significantly related to ROM
Conclusions: Most patients had Better QOL.
References
1. Swaminathan R, Shantha V, Balasubramaniam S & Sampath P. (2010). Cancer Incidence and Mortality in Chennai, India: 2006–2008. National Cancer Registry Program, Cancer Institute (WIA), Chennai.
2. Vidhubala.E., et al., Cancer Institute Quality of life Questionnaire (CI-QOL), Indian Journal of Cancer, 2005.
MASCC-0551
Relationship between oral health perception and nutritional status in senior cancer patients: preliminary results
N. El Osta1, L. El Osta 1, H.R. Kourie2, M. Hennequin1, S. Tubert-Jeannin1, M. Ghosn2
1Public Health, Faculty of Medecine Saint Joseph University, Beirut, Lebanon, 2Hematology-Oncology Department, Faculty of Medecine Saint Joseph University, Beirut, Lebanon
Introduction: Malnutrition is a major cause of morbidity and mortality in elderly. The role of anticancer treatment in inducing oral problems and thus malnutrition in aging patients has not been studied so far
Objectives: This study aims to investigate the relationship between oral health perception and nutritional status in this population
Methods: Patients were recruited from an oncologic and primary care outpatient units in Lebanon. They completed the Lebanese version of the Geriatric Oral Health Assessment Index questionnaire and the Arabic version of the Mini Nutritional Assessment index, to assess respectively the oral health perception and the nutritional status during the last 3 months.
Results: Ninety five patients participated in our study: 22 cancer patients on active chemotherapy, 23 patients on hormonal treatment, 18 cancer patients in complete remission, and 32 non-cancer patients. Mean age was 71 years (range, 65–86 years). Oral health perception and nutritional status were significantly different between groups (-p-value < 0.05). They were significantly worse in cancer patients on hormonal treatment, and the worst in chemo-treated patients. These patients reported limiting kinds and amount of food (-p-value = 0.009), trouble biting or chewing (-p-value = 0.005), and felt uncomfortable while eating in front of others (-p-value = 0.046), due to oral problems. Significant association was found between oral health perception and nutritional assessment (-p-value = 0.001)
Conclusions: Elderly cancer patients on treatment need better mouth care. Their oral health perception might be an additional risk factor of malnutrition. Thus, oncologists must be aware about oral problems and their effects in elderly while receiving anti-cancer treatment.
MASCC-0552
Characteristics and outcomes of patients admitted to the acute palliative care unit (APUC) from the emergency center (EC) versus inpatient transfers (IP)
S. Seonghoon 1, E. Bruera2, D. Hui2, G.B. Chisholm3, J.H. Kwon4, M.T. San-Miguel5, J.A. Allo2, S. Yennurajalingam2, S.E. Frisbee-Hume2
1Hemato-Oncology Internal Medicine, Kosin University Gospel Hospital, Busan, Korea, 2Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA, 3Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA, 4Department of Internal Medicine, Kangdong Sacred Heart Hospital Hallym University, Chuncheon, Korea, 5Department of Palliative Medicine, Clinica Universidad de Navarra, Nvarra, Spain
Introduction: We hypothesized that EC admissions have different characteristics.
Objectives: We compared the symptom burden and survival between both groups.
Methods: Among all 2,568 patients admitted to our APCU between September 1, 2003 and August 31, 2008, 312 (12 %) were EC patients. We randomly selected 298 IP patients as controls. We retrieved the patient demographics, cancer diagnosis, ESAS, discharge outcomes, and overall survival from time of admission.
Results: EC patients were more like to be black (22 % v 11 %, p = 0.0006) and less likely to have hematologic cancer (5 % v 14 %, p = 0.0003). EC patients had higher pain (5.4 v 4.6, p = 0.0004), fatigue (6.7 v 6.1, p = 0.0049), nausea (2.7 v 1.6, p < 0.0001), insomnia (4.8 v 4.2, p = 0.03) and were less likely to be delirious (41 % v 55 %, p = 0.001). EC patients had more public insurance (44 % v 38 %, p = 0.0142), more home discharge (29 % v 11 %, p = 0.0001), longer admission (8 v 7 days, p = 0.0002), and were 2.3× as likely to be discharged alive as compared to IP patients (p < 0.0001). Kaplan–Meier plots and log-rank test for Survival from admission of APCU for EC and IP groups were not statistically significant (Median survival after admission were 34 v 31 days, p = 0.08). In multivariate analysis, EC admission (OR = 1.9, 1.2–3.0), wellbeing (OR = 1.12, 1.02–1.23), dyspnea (OR = 0.85, 0.79–0.92) and delirium (OR = 0.39, 0.24–0.64) were independently significant for being discharge alive.
Odds Ratio Estimates (c-statistic = 0.71) | |||
Effects | OR | 95 % Wald Confidence Limits | |
Group (EC v IP) | 1.9 | 1.2 | 3.0 |
Delirium (Yes v No) | 0.4 | 0.24 | 0.64 |
Wellbeing (per point increase) | 1.12 | 1.02 | 1.23 |
Shortness of Breath (per point increase) | 0.85 | 0.79 | 0.92 |
Conclusions: EC patients have higher acute symptom burden, but more likely to be discharged alive as compared to IP patients. The APCU is successful at managing symptoms and facilitating discharge to community for EC patients.
MASCC-0553
Supportive social care for oncologic patients in Lebanon: family and volunteers single institution experience.
H.R. Kourie 1, L. EL OSTA2, S. Achkar1, J. Antoun1, S. Faddoul1, O. Salameh1, M. Ghosn1
1Hematology-Oncology Department, Faculty of Medecine Saint Joseph University, Beirut, Lebanon, 2Public Health, Faculty of Medecine Saint Joseph University, Beirut, Lebanon
Introduction: Many aspects of the supportive care were studied and discussed in different studies but the importance of the families and volunteers role was rarely elaborated. The family unity and solidarity characterizes the Middle Eastern and Lebanese societies. Tight family members’ relationship and volunteers activities, affect positively the psychological and social status of oncologic patients.
Objectives: We aim in this study to evaluate and quantify the impact of the family and volunteers on the quality of life of the oncologic patients socially, psychologically and morally
Methods: One Hundred patients with hematologic or solid tumor malignancies, aged between 18 and 70 years old, admitted to the department of hematology and oncology in Hotel Dieu de France University Hospital Beirut, were included in our study. Patients in different stages of evolution, including the palliative care, were interviewed
Results: Preliminary results of the study showed that the majority of patients evaluated positively the role of the family and volunteers on their quality of life. Females, married persons, patients at extreme ages (18–25 years old and >60 years old), and patients having more than one sibling highlighted the positive impact of the familial support on their disease evolution. Singles and patients having one sibling or less considered that volunteers support was primordial to face their illness. Detailed results are still under process
Conclusions: Social and moral support provided by families and volunteers are integrant part of the supportive care and have a direct influence on the quality of life of oncologic patients.
MASCC-0554
Changes of functional status and quality of life in Limb Salvage surgery for lower limb bone tumors
S. Madhavan Sasidharan 1, V. Srinivasan1, N. Kathiresan2, V. Surendran3
1Physiotherapy, Cancer Institute (WIA), Chennai, India, 2Surgical Oncology, Cancer Institute (WIA), Chennai, India, 3Psycho-Oncology, Cancer Institute (WIA), Chennai, India
Introduction: Medical advancements in the management of bone tumors have markedly improved the morbidity following Limb Salvage surgery (LSS)
Objectives: The Purpose of the study were to (1) Evaluate the Quality of Life (QOL) at 6 months post surgery, (2) Explore the 1 year changes of QOL and (3) Identify the Correlation between QOL and Functional Status among patients with primary bone tumors of lower limb treated with LSS
Methods: Disease Free Status Patients who underwent LSS (n = 96) age range between 18 and 53, diagnosed with osteosarcoma (81.3 %) and other bone tumors (18.7 %); reconstructed with prostheses were assessed for QOL and functional status using Cancer Institute QOL Questionnaire1 and Musculo Skeletal Tumor Society (MSTS) scale2 at 6 months. A follow up assessment was taken between 12 and 15 months (n = 85). Descriptive statistics and paired ‘t’ test were used for analysis
Results: At 6 months, 50 % of the patients had average QOL, 41.7 % reported as high, 4.2 % as very high and 4.2 % as low. There is a significant improvement in the QOL and functional status between the two assessments of QOL, General Well Being, Physical Well Being, Cognitive well Being, Body image and MSTS Score. However, Psychological wellbeing had decreased significantly at the follow-up assessment
Conclusions: Though majority of patients report better QOL, future studies can compare subjective report of QOL and objective physical assessments over different time periods following surgery
References:
1. Vidhubala.E., et al., Indian Journal of Cancer, 2005.
2. Enneking WF., et al., Clin Orthop Relat Res.1993.
MASCC-0555
Viscum Album [L.] extract therapy versus no antineoplastic therapy in patients with locally advanced or metastatic pancreatic cancer: a randomized confirmatory clinical trial (ISRCTN 70760582)
W. Tröger 1, M. Reif2, D. Galun3, A. Schumann2, N. Stankovic4, M. Milicevic5
1Med. Writing, Clinical Research Dr. Tröger, Freiburg, Germany, 2Statistics, Institute for Clinical Research, Berlin, Germany, 3HBP Surgical Department, First Surgical Clinic of the Clinical Centre of Serbia (CCS), Belgrade, Serbia, 4Monitoring, Clinicobss, Belgrade, Serbia, 5Belgrade School of Medicine, University of Belgrade, Belgrade, Serbia
Introduction: The prognosis of advanced pancreatic cancer is devastating. Viscum album extract (VaL) has cytotoxic and immunomodulating properties and is licensed in Central Europe for cancer treatment
Objectives: To compare overall survival (OS) and quality of life (QoL) of patients with locally advanced or metastatic adenocarcinoma of the pancreas receiving VaL or no antineoplastic therapy
Methods: In an open-label, group-sequential, randomized controlled trial patients, ineligible for Gemcitabine or other therapies, were stratified for good/poor prognosis—a composite index of age, UICC and ECOG—and received best supportive care alone or additional s.c.-injections of VaL (Iscador® Qu special) up to 10 mg thrice weekly. Primary endpoint was OS. Secondary efficacy parameters were the dimensions of the EORTC QLQ-C30. Tumour-related symptoms and body weight were recorded at each visit
Results: This first interim analysis examined 110 control and 110 VaL patients (mean age 63.3 years, 128 male patients, 99 UICC-IV, 108 ECOG ≥ 2). Median OS of VaL versus control was 4.8 vs. 2.7 months (HRadjusted = 0.485; p < 0.0001). For 13 of the 15 QoL dimensions a significant advantage of VaL was observed (p < 0.001). Ten dimensions showed a clinically relevant improvement of ≥10 units, from 11.4 (nausea/vomiting) and 23.5 (global health status/QoL) to 43.5 (appetite loss). Analysis of tumour-related symptoms, and change in body weight (post-hoc), confirmed the favourable effects on QoL. No VaL-related adverse events (AE) or serious AE were observed
Conclusions: VaL therapy led to a relevant increase of OS and QoL without causing severe side-effects. VaL may provide comprehensive supportive care for advanced pancreatic cancer patients.
MASCC-0556
Latent trait examination of the patient satisfaction with interpersonal relationship with navigator scale in a multicultural sample: an item response theory analysis approach
C. Shao1, P. Jean-Pierre 1, Y. Cheng1, E. Paskett2, K. Fiscella3
1Psychology, University of Notre Dame, Notre Dame, USA, 2Ohio State University Research Foundation Comprehensive Cancer Center, Ohio State University, Cleveland, USA, 3Family Medicine Research, University of Rochester Medical Center, Rochester, USA
Introduction: Patient Navigation is an important tool to reduce cancer disparities. We previously developed and validated a Patient-Satisfaction-With-Interpersonal-Relationship-With-Navigators (PSN-I) scale using classical test theory Methods.
Objectives: To calibrate items of the PSN-I using item-response-theory-analysis (IRT) and determine item-level psychometric properties to facilitate immediate latent trait scoring
Methods: We applied unidimensional-IRT to data from 751 participants (82.48 % female; age 18 to 86 years) using an unconstrained Graded Response Model (GRM), and a Rasch Model (RM) with the discrimination parameter set to be equal across items. We obtained fit indices and performed models comparison using likelihood ratio (LR)-test and information criteria. We computed item/latent trait parameter estimates, category/operating characteristic curves, and tested information curves for the better-fitting model.
Results: Log-Likelihood for the RM and GRM were −3470.653 and −3445.966. The LR-test (LR = 49.37, df = 8, p < 0.001) supported the GRM. The AIC of the RM vs. GRM were 7015.305 vs. 6981.932, and the BIC were 7186.297 vs. 7189.986, respectively. The very small margin of difference for the BIC across models, large calibration sample, item parameter estimates (IPEs) with substantial variations in items’ discrimination parameters (1.7 to 2.9), and LR-test supported the fit of the GRM. Albeit a slightly larger BIC due to its complexity, the GRM fits better
Conclusions: The GRM provides precise IPEs to enable scores comparison across subsets of items. IPEs can be adopted to estimate patient’s satisfaction with navigators. The findings will inform the development of a PSN-I Computerized Adaptive Testing (CAT) system, where patients will receive optimally selected items to measure their satisfaction level.
MASCC-0557
Meta-analysis of plasma proteins effects on food intake and growth rate, in weanling animals: implications for dietary improvement in clinical involuntary weight loss
G. Klein 1, E.W. Weaver1, R. Kuchibhatla2, A. Shaw3
1R & D, Entera Health, Cary, USA, 2Biostatistics, QED, Cary, USA, 3Clinical Research, Entera Health, Cary, USA
Introduction: Early weaned animals are immunocompromised, exhibiting increased inflammatory markers, (IL-1, IL-6, TNFα, INFγ) with associated decreased food intake, weight loss, and increased mortality. Studies administering PP to these animals report improvements in these conditions. A meta-analysis was undertaken to determine the efficacy of PP on early weaned animals. Cancer patients are also immunocompromised, and may develop cachexia with similar symptoms, including increased mortality.
Objectives: This meta-analysis evaluated plasma proteins’ ability to promote food intake and weight gain in early weaned animals.
Methods: MEDLINE, EMBASE, and PubMed were searched from 1980 through August, 2012 for specific terms and keywords. 57 articles retrieved through this process were included. The meta-analysis included descriptive analyses and Methods for combining p-values for the primary endpoint (Average Daily Growth [ADG] at Week 1) and secondary endpoints ADG, Average Daily Feed Intake [ADFI], and Gain/Feed Ratio [G:F] at Weeks 1, 2, and End-of-Study [EOS])
Results: Primary and secondary endpoint analyses werestatistically significant (p < 0.05) with one exception. ADG, ADFI, and G:F increasedwith PP in all species combined, and in pig studies alone versus control
Conclusions: Plasma proteins produced consistently positive effects across multiple species on increased food intake, body weight, and growth. Additional research in patients experiencing involuntary weight loss with compromised nutritional status will further characterize the benefits of plasma protein in clinical populations.
MASCC-0558
Lymphedema in patients with head and neck cancer
S. ridner 1, J. deng1, B.A. murphy2, A.J. moore2, M.S. dietrich1
1School of Nursing, Vanderbilt University, Nashville, USA, 2School of Medicine, Vanderbilt University, Nashville, USA
Introduction: Little is known about lymphedema in patients with head and neck cancer (HNC).
Objectives: To address gaps in the current state of science related to lymphedema in HNC patients.
Methods: We are undertaking a series of studies related to lymphedema in this population exploring prevalence, symptoms, measurement techniques, and symptom assessment tools. Study 1: A cross-sectional study of HNC patients ≥3 months or more post-treatment. Study 2: Measurement comparison of swelling pre-treatment and 6 and 12 weeks post treatment using CTCAE v.4.02 criteria and digital photography with grid overlay for external swelling and endoscopic examination with use of Patterson Scale for internal swelling. Study 3: Longitudinal study of patterns of internal and external swelling. Study 4: Symptom assessment tool development.
Results: Study 1: (N = 81). 75.3 % had late-effect lymphedema. Of these 9.8 % only had external lymphedema, 39.4 % only had internal lymphedema, and 50.8 % had both types.
Study 2: (N = 25). At baseline, digital photography identified external swelling more often than CTCAE criteria (p = 0.010). Internal swelling was identified in 10 patients at baseline, of whom only 4 had prior surgery. Ultimately, case identification merged among all measures at 6 and 12 weeks post-treatment. Digital photography captured 100 % of the internal cases and 92 % of the cases identified by CTCAE criteria.
Study 3: Data will be presented from those enrolled in the study as of 4-1-2013.
Study 4: (N = 30). 10 symptoms were reported by over 50 % of patients
Conclusions: A majority of HNC patients experience problematic lymphedema. Non-invasive assessment Methods can inform clinical practice.
MASCC-0559
Hepatitis C virus screening prior to chemotherapy
J. Hwang 1, M. Suarez-Almazor1, S. Palla2, D. Huang1, H. Torres3, M. Fisch4, A. Lok5
1General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA, 2Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA, 3Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, USA, 4General Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA, 5Internal Medicine, University of Michigan, Ann Arbor, USA
Introduction: The US Centers for Disease Control recommends hepatitis B virus screening before chemotherapy to prevent reactivation. Hepatitis C virus (HCV) reactivation can also occur during chemotherapy. There are no recommendations on HCV screening prior to chemotherapy.
Objectives: To determine predictors of HCV screening prior to chemotherapy.
Methods: We conducted a retrospective cohort study in adult patients with cancer seen at MD Anderson between 1/2004–4/2011. Screening was defined by HCV antibody test ordered before second chemotherapy cycle. Multivariable logistic regression model was fit for the odds of screening.
Results: Of 16,898 patients, 2,345 (13.9 %) were screened, more frequently in patients born after 1,965 (OR 1.9;1.6–2.2) compared to those born between 1945 and 1965. Screening was less common among black (OR 0.7,0.6–0.9) compared to white patients. Patients with HCV risk factors had significantly higher odds of screening. Screening was more frequent among patients with hematologic malignancies than patients with solid tumors (OR 60.8, 52.7–70.2). Patients who received rituximab had higher odds (OR 16.8, 12.5–22.7) of screening than those receiving chemotherapy. Overall, 1.5 % of those screened had HCV antibody. HCV antibody was positive in a higher percent of black (2.2 %) vs. white (1.6 %) patients and in patients born in 1945–1965 (2.4 %) vs. after 1965 (0.7 %).
Conclusions: Approximately 14 % of patients had HCV screening prior to chemotherapy. Current screening strategies failed to target patients who were more likely to test positive. Future work is necessary to determine the incidence of HCV reactivation and the need for HCV screening prior to chemotherapy.
MASCC-0560
Adiponectin: a novel biomarker for cancer related fatigue?
D. Barton 1, H. Liu2, A. Tan2, J. Sloan2, S.R. Dakhil3, C.L. Loprinzi1
1Cancer Center, Mayo Clinic, Rochester, USA, 2Biostatistics, Mayo Clinic, Rochester, USA, 3Oncology, Wichita Community Clinical Oncology Program, Wichita, USA
Introduction: Fatigue is a prevalent and bothersome symptom experienced by cancer survivors. There are no known fully effective treatments, likely due to incomplete knowledge of critical physiologic targets. Adiponectin, a protein secreted by adipocytes, has a role in energy, inflammation, and the metabolism of glucose and lipids. Based on its function, we evaluated adiponectin’s association with cancer related fatigue (CRF).
Objectives: To evaluate the role of adiponectin in CRF.
Methods: EDTA blood was collected as part of Alliance N07C2, a phase III randomized controlled trial evaluating American Ginseng for CRF. Participants in this correlative study were not concurrently receiving anti-cancer therapy and had to have at least moderate fatigue (4+ on 0–10 scale). Fatigue was measured with the Multidimensional Fatigue Symptom Inventory-Short Form, General Fatigue Subscale and both adiponectin (analyzed by radioimmunoassay, ng/ml) and fatigue were measured before and after 4 weeks of ginseng/placebo. Exploratory descriptive and spearman correlational analyses were done.
Results: One hundred seventy-three participants contributed blood. At baseline and 4 weeks, adiponectin concentrations were significantly correlated with fatigue, r = 0.25, p.006, r = .23, p = .02, respectively. In the ginseng arm (N = 75), those reporting at least a 10 % fatigue improvement had a mean increase in adiponectin (904 units), versus a mean decrease (274 units), in those reporting no improvement (p = 0.12). In multivariate analysis, controlling for several variables including BMI and exercise, adiponectin significantly predicted baseline fatigue (p = .03).
Conclusions: These exploratory data provide support for the hypothesis that adiponectin levels may be an important biomarker/target for fatigue. Future longitudinal studies should clarify its role, be it energy balance or anti-inflammatory.
MASCC-0561
Distress experience in women with newly diagnosed breast cancer
A. Nirenberg 1, L. Almond1, A. Swistel2
1Hunter-Bellevue School of Nursing, Hunter College, New York, USA
2Breast Surgery Center, Weill-Cornell Medical College, New York, USA
Introduction: We have observed that patients with solid tumors who have positive biopsies awaiting definitive surgery for staging and grading appear to be anxious and stressed during this time, not knowing the extent of disease or what further treatment regimen will be
Objectives: In order to begin to characterize time course, range and acute consequences of distress and anxiety in women in early phases of breast cancer care we aim to explore, describe, examine relationships of distress during the time interval between a biopsy-proven diagnosis of breast cancer and definitive surgery.
Methods: This descriptive pilot study uses prospective, repeated measures design to examine changes in self-reported distress and anxiety in women with newly-diagnosed breast cancer awaiting definitive breast cancer surgery. We obtain demographic information and satisfaction with social support. On day of enrollment and at timed intervals within this time frame, the Distress Thermometer (DT) and Hospital Anxiety Depression Scale (HADS) are administered
Results: Relationships of variables relevant to psychological distress between timed responses for each subject, differences by HADS and DT scale cut-off scores and problem categories with each of the dependent variables across time are examined. Comments from the participants that inform significant relationships are categorized.
Pathology reports from the definitive surgery are examined to investigate relationships between extent of disease, biomarkers and mitotic indices to investigate instrument score correlations
Conclusions: This study provides preliminary data for a larger study incorporating biologic markers that may influence breast cancer progression. Psychosocial factors may play roles in cancer progression.
MASCC-0562
Can gabapentin improve control of delayed nausea and vomiting (n/v)? A phase III placebo controlled trial, N08C3 (alliance)
D. Barton 1, J.A. Sloan1, P.J. Novonty1, J. Fuloria2, L. Kottschade1, A.P. Lyss3, A.J. Jaslowski4, M.A. Mazurczak5, S.C. Blair6, S.A. Terstriep7, C.L. Loprinzi1
1Cancer Center, Mayo Clinic, Rochester, USA, 2Cancer Center, Ochsner Clinic, New Orleans, USA, 3Cancer Center, Missour Baptist Medical Center, St. Louis, USA, 4Cancer Center, St. Mary’s Hospital Medical Center, Green Bay, USA, 5Cancer Center, Sanford Cancer Center Oncology Clinic, Sioux Falls, USA, 6Cancer Center, Columbus Oncology & Hematology Associates, Columbus, USA, 7Cancer Center, Sanford Medical Center, Fargo, USA
Introduction: Effective treatments for delayed chemotherapy induced nausea and vomiting (CINV) are needed. Pilot data support further evaluation of gabapentin delayed CINV.
Objectives: To evaluate the effectiveness of gabapentin for CINV due to highly emetogenic chemotherapy (HEC).
Methods: Patients receiving HEC were randomized to prophylaxis with 20 mg dexamethasone + 5HT3 receptor antagonist on the day of chemotherapy, followed by dexamethasone with gabapentin 300 mg BID or placebo, first cycle. Gabapentin/placebo began the evening of chemotherapy through day 5. Dexamethasone was 8 mg BID days 2–3, then 4 mg BID day 4. Primary endpoint, complete response (CR), was defined as no emesis, no rescue medication days 2–6, per nausea/vomiting diary. Percent CR were compared between groups by Fisher’s exact test. Secondary outcomes included the FLIE, satisfaction, and side effects.
Results: 430 patients were enrolled. There was no significant difference in CR between gabapentin (47 %) and placebo (41 %) (p = .23). Per the FLIE and diary, there were no differences in nausea days 2–6 between arms. Overall mean nausea, days 2–6, was 1.1 and 1.2 (0–10 scale) for the gabapentin and placebo arms, respectively. Altogether, 17 % of patients reported nausea ≥2.5 during days 2–6. Mean diary nausea satisfaction was 8.3 for gabapentin/dexamethasone and 8.1 for placebo/dexamethasone (p = .33). There were no differences in unwanted side effects.
Conclusions: Overall, gabapentin was well tolerated but does not appear to improve delayed nausea and vomiting significantly over dexamethasone alone. Nausea severity was low for the group as a whole and patients were satisfied with nausea control.
MASCC-0563
The role of the meaning system in the adjustment to cancer
N.F. Uwland1, A. Visser 1, A. Garssen1, G.J. Westerhof2
1Research, Helen Dowling Institute, Bilthoven, Netherlands, 2Department of Psychology Health & Technology, University of Twente, Enschede, Netherlands
Introduction: The meaning system of the person may facilitate or impede his/her adjustment to the experience of cancer.
Objectives: We have investigated if and how spiritual meaning systems (meaning systems that contain elements that relate to the transcendent) facilitate the adjustment to cancer
Methods: Twenty persons took part in semi-structured interviews on their experiences with cancer during the past year. Using a grounded theory approach, information on the interviewees’ meaning system, coping style and well-being was coded. The relationships between these concepts were investigated with a narrative approach.
Results: Four types of meaning system emerged: Omnipresent Transcendent (OT), Accompanying Transcendent (AT), Enclosed Transcendent (ET), and Absent Transcendent (NT). The persons with the OT meaning system seemed to be well-adjusted to the experience of cancer (they described integration of the experience in their lives and a positive outlook). The persons with the AT and NT seemed to be somewhat adjusted, while those with the ET meaning system showed the least adjustment. Interestingly, each type of meaning system appeared to have elements that might impede adjustment to cancer. For example, persons with an OT meaning system who described that they were not able to ascribe Transcendent Meaning to the experience of cancer seemed to have trouble adjusting to it.
Conclusions: Although the persons with a more spiritual meaning system seemed better adjusted to the experience of cancer, having such a meaning system does not guarantee adjustment. Awareness of the pitfalls of each meaning system might help cancer caregivers to facilitate their patient’s adjustment to cancer.
MASCC-0564
Randomized prospective double-blind placebo-controlled trial of celecoxib for radiation-induced oral mucositis
R.V. Lalla 1, L.C. Choquette1, K.F. Curley2, R.J. Dowsett3, R.S. Feinn4, U.P. Hegde5, C.C. Pilbeam6, A.L. Salner7, S.T. Sonis8, D.E. Peterson1
1Oral Medicine, University of Connecticut Health Center, Farmington, USA, 2Clinical Research Center, University of Connecticut Health Center, Farmington, USA, 3Radiation Oncology, University of Connecticut Health Center, Farmington, USA, 4Medical Sciences, Quinnipiac University, Hamden, USA, 5Medical Oncology, University of Connecticut Health Center, Farmington, USA, 6Medicine, University of Connecticut Health Center, Farmington, USA, 7Radiation Oncology, Hartford Hospital, Hartford, USA, 8Oral Medicine, Brigham and Women’s Hospital, Boston, USA
Introduction: Oral mucositis (OM) is a painful complication of radiation therapy (RT) for head and neck (H&N) cancer. OM can compromise nutrition, require opioid analgesics and hospitalization for pain control, and lead to treatment interruptions. Evidence suggests that inflammatory pathways contribute to pathogenesis of OM.
Objectives: To investigate the effect of cyclooxygenase-2 (COX-2) inhibition during RT on severity and morbidity of OM.
Methods: Forty H&N cancer patients were randomized to daily use of 200 mg celecoxib or identical placebo, for the duration of RT. The planned sample size of 20 per arm provided 80 % power to detect a 1 point difference in mean Oral Mucositis Assessment Scale (OMAS) score (range 0–5) at 5,000 cGy RT (primary endpoint), when applying a two-tailed, two-sample t-test at the 5 % level of significance. Clinical OM, normalcy of diet, pain scores and pain medication use were assessed 2–3 times per week by blinded investigators during the 6–7 week period of RT, using validated scales.
Results: Twenty subjects were randomized to each arm. Intent-to-treat analyses demonstrated no significant difference in mean (SD) OMAS scores at 5,000 cGy [celecoxib 1.32 (0.71), placebo 1.27 (0.86), p = 0.83]. In addition, there was no difference between the celecoxib and placebo groups in mean OMAS scores over the period of RT, mean worst pain scores, mean normalcy of diet scores, or mean daily opioid medication use in IV morphine equivalents.
Conclusions: Daily use of a selective COX-2 inhibitor did not reduce severity of radiation-induced OM, pain, dietary compromise or opioid analgesic use.
MASCC-0565
The effect of radiotherapy on the primary deciduos enamel: analyses 𝛍-EDXRF and FT-Raman
E.M. Ferreira 1, H.S. Antunes2, S.T. Uemura1, P.S. Barbosa1, H. Salmon3, A.A. Martin4, L.E. Soares4, G.R. Sant’Anna1
1Odontologia, Universidade Cruzeiro do Sul, São Paulo, Brazil, 2Pesquisa Clínica, Instituto Nacional de Câncer, Rio de Janeiro, Brazil, 3Radioterapia, Clínicas Oncológicas Integradas (COI), Rio de Janeiro, Brazil, 4Laboratório de Espectroscopia Vibracional Biomédica (LEVB), IP&D, São José dos Campos, Brazil
Introduction: Radiation-induced caries is a major complication after the treatment of head and neck cancer patients undergoing radiotherapy. It has a rapid development resulting destruction and tooth loss.
Objectives: Investigate the molecular and compositional structure of primary enamel subjected to radiotherapy.
Methods: Caries free deciduous molars were used and longitudinally sectioned. Teeth were evaluated at two moments: before radiotherapy (1G1) and after (2G1). The irradiation protocol was 54 Gy, 2 Gy/day, 5 days, 6 weeks, the dose was delivered to the teeth buccal surface with a linear accelerator (6 Mv). For evaluation of organic and inorganic of primary enamel components was used two Methods: Fourier transformed spectroscopy (FT-Raman) and by micro energy-dispersive X-ray fluorescence (μ-EDXRF).
Results: The study power test was 0.80. Paired t Student test was used for statistical analysis. The FT-Raman evaluation demonstrated that the relative area of the organic content (2,940/960 cm−1) was 3.83 (1G1) and 3.42 (2G1), p = 0.000; carbonate (1,070/960 cm−1), 1.26 (1G1) and 1.23 (2G1), p = 0.220, phosphate (430/960 cm−1), 1.02 (1G1) and 1.01 (2G1), p = 0.661. Using μ-EDXRF analysis, the average of weight percentage of calcium was 26.80 (1G1) and 28.44 (2G1), p = 0.438; phosphorus, 15.54 (1G1) and 16.03 (2G1), p = 0.411, oxygen, 57.68 (1G1) and 55.52 (2G1), p = 0.318 and the Ca/P ratio, 1.71 (1G1) and 1.77 (2G1), p = 0.115.
Conclusions: The primary enamel after radiotherapy showed a significant reduction of the organic content however, there was no change in mineral structure, showing that the enamel structure can not interfere directly as a determinant risk factor for the development of radiation caries, which warrants further studies.
MASCC-0566
Associations between medications and hyposalivation among hematopoietic stem cell transplantation (HSCT) recipients
M. Mauramo 1, L. Rohde2, T. Waltimo2, A. Rovo3
1Department of Oral and Maxillofacial Diseases, Institute of Dentistry, University of Helsinki, Finland, 2School of Dental Medicine, Institute of Preventive Dentistry and Oral Microbiology, University of Basel, Switzerland, 3University Hospital Basel, Division of Hematology, Basel, Switzerland
Introduction: We have shown hyposalivation and subjective oral dryness to be common in HSCT recipients.1,2 Oral dryness predisposes recipients to oral diseases and correlates with poor quality of life. Thus, studies focusing on the etiology of hyposalivation are needed.
Objectives: Medications are a common cause of hyposalivation. As a large variety of medications are required in HSCT, this study examines the associations of medications with saliva flow rates in HSCT recipients.
Methods: One hundred forty allogeneic HSCT recipients where included in this prospective follow-up study. The whole saliva flow rates were measured and the medications prescribed for the recipients were recorded at 0, 6 and 12 months post-HSCT. The associations of different medication groups and the quantity of medications taken by an individual with saliva flow rates were statistically analyzed
Results: None of the studied groups of medications including glucocorticoides, cytostatics, antibodies, immunophilines, antidepressants, anxiolytics and other medications were associated with saliva flow rates. In addition, only a weak, non-significant tendency towards low saliva low rates by an increasing number of medications was observed
Conclusions: Hyposalivation in HSCT recipients is independent of the medications used.
References:
1. Laaksonen M, Ramseier AM, Rovo A, Jensen SB, Raber-Durlacher JE, Zitzmann NU, et al. Longitudinal assessment of hematopoietic stem cell transplantation and hyposalivation. J Dent Res. 2011;90:1177–82.
2. Daikeler T, Mauramo M, Rovó A, Stern M, Halter J, Buser A, et al. Sicca symptoms and its impact on quality of life (QoL) among very long-term survivors after hematopoietic stem cell transplantation (HSCT) in comparison with their respective sibling donors. Bone Marrow Transplant. In press.
MASCC-0567
Relationship between intestinal mucositis, neutropenia and bacteraemia among hematopoietic stem cell transplant recipients
A.H.E. Herbers 1, A.F.J. De Haan2, W.J.F.M. Van de Velden1, J.P. Donnely1, N.M.A. Blijlevens1
1Haematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands, 2Department of Epidemiology Biostatistics and HTA, Nijmegen Institute for Infection Inflammation and Immunity (N4i), Nijmegen, Netherlands
Introduction: Since the 1960s infectious complications have been regarded as the main cause of fever during neutropenia following haematopoietic stem cell transplantation (HSCT). More recently, it has been recognised that mucositis is an important determinant of inflammatory and infectious complications.
Objectives: The objective of this prospective study was to compare the impact of intestinal mucositis as measured by citrulline levels, and neutropenia on the systemic inflammatory response and the occurrence of bacteraemia among patients who received either a myeloablative or a non-myeloablative regimen.
Methods: The course of neutropenia, citrulline, axillary temperature, C-reactive protein and the occurrence of bacteraemia were intensively studied in a cohort of 37 HSCT recipients. Eighteen patients received an autologous HSCT after preparation with the myeloablative regimen high-dose melphalan and 19 patients were given an allogeneic HSCT following the non-myeloablative regimen fludarabine and cyclophosphamide. Blood cultures were obtained (almost) daily.
Results: The myeloablative regimen induced severe intestinal mucositis manifest by citrullinaemia <10 μmol/L accompanied by an inflammatory response. Bacteraemia affected 8 (44 %) of 18 patients and coincided with the nadir of citrullinaemia. By contrast, those who had been treated with the non-myeloablative regimen did not develop severe intestinal mucositis, had a moderate inflammatory response and only 2 (11 %) of the 19 patients developed bacteraemia. Though both groups experienced profound neutropenia, its duration was significantly longer for those receiving the non-myeloablative regimen.
Conclusions: This study shows that severe intestinal mucositis (citrullinaemia <10 μmol/L) defines the period of risk of bacteraemia better than does neutropenia. Measuring citrulline may prove useful in deciding who needs empirical antimicrobial therapy and when.
MASCC-0568
Cost-effectiveness of low-level laser therapy (LLLT) in head and neck cancer patients submitted to concurrent chemoradiation
H.S. Antunes 1, D. Herchenhorn2, I. Small1, C. Araujo3, E. Cabral4, M. Rampini1, P. Rodrigues5, T. Silva4, E. Ferreira6, F. Dias7, N. Teich8, V. Teich9, L. Schluckebier1, C. Ferreira1
1Coordination of Clinical Research, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil, 2Clinical Oncology Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil, 3Radiotherapy Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil, 4Nursing Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil, 5Therapy and Technology Development Section, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil, 6Oral Medicine, Clínicas Oncológica Integradas (COI), Rio de Janeiro, Brazil, 7Head and Neck Surgery Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil, 8Education and Research Institute, Clínicas Oncológica Integradas (COI), Rio de Janeiro, Brazil, 9Decisions in Health Care, Medinsight, São Paulo, Brazil
Introduction: Oral mucositis is a main factor for increasing treatment costs in head and neck squamous cell carcinoma (HNSCC) patients treated with chemoradiation (CRT)
Objectives: This study was designed to estimate the cost-effectiveness of LLLT to prevent oral mucositis in HNSCC patients submitted to CRT.
Methods: From June 2007 to Dec 2010, 94 patients with HNSCC of nasopharynx, oropharynx and hipopharynx entered a prospective, randomized, double blind, placebo-controlled, phase III trial (47 LLLT (LG) and 47 placebo (PG)). CRT consisted of conventional RT 70.2 Gy (1.8Gy/d, 5 times/week) + concurrent cisplatin 100 mg/m2 every 3 week. The LLLT used daily was a diode InGaAlP (660 nm-100 mW-4 J/cm2). The cost per laser session was US$ 34.00 for the baseline analysis.. Hospitalization rates associated with the treatment of oropharyngeal or oral mucositis were not documented in the study and were estimated according to previously published data.
Results: Under the perspective of the Brazilian public healthcare system (SUS), total costs were higher in PG than LG on opioide use (LG = US$ 29.45; PG = US$143.72, gastrostomy (LG = US$ 41.69; PG = US$107.22) and hospitalization (PG = US$ 63.59). In LG costs were higher with laser therapy (US$ 1.549,50). The total incremental cost associated with the use of LLLT was US$ 1.306,61 per patient. The incremental cost-effectiveness ratio (ICER) was US$ 3.838,16 per case of grade 3–4 mucositis avoided when compared with no treatment.
Conclusions: Our results indicate that laser group had a smaller morbidity during treatment and LLLT is cost-effective when compared to pacebo under a threshold of at least US$ 4,000 per avoided mucositis case.
MASCC-0569
European Union (EU) pharmacovigilance requirements for biologic medicines: considerations for oncologists and hematologists
W. Brugger 1, M. Farouk2, A. Fox3, H. Mellstedt4
1Department of Hematology Oncology & Palliative Care, Schwarzwald-Baar Klinikum Academic Teaching Hospital University of Freiburg, Villingen-Schwenningen, Germany, 2International Development, Amgen Inc., Zug, Switzerland, 3Regulatory Affairs, Amgen Inc., Uxbridge, United Kingdom, 4Department of Oncology-Pathology, Cancer Centre Karolinska/Karolinska Institute/Karolinska University Hospital Solna, Stockholm, Sweden
Introduction: New EU pharmacovigilance requirements for biologic medicines became effective July 2012.
Objectives: To identify key considerations for accurate pharmacovigilance of biologic medicines used by oncologists/hematologists, given requirements of the Pharmacovigilance Directive.
Methods: Directive 2010/84/EU, Regulation (EC) 1235/2010, and guidelines were reviewed.
Results: The new directive requires additional monitoring for biologic medicines (including biosimilars). The legislation requires clear identification of any biologic medicine that may be the cause of a suspected adverse event (AE) and inclusion of brand/trade name and lot number in AE reports. It advises that member states may impose specific obligations on healthcare professionals to ensure that biologic medicines are clearly identified in AE reports. Furthermore, biosimilars will be identified by a black symbol on prescribing information. How these legislated requirements will be communicated to ensure compliance and how they will affect oncology practice is unclear.
Conclusions: Because physicians are the primary AE reporters, requiring prescription of biologic medicines (including biosimilars) by brand/trade name would ensure that the suspected product is known when an AE report becomes necessary. Such a policy would need to be complemented by national policies and practices and backed by member state medical societies to ensure that prescribed biologic medicines are not substituted without oncologist/hematologist consent. Because the primary packaging with lot number is infrequently available when AEs are reported, use of lot numbers may require electronic system changes at the pharmacy level and convenient provider access to this information. Physicians should be encouraged to submit otherwise-complete AE reports using brand names when lot numbers are unavailable.
MASCC-0570
An update on a systematic review of the use of geriatric assessment for older adults in oncology
M. Puts 1, B. Santos1, J. Hardt1, J. Monette2, V. Girre3, E. Springall4, S.M.H. Alibhai5
1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada, 2Division of Geriatric Medicine, Jewish General Hospital, Montreal, Canada, 3Department of Oncology-Hematology, Centre Hospitalier Departemental, La Roche sur Yon, France, 4Gerstein Science Information Centre, University of Toronto, Toronto, Canada, 5Department of Medicine, University Health Network, Toronto, Canada
Introduction: Cancer is a disease that mostly affects older adults. The use of Geriatric Assessment (GA) has been recommended for older adults with cancer.
Objectives: The aims of review: 1) To provide an overview of the use of GA instruments in the oncology setting; 2) To examine feasibility and psychometric properties; 3) To systematically evaluate the effectiveness of GA in predicting/modifying outcomes (impact on treatment decision, toxicity of treatment, mortality and use of care).
Methods: A systematic review of literature published between November 2010 and July 2012. Articles published in 5 databases in English, Dutch, French and German were included.
Results: Thirty-four manuscripts reporting on 33 studies were identified. The quality of most studies was moderate to good. Of all studies, 14 were prospective, 8 cross-sectional, 5 retrospective and 7 others (mostly phase II trials of a new treatment regimen). A GA was shown to be feasible, the time needed to complete ranged between 5 and 120 min, were mostly conducted in the outpatient oncology setting by nurses, and most often included the domains activities of daily living, comorbities, cognitive function, depression, medications, and fall risk assessment. Four studies examined psychometric properties of the GA with satisfactory results and 18 studies examined the predictive ability of the GA and showed that components of the GA predicted treatment toxicity and overall survival
Conclusions: Although the studies showed that GA was feasible and had predictive validity, there has not been a randomized controlled trial showing the effectiveness of the GA in improving outcomes for older adults with cancer.
MASCC-0571
Adherence to antiemetic guidelines for prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in a haematology unit and evaluation of patients’ satisfaction
C. Raynaud 1, N. Chaumard-Billotey1, P. Rey2, J.F. Latour1
1Pharmacy, Centre Léon Bérard, Lyon, France, 2Hematology, Centre Léon Bérard, Lyon, France
Introduction: Nausea and vomiting (N/V) during chemotherapy can have profound clinical consequences. Regional, national and international organizations issue antiemetic guidelines, regularly updated to harmonize antiemetic treatment.
Objectives: The aim of the study was to assess the adherence to regional recommendations for prophylaxis of CINV in a haematology unit. The secondary outcome was the evaluation of patients’ satisfaction.
Methods: We prospectively reviewed the data related to antiemetic prescriptions for all adults haematological patients undergoing chemotherapy over a 3-month period. Patients who received stem cell transplant were excluded. Adherence to guidelines was evaluated. The patient satisfaction was measured by a Satisfaction Questionnaire.
Results: Among 161 prescriptions analysed, adherence rate for antiemetic treatment was 24 %. B cell lymphoma was the most frequent pathology (60 %). The chemotherapy was highly emetogenic (HE) in 42 % and moderately emetogenic (ME) in 55 %.
The use of aprepitant was inappropriate in 58 % of the prescriptions: omission (41 %) or too short-use (17 %). An overuse of serotonin antagonists was demonstrated for prophylaxis of delayed CINV in 8 % of HE chemotherapy and in 14 % of ME chemotherapy.
The satisfaction rate of 47 patients was evaluated. For 62 % of them, management of CINV was excellent (score 10/10).
Conclusions: Compliance to regional antiemetic guidelines is suboptimal. The study highlighted an inappropriate use of aprepitant and serotonin antagonists for prophylaxis of delayed CINV. Nevertheless, patient satisfaction remains high and seems unaffected.
Adherence’s rate could be improved upon by developing practisers’ awareness of these results and integrating a computerised decision-support-therapy.
MASCC-0572
Evaluation of clinical pharmacists’ follow-up service in an oncology pain clinic
N. Ryan 1, C. Chambers1, C. Ralph1, D. England1, F. Cusano1
1Pharmacy, Tom Baker Cancer Centre, Calgary, Canada
Introduction: Patients who present with pain in an oncology setting are often complex and require a multidisciplinary approach for symptom control. The Pain and Symptom Control Clinic at Tom Baker Cancer Center includes two pharmacists who participate in weekly multidisciplinary clinics and provide a follow-up service to patients.
Objectives: This study will assess the impact of the pharmacists’ follow-up service with respect to activities performed as well as patient and health care professional satisfaction. The activities performed will also be compared to defined objectives for pharmacy practice in a hospital setting.
Methods: Activities performed by the pharmacists over a ten-week period were recorded and tabulated. Online surveys were completed by health care professionals and telephone surveys were completed by patients one-month post clinic visit
Results: Over 6 weeks, 44 patients assessed in clinic required follow-up from a pharmacist. There was an average of 2.3 interactions per patient and an average time of 85 min was spent on each patient outside of clinic. The three activities that occurred most frequently included: (1) interacting with other health care professionals, (2) making alterations to patients’ medication regimens, and (3) organizing refills. All health care professionals surveyed felt that the pharmacists’ follow-up service was a valuable component of the Pain and Symptom Control Clinic and nearly all patients surveyed reported a positive experience with the service received
Conclusions: The inclusion of pharmacists in the Pain & Symptom Control Clinic is favoured by patients and health care professionals and provides increased efficiency to the clinic.
References: Published in: JOPP (Online 09/27/12)
MASCC-0573
Chemotherapy induces fatigue and increases TNF- a in breast cancer patients
F.M. Cruz 1, B. Munhoz1, T.G. Lerner1, A. Del Giglio1, A. Del Giglio1
1Clinical Oncologist, ABC Foundation School of Medicine, Santo André, Brazil
Introduction: Chemoterapy induced fatigue (CRF) is a common complain and few studies assessed so far the role of inflammatory biomarkers as predictors of CRF
Objectives: The primary objective of our study is to evaluate potential biomarkers of CRF in breast cancer (BC) patients receiving adjuvant Chemotherapy (CHT).
Methods: Thirty-seven localized BC patients (clinical stages I–III) consecutively treated at the oncology service of Faculdade de Medicina da Fundação ABC were enrolled in this study. All patients received doxorubicin and cyclophosphamide based chemotherapy. Before the beginning of chemotherapy and before the second cycle, all patients answered the BFI (Brief Fatigue Inventory) questionnaire.
The following inflammatory markers were collected: C-reactive protein (CRP), tumor necrosis Factor alpha (TNF-α) and interleukin 6 (IL-6). We correlated these inflammatory markers with BFI scores of each patient before and after cycle 1 and cycle 2 of chemotherapy
Results: The mean values of the inflammatory markers were: CRP 4.58 mg/dL (IC 95 % 3.17–5.90), TNF-α 11 mg/dL (IC 95 % 8.84–13.79) and IL-6 3.74 (IC 95 % 1.93–5.54). We observed a positive correlation between the BFI scores and TNF-α (p = 0.0201)
Conclusions: TNF-α may represent a potential CRF biomarker. Future studies may elucidate the potential usefulness of TNF-α for monitoring the anti-fatigue effects of new drugs for the treatment of CRF
References:
Bennett B, Goldstein D, Lloyd A, Davenport T, Hickie I. Fatigue and psychological distress—exploring the relationship in women treated for breast cancer. European Journal Cancer. 2004; 40 (11): 1689–1695
Iop A, et. al.. Fatigue in cancer patients receiving chemotherapy: an analysis of published studies. Ann Oncol. 2004; 15 (5): 712–720.
MASCC-0574
Predictors of overall survival following an opioid rotation (OR) in cancer patients presenting to an outpatient supportive care center (SCC)
A. Reddy 1, S. Yennurajalingam1, K. Pulivarthi1, S. Palla2, X. Wang2, J.H. Kwon1, S. Frisbee-Hume1, E. Bruera1
1Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, USA, 2Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, USA
Introduction: Limited data exist on cancer outpatients undergoing OR. We report the analysis of predictors of overall survival following an OR.
Objectives: The aim of this study was to compare patient characteristics and survival of patients with and without follow-up after OR, and survival in patients with successful and unsuccessful OR.
Methods: In an ad-hoc analysis of previously reported data, we reviewed consecutive patients in the SCC in 2008 for OR, demographics, Edmonton Symptom Assessment Scale(ESAS), Memorial Delirium Assessment Scale(MDAS), indications for OR, and outcomes. Successful OR was defined as 2 point or 30 % reduction in ESAS score or resolved opioid-induced neurotoxicity and continuation of new opioid at follow-up.
Results: The Median age was 55 years, 56 %(106/190) male, 72 %(136/190) white, median(Q1-Q3) ECOG performance status(PS) was 2(1–3), most common cancer type was gastrointestinal 24 %(45/190) and 86 %(163/190) had advanced disease. Of 190/938(20 %) patients who underwent OR, 120/190(63 %) had follow-up visit. OR was successful in 79/120(66 %). Follow-up visits occurred more frequently in patients with localized disease 89 %(24/27; P = .0023), history of substance abuse 100 %(12/12; P = .0085), PS ≤ 2, 66 %(97/146; P = .0002), uncontrolled pain 66 %(97/146; P = .036), higher ESAS scores of fatigue(P = .0036), appetite (P = .025) and lower MDAS score(P = .0009). Follow-up after OR(P < .001) and successful OR(P = .012) were predictors of longer overall survival with difference in median survival of 4.3 and 3 months respectively
Conclusions: Patients who followed up after OR are more likely to have localized disease, better PS, history of drug abuse, uncontrolled pain, better MDAS scores and longer overall survival. Successful OR is significant predictor of longer overall survival.
MASCC-0575
The relationship of self-rated health with measures of functional status and mortality: results of a prospective pilot study with older newly-diagnosed cancer patients
M. Puts 1, J. Monette2, V. Girre3, C. Wolfson4, J. Monette5, G. Batist6, H. Bergman7
1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada, 2Division of Geriatric Medicine, Jewish General Hospital, Montreal, Canada, 3Department of Oncology-Hematology, Centre Hospitalier Departemental, La Roche sur Yon, France, 4Research Institute, McGill University Health Centre, Montreal, Canada, 5Solidage Research Group on Frailty and Aging, Jewish General Hospital, Montreal, Canada, 6Segal Cancer Centre, Jewish General Hospital, Montreal, Canada, 7Division of family medicine, McGill University, Montreal, Canada
Introduction: In the general older population, self-rated health (SRH) has been shown to be a strong predictor of functional status but this has less often been studied in older adults with cancer.
Objectives: The aim of this study was to determine the association between SRH and functional status, comorbidity, toxicity of treatment and mortality in older newly diagnosed cancer patients.
Methods: Patients aged 65 and over, newly diagnosed with cancer recruited at the Jewish General Hospital, Montreal. SRH and functional status were evaluated prior to treatment, and at 3, 6 and 12 months. Functional status (Instrumental Activities of Daily Living (IADL), Basic Activities of Daily Living (ADL), ECOG Performance Status (ECOG PS) and frailty markers (low grip strength, mobility impairment, physical inactivity, cognitive impairment, mood impairment, and poor nutritional status). Treatment toxicity and mortality data were abstracted from the chart. Chi-square tests and t-tests were used to compare patients who rated their SHR as fair/poor/very poor to those very good/good with regard to functional status, frailty, and comorbidity. Logistic and Cox regression were used to examine the association between baseline SRH and treatment toxicity/time to death.
Results: There were 112 participants, median age 74.1. At baseline, 74 (66.1 %) had a good SRH and 38 (33.9 %) had poor SRH and those had more comorbidities, more frailty markers present, lower ECOG PS and IADL impairments. We found no association between SRH and toxicity or mortality.
Conclusions: There was a moderate correlation between SRH and the number of frailty markers, IADL disability and comorbidities but SRH did not predict outcomes.
MASCC-0576
A systematic review of factors influencing older adults’ decision to accept or refuse cancer treatment
M. Puts 1, S. Novak1, D. Howell2, M. Fitch3, M. Krzyzanowska4, N. Leighl4, J. Monette5, D. Wan-Chow-Wah5, E. Springall6, S.M.H. Alibhai7
1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada, 2Oncology Nursing Research, Princess Margaret Hospital, Toronto, Canada, 3Oncology Nursing, Odette Cancer Centre, Toronto, Canada, 4Medical Oncology, Princess Margaret Hospital, Toronto, Canada, 5Division of Geriatric Medicine, Jewish General Hospital, Montreal, Canada, 6Gerstein Science Information Centre, University of Toronto, Toronto, Canada, 7Department of Medicine, University Health Network, Toronto, Canada
Introduction: Cancer is a disease that mostly affects older adults. The treatment decision for older adults may be complicated as older adults often have significant comorbidities which impact on life expectancy as well as treatment tolerability.
Objectives: The primary objective of this systematic review is to synthesize all studies which identify the factors influencing older adults’ decisions to accept or refuse the cancer treatment proposed by their physician across studies.
Methods: Two independent reviewers are reviewing eligible studies. Inclusion criteria: Publications reporting on factors influencing the cancer treatment decision of older patients aged 65 and over diagnosed with cancer (any type of study both qualitative and quantitative) published in English, French, Dutch or German and the search used key words/mesh terms such as decision making, patient decision making, treatment refusal, treatment preferences AND neoplasms/cancer AND Aged, 65 and over. Databases searched include Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), Allied and Complementary Medicine (AMED), Psych INFO, Ageline, Sociological Abstracts, Web of Science, Applied Social Sciences Index and Abstracts (ASSIA) databases. We will use the Mixed Methods Appraisal Tool to score the quality of all included studies.
Results: The 2 reviewers are currently reviewing the abstracts and will follow with reviewing full text citations and data abstraction. The number of abstracts under consideration is significant in volume (over 15,000). The results will be forthcoming.
Conclusions: The review is in proces and results will be presented at the conference.
MASCC-0577
The development of a questionnaire to measure reasons for accepting or refusing cancer treatments by older adults with cancer in Ontario
M. Puts 1, S. Novak1, M. Fitch2, A. Tourangeau1, M. Krzyzanowska3, N. Leighl3, S.M.H. Alibhai3
1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada, 2Oncology Nursing, Odette Cancer Centre, Toronto, Canada, 3Department of Medical Oncology, Princess Margaret Hospital, Toronto, Canada
Introduction: Cancer is a significant health problem in older persons. Little is known concerning which factors influence the acceptance or refusal of treatment. Currently, there is no instrument available to measure reasons for accepting or refusing cancer treatment.
Objectives: The aim of this study is to generate a framework which delineates the factors that are important for accepting or refusing cancer treatment by older adults undergoing chemotherapy and/or radiation therapy. In subsequent steps we will develop and test a new instrument measuring reasons for accepting or refusing cancer treatments in older adults with cancer.
Methods: In the first phase of the project in-depth interviews are conducted with older adults undergoing chemotherapy and/or radiation therapy recently diagnosed with breast, lung, colorectal or prostate cancer to generate possible items for the instrument. The data is analyzed using content analysis.
Results: So far 10 participants have been included, 9 who have accepted treatment recommended and one that has refused partial cancer treatment. Older adults find the ease of treatment, expected risks and benefits, and anticipated side-effects important in making the treatment decision. Patients interviewed to this point have perceived the guidance of their primary care physician and/or oncologist as the most crucial factor in accepting or declining treatment. If the patient had an established trusting and respectful relationship with a health care provider, typically the patient would choose to accept the suggested treatment.
Conclusions: The project is ongoing and final results will be presented at the conference.
MASCC-0578
A systematic review of factors influencing treatment adherence in older adults with cancer
M. Puts 1, H.A. Tu1, A. Tourangeau1, D. Howell2, M. Fitch3, E. Springall4, S.M.H. Alibhai5
1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada, 2Oncology Nursing Research, Princess Margaret Hospital, Toronto, Canada, 3Oncology Nursing, Odette Cancer Centre, Toronto, Canada, 4Gerstein Science Information Centre, University of Toronto, Toronto, Canada, 5Department of Medicine, University Health Network, Toronto, Canada
Introduction: Cancer is a disease that mostly affects older adults. Treatment adherence is defined by the World Health Organization (WHO) (2003) as “the extent to which a person’s behaviour- taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendation from a health care provider”. Cancer treatment adherence is crucial in order to obtain optimal health outcomes such as cure or improvement of quality of life.
Objectives: The objective of this systematic review is to synthesize all studies with regard to the following research question: What factors influence adherence to cancer treatment in older adults diagnosed with cancer?
Methods: Two independent reviewers are reviewing eligible studies published in English, French, Dutch or German currently and the search used key words/mesh terms such as medication adherence, guideline adherence, compliance, treatment preferences, medication management, and perceptions of medication AND neoplasms/cancer AND Aged, 65 and over, elderly, older adult. Databases searched include Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), Allied and Complementary Medicine (AMED), Psych INFO, Ageline, Sociological Abstracts, Web of Science, Applied Social Sciences Index and Abstracts (ASSIA) databases. We will use the Mixed Methods Appraisal Tool to score the quality of all included studies
Results: Two reviewers are reviewing the abstracts and this will be followed by full text citations and data abstraction. The number of abstracts to review is significant (over 15,000).
Conclusions: The review is in process and the results will be presented at the conference.
MASCC-0579
FATIGUE IN LOW RISK FEBRILE NEUTROPENIA (FN) TREATED AS OUTPATIENTS (OPS)
C.P. Escalante 1, J.T. Patlan1, E. Manzullo1, X. Wang2, S. Gao1, M.B. Row3, X.S. Wang4, P.K. Morrow5, M.N. Richardson1, R. Abisaid Baker1, S.J. Yeung3
1General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, USA, 2Biostatistics, University of Texas MD Anderson Cancer Center, Houston, USA, 3Emergency Medicine, University of Texas MD Anderson Cancer Center, Houston, USA, 4Symptom Research, University of Texas MD Anderson Cancer Center, Houston, USA, 5Hematology/Oncology Therapeutic Area, Amgen, Thousand Oaks, USA
Introduction: OP management of FN in low risk cancer patients is standard of care. Frequently, these patients complain of fatigue.
Objectives: To describe patient population and determine whether fatigue improves as patients are treated for FN as OPs.
Methods: Low risk cancer patients enrolled in our OP FN pathway were eligible for the study if Brief Fatigue Inventory (BFI) question #3 was ≥4 at pathway d#1. Patients were enrolled on d#2 of the pathway and completed the BFI on d# 2, 3 and 7. Demographic and diagnostic information was collected.
Results: Sixty-eight patients were enrolled. 38 (56 %) were females with mean age 52 years (18–80). 37 (54 %) had sarcoma and 67 (98 %) were on chemotherapy with a mean maximum temperature of 38.8oC, mean absolute neutrophil count of 0.18 k/ul (0–0.98), mean Hgb of 9.9 g/dl at d#1 and mean Hgb of 10.4 g/dl at d#7. 20 (29 %) patients required transfusion. Mean duration of antibiotic treatment was 9 days and 54 (79 %) had resolution of symptoms on initial antibiotics. 11 (16 %) were admitted to the hospital. The mean score on question #3 of the BFI at d#1 was 7.3 (SD = 1.9). The mean BFI score on d#2 was 5.2 (SD = 2.0) and 2.7 (SD = 2.3) on d#7 (p < 0.0001).
Conclusions: Patients with FN had significant improvement in fatigue as they were treated over 1 week. There are likely multiple factors contributing. This is the first report correlating the NF trajectory and fatigue in cancer patients.
MASCC-0580
Getting your life back after cancer: findings from a feasibility study of life coaching for cancer survivors
R. Wagland 1, D. Fenlon1, R. Tarrant2, A. Richardson3, J. Lee4, I. Van der Venn4
1Faculty of Health Sciences, Macmillan Survivorship Reserch Group, Southampton, United Kingdom, 2Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
3Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom, 4Lylac Coaching, Lylac Coaching, Southampton, United Kingdom
Introduction: Growing evidence demonstrates that life coaching can empower people to manage chronic illness and create sustainable behaviour change. However, little is known about how this might apply in the context of cancer survivorship, where people frequently experience reduced confidence following treatment. We hypothesise that life coaching could provide cancer survivors with a means to regain confidence, enhance quality of life and sustain positive lifestyle behaviour change.
Objectives: To determine the acceptability, feasibility and practicality of conducting research into life coaching for cancer survivors.
Methods: A one group pre-test, post-test feasibility study was conducted, recruiting participants from community organisations. Eligibility criteria included: within 1 year of completion of primary cancer treatment; over 18; no metastases; no mental health problems. One face to face and five telephone sessions were given over 3 months. Outcome measures included quality of life, self-efficacy, coping and goal attainment. Interviews explored the feasibility and acceptability of life coaching and research issues.
Results: Nine women and two men were recruited, representing varying cancer diagnoses. All outcome measures were sensitive to change and indicated positive trends post intervention. Participant interviews indicated that the intervention was well received and had a positive impact. Lessons were learnt about study design, recruitment and acceptability of the intervention type and delivery.
Conclusions: This study showed that cancer survivors are prepared to be recruited into research about life-coaching and shows promise with regard to helping people regain confidence following cancer. It merits further evaluation through conducting an exploratory randomised controlled trial.
MASCC-0581
Phase ii randomized, placebo-controlled trial of phytotherapeutic product Catuama® for breast cancer women undergoing adjuvant radiation therapy
F.M. Cruz 1, D.I.G.C. Cubero1, P.X. Santi1, A.S. Tamashiro1, L.R. Soares1, A. Del Giglio1
1Clinical Oncology, ABC Foundation School of Medicine, Santo André, Brazil
Introduction: Catuama® is a registered phytotherapic that contains 4 brazilian herbs: Trichilia catigua, Ptychopetalum olacoides, Paullinia cupana and Zingiber officinale.
Objectives: Evaluate the Catuama® potential anti-fatigue effects in BC women undergoing adjuvant Radiation Therapy (RxT).
Methods: This is a double blinded, randomized, placebo-controlled, Phase II cross-over trial. Patients with BC with the indication of adjuvant RxT, older than 18 years of age, with ECOG PS 0 or 1, without a history of cardiac, renal, hepatic or psychiatric decompensation, received Catuama® 1 capsule twice daily versus a matching placebo for the first 2 weeks of RxT treatment, followed by a week of wash out, followed by an additional 2 weeks of treatment with crossover of experimental arms. Patients were evaluated on days 1, 15 and 36 with the Brief Fatigue Inventory (BFI), Hospital Anxiety and Depression Scale (HADS), Quality of Life FACIT-F, FACIT-ES questionnaires, and Chalder Fatigue scale.
Results: We enrolled 90 patients with a median age of 53 years (26–80). We saw no statistically significant differences of FACIT ES, FACIT F, HADS, Chalder or BFI scores treated with Catuama® or Placebo when we considered all included patients. When we selected only patients with a BFI score above 30, Catuama® significantly decreased BFI scores as compared to baseline (p < 0.0001). We observed one instance of grade 3 hypermagnesemia in the Catuama® arm and one patient had hyperglicemia grade 3 both in the Catuama® and in the placebo arm. No grade 4 toxicities were seen.
Conclusions: Catuama® may help selected patients who already start RxT with evidence of fatigue.
MASCC-0582
Swallowing problems in head and neck cancer: developing a cognitive behavioural intervention
J. Patterson 1, E. McColl1, V. Deary2
1IHS, Newcastle University, Newcastle upon Tyne, United Kingdom, 2Health Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
Introduction: Chronic swallowing difficulties are a common side effect of advanced head and neck cancer treatment. Much of the evidence for interventions focuses on muscle conditioning exercises.
Objectives: This preliminary study is the first step in developing an intervention which addresses both the biological and psychological processes of dysphagia.
Methods: A speech and language therapist, with intermediate skills in cognitive behavioural therapy(CBT) conducted a small series of structured assessments with head and neck cancer patients with swallowing difficulties following chemoradiotherapy treatment. Data were compiled and analysed in consultation with CBT experts.
Results: Ten patients agreed to an in-depth interview to explore their swallowing problem. Seven patients had a feeding tube in situ. Patients’ goals included increasing oral intake and re-joining social eating situations. All described on-going mouth and throat discomfort. Many experienced choking sensations and food sticking in the throat. A commonly held belief was that swallowing was no longer safe and the throat no longer worked. There was high avoidance of attempting solid foods. Social lives were severely restricted with most patients preferring to eat and drink alone. Points for pschosocial intervention were identified.
Conclusions: We present a structured exploration of the psychosocial impact of a swallowing difficulty. We identified a cycle of symptom and emotional distress which suggests that working on cognitions and behaviours could have an impact on patient’s adjustment and physical functioning. This cognitive behavioural approach could be used alongside traditional swallowing therapy techniques. This forms the basis of our ongoing research.
MASCC-0583
Introduction of l-type calcium antagonists as broad-spectrum antiemetics
N. Darmani 1, S. Chebolu1, T. Alkam1, M. Vaezi1, W. Zhong1
1Basic Medical Sciences, COMP/WUHS, Pomona, USA
Introduction: Neuroransmitter release requires calcium. Diverse channels allow calcium entry into cells. Activation of 5-HT3Rs can increase calcium influx through both 5-HT3Rs and L-type channels. The induced influx can be blocked by both L-type and 5-HT3 antagonists. We predicted the L-type calcium agonist FPL 64176 should induce emesis, and it did. Subsequently we investigated the antiemetic potential of the L-type calcium antagonist nifedipine either alone or in combination with the 5-HT3 antagonist, palonosetron.
Objectives: This study provides evidence for broad-spectrum antiemetic efficacy of nifedipine.
Methods: Agonists of serotonergic 5-HT3 (e.g. 5-HT or 2-Me-5-HT; both at 5 mg/kg)-, tachykinin NK1 (GR73632; 5 mg/kg)-, dopamine D2 (apomorphine or quinpirole; 2 mg/kg)-, cholinergic M1 (McN-A343; 2 mg/kg)-receptors, FPL 64176 (10 mg/kg), or cisplatin (10 mg/kg), were administered in the least shrew to induce vomiting. The antiemetic potential of nifedipine (1–10 mg/kg) was evaluated.
Results: FPL 64176-induced vomiting was suppressed by nifedipine or palonosetron. Combination of their non-effective doses attenuated the vomiting. Nifedipine also attenuated vomiting caused by 2-Me-5-HT, 5-HT, GR73632, apomorphine, quinpirole and McN-A343. By itself nifedipine was ineffective against cisplatin, but potentiated the efficacy of palonosetron
Conclusions: FPL 6417-induced vomiting was suppressed by nifedipine or palonosetron. Their combined non-effective doses reduced the emesis. Similar effects were observed against 2-Me-5-HT. The antiemetic potential of nifedipine extends against vomiting caused by dopamine D2, tachykinin NK1, and cholinergic M1-receptors. Nifedipine was ineffective against cisplatin but a combination of non-effective doses of nifedipine and palonosetron attenuated the vomiting. These findings demonstrate nifedipine possess broad-spectrum antiemetic efficacy.
MASCC-0584
Regional differences in reported febrile neutropenia (FN), adverse events (AES), and serious AES (SAES) in a multinational phase 3 trial
J. Decaestecker 1, A. Cesas2, Y. Hotko3, E. Abella4, M. Mo5, W. Rogowski6
1Gastroenterology, H.-Hartziekenhuis Roeselare-Menen, Roeselare, Belgium, 2Department of Oncology, Klaipeda University Hospital, Klaipeda, Lithuania, 3Department of Oncology, Uzhgorod National University, Uzhgorod, Ukraine, 4Global Development, Amgen Inc., Thousand Oaks, USA, 5Global Biostatistical Science, Amgen Inc., Thousand Oaks, USA, 6Oncology Department, Gdynskie Cancer Center, Gdynia, Poland
Introduction: Regional differences in reported FN and AEs were observed during conduct of a randomized, double-blind, multicenter, placebo-controlled trial to evaluate efficacy of pegfilgrastim (Neulasta®) in reducing FN incidence in patients with locally-advanced or metastatic colorectal cancer (mCRC) receiving first-line treatment with bevacizumab and FOLFOX or FOLFIRI
Objectives: To determine reported incidences of FN, AEs, and SAEs in North America (NA) vs rest of world (ROW)
Methods: Key eligibility criteria: age ≥18 years and measurable, nonresectable CRC (RECIST v1.1). Patients were randomly assigned 1:1 to receive chemotherapy/bevacizumab plus either placebo or 6 mg pegfilgrastim. Study treatment period was four Q2W cycles. Stratification factors: region (NA/ROW), stage (locally-advanced/mCRC), and chemotherapy (FOLFOX/FOLFIRI). Grade 3/4 FN was defined as, within ±1 day, temperature ≥38.0 °C/100.4 °F and absolute neutrophil count (ANC) <1.0 × 109/L or ANC <1.0 × 109/L and sepsis/infection or neutropenia-related hospitalization,
Results: 422 patients received pegfilgrastim; 423 received placebo. The study met its primary endpoint: Pegfilgrastim significantly reduced overall incidence of grade 3/4 FN in the first four chemotherapy cycles (2.4 % vs 5.7 %; P = 0.014). Grade 3/4 FN incidences were higher in NA vs ROW in the placebo (8.9 % [95%CI: 3.6–17.4] vs 4.9 % [2.9–7.8]) and pegfilgrastim groups (5.2 % [1.4–12.8] vs 1.7 % [0.6–3.7]). Similar patterns were seen with AE and SAE incidences (Table).
Conclusions: Regional differences in FN, AE, and SAE reporting may complicate comparisons of trials from different regions. Further exploration is needed to understand causes of regional differences.
NA ( N = 156) | ROW ( N = 689) | |||
Placebo N = 77 | Pegfilgrastim N = 77 | Placebo N = 344 | Pegfilgrastim N = 343 | |
Grade ≥3 AEs, % | 44.2 | 45.5 | 24.7 | 23.3 |
SAEs, % | 22.1 | 23.4 | 11.0 | 14.6 |
MASCC-0585
Actigraphy findings and cancer related fatigue (CRF) in advanced cancer patients treated with methylphenidate (MP) and nursing telephone intervention (NTI)
S. Yennu 1, D. Balachandran2, N.S. Padhye3, J.L. Williams1, S. Frisbee-Hume1, E. Bruera1
1Palliative Care and Rehab Medicine, University of Texas MD Anderson Cancer Center, Houston, USA, 2Pulmonary and Sleep Medicine, University of Texas MD Anderson Cancer Center, Houston, USA, 3Biostatistics, University of Texas Health Sceince Center of Houston, Houston, USA
Introduction: There are limited studies about actigraphic sleep, wakefulness, activity and fatigue and treatment in advanced cancer patients.
Objectives: The objective of this study was to evaluate the changes in the nocturnal sleep/rest, and daytime wake/activity and subjective measures of fatigue before and after treatment with MP+/− NTI.
Methods: An adhoc analysis of previous reported placebo controlled RCT of MP and/or NTI for CRF was conducted. Subjective and objective assessments were analyzed at Day-8 and Day-15 as a result of treatment with MP and/or NTI or their control arms. Actigraphic sleep measures assessed were total sleep time (TST), sleep efficiency, and wake after sleep onset (WASO). Additionally, activity (mean day-time activity), and fatigue (FACIT-F, ESAS-Fatigue item) were included in the multivariate analysis.
Results: A total of 60 (MP = 30, Placebo = 30; NTI = 35; CTI = 25) patients were evaluated. The median age was 56, 62 % were female; most common cancer type was breast 13/60(22 %). The baseline mean FACIT-F subscale, ESAS Fatigue item, TST, WASO, sleep efficiency and day-time activity were 22.4 (9.33), 6.5(1.74), 437(162.4), 139(121.4), 71(16.4), 202(438). Multivariate outcomes at Day-8 showed significant change from baseline (η2 = 0.38, p < 0.001) and interaction effect between MP and NTI (η2 = 0.26, p = 0.015). WASO had an interaction effect (β = −101.4, p = 0.009; Fig. 1), an MP effect (β = 80.4, p = 0.002) and reduction in time (β = −52.1, p = 0.003). FACIT-F and ESAS-Fatigue item showed improvement in time (β = 6.9, p = 0.010; β = −2.4, p < 0.001).
Conclusions: WASO was significantly lower in patients receiving methylphenidate and nursing telephone intervention. Further larger studies are needed to validate these findings.
MASCC-0586
Tamoxifen & antidepressant drug interactions in a cohort of breast cancer survivors cared for in large healthcare delivery systems in California
R. Haque 1, J. Shi1, S.W. Fletcher2, J. Schottinger3, S.A. Ahmed4, T.C. Cheetham5, J. Chung1, C. Avila1, L.A. Habel6, M.L. Kwan6
1Research and Evaluation, Southern California Kaiser Permanente, Pasadena, USA, 2Population Medicine, Harvard Pilgrim Health Care Institute, Boston, USA, 3Internal Medicine, Southern California Kaiser Permanente, Pasadena, USA, 4Genetic Services, Southern California Kaiser Permanente Riverside Medical Center, Riverside, USA, 5Pharmacy Analytical Service, Southern California Kaiser Permanente Downey Medical Center, Downey, USA, 6Division of Research, Northern California Kaiser Permanente, Oakland, USA
Introduction: Controversy exists whether certain antidepressants, such as paroxetine, can reduce tamoxifen’s effectiveness on breast cancer recurrence. However, previous studies were limited by small samples or poor medication measurement.
Objectives: To determine whether taking tamoxifen and antidepressants concomitantly is associated with an increased subsequent breast cancer risk
Methods: We assembled a cohort of 16,887 breast cancer patients (Stage 0–II) from 1996 to 2007, treated with tamoxifen, and followed through 12/31/09. The main independent variables were antidepressant type and percent overlap when both tamoxifen and antidepressants were used. Women were followed through subsequent breast cancer, health plan disenrollment, death or study’s end. Multivariate adjusted hazard ratios (HR) and 95 % confidence intervals (CI) were estimated using Cox models using time-varying medication variables.
Results: Overall, 2,946 women developed subsequent breast cancer during the 14-year study period. Of the 16,887 total women, about half used antidepressants (n = 8,099, Table 1). We observed a small non-significant increased risk of subsequent breast cancer in women who concurrently used paroxetine and tamoxifen in the first year (HR = 1.06, 95 % CI: 0.98–1.14). For every 25 % increase in percent overlap, the risk increased insignificantly by 6 %. However, the risk attenuated with longer tamoxifen duration (Table 2). For the other antidepressants, we found no such trend
Conclusions: Using one of the most complete pharmacy databases of insured patients, we observed a slight increased risk of subsequent breast cancer in women who concurrently used paroxetine in the first year of endocrine therapy. Nevertheless, taking tamoxifen for a longer duration mitigated such risks.
Table 1: Distribution of antidepressant use in the cohort of 16,887 breast cancer patients
Antidepressant | N | % |
Paroxetine only | 481 | 3.0 |
Fluoxetine only | 1032 | 6.0 |
Other SSRIs | 272 | 2.0 |
Tricyclics | 1163 | 7.0 |
Other types | 1259 | 7.0 |
Multiple types | 3892 | 23.0 |
No antidepressants | 8788 | 52.0 |
Table 2: HRs for subsequent breast cancer risk among women who had 25 % days of concominant paroxetine and tamoxifen use by year of endocrine treatment
Adj HR | (95 % CI) | P-value | |
Tam 1 year | 1.06 | (0.99 1.14) | 0.09 |
Tam 2 year | 1.03 | (0.97 1.10) | 0.32 |
Tam 3 year | 1.00 | (0.93 1.09) | 0.95 |
Tam 4 year | 0.97 | (0.87 1.09) | 0.64 |
Tam 5 year | 0.94 | (0.81 1.10) | 0.46 |
MASCC-0587
Distress and quality of life in early stages of cancer diagnosis—are there significant gender differences?
M. bernardo 1, S.R. Ouakinin1, G. Gonçalves1, I. Nabais1, M.J. Costa1
1Hematology-Oncology Unit, hospital CUF infante santo, Lisbon, Portugal
Introduction: Distress seems to be a common psychological reaction to cancer, particularly in early stages of the adaptation process. However, emotional experience and expression, facing disease, can be determined not only by the threat that cancer represents, but also by individual and contextual differences.
Objectives: The aim of our study is the evaluation of distress levels and its relationship with Quality of Life (QoL), according to gender, in a screening of recent diagnosed cancer patients, in a Day Care Hemato/Oncology Unit.
Methods: Patients were enrolled during admission. After informed consent, they completed a basic sociodemographic and medical questionnaire, the Distress Thermometer (Roth et al, 1998), the Brief Symptom Inventory (Derogatis, 1993) and a Quality of Life Questionnaire (QLQ-C30, Aaronson et al, 1993).
Results: Sample included 124 subjects, 61.5 % females. Mean age was 59.1 years; breast (28 %) and colo-rectal (19 %) were the most frequent cancers. Comparing genders, there were significant differences in several BSI and Symptoms Index scales, all higher in women. Differences in Distress (DT) and Global Quality of Life did not reached statistical significance, although QoL was lower in women. Correlation analysis points to a pattern of relationship between global QoL and emotional distress in women and a relationship between age, emotional distress and health related QoL in men, using the sub scale of Global Health/QoL from QLQ-C30.
Conclusions: Emotional distress and QoL are clearly related in all patients, but these results may reflect gender diversity in disease evaluation, as well as in health concerns and expectations.
MASCC-0588
Validity, reliability, responsiveness and measurement equivalence of the English and Chinese versions of the functional assessment of cancer therapy-cognitive (FACT-Cog) in breast cancer patients
Y.T. Cheung 1, S.R. Lim2, Y.L. Foo2, W.K. Chui2, Y.P. Tan3, A. Chan1
1Pharmacy, National University of Singapore/National Cancer Centre Singapore, Singapore, Singapore, 2Pharmacy, National University of Singapore, Singapore, Singapore, 3Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore
Introduction: Subjective neuropsychological tools are often used to evaluate perceived cognitive changes in cancer patients.
Objectives: To examine the psychometric properties and measurement equivalence of the English and Chinese versions of FACT-Cog in breast cancer patients.
Methods: This prospective, longitudinal study involved 330 breast cancer patients (187 English-speaking and 143 Chinese-speaking). Concurrent and convergent validities, reliability and responsiveness of FACT-Cog were determined. Multiple regression analysis was performed to investigate the comparability of the mean scores obtained from both versions after adjusting for clinically-relevant covariates. Equivalence was established if the 95 % confidence interval (CI) of the adjusted mean difference fell within the equivalence margin of ±0.5 standard deviation (SD).
Results: Both the English and Chinese FACT-Cog total scores correlated strongly with the validated EORTC-cognitive functioning scale (r = 0.725 and 0.646, respectively). Convergent validity with fatigue, anxiety and global health status were moderately strong (|r| = 0.376 to 0.589). Internal consistencies within the cognitive domains were high (Cronbach’s α = 0.707 to 0.929), and test-retest reliability was satisfactory (ICC = 0.762 and 0.697). For patients who reported a minimal deterioration in cognitive functioning in the follow-up visit, responsiveness measured by Cohen’s effect size, standardized response mean, and Guyatt’s responsiveness index ranged from −0.58 to −0.72. The 95 % CIs for the adjusted difference between English and Chinese scores fell within the ±0.5 SD margins, except for the multitasking domain.
Conclusions: FACT-Cog is a valid, reliable and responsive instrument for evaluating perceived cognitive changes in breast cancer patients. English and Chinese FACT-Cog results are equivalent and can be pooled for future epidemiological and clinical trials.
MASCC-0589
Oral glutamine and chemotherapy induced mucositis in patients with colon cancer
M.M. Vaslamatzis 1, A. Laskarakis1, N. Alevizopoulos1
1Medical Oncology, “Evaggelismos” General Hospital, Athens, Greece
Introduction: Cancer related glutamine deficit seems to influence patients’ tolerance to chemotherapy due to mucositis.
Objectives: The aim of the study was to investigate whether oral glutamine intake in patients with colon cancer could decrease chemotherapy induced diarrhea and dysphagia, thus preventing weight loss and the need for hospitalization due to dehydration.
Methods: In a prospective study between 10/2011–12/2012, 15 of the patients who were consecutively admitted in our department with colon cancer, exposed to segmental colectomy and treated adjuvantly or for metastatic disease with FOLFOX ± AVASTIN as first line chemotherapy, received 30 gr glutamine per os daily from day one of chemotherapy until the end of treatment period. Hepatic and renal function were assessed before glutamine oral administration.
Results: Patients’ median age, disease stage and weight were 65 years, stage IV and 74 kgrs respectively. All patients were estimated before and after 6 cycles of chemotherapy (3 months of glutamine consumption). During first cycle of chemotherapy, 5 reported dysphagia and we observed 3 episodes of grade II diarrhea and one of grade III, with one patient requiring hospitalization. At the subsequent cycles, no dysphagia and episodes of diarrhea were reported and no patient required hospitalization or lost weight due to chemotherapy induced mucositis. No side effects related to glutamine consumption were reported.
Conclusions: Oral glutamine administration seems to reduce, without side effects, the severity of chemotherapy induced mucositis in patients with colon cancer.
MASCC-0590
Oral and dental supportive care in children with cancer: 13 years experience in the pediatric hemato-oncology center of Rabat
N. Otmani 1, L. Hessissen1, M. Khattab1, F. Msefer Alaoui2
1Hemato-Oncology, Pediatric Hemato-Oncology Center, Rabat, Morocco, 2Association Avenir, Association Avenir, Rabat, Morocco
Introduction: Oral and dental supportive care is an important component in children with cancer. To improve the quality of this care, a dental unit was created at the Pediatric Hematto-Oncology Center CHOP of Rabat in 2000.
Objectives: The aim of this study was to investigate oral and dental supportive care in patients admitted to the CHOP during the past 13 years.
Methods: Medical records of patients seen at the dental unit between January 2000 and December 2012 were retrospectively reviewed. Studied variables were: total number of patients, type of disease, treatment regimen and type of oral care.
Results: Out of the 5,522 newly admitted patients to the CHOP, 3,593 (65.1 %) were referred to the dental unit. Patients with acute leukemia and lymphoma represented more than 64 %. As a consequence, up to 20 580 dental consultations were performed for in- and out-patients, and during pre- and post-cancer treatment. Most dental procedures in patients with tooth decay were fillings (53.9 %) and tooth extraction (35.9 %). Special supportive care was provided during cancer therapy by prevention and/or treatment of mucositis, infection, dysphagia, pain and radiation caries.
Conclusions: Results have shown that integrating dental unit for cancer patients at the CHOP has proven their worth, especially in poor setting countries as Morocco where poor dental hygiene and oral self-care education are needed.
MASCC-0591
Intestinal Lactobacillus spp. increase following radiotherapy in rats: an unusual finding
M. Radzuan1, E. Bateman2, J. Bowen3, A. Wignall2, D. Keefe2, A. Stringer 1
1School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia, 2School of Medicine, University of Adelaide, Adelaide, Australia, 3School of Medical Sciences, University of Adelaide, Adelaide, Australia
Introduction: Mucositis is a common side-effect of radiotherapy. Toll like receptor (TLR)-9 is involved in maintaining immune gut homeostasis and recognizing bacterial DNA, involved in mucositis.
Objectives: To investigate composition of intestinal microbiota and TLR-9 expression following radiotherapy.
Methods: Dark Agouti (DA) rats received 45 Gy (18 fractions of 2.5 Gy), 54 Gy (18 fractions of 3.0 Gy), 68.25 Gy (15 fractions of 3.5 Gy), or 67.2 Gy (12 fractions of 4.0 Gy). Rats were killed at the end of radiotherapy (acute), or 22 weeks post-radiotherapy (chronic). Controls were sham-irradiated. Ileum, and caecum and colon contents were collected. H&E, TLR-9 immunohistochemistry and real-time PCR were completed. Statistical analysis was completed using Kruskal-Wallis and Mann–Whitney U tests (Bonferroni correction applied).
Results: Villous fusion and blunting, and crypt ablation were observed in the ileum (acute and chronic). TLR-9 expression increased significantly in rats receiving 68.25 and 67.2 Gy (p < 0.05). Significant differences in bacterial levels were observed. Bifidobacterium spp. levels decreased significantly (p < 0.05; 67.2 Gy, caecum). Enterococcus spp. levels significantly increased (p < 0.05; 54 and 67.2 Gy, caecum and colon), as did Bacteroides spp. (p < 0.05; 68.25 Gy, colon), and Lactobacillus spp. levels (p < 0.05; 54, 68.25 and 67 Gy, caecum and colon), the latter unexpected.
Conclusions: Intestinal microbiota and TLR-9 are altered following radiotherapy. Of interest is the increase in Lactobacillus spp., a probiotic organism expected to decrease. These results suggest mechanisms affecting host-microbe interactions may be affected by radiotherapy, highlighting the importance of characterizing microbiota if they are to become successful therapeutic targets.
MASCC-0592
Psychosocial care for cancer patients as identified by nurses in the EHR in an acute setting
H. Tseng 1
1College of Nursing, University of Utah, Salt Lake City, USA
Introduction: Psychosocial problems are common in patients throughout the cancer journey.
Objectives: The purpose of this study was to identify the psychosocial care needs of cancer patients as documented by nurses in the electronic health record.
Methods: In this descriptive retrospective study, we included 2,237 patients with cancer admitted on four oncology units in a tertiary hospital over 7 months. Data collection included diagnoses, interventions, and outcomes. Data were retrieved from medical records, the nursing documentation system, and the tumor register.
Results: The sample was primary female(63 %), white(89 %), with a major group undergoing investigation of cancer diagnosis(42 %) in current visit, and a diagnosis of cancer in gynecological site, head and neck (13 %). Psychosocial concerns were rarely documented by nurses in the EHR. The most common psychosocial problem documented was anxiety, but it only occurred in 192 inpatient stays of the 2,237 patient records samples. Other psychosocial problems documented included Coping(53, <1 %), Grief Resolution(49, <1 %), and Dignified Life Closure(18, <1 %). Progress in problem resolution was tracked using a 5-point-Likert scale(105). For Anxiety, patients providing at least two time points of assessment during hospitalizations showed decreased anxiety in 49 %, unchanged in 37 % and 14 % became worse. For Coping concerns(29), 45 % improved, 31 % remained same scores, and 24 % became worse.
Conclusions: Study findings suggest that cancer patients in the inpatient setting rarely have psychosocial needs documented by nurses in the EHR. Future studies should describe current systems for delivering psychosocial care to cancer patients by primary care health providers.
MASCC-0593
Influence of anaemia on clinical symptoms, quality of life and cognitive functions in chemotherapy naive cancer patients
R. Dobrila-Dintinjana 1, D. Petranovic2, A. Nacinovic-Duletic2, D. Petranovic3, M. Dintinjana4
1Radiotherapy and Oncology Clinic, University Hospital Rijeka, Viskovo, Croatia, 2Internal Clinic, University Hospital Rijeka, Rijeka, Croatia, 3Internal Clinic, Private Hospital, Rijeka, Croatia, 4Ambulance, General Practice, Rijeka, Croatia
Introduction: Anaemia, bad Quality of Life (QoL) and cognitive dysfunctions are commonly present in cancer patients (pts). Previous studies mainly evaluated these problems during chemotherapy (CHT) or under influence of eritropoetic agents (EPO).
Objectives: We evaluated influence of anaemia “per se” on QoL, clinical symptoms and especially on cognitive functions in chemotherapy naïve cancer patients and if correction of anaemia could improve this functions.
Methods: Two hundred pts (100 anaemic and 100 without initial anaemia) in very early phase of diagnostic procedure which finally resulted in diagnosis of malignancies were evaluated by FactAn QoL Questionnary and five point scale for subjective clinical symptoms. Cognitive functions have been measured by Complex Reactiometer Drenovac (CRD). Patients without malignant disease presented control group.
All parameters have been measured twice: before and after therapy for anaemia.
Results: When statistically analysed, the effects of gender, age, education and Haemoglobin level showed that Haemoglobin level is the most effective variable on cognition functions analysed by beta weights. Anaemia and cancer have additive negative effect. Correction of anaemia in cancer pts significantly improve QoL and cognitive functions but not in all categories (visual orientation and memory).
Conclusions: Anaemia in cancer pts profoundly affects cognition, psychological well-being and QoL. Correction of anaemia in cancer patients has positive influence on their cognitive functions and QoL.
References:
Holzner B, Kemmler G, Greil P i sur. The impact of hemoglobin levels on fatigue and quality of life in cancer patients. Ann Oncol 2002;13(6):965–73
Meyers CA. Neurocognitive dysfunction in Cancer Patients. Oncology 2000;14(1):75–81.
MASCC-0594
Exploring oncology care in an acute setting: the impact of the use of electronic standardized nursing terminology
H. Tseng 1
1College of Nursing, University of Utah, Salt Lake City, USA
Introduction: We need a simple and intense tool to evaluate patient outcomes for cancer patients in acute settings. As main workforce for cancer patients, nurses are the best resource to evaluate patient outcomes.
Objectives: The study aimed to evaluate patient outcomes documented by nurses using standardized terminology in electronic health records for oncology care.
Methods: In this descriptive retrospective study, we included patients with cancer admitted in four oncology units in a tertiary hospital over 7 months. Data collection included demographics, diagnoses, interventions, and outcomes. Patient outcomes were tracked using a 5-point-Likert scale. Data were retrieved from medical records, and the nursing documentation system.
Results: The sample (2,237) was primary female (63 %) and white (89 %) with a major group undergoing investigation of cancer diagnosis(42 %) in current visit, and a diagnosis of cancer in gynecological site, head and neck (13 %). We found 70 patient outcomes documented in the study. For Pain Level, patients providing at least two time points of assessment during hospitalizations showed decreased pain in 49 %, unchanged in 39 % and 12 % became worse. The health problems differed by unit and length of stay(LOS). Age and LOS are associated with patient outcomes. We also found that patient safety, such as Fall Prevention, was common among the top ten concerns in the study.
Conclusions: The study findings suggest that patient outcomes recognized by nurses for inpatient care setting with the use of electronic standardized terminologies provide a valuable overview of evaluation of patient care for all healthcare providers.
MASCC-0595
Characteristics and length of stay on oncology specialty units
H. Tseng 1
1College of Nursing, University of Utah, Salt Lake City, USA
Introduction: Length of stay has been regards a quality indicator related to cost. Exploring characteristics of oncology patients, and how they being cared in acute care assisted in disclose hidden problems in current acute care for oncology population.
Objectives: The study is to understanding the relationship of characteristics and length of stay in acute oncology care.
Methods: We conducted a retrospective medical records review in a Midwestern tertiary hospital and 2,237 patients were selected from their first records of all oncology admissions from June 1 to December 31, 2010.A descriptive analysis addressed the relationship and characteristics and length of stay in an acute setting during the study period.
Results: Certain characteristics showed longer length of stay, such as, adult leukemia and bone transplant unit, radiotherapy or multiple treatments. Insured patients showed obvious shorter length of stay. In the earlier admission day, patients reported more health concerns related to respiratory problems, and as hospitalization stay, patients tend to have more health problems in Risk for Infection, Nausea, Risk for Falls. Activities, Deficient Knowledge Disease Process, Imbalanced Nutrition: Less than Body Requirements, and Anxiety.
Conclusions: The study findings that patients reported different primary health problems during hospitalization. Insured patients tended to have shorter length of stay; however, the quality of care at discharge for this population discarding financial pressure is questioned. Future studies should examine specific characteristics related to length of stay in an acute oncology setting may lead to interventions that shorten length of stay.
MASCC-0597
Oncology therapy at the end of the life: benefit or harm?
R. Dobrila-Dintinjana 1, A. Redzovic2, J. Peric2
1Radiotherapy and Oncology Clinic, University Hospital Rijeka, Viskovo, Croatia, 2Radiotherapy and Oncology Clinic, University Hospital Rijeka, Rijeka, Croatia
Introduction: The number of patients receiving chemotherapy at the end of their life is increasing. According to ESMO reports from 2005, the proportion of patients starting a chemotherapy regimen within 3 months and 1 month before death was 67 % and 25 %, respectively.
Objectives: We sought to determine the proportion of our admitted patients in terminal phase of ilness who recieved some kind of active oncological therapy.
Methods: We conducted a pilot study on the records of patients who died in the University Hospital. We assessed the percentage of mortality, a therapeutic approach in terms of treating the underlying disease, and access to palliative treatment.
Results: Of 2,097 patients hospitalized in the UHC Rijeka Department of Radiation Therapy and Oncology during 2010 and 2011, 44 pts died which accounts for 2.1 %. Ten (22.7 %) patients were admitted exclusively to receive palliative care, while others (34–77.3 %) were admitted for planned active chemo- and/or radiotherapy administration. Within 3 months before death, 18 (40.9 %) patients underwent chemotherapy treatment
Conclusions: The number of patients hospitalized due to providing palliative care is extremely low, which could indicate a good supply of out-patient treatment of cancer patients in the terminal stage of the disease. However, concerned about the high percentage of patients who tried to provide oncology treatments in the 3 months before his death.
References: Chastek B, Harley CR, Kallich JD, Newcomer LN, Paoli JC Teitelbaum A, J Clin Oncol, 29 (2011).
MASCC-0598
Post-chemotherapy cognitive changes in Asian breast cancer patients: a prospective cohort study
Y.T. Cheung 1, M. Shwe2, Y.C. Kee3, H.K. Ho2, W.K. Chui2, G. Fan4, W.S. Yong5, P. Madhukumar5, W.S. Ooi6, W.Y. Chay6, R.A. Dent7, S.F. Ang6, S.K. Lo6, Y.S. Yap6, R. Ng7, A. Chan1
1Pharmacy, National University of Singapore/National Cancer Centre Singapore, Singapore, Singapore, 2Pharmacy, National University of Singapore, Singapore, Singapore, 3Pharmacy, National Cancer Centre Singapore, Singapore, Singapore, 4Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore, 5Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore, 6Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore, 7Medical Oncology, National Cancer Centre Singapore/Duke-NUS Graduate Medical School, Singapore, Singapore
Introduction: Emerging evidence shows that Asian breast cancer patients suffer post-chemotherapy cognitive impairment.
Objectives: To evaluate the prevalence, severity and psychosocial determinants of post-chemotherapy cognitive changes in Asian breast cancer patients.
Methods: This is a prospective, cohort study conducted at the largest cancer center in Singapore. Early-stage Asian breast cancer patients receiving anthracycline and/or taxane-based chemotherapy were recruited. A computerized neuropsychological assessment (Headminder®) was administered to evaluate patients’ cognitive performances prior to chemotherapy (T1) and at end of chemotherapy (T2). Changes of the Headminder® scores were calculated by the reliable change index(RCI) for repeated cognitive measurements. Fatigue and anxiety were measured by the Brief Fatigue Inventory and Beck Anxiety Inventory, respectively.
Results: Seventy-nine patients were recruited (mean age 49.7 ± 8.5 years; 72.2 % Chinese; 50.6 % post-menopausal). Impairments in attention and response speed were the most prevalent (Table 1). Overall, 48.4 % of patients experienced impairments in 2 or more cognitive domains. Hogher degree of anxiety was associated with poorer response speed performance (r = −0.230, p = 0.030), and more severe fatigue was associated with poorer attention span (r = −0.201, p = 0.061).
Table 1: Proportion of patients with cognitive impairment on Headminder® from T1 to T2 (n = 79)
Memory | Attention | Response speed | Processing speed | |
Mild impairment (%) 1 | 19.0 | 21.5 | 22.8 | 19.0 |
Severe impairment (%) 2 | 13.9 | 17.7 | 16.5 | 13.9 |
Total (%) | 32.9 | 39.2 | 39.3 | 32.9 |
1,2 Defined as a RCI of −1.5 to −2.5, and lower than −2.5, respectively
Conclusions: Half of Asian breast cancer patients experience more than one domain of post-chemotherapy cognitive changes. Fatigue and anxiety are determinants of cognitive deterioration.
MASCC-0599
Fatigue and anxiety-related dimensions in early-stage breast cancer patients: a prospective cohort study
Y.T. Cheung 1, Y.C. Kee2, M. Shwe3, W.K. Chui3, G. Fan4, W.S. Yong5, P. Madhukumar5, W.S. Ooi6, W.Y. Chay6, R.A. Dent7, S.F. Ang6, S.K. Lo6, Y.S. Yap6, R. Ng7, A. Chan1
1Pharmacy, National University of Singapore/National Cancer Centre Singapore, Singapore, Singapore, 2Pharmacy, National Cancer Centre Singapore, Singapore, Singapore, 3Pharmacy, National University of Singapore, Singapore, Singapore, 4Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore, 5Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore, 6Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore, 7Medical Oncology, National Cancer Centre Singapore/Duke-NUS Graduate Medical School, Singapore, Singapore
Introduction: Early-stage breast cancer patients (ESBC) commonly experience anxiety and fatigue from chemotherapy treatment. However, the correlation between fatigue and anxiety-related dimensions has not been explored.
Objectives: To elucidate the correlation between fatigue and anxiety-related dimensions in Asian ESBC patients
Methods: This is a prospective, cohort study conducted at the largest cancer center in Singapore. Stages I to III ESBC patients receiving anthracycline and/or taxane-based chemotherapy were recruited. Fatigue and anxiety were measured by the Brief Fatigue Inventory (BFI) and Beck Anxiety Inventory (BAI), which contains four anxiety-related dimensions (Table 1). Patients were assessed prior to chemotherapy (T1) and 12 weeks after the inception of chemotherapy (T2).
Results: Seventy-nine patients were recruited (mean age 49.7 ± 8.5 years; 72.2 % Chinese). From T1 to T2, patients reported more fatigue [median(IQR): 1.30(0.1–2.3) vs 1.74(0.8–3.6), p = 0.005] and higher degree of anxiety [5.5(2.3–10.0) vs 7.0(3.0–15.0), p = 0.017]. Changes in fatigue severity were moderately correlated with anxiety symptoms within the neurophysiological- and subjective-related anxiety dimensions (Table 1).
Table 1: Correlation between change in fatigue (BFI scores) and change in anxiety-related dimensions (BAI scores) (n = 79)
Anxiety dimension | Examples of dimension-specific anxiety symptoms | Correlation (r s ) | p-value |
Autonomic | Indigestion, flushed face, hot/cold sweats | 0.270 | 0.019 |
Neurophysiological | Numbness, wobbliness, hands trembling, shaky, faintness | 0.333 | 0.003 |
Panic | Heart pounding, breathing difficulty, fear of dying | 0.264 | 0.023 |
Subjective | Terrified, nervousness, scared, fear of losing control | 0.383 | 0.001 |
Conclusions: ESBC patients experience fatigue and anxiety throughout their chemotherapy treatment, and results show that the fatigue symptoms overlap and correlate well within the neurophysiological- and subjective-related anxiety dimensions.
MASCC-0600
Intestinal injury induced by fractionated radiotherapy in a rat model is dependent upon fraction dose in the acute phase and total dose in the chronic phase
E. Bateman 1, J. Bowen1, A. Wignall1, E. Plews1, D. Keefe1
1Mucositis Research Group, University of Adelaide, Adelaide, Australia
Introduction: Radiation causes both acute and chronic damage to the Gastrointestinal Tract (GIT). We have developed a model in rats that investigates the differences between acute (< 6 weeks) and chronic (22 weeks) radiation damage, using clinically-based dose schedules. We found that bodyweights of all irradiated animals were significantly lower than those of control animals. Only animals receiving lowest dose recovered this loss during the chronic phase.
Objectives: To explore the relationship between severity of tissue damage and radiation dose, according to acute versus chronic time points.
Methods: Histological, immunohistochemical and morphometric analyses were performed on jejunum and colon collected previously, to assess tissue architecture and composition, cell death and proliferation. Radiation injury was scored according to histopathological observations.
Results: Injury scores of irradiated animals were significantly higher than controls, particularly in animals that received the highest fraction dose in the acute phase, and the highest total dose in the chronic phase (P < 0.0001). Apoptotic cell counts showed a significant fraction dose-dependent increase in jejunum (P = 0.0072) and colon (P < 0.0001) in the acute phase, and a significant decrease in proliferative cell numbers in chronic phase jejunum (P = 0.0199). Morphometric analyses revealed significantly increased colon crypt length in the highest acute phase fraction dose group (P = 0.0003) and the highest chronic total dose group (P = 0.0095).
Conclusions: Tissue analysis showed that severity of acute damage is dependent upon fraction dose and is linked to apoptosis, inflammation and direct damage, whereas chronic damage is dependent upon accumulated dose and tissue changes comparable to a complex wound.
MASCC-0601
Utility of PROMIS and LASA to measure impact from minimally invasive surgical procedures
J. Bingener 1, D. Seisler1, D. Farley1, M. Truty1, J. Sloan1
1Surgery, Mayo Clinic, Rochester, USA
Introduction: Measuring the impact of minimally invasive surgical procedures is complex and the optimal approach is unknown.
Objectives: We tested the performance of an NIH-sponsored Patient-Reported Outcomes Measures Information System (PROMIS) and Linear Analog Self-Assessment (LASA) for use with laparoscopic surgery.
Methods: From May 2011 through Nov 2012, of 84 enrolled patients 81 undergoing laparoscopic procedures completed PROMIS global health short form, LASA and Visual analog pain scale (VAS) preoperatively, 4 h., 1 day and 1 week after surgery. Composite scores and single item responses were compared over time using the Kruskal-Wallis test.
Results: At perioperative time points 81, 66, 59 and 59 patients provided scores for analysis (mean age 55, 56 % female).
For group mean comparisons, clinically meaningful differences from baseline were encountered in the PROMIS physical subscale and physical T-score (14.2 ±2.9/46.8 ± 7.7) to POD 1 (12.6 ± 3/41.8 ± 8.3) (p = 0.0067/0.0038), driven by everyday physical activity (p = 0.0001). Mean LASA scores revealed worsening pain frequency (p = 0.0017) and severity (p = 0.0009). VAS revealed clinically worse pain from baseline (mean 1.8 ± 2.4) to POD1 and 7 (mean 4.5 ± 2.5/2.4 ± 2.1; p < 0.0001). The within subject changes are depicted in the table.
PROMIS individuals worse POD1 (EQ5D/T-scores) | LASA individuals worse POD 1 | |
Overall well-being | 32 % | 33 % |
Physical well-being | 32 % | 17 % |
Mental well-being | 14 % | 13 % |
fatigue | – | 29 % |
pain | – | 30 % |
Conclusions: Mean composite QOL scores had limited discrimination for the impact of minimally invasive procedures. Single items and subscales appear more promising. Change from baseline within subject revealed clinically meaningful fluctuation for all domains/items.
MASCC-0602
the effect of the new selective GLP-2 agonist, Elsiglutide, on irinotecan-induced diarrhoea and mucositis in the rat
B. Mayo 1, E. Bateman2, A. Stringer1, E. Plews2, K. Pishas2, C. Pietra3, S. Cantoreggi3, D. Keefe2
1School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia, 2Discipline of Medicine, University of Adelaide, Adelaide, Australia, 3Research and Development, Helsinn Healthcare SA, Lugano, Switzerland
Introduction: Mucositis, a debilitating gastrointestinal (GI) side-effect of cancer treatment, affects cancer patients’ quality of life and treatment regimens. Glucagon-like peptide-2 (GLP-2), a growth-promoting GI peptide, is a potential agent for mucositis treatment and prevention.
Objectives: We aim to test a longer-acting synthetic derivative of GLP-2 in a model of mucositis (Elsiglutide (Helsinn Healthcare, Switzerland)), which could improve GI damage and diarrhoea caused by chemotherapy.
Methods: A Dark Agouti rat model of irinotecan (IRI)-induced mucositis was used to characterise effects of Elsiglutide on IRI-induced diarrhoea, GI pathology, cell proliferation and inflammation. Animals were given 200 mg/kg intraperitoneal IRI, followed by daily subcutaneous dosing of 0.9 or 1.8 mg/kg Elsiglutide, then killed at 6, 72 or 120 hours post-chemotherapy. Sections of jejunum and ileum were taken for analysis.
Results: Elsiglutide treatment significantly ameliorated incidence of IRI-induced diarrhoea. It also significantly (p < 0.05) increased small intestinal wet weight of IRI-treated rats receiving 0.9 mg/kg Elsiglutide (4.3 ± 0.5 g at 72 h, 8.6 ± 0.3 g at 120 h) when compared with controls (3.2 ± 0.09 g at 72 h, 6.4 ± 0.5 g at 120 h). Small intestinal histology showed that villous blunting, crypt ablation and enterocyte disruption was improved in the jejunum of IRI-treated rats in combination with 0.09 mg/kg Elsiglutide at both 6 h and 72 h. Plasma endotoxin levels showed a trend towards decreasing at 6 h and 72 h in response to Elsiglutide.
Conclusions: These preliminary results indicate that Elsiglutide can improve IRI-induced diarrhoea and damage from as early as 6 h after treatment. Investigation and dose refinement of Elsiglutide is ongoing in order to provide further evidence of mucositis prevention and amelioration.
MASCC-0604
Hyperthyroidism and thyroid carcinoma: Puerto Rican experience
E. Vazquez-Quintana 1, D. Vazquez2
1Surgery Department, University of Puerto Rico, San Juan, Puerto Rico, 2Surgery Department, University of Tampa, Tampa, USA
Introduction: The association of hyperthyroidism and carcinoma of the thyroid had been controversial throughout the literature. The incidence of thyroid cancer varies from 0.1 % to 21 %.
Objectives: The objective of this study is to analyzed the frequency of coexisting hyperthyroidism and thyroid carcinomas in a private endocrine surgery practice.
Methods: We analyzed the demographic, clinical and pathological data from 174 patient/medical records diagnosed with hyperthyroidism from January 1, 2000 to December 31, 2012.
Results: Total thyroidectomy was done on all the 174 patients followed by radioactive iodine 1 month postoperatively. The association of hyperthyroidism and thyroid cancer was observed in 36 patients (20.68 %). Seven (7) were males and 29 females. Age ranged from 32 to 81 years of age, average age was 56 years.
Conclusions: The association of hyperthyroidism to thyroid carcinoma is higher than previously reported. Patients with hyperthyroidism and thyroid nodules should not be treated with radioactive iodine, instead all should be submitted to total thyroidectomy.
References: Gul, K., Di Ri Koc, A., Ki Yak, G., Ersoy, P., Ugras, N., Ozdemi, D., & … Cakir, B. (2009). Thyroid carcinoma risk in patients with hyperthyroidism and role of preoperative cytology in diagnosis. Minerva Endocrinologica, 34(4), 281–288.
MASCC-0605
The multi-institutional, randomized, double-blind, placebo-controlled trial to assess the efficacy of MuGard in mitigating oral mucositis (OM) in chemoradiation-treated (CRT) head and neck cancer patients
R.R. Allison 1, A.A. Ambrad2, Y.M. Arshoun3, D.F. Carmel4, D.F. Ciuba5, E. Feldman6, S.E. Finkelstein7, R.B. Gandhavadi8, D.E. Heron9, S.C. Lane10, J.M. Longo11, C.J. Meakin12, D. Papadopoulos13, D.E. Pruitt14, L.M. Steinbrenner15, M.A. Taylor16, W.M. Wisbeck17, G.E. Yuh18, D.P. Nowotnik19, S.T. Sonis20
1Radiation Oncology, 21st Century Oncology Carolina Radiation Medicine, Greenville, USA, 2Radiation Oncology, Ironwood Cancer and Research Centers, Mesa, USA, 3Radiation Oncology, Allegheny General Hospital, Pittsburgh, USA, 4Radiation Oncology, John Muir Health Medical Center, Concord, USA, 5Radiation Oncology, John B. Amos Cancer Center, Columbus, USA, 6Thoracic/Head and Neck Cancers, MD Anderson Cancer Center, Orlando, USA, 7Translational Research Consortium (TRC), 21st Century Oncology, Scottsdale, USA, 8Radiation Oncology, Columbia St. Mary’s Hospital, Milwaukee, USA, 9Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, USA, 10Radiation Oncology, Signature Healthcare Brockton Hospital, Brockton, USA, 11Radiation Oncology, Missouri Valley Cancer Consortium, Omaha, USA, 12Radiation Oncology, CaroMont Health Comprehensive Cancer Center, Gastonia, USA, 13Radiation Oncology, Vassar Brothers Medical Center, Poughkeepsie, USA, 14Radiation Oncology, St. Joseph’s Mercy Cancer Center, Hot Springs, USA, 15Radiation Oncology, VA Western New York Health System, Buffalo, USA, 16Radiation Oncology, Peace Health St. Joseph Cancer Center, Bellingham, USA, 17Radiation Oncology, Providence Regional Medical Center, Everett, USA, 18Radiation Oncology, Enloe Medical Center, Chico, USA, 19Research and Development, Access Pharmaceuticals Inc., Dallas, USA, 20Consultant, Clinical Assistance Programs LLC, Boston, USA
Introduction: OM is a frequent debilitating adverse side effect of concomitant CRT used to treat HNC for which there is no accepted prophylaxis or therapy. MuGard™ was granted CE Mark certification in Europe based on data from a small prior clinical study, and is indicated for the prevention and management of oral mucositis.
Objectives: A multi-institutional, randomized, double-blind, placebo-controlled study was performed to assess the true efficacy of MuGard™ for the management of OM. The ability of MuGard™ to attenuate OM symptoms in HNC patients receiving CRT was compared with a saline bicarbonate rinse (SBC) packaged identically. SBC is recommended by the NCI as standard of care for HNC patients.
Methods: Patients rinsed up to six times daily while during CRT (6–8 weeks) and completed the validated Oral Mucositis Daily Questionnaire (OMDQ) daily, reporting mouth and throat soreness (MTS) and other parameters. The primary efficacy end point compared the effectiveness of MuGardTM vs. SBC on reducing OM symptoms, as determined by the area-under-the-curve (AUC) of MTS as defined by the OMDQ MTS.
Results: An interim data analysis of the first 70-patients were reported at MASCC 2012 and showed that for the primary objective, the MuGard™ group had a mean AUC of 58.9 in patients completing treatment compared with 92.1 in the SBC group; p = 0.041. MuGard™ was also significantly superior in several other key parameters.
Results of data analysis of 120+ patients will be presented.
Conclusions: An interim analysis data indicated that MuGard™ was safe and effective in mitigating OM.
MASCC-0606
Measuring cancer fear in older Chinese adults: an application to colorectal cancer screening
D.Y.P. Leung 1, E.M.L. Wong1, W.K.W. So1, K.S. Wong1, C.W.H. Chan1
1The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China
Introduction: Older people are more susceptible to colorectal cancer (CRC). Previous studies suggest that cancer fear may be a key predicotr of cancer prevention related behaviors such as participation in cancer screening. Yet there is a lack of validated measuring tools of cancer fear for the Chinese older adult population.
Objectives: This study aims to test the psychometric properties of a Chinese translation of the Champion’s 7-item Breast Cancer Fear Scale with an adaption to CRC in a Chinese older adult sample.
Methods: The CRC Cancer Fear Scale was translated into Chinese by the research team who are fluent in both English and Chinese. A convenience sample of 250 community-dwelling adults aged ≥60 were recruited from three non-government organizations between May and July 2012 in Hong Kong. Factor structure, reliability and construct validity of the scale were assessed by confirmatory factor analysis (CFA), Cronbach’s alpha and correlations with perceived risk of developing CRC respectively.
Results: CFA results revealted that the one-factor model provided an adequate fit to the data (R-χ2 = 46.98, df = 20, R-CFI = 0.988, R-RMSEA = 0.974 and SRMR = 0.029). The factor loadings ranged from 0.72 to 0.88 and all were statistically significant. Cronbach’s alpha value of the scale was 0.95. Positive and signficiant correlations of CRC cancer fear with susceptibility (r = 0.14), severity-fear (r = 0.61) and severity-life impact (r = 0.49) were observed.
Conclusions: The findings provide support for the psychometric properties of a Chinese version of the Champion Cancer Fear with an adaption to CRC in a sample of community dwelling Chinese older adutls.
MASCC-0607
Creating evidence-based computable algorithms providing real-time specific symptom management suggestions in both a community and an academic outpatient thoracic oncology setting
J.L. Abrahm 1, D.F. Lobach2, B. Halpenny3, M.S. Rabin4, K. Finn5, P. Calarese6, G. Del Fiol7, K. Zaner8, I.L. Berenbaum8, E. Johns2, T.A. Saunders9, D.L. Berry3, M.E. Cooley3
1Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, USA, 2Biomedical engineering, Duke University Medical Center, Durham, USA, 3Cantor Center for Research in Nursing and Patient Care, Dana-Farber Cancer Institute, Boston, USA, 4Medical Oncology, Dana-Farber Cancer Institute, Boston, USA, 5Thoracic Oncology, Boston Medical Center, Boston, USA, 6Medical Oncology, Dana-Farber Cancer Intitute, Boston, USA, 7Biomedical informatics, University of Utah, Salt Lake City, USA, 8Medicine Thoracic Oncology, Boston Medical Center, Boston, USA, 9NICHQ, National Initiative for Children’s Health Care Quality, Boston, USA
Introduction: Adequate symptom management is essential to ensure quality cancer care, but symptom management is not always evidence-based. Adapting, automating, and personalizing national guidelines and delivering these guideline-based therapeutic recommendations to clinicians in real time at the point-of-care is a way to operationalize guideline use.
Objectives: This paper reports a process of adapting research evidence for use in a clinical decision support system that provided individualized symptom management recommendations to clinicians at the point-of-care.
Methods: Using a modified ADAPTE process, panels of local experts adapted national guidelines and integrated research evidence to create computable algorithms with explicit, personalized recommendations for patients with the most common symptoms associated with lung cancer (pain, fatigue, dyspnea, depression, and anxiety).
Results: Multidisciplinary small groups that included content experts, and a consensus panel, using a nominal group technique, modified and subsequently approved computable algorithms for fatigue, dyspnea, moderate pain, severe pain, depression and anxiety. The approved algorithms represented consensus of multidisciplinary clinicians on pharmacological and behavioral interventions tailored to the patient’s age, co-morbidities, laboratory values, current medications, and patient-reported symptom severity. Algorithms were reconciled with one another to enable simultaneous management of several symptoms and delivery of a report in real time to clinicians.
Conclusions: A modified ADAPTE process and nominal group technique enabled the development and approval of locally adapted computable algorithms for individualized symptom management in lung cancer patients. The process was more complex and required more time and resources than initially anticipated, but resulted in computable algorithms that operationalized expert consensus.
MASCC-0608
Carbamazepine for the prevention of chemotherapy-induced nausea and vomiting: a pilot study using Simon’s optimal two-stage design
T. Aragão Santana 1, D. Trufelli1, F. Silva Melo Cruz1, A. DelGiglio1
1Clinical Oncology Department, ABC Medical School, SÃO PAULO, Brazil
Introduction: Nausea and vomiting have been a major drawback to patients undergoing chemotherapy. Despite standard preventive treatment, chemotherapy-induced nausea and vomiting (CINV) rates can still reach 50 %.
Objectives: In pursuit of ameliorating prevention of CINV at lower costs, we studied the efficacy of addition of carbamazepine to a regimen of corticosteroid plus 5-hidroxitriptamine-3 receptor antagonist, as well as its side effects and influence on patients’ quality of life (QoL)
Methods: A prospective open label phase II nonrandomized study was carried out in a Brazilian Oncology service. Patients allocated for their first cycle of highly emetogenic chemotherapy received, besides the current standard antiemetic treatment, carbamazepine, p.o., with staggered doses, from the third day before until the fifth day after chemotherapy. Considering sparse evidence about the anticonvulsants’ efficacy in CINV prevention, we adopted Simon’s optimal two-stage design, which should include 43 patients unless overall complete prevention was not achieved in 9 out of the first 15 entries. Functional Living Index-Emesis questionnaire was used to measure impact on QoL
Results: None of ten studied patients (0 %) had overall complete prevention and nine needed rescue medication. Three quitted carbamazepine therapy because of somnolence and vomiting before chemotherapy infusion. Seven were able to take medication for the entire period and none were responsive, so the study was closed. There was no impact on patients’ QoL.
Conclusions: Carbamazepine was ineffective for prevention of CINV. Simon’s optimal design allowed us to stop the trial for futility, minimizing the amount of patients possibly exposed to an inactive agent.
MASCC-0609
Prediction of anthracycline-induced cardiac injury
R.E. Reinbolt 1, S.V. Raman2, A.S. Ruppert3, S. Carothers4, C.L. Shapiro4, M.B. Lustberg4
1Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA, 2Cardiology, The Ohio State University, Columbus, USA, 3Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, USA, 4Stefanie Spielman Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, USA
Introduction: Cardiac toxicity from anthracyclines including doxorubicin (DOX) needs to be better characterized. Cardiac magnetic resonance imaging (CMR) may better predict early DOX-related cardiotoxicity.
Objectives: We prospectively obtained serial CMRs and Troponin I (Ti) levels in patients (pts) with breast cancer receiving DOX chemotherapy.
Methods: Enrolled pts underwent CMR at baseline, after 1 cycle of DOX, and immediately after completion of DOX. Repeated measures analysis of variance modeled changes in cardiac markers over time. CMR at ≥12 months post DOX exposure is planned in a subset of patients.
Results: Forty-two pts were enrolled. The average age was 52 years (range 33–68). Twenty-nine patients (69 %) had CMR examinations at the first three time points (Table 1). Maximum T2 measures increased (p = 0.09), corresponding to acute tissue edema, and systolic strain rates significantly decreased (p = 0.001), corresponding to lower contractility, by the end of therapy. Nearly 54 % of patients had abnormal troponin levels (median: 0.03, 0.02–0.17). A trend toward lower systolic strain was present in patients with elevated troponins, consistent with early LV dysfunction (Figure 1). LVEF was not significantly decreased immediately following treatment completion.
Results: of LVEF changes after ≥12 months post DOX exposure are currently pending.
Table 1
Patient Characteristics | N (%) |
Enrolled | 42 (100) |
Enrolled and cardiac biomarkers × 3 | 36 (86) |
Enrolled and CMR × 3 | 29 (69) |
Median age (range) | 52 (33–68) |
Stage | |
I | 5 (14) |
II | 21 (58) |
III | 10 (28) |
Menopausal status | |
Pre | 9 (25) |
Post | 27 (75) |
Tobacco use | 16 (44) |
Diabetes | 3 (8) |
Hypertension | 14 (39) |
Hyperlipidemia | 13 (37) |
Median heart age (Range) | 54 (30–80) |
Conclusions: We observed cardiac tissue changes that are suggestive of acute injury after DOX. These may be predictive of future functional impairments. By obtaining an additional CMR study at ≥12 months post treatment, we intend to clarify if these effects are permanent. The results from this subset analysis will be reported.
MASCC-0610
Family support for outpatients undergoing cancer treatment
N. Hira 1, F. Karatsu1, I. Tanaka2, H. Narui3
1Nursing and Social Services, Health Sciences University of Hokkaido, Tobetsucho, Japan, 2Nursing division, Teine Keijinkai Hospital, Sapporo, Japan, 3Nursing, Aomori University oh Health and Welfare, Hirosaki, Japan
Introduction: It’s not clear how support program can be organized to help the families in Japan. The future direction of this study will be one that encompasses the program of support group for care of families
Objectives: To understand how families of cancer outpatients support the patients as caregivers.
Methods: The subjects are 16 people who are family members of cancer outpatients. Data was collected from semi-structured interviews and was analyzed qualitatively and inductively. The results are summarized as follows:
Results:
- Family members say that, when spending time with cancer patients, they are aware that the patients have little time left to live, and the family members look for ways to spend everyday life with them.
- To care for the cancer patients physically and to respond to changes in their physical condition, family members prepare for emergencies, pay close attention to the patients’ condition, avoid putting physical and mental strain on them, try to find time to stay with them as much as possible, help them or let them do things by themselves at the right moment and receive necessary information.
- Family members feel that, as caregivers, they are not enough to meet the patient’s expectations.
- Family members have ways of communicating smoothly with the patients (e.g., they suggest ideas and ask the patients to understand them).
Conclusions: This study shows that family members of cancer outpatients support the patients by responding to changes in the patient’s physical condition and their desire to maintain good family relationships.
MASCC-0611
Fractionated radiotherapy in a rat model causes dose-dependent changes in collagen deposition, and expression of transforming growth factor ?1, smad3 and smooth muscle actin ?1
E. Bateman 1, C. Wilson1, C. Keefe1, J. Bowen1, A. Wignall1, E. Plews1, D. Keefe2
1Mucositis Research Group School of Medicine, University of Adelaide, Adelaide, Australia, 2Cancer Centre, Royal Adelaide Hospital, Adelaide, Australia
Introduction: Radiation-induced fibrosis is a common treatment-related toxicity in the gastrointestinal tract (GIT). It is largely mediated by upregulation of transforming growth factor beta 1 (TGF-β1) and phosphorylation of signal transducer Smad3, which induces proliferation and increased deposition of collagen within the GIT wall by mesenchymal cells.
Objectives: To assess the degree of radiation-induced fibrosis, and the expression patterns of TGF-β1/Smad3 and smooth muscle actin alpha-1 (SMA-α1) in a rat model of acute and chronic radiation-induced GIT injury[1].
Methods: Tissue sections of 4 μm of colon and jejunum were stained with Masson’s Trichrome/Verhoeff’s stains to assess changes in connective tissue (CT). Measurements relating to wall thickness were analysed using the Kruskal Wallis test (with Dunn’s post hoc analysis). Immunohistochemistry was performed, using heat-mediated antigen retrieval, and optimised titres.
Results: Colon and jejunum of irradiated animals showed a significant fraction dose-dependent disruption of CT architecture within the acute phase of injury (P < 0.05). Within the chronic phase, there was a significant total dose-dependent deposition of dense collagen and elastic fibres, mostly in submucosa (P < 0.05). Immunostaining of SMA-α, TGF-β1 and Smad3 showed a similar fraction dose-dependent increase in acute phase groups and a total dose-dependent increase in chronic phase groups.
Conclusions: Increased TGF-β1/Smad3-mediated collagen deposition and smooth muscle cell proliferation is dependent upon fraction dose in the acute phase, and accumulated dose in the chronic phase of radiation injury. Since the pathways involved are complex and multifactorial, further investigation into quantified protein and mRNA expression patterns may be useful.
References: [1] Support. Care Cancer, 2012; 20(Suppl1): 1–283.
MASCC-0612
The accuracy of clinicians’ prediction of survival and prognostic factors indicative of survival: a systematic literature review
M. Zhou1, N. Lao 1, R. Chow1, L. Zeng1, H. Lam1, E. Chow1, L. Holden1
1Rapid Response Radiotherapy Program Department of Radiation Oncology, Sunnybrook Health Sciences Odette Cancer Centre, Toronto, Canada
Introduction: Terminally ill patients may want to accomplish certain tasks or consider different alternatives for palliative care before their death. However, predicting and disclosing the remaining duration of survival is a difficult task for health care professionals.
Objectives: The purpose of this study was to review the literature and examine the accuracy of clinicians’ prediction of survival as well as prognostic factors predictive of shorter survival.
Methods: A literature search was conducted to obtain studies that examined the accuracy of prediction of survival and prognostic factors indicative of survival in patients with terminally cancer. Descriptive statistics summarized the extracted data.
Results: A total of 85 studies were identified published from 1972 to 2012 with a study cohort of 30–5256. Clinicians’ prediction of survival was determined to be correlated with patient’s actual survival although tending to be too optimistic. The ability of varying members of the health care professionals to estimate survival was contradictory amongst studies. The estimations were also reported to be more accurate during certain time ranges such as the ‘horizon effect’. Few assessment tools to assist in predicting duration of survival in patients were developed and validated.
Conclusions: Demographic information and clinical symptoms can assist in determining the remaining length of survival in terminally ill cancer patients. Even with the application of instruments, error cannot be completely eliminated. Physicians’ should warn the patient and their family and friends of the uncertainty in the predictions.
Keywords: prediction of survival, review, advanced cancer, terminally ill, prognostic factors
MASCC-0613
Hospital utilization in last 6 months of life for cancer patients: a novel method and implications for supportive care
B. Cassel 1, E. Del Fabbro1
1Massey Cancer Center, Virginia Commonwealth University, Richmond, USA
Introduction: In the US, organizations such as the National Quality Forum (NQF) have developed metrics to assess the quality of cancer care, and several are specific to care near the end of life. Cancer centers need feasible Methods for self-evaluating the quality and cost of their cancer care, the results of which may highlight the unmet need for supportive care for these patients.
Objectives: To devise a new method for retrospective evaluation of quality and cost of care for cancer patients toward the end of life; and by assessing those metrics to infer the possible contribution that outpatient supportive care could make.
Methods: Social Security Death Index (SSDI) data were acquired and linked to claims data for our center’s cancer patients. 3,128 adult cancer patients died between January 2009 and July 2011 and had contact with our center in their last 6 months.
Results: Bone marrow transplant and hematological malignancy patients had higher hospital utilization, greater costs, and lower NQF quality metrics than solid tumors. There was a dramatic increase in ICU days, hospital days, and costs in each of the last 6 months of life. Inpatient palliative care was used by 27.5 %, at a median of 22 days before death. Earlier inpatient palliative care was associated with greater use of hospice (p < .001) and lower rate of in-hospital death (p = .041).
Conclusions: Once date of death is known, end-of-life quality and cost metrics can be assessed relatively easily. This makes salient the inability of inpatient palliative care to prevent hospitalizations.
MASCC-0614
Psychosocial analysis of cancer survivors in rural NSW, Australia
Z. Ansari 1, M. George2
1Medical Oncology, Calvary Mater Newcastle, Newcastle, Australia, 2Medical Oncology, Tamworth Rural Referral Hospital, Tamworth, Australia
Introduction: Psychosocial aspects of cancer and their management occupy an important place in oncology, but often ignored by clinicians in day-to-day practice. Such issues vary from urban to rural areas, survival period and according to the type of cancer.
Objectives: In this study we aimed to analyse the psychosocial aspects of various cancers in patients who have visited a rural oncology clinic in New England region, Australia.
Methods: All patients with various cancers have participated the study. The inclusion criteria included 3 years after diagnosis of cancers. Excluded were those who were having active cancer treatment. Three domains were studied using a standardised and validated tool. This includes demographic parameters, quality of life, treatment information and wellbeing.
Results: Most of the participants were under 65 years of age and females (64.7 %). 49 % were breast cancer followed by colo-rectal cancer (39.2 %). Regarding the psychological functions 49 % reported feeling happy often and 25.5 % always; 41.2 % felt depressed rarely. 56.9 % reported that they enjoyed life always. 31.4 % were never bothered by pain. Majority of patients reported positive outlook on life. Although 25.5 % stated that they were always and 33.3 % sometimes worried about dying. 45 % reported that they appreciated life more because of cancer diagnosis. 33 % never worried and 15.7 % rarely worried about their appearance. 33.3 % always worried that cancer would come back. 50 % had no financial issues because of cancer.
Conclusions: Psychosocial aspects of cancer patients who survived for more than 3 years in a rural setting have shown reasonably good quality of life in all domains.
MASCC-0615
Systematic review of pooled series analyses of phase I clinical trials for cancer: implications for ethics and supportive care
B. Cassel 1, E. Del Fabbro1
1Massey Cancer Center, Virginia Commonwealth University, Richmond, USA
Introduction: Each year, hundreds of thousands of cancer patients reach the point where they have exhausted conventional therapies. At that point, some of them turn to Phase I studies, which represent a key translational step in the expensive process of developing new agents or combinations of agents.
Objectives: To review the performance status, survival, and prognostic factors for patients in phase I trials; to draw out the evolution of ethical issues for phase I trials over the past 20 years and to discuss how supportive care could be involved more systematically for these patients
Methods: Systematic literature review of pooled series analyses of phase I clinical trials for cancer
Results: 29 studies met criteria, representing >550 trials and nearly 18,000 patients. 0 % to 32 % (median: 6 %) had an ECOG performance status of >=2. Median survival ranged between 5 and 10.5 months (median: 8.4). 90-day mortality ranged from 9.8 % to 27 % (median: 16.5 %). A small set of prognostic factors including albumin, lactate dehydrogenase, and metastatic disease provides an adequate prediction of early mortality. The few studies that included patients referred, but not enrolled, indicate that referrals are often made for patients who are too debilitated and symptomatic to participate.
Conclusions: Low toxicity rates, stable disease, and extremely rare deaths have changed the ethical landscape of recruiting phase I trial participants. Supportive care should be engaged for all patients referred for phase I trial consideration, to address symptoms, improve chances of enrolling in and completing phase I trials, and meeting their end-of-life needs.
MASCC-0616
Envoy service, a form of dignity therapy, to assist to express personal values and communication with family members and care givers: a preliminary report
S. Lee1, S. Shin 1, S. Whang2, S. Kim1, S. Cho3, S. Oh4
1Medical Oncology, Korea University Medical Center, Seoul, Korea, 2Department of Psychiarty, Korea University Medical Center, Seoul, Korea, 3Hospice Team, Seoul Medical Center, Seoul, Korea, 4Oncology and Hematology, Seoul Medical Center, Seoul, Korea
Introduction: Patients with incurable illness could have difficulties to express and communicate regarding their wishes, personal values and end of life care option.
Objectives: ‘Envoy Service’ was designed to assist the patients with incurable disease, to deliver a detailed message to family members and care givers.
Methods: The assigned patients were helped by trained dialogist to express in narrative form regarding the personal values and end of life care options. The dialogue could be videotaped, voice recorded, or wrote down by the dialogist, upon the patients’ choices. The dialogue was carefully edited by the Envoy Service team. The final products were delivered to family members and caregivers and their responses were collected.
Results: Ms. N, 53 of age, treated with advanced myelofibrosis for over 20 years and having prognosis of limited life expectancy, agreed to have ‘Envoy Service’. She had an hour talk with dialogist, regarding her life values and emotional expression of suffering and end-of- life care options. The dialogue was dictated by the clinical psychologist in her case. Detailed report regarding the life of her and her wishes in end-of-life care was made. We will present around 10 patients experiences of ‘Envoy Dialogist Services’ at the meeting.
Conclusions: ‘Envoy Service’ could be valuable for patients with incurable disease to help to express regarding their personal life values and communication in end-of- life options between the patients, family members and care givers and might help to facilitate early palliative care.
MASCC-0617
Biphasic response of pro-inflammatory cytokines and Chemokines expressions in a radiation-induced glossitis model
T. Nakashima 1, N. Uematsu2, M. Shibamori2, M. Sato2, K. Sakurai2, T. Ishida1, H. Kiwada1
1The University of Tokushima, Institute of Health Biosciences, Tokushima, Japan, 2Otsuka Pharmaceutical Co. Ltd., Third Institute of New Drug Discovery, Tokushima, Japan
Introduction: Oral mucositis is one of major side effects of chemoradiotherapy for patients with head and neck cancer.
Objectives: We developed a glossits model induced by X-ray irradiation and studied the expression of inflammatory cytokines and chemokines during the development of glossits in rats.
Methods: Rats were received a single dose of 15 Gy of X-ray with a vertical beam to the entire snout under double shielding the body with 0.5 mm-thick lead plate (Day 0). The tongue injuries were analyzed by digital photoimagings from Day 1 to Day 28. The halves of tongue specimens were assessed general histology by H&E and Azan stain. The others were measured gene expression level of inflammatory cytokines (IL6, IL1b, TNF-a) and chemokines (Gro-a, MCP-1) by a quantitative real-time PCR method. In the initiation phase (0 to 24 h after X-ray irradiation), these gene expressions were also analyzed.
Results: In the initiation phase without both injuries and inflammation, the transient expressions of inflammatory cytokines and chemokines genes were observed within 1–4 h after X-ray irradiation. After that, the dramatic elevations of these gene expressions were observed on Day 7 when the ulcer and inflammation emerged. The changes of gene expression of these inflammatory cytokines and chemokines were associated with the time course after the sever tong injury.
Conclusions: Our finding suggests that pro-inflammatory cytokines and chemokines in tongue epthelial cells produced by X-ray irradiations may trigger the development of glossitis.
MASCC-0618
Olvanil interferes with the anti-emetic action of ondansetron, but not dexamethasone, in ferrets
J.A. Rudd 1, K.M. Chu1, M.P. Ngan1, M.K. Wai1, C.K. Yeung1
1Emesis Research Group, Chinese University of Hong Kong, Shatin, Hong Kong China
Introduction: Pungent TRPV1 channel activators have broad inhibitory anti-emetic activity against centrally- and peripherally-acting challenges, but at doses having adverse effects on the cardiovascular system and on temperature homeostasis.
Objectives: In the present studies, we investigated whether combining the ‘non-pungent’ TRPV1 activator, olvanil, with ondansetron or dexamethasone, could improve the control of cisplatin-induced acute and delayed emesis in the ferret.
Methods: Ferrets were implanted under general anaesthesia with DSI radiotelemetry transmitters to record heart rate (HR) and body temperature. Seven days later, they received cisplatin (5 mg/kg, i.p.) alone or in combination with ondansetron (1 mg/kg, i.p.), dexamethasone (1 mg/kg, i.p.), and/or olvanil (0.5 mg/kg, s.c.). Dosing of anti-emetics and/or olvanil or vehicles continued at 8 h intervals until the end of the experiment (n = 3–5).
Results: Vehicle-treated animals (HR 260.6 ± 3.7; basal temperature, 37.7 ± 0.3 °C) that did not receive cisplatin exhibited transient emesis. Cisplatin induced a weak acute (24 h) emetic response (31.0 ± 10.8 retches + vomits; RV). However, the delayed (48–72 h) response comprised 198.5 ± 27.9 RV, which was reduced by ondansetron and dexamethasone by 75.2 and 87.2 %, respectively (P < 0.05). Olvanil failed to antagonize the response and prevented the anti-emetic action of ondansetron but not dexamethasone. None of the treatments affected HR or body temperature.
Conclusions: Concomitant administration of non-pungent TRPV1 activators with anti-emetic drugs may not be useful for the treatment of acute and delayed emesis induced by cisplatin. These studies were fully supported by the Research Grants Council of Hong Kong (CUHK4527/05M).
MASCC-0619
Caring for palliative patients: impact on caregivers
C. Shunmugam 1, S. Veeraiah1, V. Elangovan1
1Psycho-Oncology, Cancer Institute (WIA), Chennai, India
Introduction: Cancer not only affects patients but also their carers. It is reported that carers of cancer patients have depression (32 %), worry (71 %), tiredness (11 %), loss of work productivity (22.9 %), distress (15.4 %), hopelessness (68 %) and heavy burden (90 %).
Objectives: To understand the impact of caregiving on the life of caregivers of palliative care patients.
Methods: A cross sectional study design using purposive sampling was employed on the caregivers (n = 24) of consecutive patients attending the palliative outpatient department. Semi-structured interview was conducted to explore their concerns. In addition, they were assessed for their Fatigue, Distress, Anxiety and Quality of Life using appropriate tools.
Results: Preliminary analysis revealed that more than half (58 %) of the caregivers were females and 37 % of the primary caregivers were patients’ children. Reactions to diagnosis were sadness (62.5 %), helplessness (45.8 %), and shock (54.2 %). Only 62.5 % of the caregivers were aware of the patient’s prognosis and their reactions were sadness (79 %), uncertainty about patient condition (52.6 %), worry about their future (37 %) and fear (47.3 %). About two-third of the caregivers were employed, of which 62.5 % faced work-related issues such as absenteeism, poor concentration, and loss of pay. Since the patient’s diagnosis, 54 % of them underwent significant life changes. Caregivers experienced financial problems (70.8 %), sleep problems (46 %), adjustment issues (50 %), high anxiety (50 %), average fatigue (50 %), severe distress (58.3 %) and moderate quality of life (66.7 %).
Conclusions: Emotional, physical and economic well-being is disrupted in caregivers of palliative patients. These unmet needs should be identified and addressed using appropriate intervention.
MASCC-0620
An evaluation of the implementation of the Liverpool care pathway in rural western Australia
A.M. Wilkinson 1, C. Johnson2, H. Walker3, V. Colgan3
1Western Australia Centre for Cancer and Palliative Care, Edith Cowan University, Perth, Australia, 2Cancer and Palliative Care Research and Evaluation Unit, The University of Western Australia, Perth, Australia, 3The Western Australian Cancer and Palliative Care Network, Government of Western Australia Department of Health, Perth, Australia
Introduction: While most people would prefer to die at home; approximately 50 % to 70 % of patients worldwide still die in a hospital.
Objectives: The Liverpool Care Pathway (LCP), a widely recognized clinical guideline for the optimal management of the terminally ill in the last 72 h of life, was introduced in 16 rural/regional hospitals in Western Australia. This study aimed to evaluate whether the systematic use of the LCP improved the quality and cost of end of life care in rural WA.
Methods: Patient, caregiver and health services outcomes were evaluated pre/post implementation of the LCP. Data included medical record audits of the last admission for 415 deceased patients (223 pre/192 post) who were in hospital for more than 24 h prior to death; a survey of the primary nurse involved in the patient’s care; and a telephone interview with the caregiver (3 months after the patient’s death).
Results: Mean length of stay was 10 days (range 1–121) prior to death. The mean time on the LCP was 5.58 days (range 0–44). Analyses document significant improvements in the appropriate identification of dying patients and documentation of their care pre/post. Communication improved between health professionals and with the patient and their family. Use of the LCP resulted in improved symptom management, improved caregiver satisfaction with care, and a reduction costs through a reduction in inappropriate procedures and investigations.
Conclusions: Use of the LCP appears to improve end of life care, reduce the use of inappropriate or burdensome life-sustaining interventions and reduce costs once implemented.
MASCC-0621
Improving efficacy and safety of docetaxel in second line lung cancer
G.S. Bhattacharyya 1, A.A.B. Bhushan2, G. Biswas3, H. Malhotra4, K. Govindbabu5, S. Basu6, N. Bascomb7
1Medical Oncology, Fortis Hospital, Kolkata, India, 2Medical Oncology, Deenanath Mangeshkar Hospital, Pune, India, 3Medical Oncology, Sparsh Hospital, Bhubaneshwar, India, 4Medical Oncology, SMS Hospital, Jaipur, India, 5Medical Oncology, Kidwai Memorial, Bangalore, India, 6Radiation Oncology, AMRI, Kolkata, India, 7Drug Development, Vicus Therapeutics, New Jersey, USA
Introduction: Docetaxel is an accepted second line drug for NSCLC not used frequently for its side effects. VT122 (propanolol and etodolac) which has anti-angiogenic COX-2 inhibition properties. Modifying the tumor-microenvironment and sympathetic system has anticancer activity as well as ameliorates toxicity of anticancer drugs. Docetaxel efficiency can be improved with VT122 which possesses the above property.
Objectives: To increase efficacy of docetaxel and safety profile using VT122
Methods: Twenty (10 in each arm) patients (55–65 years) were treated with docetaxel (75 mg/m2) with or without VT122. VT122 was started 7 days before giving docetaxel. Propanolol doses were titrated to maintaining heart rate around 60. Etodolac was titrated on the basis of CRP to a maximum of 1,200 mg/m2.
Results: Overall Response seen in 4 patients (VT122 arm) and 2 patients (docetaxel arm). 6 patients in VT122 arm completed 6 cycles of docetaxel while in non-VT122 4 patients completed the 6 cycles. 1 year survival was 30 % vs 10 %; p = 0.025. Grade III/IV hematologic toxicity was decreased by 50 % ie 6 cases in docetaxel arm and 3 in VT122. In non-hematological toxicity this trend was seen for asthenia, neuropathy, skin and nail changes and weight loss.
Conclusions: Addition of VT122 (propanolol and etodolac) increases efficacy of docetaxel and is cost effective.
MASCC-0622
The implementation of a care partner program and its effects on oncology caregiver stress
J. Peckham1, S. Singh-Carlson 1
1Graduate Nursing, California State University Long Beach, Long Beach, USA
Introduction: It has been identified that lack of communication with health care providers leaves oncology patients and their caregivers feeling unprepared and can lead to increased caregiver stress.
Objectives: The objective of this study is to identify if the implementation of a Care-Partner Program on an acute oncology unit will decrease caregiver stress. It is anticipated that increased communication and the integration of the family caregiver into the care of the patient while in the hospital will prepare the oncology caregiver for discharge and thereby decrease their stress.
Methods: This study will involve two phases, a standard care phase and an interventional phase. Each phase will have a minimum of 38 subjects. A survey will be completed by the caregiver on admission to assess the level of comfort in caring for the oncology patient and again on the day of discharge. The standard care group will receive no intervention and serve as a baseline group while the interventional group will participate in a program that integrates the identified family caregiver into the care of the patient while in the hospital. The two groups will be compared to see of the intervention decreased oncology caregiver stress.
Results: Preliminary results indicate that a care-partner program does decrease caregiver stress as well as health care provider stress, however there a whole host of other factors that interplay that needs further analysis
Results will be complete at presentation.
Conclusions: It is anticipate that the implementation of a Care Partner Program on an acute oncology unit will decrease caregiver stress.
MASCC-0623
The role of palliative care in mass casualty and disaster events with scarce resources
A. Wilkinson 1
1Western Australia Centre for Cancer and Palliative Care, Edith Cowan University, Joondalup, Australia
Introduction: Catastrophic mass casualty events (MCEs) can yield thousands of victims whose needs overwhelm local and regional health care systems, personnel, and resources requiring difficult decisions regarding the allocation of scarce resources and the alteration of standards of care in all care settings. Guidance regarding preparation for, management, and provision of medical care under such circumstances remains limited
Objectives: Although the primary goal of a coordinated response to an MCE is to maximize the number of lives saved, a comprehensive response should also seek to minimize the suffering of those who may not survive. The purpose of this paper is to explore the role of palliative care in the support of individuals not expected to survive an MCE and to provide recommendations for specific actions for a coordinated disaster response plan.
Methods: Semi-structured telephone discussions with key stakeholders and an expert group meeting identified five domains of importance: (1) the role of palliative care in a mass casualty event; (2) the triage and ensuing treatment decisions for those “likely to die;” (3) the critical palliative care services, personnel and settings vital to provision; (4) the pragmatic plans needed for ensuring training, supplies, and organizational/jurisdictional arrangements; and (5) unusual issues affecting palliative care under MCE scenarios.
Results: Palliative care minimizes the suffering of those who will not survive and may free up resources to optimize survival of others.
Conclusions: Planning to provide palliative care during mass casualty events should be part of the current state and local disaster planning/training guidelines, protocols, and activities.
MASCC-0624
Validation of the head and neck patient symptom checklist as a nutrition impact symptom assessment tool for head and neck cancer patients
K. Schmidt 1, K. Olson2, C. Kubrak3, M. Parliament3, S. Ghosh3
1Head and Neck Tumor Group, Cross Cancer Institute, Edmonton, Canada, 2Faculty of Nursing, University of Alberta, Edmonton, Canada, 3Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
Introduction: Individuals with head and neck cancer (HNC) often present with reduced nutritional intake prior to treatment. Many authors have shown that reduced dietary intake is associated with decreased clinical response to treatment, quality of life, and survival.
Objectives: The purpose of this study was to test the validity of the Head and Neck Patient Symptom Checklist (HNSC).
Methods: Three hundred and sixty-eight treatment naïve individuals diagnosed with HNC completed the HNSC and the Patient Generated Symptom Global Assessment (PG-SGA). The predictive validity was determined by comparing the HNSC symptoms interference scores to the PG-SGA scores. Additionally, logistic regression was used to determine the HNSC symptoms scores predicting reduced dietary intake, weight, and functional performance (FP).
Results: HNSC sensitivity (79–98 %), specificity (99–100 %), positive predictive value (92 %–100 %), and negative predictive value (94 %–100 %) were excellent. The multivariate logistic regression showed that advanced tumor stage, pain, loss of appetite (LOA), and difficulty swallowing significantly predicted dietary intake. Advanced tumor stage, LOA, and difficulty swallowing were also significant predictors of ≥5 % weight loss over 6 months. LOA, difficulty swallowing, feeling full, and lack of energy were significant predictors of reduced FP.
Conclusions: The HNSC appears to be a valid tool for determining symptoms interfering with dietary intake of HNC patients. This instrument may aid in early identification of symptoms that place HNC patients at risk for reductions in dietary intake, weight, and functional performance.
MASCC-0625
Physician perspective on incorporation of oncology patient quality of life (QOL), fatigue, and pain assessment into clinical practice
J. Hubbard 1, A. Grothey1, R. McWilliams1, J. Sloan1
1Medical Oncology, Mayo Clinic, Rochester, USA
Introduction: Patient reported outcomes such as pain, fatigue and QOL are important for morbidity and mortality in cancer patients. However, systematic approaches to collect and incorporate PROs in clinical practice are still evolving.
Objectives: We set out to determine the impact of PRO assessment on routine clinical practice.
Methods: Beginning in July 2010 the symptom assessment questionnaire (SAQ) was administered to every patient in a solid tumor oncology practice at an academic center. The SAQ measures pain, fatigue, and QOL each on a 0–10 point scale.
Results are available to providers before each visit in the electronic medical record. 18 months after the SAQ was implemented, an online survey was sent to 83 oncology care providers regarding the use of the SAQ and how it impacted their clinical practice, including the discussion with patients, duration of visits and work burden.
Results: Fifty-three percent of the care providers completed the online survey, producing 44 evaluable surveys. 86 % of care providers reported using information from the SAQ. Over 90 % of the care providers indicated that the SAQ did not change the length of clinic visits or contribute to increased work burden. Over 78 % of care providers indicated that the SAQ had helped or enhanced their practice. Providers overwhelmingly endorsed the SAQ for facilitating communication with their patients.
Conclusions: This study indicates that simple single-item measures of pain, fatigue and QOL can be incorporated into oncology clinical practice with positive implications for both patients and physicians without increasing duration of visits or work burden.
MASCC-0626
prevalence of factor V leiden and prothrombin G20210A mutations and the risk of venous thromboembolism: data from a cohort of 258 consecutive cancer patients
A. Vargas 1, A. Fernandez-Martinez2, M. Selvi2, G. Luengo-Gil2, A. Carmona-Bayonas2, C. Font2, D. Tàssies3, J.C. Reverter3
1Radiation Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
2Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
3Hemostasis and Hemotherapy, Hospital Clinic de Barcelona, Barcelona, Spain
Introduction: Factor V Leiden and the prothrombin G20210A are the two most common genetic polymorphisms associated with an increased risk of VTE. There is little information on the prevalence and contribution of these mutations to increase the underlying thrombotic risk in cancer patients.
Objectives: To determine the prevalence of factor V Leiden and prothrombin G20210A mutations in a cohort of cancer patients with VTE and to evaluate its influence on the development of arterial and venous rethrombosis.
Methods: From May 2006 to April 2008, 258 consecutive cancer patients who developed VTE were recruited. A group of 200 healthy blood donors (HC) and 142 cancer patients without VTE matched by age, sex and tumour type, were used as controls (CC).
Results: The prevalence of heterozygous factor V Leiden was 3.9 % (10 patients) in the group with VTE and 1.3 % (2 patients) in CC (p = NS). In the group with VTE, prothrombin G20210A mutation was found in 5.9 % (15 patients) vs. 3.9 % (6 patients) in CC (p = NS). A total of 50 cancer patients with VTE developed rethrombotic events (19.4 %) during follow-up. No differences in the prevalence of factor V Leiden (3.9 % vs. 3.9 %; p = NS) and in prothrombin G20210A mutations (2 % vs. 6.9 %; p = NS) according to the development of rethrombosis. In HC the prevalence of factor Leiden and prothrombin G20210A mutations were 3 % and 2.5 %, respectively.
Conclusions: The low prevalence of factor V Leiden and prothrombin G20210A argues against a pathogenic role in the development of thrombosis in this setting.
MASCC-0627
Experimental validation of peripheral dose distribution for electron beams
H. Acar1, G. Yavas 2, C. Yavas3
1Radiation Oncology, Medipol University, Istanbul, Turkey, 2Radiation Oncology, Selcuk University, Konya, Turkey, 3Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey
Introduction: In radiation therapy, the peripheral dose is important when anatomical structures with very low dose tolerances are involved.
Objectives: In this study, the two available calculation algorithms of the Varian Eclipse treatment planning system(TPS), the electron montecarlo algorithm(eMC) and general gaussian pencil beam algorithm (GGPB) was used to compare measured and calculated peripheral dose distribution of electron beams.
Methods: Peripheral dose measurements were carried out for 6, 9, 12, 15, 18 and 22 MeV electron beams using parallel platei onization chamber in the slab phantom. Measurements were performed for 6 × 6, 10 × 10 and 25 × 25 cone sizes at dmaxof each energyup to 20 cm beyond the field edges. Peripheral dose was further computed using two different algorithms of a TPS. The measured and calculated data were then compared to find which algorithm calculates peripheral dose distribution more accurately.
Results: The agreement between measurement and eMC was better than GGPB. The TPS may have underestimated the out of field doses. The difference between measured and calculated doses increase with the cone size. The largest deviation between calculated and measured dose distribution is less than 10.37 % using theeMC, but can increase up to 14.52 % of the distribution using GGPB.
Conclusions: Our results show that the Monte Carlo algorithm for electron planning in Eclipse is more accurate than previous algorithms for peripheral dose distri-butions. It must be emphasized that the use of GGPB for planning large field treatments with 6 MeV could lead to inaccuracies of clinical significance.
MASCC-0628
Irinotecan-induced mucositis is associated with mucus dysregulation and enteric nerve depletion
D. Thorpe 1, A. Stringer1, R. Butler1
1School of Pharmacy and Medical Sciences, The University of South Australia, Adelaide, Australia
Introduction: Irinotecan–induced mucositis is a major oncological problem. Goblet cells secrete mucus, protecting the intestinal mucosa, with secretion altered during mucositis. The enteric nervous system is involved in regulating gut motility and secretion.
Objectives: To determine whether enteric nerves and goblet cells are altered following chemotherapy.
Methods: Dark Agouti rats were administered a single dose of 175 mg/kg of irinotecan intraperitoneally and 0.01 mg/kg atropine subcutaneously before being killed at times 6, 24, 48, 72, 96 and 120 h after treatment. Haematoxylin and eosin staining, Alcian Blue-PAS staining, and immunohistochemistry with S-100 antibody (nerve marker) were carried out. Goblet cells (intact and cavitated) and nerve bundles and axons were counted. Statistical analysis was carried out using a Kruskal-Wallis test with Dunns post test.
Results: The percentage of cavitated goblet cells increased compared to controls in the duodenum at 48 h, and in the jejunum at 72 h. The villous percentage of cavitated goblet cells increased significantly (p < 0.05) between control and 72 h in the ileum. The percentage of cavitated goblet cells decreased compared to all other time points at 120 h in the colon. The number of axons in the myenteric plexus decreased compared to controls. Nerve bundles in the myenteric plexus of the jejunum also decreased at 24 h and 96 h compared to controls.
Conclusions: Irinotecan-induced mucositis is associated with increases in mucus secretion, and depletion of enteric nerves. These changes are likely to contribute to the pathophysiology of mucositis and associated diarrhoea through the dysregulation of neural signalling following enteric nerve damage.
MASCC-0629
Nutrition screening and risk factors prior to chemotherapy in cancer patients 65 years and older
A. McCarthy1, E. Isenring 2, S. Baumann2, P. Yates1, H. Skerman1, E. Walpole3, D. Thomson3
1School of Nursing, Queensland University of Technology, Brisbane, Australia, 2School of Human Movement Studies, University of Queensland, Brisbane, Australia, 3Cancer Care Services, Princess Alexandra Hospital, Brisbane, Australia
Introduction: The largest proportion of cancer patients are aged 65 years and over. Increasing age is also associated with nutritional risk and multi-morbidities—factors which complicate the cancer treatment decision-making process in older patients.
Objectives: To determine whether malnutrition risk and Body Mass Index (BMI) are associated with key oncogeriatric variables as potential predictors of chemotherapy outcomes in geriatric oncology patients with solid tumours.
Methods: In this longitudinal study, geriatric oncology patients (aged ≥65 years) received a Comprehensive Geriatric Assessment (CGA) for baseline data collection prior to the commencement of chemotherapy treatment. Malnutrition risk was assessed using the Malnutrition Screening Tool (MST) and BMI was calculated using anthropometric data. Nutritional risk was compared with other variables collected as part of standard CGA.
Results: Over half of the 175 geriatric oncology patients were at risk of malnutrition (53.1 %) according to MST. BMI ranged from 15.5 to 50.9 kg/m2, with 35.4 % of the cohort overweight when compared to geriatric cutoffs. Malnutrition risk was more prevalent in those who were underweight (70 %) although many overweight participants presented at risk (34 %). Malnutrition risk was associated with a diagnosis of colorectal or lung cancer (p = 0.001), dependence in activities of daily living (p = 0.015) and impaired cognition (p = 0.049). Malnutrition risk was positively associated with vulnerability to intensive cancer therapy (rho = 0.16, p = 0.038). Larger BMI was associated with greater number of multi-morbidities (rho = .27, p = 0.001).
Conclusions: Malnutrition risk is prevalent among geriatric patients undergoing chemotherapy, is more common in colorectal and lung cancer diagnoses, is associated with impaired functionality and cognition, and negatively influences ability to complete planned intensive chemotherapy.
MASCC-0630
Association of CYP3A5 polymorphism with toxicities in metastatic renal cell carcinoma patients (MRCC) receiving an alternative dosing (AD) regimen of sunitinib
Y.L. Teo 1, H.L. Wee1, X.P. Chue1, N.M. Chau2, M.H. Tan2, R. Kanesvaran2, H.L. Wee1, H.K. Ho1, A. Chan1
1Department of Pharmacy, National University of Singapore, Singapore, Singapore, 2Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
Introduction: Sunitinib is metabolized by CYP3A4 and the highly polymorphic CYP3A5 enzyme. Expression of the *3 allele, which is abundant in Asians, leads to the expression of non-functional enzyme. An AD regimen of 37.5 mg daily in repeated 4-weeks on, 2-weeks off cycle has been proposed to ameliorate frequent dose modifications due to toxicities observed with the approved dosing regimen.
Objectives: This study aims to determine the effect of CYP3A5 polymorphism on toxicities in patients receiving this regimen.
Methods: All mRCC patients starting on sunitinib were invited to participate. In week 4 of each cycle, toxicities were assessed and graded according to CTCAE. Blood was obtained for genotype determination via restriction fragment length polymorphism.
Results: Twenty patients were available for analysis. After 1 cycle, common all grades toxicities were anemia (80 %), fatigue (76 %), hypertension (75 %), altered taste (71 %), mucositis (57 %) and hand-foot syndrome (HFS) (57 %). Those with functional CYP3A5 appear to have increased risk for hypertension and decreased risk for anemia, fatigue, altered taste and mucositis. However, these differences were not statistically significant. (Table 1)
Functional vs. Non-functional CYP3A5 for all grade toxicities | |||
RR | 95 % CI | P | |
Anemia | 0.60 | 0.36–1.00 | 0.09 |
Fatigue | 0.83 | 0.53–1.30 | 0.60 |
Hypertension | 1.67 | 0.40–6.97 | 0.46 |
Altered Taste | 0.62 | 0.34–1.14 | 0.18 |
Mucositis | 0.61 | 0.28–1.30 | 0.35 |
HFS | 1.02 | 0.51–2.05 | 1.00 |
Functional CYP3A5: Carrier of *1*1 or *1*3
Non-functional CYP3A5: Carrier of *3*3
Conclusions: CYP3A5 polymorphisms seem to have varied effect on different toxicities. Further studies with a larger sample size would be required to confirm this association.
MASCC-0631
Management of neutropenic fever in patients with hematologic malignancy in a Hong Kong Teaching Hospital
K. Zhou 1, K.K. Chiu1, M.C. Wong1, R. Wong2
1School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong China, 2Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong China
Introduction: Neutropenic fever (NF) can cause substantial morbidity and mortality in patients with hematologic malignancies. IDSA has recently updated the guideline on the management of NF. However, local practice in Hong Kong and the compliance to the guideline have never been measured.
Objectives: To assess the current management of NF in a Hong Kong teaching hospital, with focus on compliance to the existing international guideline.
Methods: Retrospective review of all medical records of patients with febrile neutropenic episodes who received inpatient management at the Prince of Wales Hospital (PWH) from 2007 to 2011 was done. Only patients with hematologic malignancies were included. Comparisons on treatment outcomes were done between the guideline compliant versus non-compliant cases using non-parametric Fisher’s Exact test and Mann–Whitney U test.
Results: One hundred and sixty-five NF episodes were evaluated. Most patients were given a combination of piperacillin-tazobactam and an aminoglycoside antibiotic as the empiric treatment upon the onset of NF. Overall compliance to guideline was 49 %. Individual compliance rates were 69 % for empirical antibiotic treatment regimen, 76 % for antibiotic treatment modification, 90 % for vancomycin initiation, 50 % for antifungal treatment modification, 92 % for usage of G-CSF, 89 % for discontinuation of empirical treatment, and 99 % for IV-PO switch. No significant difference was found between compliant versus non-compliant cases, while an appropriate switch of antibiotics correlated to a shorter fever duration (4 days (2–7) versus 8 days (6–12), p = 0.017).
Total NF Episodes ( N = 165) | |
Demographics: | |
Male | 97 (58.8 %) |
Median age | 56 (IQR: 46–64) |
Subjects with age ≥60 years old | 59 (35.8 %) |
Malignant Disease Types: | |
Leukemia | 71 (43.3 %) |
Lymphoma | 80 (48.8 %) |
Multiple Myeloma | 9 (5.5 %) |
Others | 4 (2.4 %) |
Cancer Management: | |
Chemotherapy documented | 118 (72 %) |
Supportive care | 18 (11 %) |
Newly diagnosed | 5 (3 %) |
No chemotherapy documented | 23 (14 %) |
Baseline Characteristics: | |
ANC < 100cells/min3 | 67 (43.8 %) |
ANC < 500cells/mm3 | 46 (30.1 %) |
ANC > 500cells/mm3 | 40 (26.1 %) |
Impaired Liver Function (ALT > 180 IU/L) | 4 (2.8 %) |
Impaired Rental Function (CrCL < 30 ml/min) | 6 (4.6 %) |
Fever Duration (Days) | |||
Compliant Cases | Non-compliant Cases | P-value | |
Overall Compliance (N = 66) | 4 (2–7) | 5 (2–11.25) | 0.315 |
Empiric Antibiotic Regimen (N = 66) | 5 (2–12) | 4.5 (2–7) | 0.436 |
Antibiotic Treatment Modification (N = 64) | 4 (2–7) | 8 (6–12) | 0.017 |
Antifungal Treatment Modification (N = 28) | 12.5 (7.5–19.25) | 12 (8–15.25) | 0.804 |
Conclusions: This study identified the areas with potential for improvement in management of NF in patients with hematologic malignancy at PWH.
MASCC-0632
Short and longterm outcomes of cancer patients with incidental and symptomatic pulmonary embolism (PE): data on a prospective cohort of 138 consecutive patients
A. Fernandez-Martinez 1, M. Selvi1, A. Vargas2, A. Carmona-Bayonas3, J. Aibar1, C. Beato1, C. Font1
1Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain, 2Radiation Oncology, Hospital Clinic de Barcelona, Barcelona, Spain, 3Medical Oncology, Hospital Morales Meseguer, Murcia, Spain
Introduction: Incidental pulmonary embolism (IPE) has become a common clinical presentation of venous thromboembolic disease in cancer patients. Information on clinical outcomes of IPE is based on retrospective and small observational series.
Objectives: To compare the short and longterm clinical outcomes of patients with IPE and ‘acute symptomatic PE’ (SPE) in cancer patients.
Methods: From May 2006 to December 2009 a prospective observational study of consecutive unselected cancer patients with newly-diagnosed PE (IPEs and SPEs) was performed in our Medical Oncology Department. All patients were routinely anticoagulated irrespective of IPE or SPE according to international guidelines.
Results: A total of 138 patients with PE were recruited (62 IPE and 76 SPE). The mortality rate at 7-day was 0 in IPE vs. 8 (10.7 %) in SPE (p = 0.008), at 1-month was 2 (3.2 %) in IPE vs. 13 (17.1 %) in SPE (p = 0.01) and at 3-months of follow-up was 9 (14.5 %) in IPE vs. 23 (30.3 %) in SPEs (p = 0.02).
Conclusions: Cancer patients with IPE had better clinical outcomes compared to those with SPE in our prospective cohort. Further studies are needed to better define the clinical relevance and optimal management of IPE.
References:
[1] Font C, Farrús B, Vidal L, et al. Incidental vs. symptomatic venous thrombosis in cancer patients. Analysis of a prospective observational series with 340 consecutive patients. Ann Oncol 2011; 23 (9): 2101–2106
[1] den Exter PL, Hooijer J, Dekkers OM, Huisman MV. Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: a comparison with symptomatic patients. J Clin Oncol. 2011 Jun 10;29(17):2405–9.
MASCC-0633
Factors affecting patient’s perception of anticancer treatments side-effects: an observational study
S. Russo 1, L. Gerratana1, M. Cinausero1, C. Bozza1, D. Iacono1, R. Sottile1, G. Fasola1, F. Puglisi2
1Department of Oncology, University Hospital of Udine, Udine, Italy, 2Department of Oncology Department of Medical and Biological Sciences, University Hospital of Udine University of Udine, Udine, Italy
Introduction: Analysis of relative importance of side-effects of anticancer therapy is extremely useful in the process of clinical decision making.
Objectives: Aim of this study was to evaluate the perceptions of physical and non-physical side-effects of contemporary anticancer therapy and their association with clinical and social features of the patients.
Methods: Participants were asked to rank their side-effects in order of distress by using two sets of cards naming physical and non-physical effects, respectively. The association between the first five cards chosen and clinical or social features of patients was estimated by calculating Odds Ratios (OR) through uni- and multi-variate logistic regression.
Results: Four hundred and sixty-four patients (153 men and 311 women) entered the study. Median age was 63 years. Patients ranked the non-physical side-effect “Affects my family or partner” first (40.1 % of the total population). “Constantly tired” (32.5 %) and “Loss of hair” (20.7 %) were ranked second and third, respectively. These concerns were selected as the most important in the majority of the subgroups.
Interestingly, marital status was the predominant characteristic in driving patient’s perception, being associated with several side-effects(Constantly tired, Loss of appetite, Affects my work, Affects my social activities, Infertility, Diarrhea).
Other significant factors influencing patient’s perception of side-effects included age, disease characteristics and ongoing anticancer therapy
Conclusions: This study identified crucial factors that may influence patient’s perception of anticancer treatments side-effects. Therefore, these results could be use in pre-treatment patient’s education and counseling.
MASCC-0634
Supportive care management in cancer: a 2 years assessment of a prospective multidisciplinary in care model
F. Scotté 1, S. Richard1, P. Leroy2, S. Hans3, C. Hervé4, N. Pelicier5, C. Vulser6, C. Sauvajot7, F. Tetelin1, E. Nariana2, S. Oudard8, D. Brasnu8
1Department of Oncology and Supportive Care Unit, Georges Pompidou European Hospital, Paris, France, 2Department of Supportive Care Unit, Georges Pompidou European Hospital, Paris, France, 3Cancerology Federation, Georges Pompidou European Hospital, Paris, France, 4Department of Ethics, University of Paris Descartes, Paris, France, 5Psycho-oncology Department, Georges Pompidou European Hospital, Paris, France, 6Pain Evaluation and Treatment Department, Georges Pompidou European Hospital, Paris, France, 7Cancerology Federation, Georges Pompidou European Hospital, Paris, France, 8Department of Oncology, Georges Pompidou European Hospital, Paris, France
Introduction: Supportive care depends on multidisciplinary coordination. Their institutional organization has to be developed.
Objectives: To improve the management of patients in complex situations during and after cancer care, a four-bed inpatient unit for supportive care in cancer (SCCU) was created. The activity of this unit over a two-year period is assessed.
Methods: The 2 years of activity (347 stays) were analyzed in an observational prospective study. Quality of care and costs were assessed throughout this period.
Results: Over this 2 years period, we observed a 23 % admission enhancement. Of the patients admitted, 64 % came directly from home, avoiding emergency admission. Average length of stay was 10.2 days with a majority of patients with high levels of disease severity. An interdisciplinary approach was used (i.e. psycho-oncology, pain management, palliative care, etc.). The main diagnostic groups were: health statement alteration (30 %), pain (21 %), palliative care (11.5 %), and nutritional disorders (10.2 %). Discharge of patients was organized with return home for 60 % of patients. During the first year of activity, this SCCU generates a financial income of 750,896.96 €, which includes 240,954.88 € for institution’s expenses.
Conclusions: Improved management of patients is feasible despite complex conditions of supportive cancer care. We attempted to show bases on this organizational structure, the ability and efficacy of a specific unit to promote supportive care management.
MASCC-0635
Actual and expected treatment-related side-effects predict low health related quality-of-life in prostate cancer survivors
F. Drummond 1, H. Kinnear2, K. O’Brien1, A. Gavin3, L. Sharp1
1Research, National Cancer Registry Ireland, Cork, Ireland, 2Research, Northern Ireland Cancer Registry, Belfast, Ireland, 3Director, Northern Ireland Cancer Registry, Belfast, Ireland
Introduction: Most prostate cancer (PCa) treatments are associated with significant side-effects, but the extent to which side-effects impact on health-related quality-of-life (HRQoL) longer term is poorly understood.
Objectives: In a population-based study of PCa survivors, we investigated associations between treatment-related side-effects and HRQoL.
Methods: Six thousand nine hundred thirty-seven PCa (ICD10 C61) survivors, 1.5–15 years post-diagnosis, were identified from the National Cancer Registry Ireland and Northern Ireland Cancer Registry and invited to complete postal questionnaires, including questions on socio-demographic characteristics, treatment received, side-effects expected and experienced (including incontinence, impotence, bowel problems, hot flushes, fatigue) and HRQoL. Low HRQoL was defined as an EORTC QLQ30 global health score in the lowest quartile (≤38.1 ± 14.2). Predictors of low HRQoL were investigated using multivariate logistic regression.
Results: Three thousand eight hundred two3,802 men participated (response rate = 55 %). In multivariate analysis of the first 1,344 respondents, the significant socio-demographic predictors of low HRQoL were age, marital status, educational level and employment status. Risk of low HRQoL was: higher in men with comorbidities; varied by treatment received; and increased with time since diagnosis. Men who currently experienced treatment-related incontinence had increased risk of low HRQoL (OR = 2.90,95%CI 1.90–4.43). Risk was increased in men whose side-effects were worse than expected (OR = 1.82,95%CI 1.17–2.84), and reduced in those whose side-effects were not as bad as expected (OR = 0.54,95%CI 0.34–0.86).
Conclusions: Actual and expected side-effects predicted risk of low HRQoL. If confirmed in analysis of all respondents, these findings suggest that men with PCa may benefit from realistic information pre-treatment on risk of side-effects and long-term support in managing side-effects.
MASCC-0636
A web-based tool to monitor chemotherapy induced peripheral neuropathy and quality of life
C. Eeltink 1, I. Verdonck- de Leeuw2, M. Minnema3, M. Eurelings4, G. Kunst5
1Haematology, VU University Medical Center, Amsterdam, Netherlands, 2Clinical Psychology, VU University Medical Center, Amsterdam, Netherlands, 3Haematology, University Medical Center Utrecht, Utrecht, Netherlands, 4Neurology, Spaarne Hospital, Hoofddorp, Netherlands, 5Medical Affairs Department Pharmaceutical Compagnies of Johnson&Johnson, Janssen Pharmaceutical Compagnies of Johnson&Johnson, Tilburg, Netherlands
Introduction: Treatment with neurotoxic chemotherapy in patients with hematological malignancies like Multiple Myeloma may cause Chemotherapy-Induced Peripheral Neuropathy (CIPN). CIPN can induce functional disability which can diminish patients’ quality of life (QoL) significantly. Although standardized measures of CIPN are available, they do not grade the seriousness of CIPN, and they do not assess the impact of CIPN on daily living and QoL.
Objectives: To develop and evaluate a web-based tool including CIPN and QoL questionnaires to be used in clinical practice.
Methods: In a multidisciplinary setting a new CIPN questionnaire was developed, comprising 31 items. A web-based tool, named ‘Monitor Klinisch Beeld’, was developed and build including the CIPN questionnaire, the EORTC QLQ-C30, EORTC QLQ-MY20 Module, EORTC QLQ-ELD15 for elderly patients, and the Hospital Anxiety and Depression Scale (HADS). Patients complete the questionnaires via the internet at home or in the hospital.
Results: It had been shown to be feasible to apply the web-based tool in clinical practice. The web-based tool is used by nurses. In case of CIPN, the hematologist is informed and may consider treatment dose adjustments to avoid progression of CIPN and to reduce existing complaints. It is important that patients are informed that adjustment of treatment does not necessarily lead to reduced effectiveness but enables continuation of treatment.
Conclusions: This web-based tool can help nurses and hematologists to identify patients at risk for neuropathy and limitations in daily functioning and compromised QoL. Further research is planned to validate the CIPN questionnaire.
Conflict of interest: This project is supported by Janssen, pharmaceutical companies of Johnson&Johnson.
MASCC-0637
Dramatic and durable response to denosumab given for humoral hypercalcemia with malignancy refractory to weekly zoledronic acid
M. Tsuda 1, H. Ishiguro2, T. Sugie1, A. Yasoda1, M. Toi1
1breast surgery, Kyoto University Hospital, Kyoto, Japan, 2Outpatient Oncology Unit, Kyoto University Hospital, Kyoto, Japan
Introduction: Denosumab sometimes causes severe and fatal hypocalcemia as an adverse event. Conversely, if used safely, denosumab has the potential to become a key drug for treating severe hypercalcemia refractory to bisphosphonates. However, the optimal dose and treatment frequency for hypercalcemia have not been determined.
Objectives: To report a case of humoral hypercalcemia with malignancy refractory to weekly zoledronic acid dramatically and durably treated with denosumab.
Methods: A 47-year-old woman with bone metastases from breast cancer presented with hypercalcemia. Her serum parathyroid hormone-related protein (PTHrP) level was high, and her kidney function was normal. As her hypercalcemia was refractory to aggressive hydration, furosemide, and weekly zoredronic acid, we decided to try denosumab. We monitored pharmacodynamics (PD) markers to control serum calcium levels safely.
Results: A single dose of denosumab (120 mg) immediately and durably normalized serum calcium levels for more than 8 weeks (Figure 1). During the period, PTHrP levels were consistently high. No calcium or vitamin D supplements were given because they might have re-elevated serum calcium levels, so careful monitoring of PD markers was performed.
Conclusions: Denosumab has potential to become an effective agent for treating hypercalcemia refractory to bisphosphonates. Further studies are warranted to understand the optimal dose and frequency to avoid severe and fatal hypocalcemia.
MASCC-0638
Personalized medicine: from bench to bed
F. Scotte 1, M.F. Mamzer2, P. Leroy3, M. De Jesus Cabral2, C. Bommier2, M.L. Viallard2, C. Herve2
1Department of Oncology and Supportive Care Unit, Georges Pompidou European Hospital, Paris, France, 2Department of Ethics, University of Paris Descartes, Paris, France, 3Department of supportive Care Unit, Georges Pompidou European Hospital, Paris, France
Introduction: The development of personalised medicine in oncology requires a better understanding of targeted therapies to improve the management of patients. This includes a constant sharing of knowledge between clinicians, research platforms and patients, based on patient consent as well as ethical reflection.
Objectives: In order to facilitate an exchange between researchers, clinicians and patients, a practical model must be created.
Methods: Research objectives will be to the development research information and to assess its impact for patients and professionals, in order to facilitate their participation in research.
Results: Based on this methodology we developed a four stages model :
1/For each phase of the course, analysis of the exchange of information and the link between teams assessing the fluidity of data until target diagnosis and treatment decisions are made.
2/Development of information materials and consent procedures, validated in the context of head and neck cancer and shared with all oncological disciplines. Two committees will validate these elements: one with patients and the other with health professionals (researchers and clinicians).
3/A major conference will be organised for all patient care teams including a video presentation of the patient’s course with a media outlet for each intervention. A website will be set-up and dedicated to bringing together professionals and patients.
4/Building a cross-disciplinary consultation meetings even a functional unit ensuring consistency of decision making from research to therapy.
Conclusions: This model promotes the sharing between research platforms, physicians and patients to enhance decision understanding and subsequent treatment efficacy.
MASCC-0639
Cancer fatalism in older chinese adults: a validation study
D.Y.P. Leung 1, E.M.L. Wong1, S.S.M. Ho1, J.W.H. Sit1
1The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong China
Introduction: Qualitative studies suggest that cancer fatalism may have an impact on participation in cancer screening among Chinese people. A previous study has provided a preliminary support of reliability and factorial validity of a 15-item modified version of a Cancer Fatalism Scale with an adaption to colorectal cancer screeing in older Chinese people.
Objectives: To further examine the psychometric properties of the 15-item modified Cancer Fatalism Scale in general in older Chinese adults.
Methods: The original 20-item Cancer Fatalism Scale was administered to a convenience sample of 257 community-dwelling adults aged ≥60 at four non-governmental organizations between June and July 2012 in Hong Kong. Confirmatory factor analysis (CFA), Cronbach’s alpha, and ANOVA and correlations were used to assess factorial structure, reliability and concurrent validity of the scale respectively. Participants with MMSE score >17 were included in the analysis (n = 257).
Results: CFA revealed that the three-factor model provided an adequate fit to the 15-item modified Cancer Fatalism Scale (R-χ2 = 225.43, df = 87, R-CFI = 0.917, R-RMSEA = 0.078 and SRMR = 0.078); all the factor loadings were >0.30 and statistically significant. Cronbach’s alpha values of the three subscales (Predetermination, Fatalistic voluntarism and Luck) were >0.8. ANOVA results shwo that participants with higher education level socred significantly lower in the three subscales, and positive significant correlations were obtained between age and the three subscale scores.
Conclusions: The findings provide further support for the psychometric properties of the 15-item version of the Cancer Fatalism Scale; suggesting that the modified scale can be used to assess cancer fatalism in community-0dwelling older Chinese adults.
MASCC-0640
Health resource utilisation (HRU) associated with pathologic fracture (PF) in eight European countries: results from a retrospective study
J. Body 1, Y. Acklin2, G. Hechmati3, J. Pereira4, N. Maniadakis5, E. Terpos6, J. Finek7, H. Sleeboom8, R. von Moos9
1Department of Medicine, C.H.U. Brugmann, Brussels, Belgium, 2Surgery, Kantonsspital Graubünden, Chur, Switzerland, 3Health Economics, Amgen (Europe) GmbH, Zug, Switzerland, 4Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal, 5Department of Health Services Management, National School of Public Health, Athens, Greece, 6Department of Clinical Therapeutics, University of Athens School of Medicine Alexandra General Hospital, Athens, Greece, 7Department of Oncology and Radiotherapy, University Hospital, Plzen, Czech Republic, 8Department of Medical Oncology, HAGA Hospital, The Hague, Netherlands, 9Department of Medical Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland
Introduction: There is a paucity of health-resource utilisation data relating to the impact of bone metastases.
Objectives: Evaluate HRU associated with PF in patients with bone metastases secondary to breast/lung/prostate cancer or multiple myeloma.
Methods: Eligible patients: ≥1 skeletal-related event (SRE); from Austria, Czech Republic, Finland, Greece, Poland, Portugal, Sweden or Switzerland. HRU data were extracted from patients’ charts at baseline (pre-SRE period: 3-month SRE-free period, beginning 3.5 months before the SRE) and post-SRE (14-day diagnosis period pre-SRE to 3 months post-SRE). Data presented are mean (bootstrapped 95 % confidence interval [CI]) HRU changes from baseline per PF for long bone and for other bone.
Results: Of 1,022 enrolled patients, 359 had PF, key HRU data are listed in the table. A PF required an additional 0.8–1.23 inpatient stays (varying according to fracture site and country-specific treatment practices). Inpatient stays generally required treatment in orthopaedic, oncology, internal medicine or haematology wards/units with a mean total duration (change from baseline) of 20.9 days for long bone PF and 12.3 days for other bone PF. Inpatient stays were more frequent and lasted longer for long bone PF than for other bone PF. Number of outpatient visits increased by a mean of 2.58 visits per PF for long bone PF and 3.96 visits for other bone PF. Number of procedures increased by a mean of 6.10 and 5.85 per PF for long bone and other bone, respectively.
Mean Total Change (95 % CI) | Long bone (N = 118) | Other bone (N = 241) | ||
Number of inpatient stays | 1.23 (1.02, 1.44) | 0.80 (0.65, 0.95) | ||
Number of inpatient stays for most common unit/ward | Orthopaedic | 0.54 (0.44, 0.65) | Internal Medicine | 0.19 (0.12, 0.27) |
Other* | 0.14 (0.00, 0.28) | Oncolody | 0.18 (0.10, 0.27) | |
Oncology | 0.11 (0.06, 0.16) | Haematology | 0.10 (0.04, 0.16) | |
Duration of inpatien stays, days | 20.9 (16.9, 24.9) | 12.3 (9.7, 14.8) | ||
Duration of inpatient stays for unit/ward with largest mean duration, days | Orthopaedic | 7.72 (5.88, 9.56) | Internal Medicine | 2.74 (1.66, 3.82) |
Oncology | 1.85 (0.31, 3.38) | Oncolody | 1.45 (0.64, 2.26) | |
Pneumology | 1.68 (0.28, 3.09) | Orthopaedic | 1.44 (0.62, 2.25) | |
Mean number of outpatient visits | 2.58 (1.70, 3.46) | 3.96 (3.22, 4.71) | ||
Mean number of outpatient visits for most common providers | Radiation oncology/radiotherapist | 0.99 (0.53, 1.44) | Radiation oncologist/radiontherapist | 1.52 (1.04, 2.00) |
Medical oncologist | 0.51 (0.17, 0.85) | Medical oncologist | 0.81 (0.53, 1.08) | |
Orthopaedic surgeon | 0.29 (0.17, 0.42) | Radialogist | 0.60 (0.38, 0.83) | |
Mean number of procedures | 6.10 (4.80, 740) | 5.85 (5.03, 6.67) | ||
Mean number of most common precedures | Other† | 2.29 (1.61, 2.98) | External beam radiation to bone | 2.58 (2.00, 3.17) |
External bean radiation to bone | 2.08 (1.38, 2.78) | Other† | 1.67 (1.25, 2.08) | |
Surgery to bone - extremities | 0.49 (0.40, 0.58) | Computed Tomography | 0.62 (0.48, 0.77) | |
*e.g.,trauma surgery, casualty ward, cardiology, nursing unit, etc.; †e.g., bone marrow biopsy, brain CT, bronchoscopy, chest x-ray, radioisotope bone scanning, thorax, x-ray, etc.
Conclusions: PF is associated with increased HRU burden, including inpatients stays, outpatient visits and procedures.
MASCC-0641
Patterns of treatment with bone-modifying agents (BMA) in patients with bone metastases (BM) in the US
J. Arellano 1, J. Quigley2, R. Hernandez3, K. Cetin3, M. Pirolli2, D. Quach2, A. Liede4
1Health Economics, Amgen Inc., Thousand Oaks, USA, 2Health Economics, IMS Health, Plymouth Meeting, USA, 3Center for Observational Research, Amgen Inc., Thousand Oaks, USA, 4Center for Observational Research, Amgen Inc., San Francisco, USA
Introduction: BM can lead to serious and debilitating skeletal-related events (SREs: fracture, spinal cord compression, and surgery or radiation to bone). Three BMAs are approved in the US for prevention of SREs in cancer patients with BM: two intravenous bisphosphonates (IV BP) with recommended dosing every 3–4 weeks (pamidronate and zoledronic acid), and one RANK ligand inhibitor with subcutaneous injection every 4 weeks (denosumab).
Objectives: To examine characteristics and treatment trends among patients with BM treated with BMAs in US clinics.
Methods: A retrospective cohort was defined from the Oncology Services Comprehensive Electronic Records (OSCER) database, which includes medical records from >500 K patients treated at 76 US oncology practices. Adult solid tumor patients with BM who initiated treatment with a BMA Jan 2011–Oct 2011 were included and followed for 12 months after treatment initiation. Patients were either naïve (no BMA in previous 6 months) or transition (different BMA received in previous 6 months).
Results: The cohort included 1445 denosumab (62 % naïve) and 1807 IV BP (99 % naïve) patients. Patient characteristics were similar, although denosumab patients were more likely to receive regular treatment during follow-up and less likely to switch treatment than IV BP patients (Table). Trends were consistent across tumor types and for naïve and transition patients.
Table. Patterns of treatment for BMA patients during 1 12-month follow-up period.
Denosumab | IV BP | |
( N = 1445) | ( N = 1807) | |
Switched treatment n (%) | 89 (6 %) | 245 (14 %) |
Received 12 treatment administrations n (%) | 373 (26 %) | 301 (17 %) |
# treatment administrations | ||
Mean (range) | 7.3 (1, 14) | 5.8 (1,18) |
Median (25 %, 75 %) | 8.0 (3, 12) | 4.0 (2, 10) |
Conclusions: Denosumab represented almost halfDenosumab represented almost half (44 %) of patients initiating a BMA and one-third of patients naïve to treatment. Uninterrupted treatment was more common for denosumab versus IV BP patients. Trends, including reasons for and consequences of treatment interruption, should be monitored as the patient experience develops.
MASCC-0642
Social media perceptions of oncology practitioners for supportive cancer care
K. Yap 1,2
1Department of Pharmacy, National University of Singapore, Singapore, Singapore, 2Academic Informatics Office, National University Health System, Singapore
Introduction: Little is known about oncology practitioners’ attitudes towards, and usage of, social media (SM) channels for supportive cancer care.
Objectives: A cross-sectional study was done from May-July 2012 to obtain the perceptions and SM usage patterns of oncology practitioners, and their views on how SM can potentially affect clinical practices.
Methods: An online survey (14 questions) was sent via an invitation email to MASCC/ISOO members. Participants’ demographics, SM usage behavior, perceptions regarding health information on SM channels and on patients’ use of SM for supportive care information were obtained. Responses were analyzed using SPSS (v19).
Results: Response rate was 16 % (128 people). Most were from Europe (38 %) and America (34 %). Participants were mainly physicians (33 %), nurses (32 %) and pharmacists (12 %). Over half (54 %) had 11–30 years of practice experience. The most popular SM channels were YouTube (69 %) and Wikipedia (68 %). Over half (57 %) encountered patients who searched SM for health information in their practices. Majority felt that SM channels often recommended unproven treatment
Methods: and could potentially cause harm to patients (63 % each). However, similar proportions (61 % each) agreed that patients who searched information on SM channels were better empowered to manage their conditions and those who shared experiences on social networking sites could cope better with their supportive care.
Conclusions: Certain SM channels (YouTube, Wikipedia) are popular among oncology practitioners. Practitioners are supportive of patients using SM for health information but are concerned regarding its quality. Therefore, patients should be educated on how to utilize these channels appropriately to supplement their cancer care.
MASCC-0643
Screening of epidermal fish mucus extract (Channa striatus) for different pharmacological activities
S. dahham 1, S. Al Rawi1, A.S.I.F. Muhammad1, L. Hassan1, A. Abdul Majid1
1Pharmacology, University Science Malaysia(USM), Pinang, Malaysia
Introduction: Recently, fish by-products have been evaluated as a source of structurally diverse bioactive compounds. Fish mucus has a myriad of pharmacological activities including anti-microbial, anti-inflammatory, wound healing and cell proliferation properties.
Objectives: The present study describes the potential activity of Channa striatus epidermal mucus for in vitro antioxidant, antibacterial, wound healing, cell proliferation and ex vivo Rat aortic assays.
Methods: The free radical scavenging activity was studies in vitro by measuring 2,2-diphenyl-1-picrylhydrazyl (DPPH). Antibacterial activities were evaluated against six microorganisms using agar well diffusion method. The cell viability and proliferation of human umbilical vein endothelial cells (HUVEC) and retinal ganglion cells (RGC-5) were evaluated using MTT assay. An in vitro assay of scratch wound healing onto monolayer of HUVEC cells was used to assess the effect of fish mucous on cell migration into a wound space. Rat aortic assay was employed to evaluate proliferation of blood vessel formation.
Results: Experimental results have shown that fish mucous exert pro-angiogenic effects by stimulating the growth of new blood vessels in rat aorta. HUVEC and RGC-5 cell proliferation increased significantly compared to the negative control. HUVEC cells migration was significantly enhanced, the extract after 12 h enhanced the wound healing in scratch model assay. In addition, fish mucus exhibited strong antioxidant and antibacterial activity. Among the selected bacterial cultures, the highest activity was recorded against Pseudomonas aeruginosa. These potent activities might be due to it high antioxidant property, IC50 = 2.83ug/ml.
Conclusions: The present investigation has provided preliminary information for a better understanding of epidermal fish mucus role and its pharmacological activities.
MASCC-0644
Place of death of patients in a newly established home palliative care service in greece
S. Katsaragakis1, A. Tserkezoglou1, S. Amoiridou1, E. Avgetidou1, I. Liakopoulos1, O. Mpagiaou1, H. Oikonomou1, E. Petta1, H. Raimondou1, S. Tsotakos1, A. Hamou1, E. Patiraki 1
1Holy Metropolis of Mesogaia & Lavriotiki, Palliative Care Unit Galilee, Athens, Greece
Introduction: ‘Galilee’ palliative care service has been providing home care for adult cancer patients, in a large suburban area of Athens since 2010.
Objectives: Explore factors associated with the patients’ place of death and length of care.
Methods: Sample consisted of 162 cancer patients receiving home palliative care. Retrospective data collection included: demographic and clinical characteristics, patients’ ESAS-r (Edmond Symptom Assessment System Revised) evaluation of symptoms (Likert type 1–10 scale) at the time of referral to the service (T0), 1 (T1) and 2 months later (T2).
Results: Most patients were female (53.1 %), with a mean age 67.1 years and ECOG performance status 2.7. The husband/wife (34.6 %) was the most frequent primary caregiver. The prevalent diagnosis was lung cancer (18.5 %) and 54.1 % of patients received antineoplasmatic treatment during care. Patients’ median length of care was 54.5 days and 47.8 % were hospitalized during care. The majority of patients (70.8 %) died and 36.8 % and 20.2 % of them within the first and the second month respectively after referral to the service. Most of the patients (62.6 %) chose and were supported to die at home. A family member primary caregiver (x2(12) = 36.1, p = 0.003) and the lack of any antineoplasmatic treatment (x2(10) = 18.6, p = 0.046) were associated with patients’ death at home. High performance status (rho = −0.55, p < 0,001) and female sex (z = −2.1, p = 0,034) was associated with longer length of home palliative care.
Conclusions: Study results highlight that regardless of late referral of patients to the service, a great number of patients were supported to die at home.
MASCC-0645
Personalized care program (PCP) to breast cancer patients improves the patient satisfaction
L. vanlemmens 1, S. giscard2, L. rotsaert3, B. noirot3, A. mailliez1, F. aitkaci4, C. claret3, T. loridan5, N. dereumaux6, M.H. loucheux7, M. lefebvre1, M. cucchi8, I. sakli9, J.L. cazin9, J. bonneterre1
1Breast Cancer, Centre Oscar Lambret, Lille, France, 2Quality, Centre Oscar Lambret, Lille, France, 3Supportive Care, Centre Oscar Lambret, Lille, France, 4Psycho-Oncology, Centre Oscar Lambret, Lille, France
5Association “Vivre Comme Avant”, Association “Vivre Comme Avant”, Lille, France, 6Day Hospital, Centre Oscar Lambret, Lille, France, 7Comité du Nord de la Ligue Contre le Cancer, Comité du Nord de la Ligue Contre le Cancer, Lille, France, 8Medical Information, Centre Oscar Lambret, Lille, France, 9Pharmacy, Centre Oscar Lambret, Lille, France
Introduction: Overall care requires evaluation, analysis of best professional practice, constantly improving information.
Objectives: We wanted to optimize written support for breast cancer patients (pts) who require neoadjuvant or adjuvant medical treatment. Then, we evaluated the impact on pts satisfaction.
Methods: After assessing pts satisfaction in comprehensive care with a questionnaire, we created a PCP, validated by pts. After given it, we assessed pts satisfaction with the same questionnaire. Then we compared results before (n = 310) and after PCP (n = 177).
We selected the Excellence Score (ES) by taking into account only ‘very satisfied’ and excluding ‘satisfied’ scores and the Dissatisfaction Score (DS) by combining ‘not very satisfied’ and ‘very dissatisfied’.
Results: As regards the explanation of treatment justification, ES rose from 67 to 74 % (p NS). Concerning procedure and adverse effects information, ES rose from 63 to 79 % (p 0,001) and 52 to 62 % (p 0,043). When we focus on information related to disease and treatment, ES of written information rose respectively from 36 to 56 % and 39 to 62 % (p < 0,001), DS decreased from 21 to 3 % (p 0,001) and 20 to 1 % (p < 0,001). ES of oral information of 49 and 48 % increased to 65 and 72 % (p < 0,001). The satisfaction about possibility to ask questions and to have response rose respectively from 68 to 99 % (p 0,021) and 61 to 97 % (p 0,017).
Conclusions: This study confirms the importance of good written documentation with positive impact not only on written records but also on the face to face physician-patient relationship.
MASCC-0646
Risk factors for severe outcome in neutropenic enterocolitis in oncology patients; a systematic review
L. Naeije 1, L.C.M. Kremer1, E. Leclercq1, M.D. van de Wetering1
1Paediatrics Oncology, Academic Medical Center, Amsterdam, Netherlands
Introduction: Neutropenic enterocolitis (NEC) is a potential life threatening complication of the treatment of malignancies. NEC is characterized by a triad of symptoms: neutropenia, fever and abdominal pain and the aetiology is not well understood. The outcome can be very unpredictable with a reported mortality rate of more than 50 %.
Objectives: The aim of this systematic review was to evaluate the evidence of risk factors for severe outcome of NEC in oncology patients.
Methods: MEDLINE and EMBASE were searched. All studies describing risk factors for mortality or ICU admittance were included. Information about study characteristics, prevalence and risk factors were abstracted and the quality of the studies with prognostic factors was assessed.
Results: The search identified 1,613 studies. 16 studies reported on risk factors for outcome of NEC. The prevalence of NEC in oncology patients was 0.34–16 %, the mortality rate varied between 2.1 % and 66 %. All studies had severe methodological limitations and various definitions of NEC were used. In total 16 risk factors were suggested, potentially useful in the risk assessment of NEC. Only two studies used multi-variate analysis for risk factors.
Author (year) | Risk factor | P value | 95 % CI |
Rizzatti (2010) | Use of Cytarabine | 0.0195 | 1.21–8.6 |
>4 No. of abdominal symptoms | 0.0255 | 0.47–6.07 | |
Van de Wetering (2003) | Abdominal distention | 0.0118 | 1.30–7.98 |
CRP > 150 mg/L | 0.023 | 0.92–45.1 | |
IL-8 > 1000 pg/ml | 0.001 | 1.6–77.9 |
Conclusions: There is limited evidence to predict the course and outcome of NEC. Literature suggests a high mortality rate and more investigation is necessary to validate risk factors for a severe outcome.
Author (year) | Type of study | Number NEC patients | Age (years) | Prognostic factors |
Baerg (1999) | Retrospective chart review | 33 | 1–16 | Diffuse abdominal pain, T > 38.5 °C, multiple bacteria in blood culture. |
Cardona Zorilla (2006) | Literature search | 275 | adults | Bacteraemia, bowel wall thickening, mucositis, use of antifungal agents |
Cartoni (2001) | Retrospective | 88 | 6–63 | Bacteraemia, bowel wall thickening |
Dietrich (2006) | Prospective | 14 | 17–66 | Bowel wall thickening, CRP > 150 mg/L |
Gomez (1998) | Retrospective | 17 | Adults | Positive imaging (unspecified) |
Gorschlüter (2002) | Prospective | 4 | 21–78 | Bowel wall thickening |
Jain (1999) | Retrospective | 11 | 4–12 | Prolonged neutropenia |
Kies (1978) | Retrospective | 2 | 16–20 | Prolonged neutropenia |
Kunkel (1986) | Retrospective | 3 | 10–60 | Prolonged neutropenia |
McCarville (2005) | Retrospective | 92 | 1–22 | Age >16 years, diffuse abdominal pain, T >38.5 °C, prolonged neutropenia |
Mower (1986) | Retrospective | 13 | 15–76 | Bacteraemia |
Pastore (2002) | Prospective | 7 | 18–60 | Bowel wall thickening, diffuse abdominal pain |
Rizzatti (2010) | Retrospective | 188 | 0–24 | Use of cytarabine, abdominal distention, ? 4 symptoms (abdominal pain/fever/vomiting/diarrhea/intestinal obstipation/distention/gastrointestinal bleeding) |
Sloas (1993) | Retrospective | 24 | 2–20 | Early onset of symptoms after neutropenia (<2 days) |
Van de Wetering (2004) | Prospective | 24 | 1–17 | CRP > 150 mg/L, IL-8 > 1000 pg/ml |
Wade (1992) | Retrospective | 22 | 5–66 | Prolonged neutropenia |
References:
Rizzatti MB. Pediatric Hematology and Oncology. 2010;27:462–470.
Van de Wetering et al. Eur J Cancer. 2004;40:571–578.
MASCC-0647
A prospective multicenter, single blind, randomized phase iii trial to compare ramosetron, aprepitant and dexamethasone with ondansetron, aprepitant and dexamethasone for preventing CINV: KCSG PC10-21.
H.J. Kim 1, E.K. Song2, J.S. Kim3, J.S. Ahn4, H.J. Yun5, Y.H. Cho6, K.U. Park7, S.Y. Kim8, J.S. Jang9, S.W. Kim10, H.W. Lee11, S.R. Lee12, Y.S. Kim13, S.N. Lee14, Y.H. Ko15, H.J. Kim16, J.H. Kang17, S.W. Shin18
1Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea, 2Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea, 3Internal Medicine, Korea University Guro Hospital, Seoul, Korea, 4Internal Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea, 5Internal Medicine, Chungnam National University Hospital, Daejeon, Korea, 6Internal Medicine, Konkuk University Medical Center, Seoul, Korea, 7Internal Medicine, Dongsan Medical Center Keimyung University, Daegu, Korea, 8Internal Medicine, Kyunghee University Hospital, Seoul, Korea, 9Internal Medicine, Chung-Ang University Hospital, Seoul, Korea, 10Internal Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea, 11Internal Medicine, Ajou University School of Medicine, Suwon, Korea, 12Internal Medicine, Korea University Ansan Hospital, Ansan, Korea, 13Internal Medicine, Kosin University Gospel Hospital, Busan, Korea, 14Internal Medicine, Ewha Womans University, Seoul, Korea, 15I4nternal Medicine, Uijeongbu St. Mary’s hospital, Uijeongbu, Korea, 16Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea, 17Internal Medicine, Seoul St. Mary’s Hospital The Catholic University of Korea, Seoul, Korea, 18Internal Medicine, Korea University College of Medicine, Seoul, Korea
Introduction: The combination regimen of aprepitant, 5-HT3receptor antagonist, and dexamethasone has been widely accepted as the standard treatment for preventing highly emetogenic chemotherapy induced nausea/vomiting (CINV). Until now, there has been no clinical data whether ramosetron is as effective as other 5-HT3receptor antagonists for the regimen.
Objectives: We conducted a prospective randomized phase III clinical trial to compare ramosetron, aprepitant, and dexamethasone (RAD) with ondansetron, aprepitant, and dexamethasone (OAD) to prove the non-inferiority of RAD in controlling highly emetogenic CINV.
Methods: Aprepitant (125 mg, day1; 80 mg, day2, 3) and dexamethasone (12 mg day1; 8 mg day2–4) were administered for both groups. Ramosetron (0.3 mg, day1) and ondansetron (16 mg, day1) were intravenously given to each group. The primary end point was CR rate (no vomiting without rescue medication) during the acute period (day1).
Results: Two hundred ninety-nine patients (RAD 143 vs. OAD 156) were eligible for the efficacy analyses. Median age and sex ratio (M:F) in RAD and OAD were 60 and 61, and 90:66 and 114:29, respectively (p = 0.54 and p < 0.0001). The CR rates of RAD vs. OAD were 84.6 % vs. 77.6 % (95 % C.I. −0.4 ~ 14.5 %) during acute period, 69.5 % vs. 62.6 % (−2.1 ~ 16.0 %) during delayed period (days 2–5), and 66.7 % vs. 58.1 % (−0.6 ~ 17.8 %) during overall period. Median nausea score during acute period were 4 (IQR 2 ~ 5) and 3 (2 ~ 5, p = 0.14) in RAD and OAD, respectively. There were no grade 3 or 4 toxicities.
Conclusions: RAD regimen is as effective and tolerable as OAD combination for the prevention of CINV in the cancer patients receiving highly emetogenic chemotherapy.
MASCC-0648
Cost-effectiveness of aprepitant in combination with ondansetron and dexamethasone for prevention of chemotherapy-induced nausea and vomiting (CINV) among patients with breast cancer in the UK
S. Humphreys1, J. Pellissier2, A. Jones 3
1Market Access, Merck Sharp & Dohme Ltd, Hoddesdon, United Kingdom, 2Health Economic Statistics, Merck Research Laboratories, Upper Gwynedd, USA, 3Medical Oncology, University College Hospital, London, United Kingdom
Introduction: Prevention of chemotherapy-induced nausea and vomiting (CINV) remains an important goal for patients receiving chemotherapy, however antiemetic regimens recommended in clinical guidelines are not always administered in UK routine practice.
Objectives: To define, from the UK payer perspective, the cost-effectiveness of an antiemetic regimen using aprepitant, a selective neurokinin-1 receptor antagonist, for patients receiving chemotherapy for breast cancer.
Methods: A decision-analytic model was developed to compare an aprepitant regimen (aprepitant, ondansetron, and dexamethasone) with a standard UK antiemetic regimen (ondansetron, dexamethasone, and metoclopramide) for expected costs and health outcomes after single-day adjuvant chemotherapy for breast cancer. The model was populated with results from patients with breast cancer participating in a randomized clinical trial of CINV preventative therapy for cycle 1 of single-day chemotherapy.
Results: During 5 days after chemotherapy, 64 % of patients receiving the aprepitant regimen and 47 % of those receiving the UK comparator regimen had a complete response to antiemetic therapy (no emesis and no rescue antiemetic therapy). A mean of £37.11 (78 %) of the additional costs of the aprepitant regimen were offset by reduced health-care resource utilization costs. The predicted gain in quality-adjusted life-years (QALYs) with the aprepitant regimen was 0.0048. The incremental cost effectiveness ratio (ICER) with aprepitant, relative to the UK comparator, was £10,847/QALY, which is well below the threshold commonly accepted in the UK of £20,000–£30,000/QALY.
Conclusions: The results of this study suggest that aprepitant is cost-effective for preventing CINV associated with chemotherapy for patients with breast cancer in the UK health-care setting.
MASCC-0649
Impact of paracentesis on health-related quality-of-life (HRQOL) in cancer patients with malignant ascites
B. Ehlken 1, C. C Schimanski2, K. Berger1, F. Lordick3
1Health Economics & Outcomes Research, IMS Health, Munich, Germany, 2Clinic Internal Medicine, Marien-Hospital, Darmstadt, Germany, 3University Cancer Center, University Cancer Center Leipzig, Leipzig, Germany
Introduction: Malignant ascites (MA) is an accumulation of fluid in the abdominal cavity due to uncontrolled tumor growth on the peritoneal surface. MA leads to a significantly impaired general health status and to poor quality-of-life. Paracentesis is the most common treatment for MA.
Objectives: This study was designed to evaluate the impact of paracentesis on HRQoL in cancer patients with MA.
Methods: The study was conducted as a prospective, observational, multicentre study in Germany. The impact was measured by using EQ-5D before and within 1 day after paracentesis.
Results were compared with EQ-5D utility scores of other health conditions reported in the literature.
Results: In total, 29 patients were enrolled between 07/2007–08/2009; 45 paracenteses in 28 patients were available for QoL analysis. Mean EQ-5D scores before (0.48 ± 0.26) and after (0.56 ± 0.30) paracentesis revealed a mean increase of 0.08 ± 0.25 indicating a 17 % improvement. QoL improved after 44.4 % of paracenteses, remained unchanged after 26.7 % and even deteriorated after 28.9 %. Literature search for other conditions revealed 0.56 mean score for hemodialysis patients (1) and 0.48 mean score for patients with chemotherapy-induced-anaemia (2).
Conclusions: In over 50 % of patients undergoing paracentesis for MA, no benefit in terms of HRQoL was detected. Before paracentesis, MA patients reported HRQoL equivalent to patients with chemotherapy-induced-anaemia. Even after an improvement with paracentesis, patients’ HRQoL improved only to a mean level of hemodialysis patients. Study results confirmed poor HRQoL in patients with MA even after paracentesis.
References:
(1) Liem YS et al. Value Health 2008;11(4):733-41
(2) Ossa DF et al. Pharmacoeconomics 2007;25(3):223-37
MASCC-0651
Supportive care and symptoms management in Pisa medical oncology
A. Antonuzzo 1, L. Ginocchi1, E. Vasile1, M. Lucchesi1, I. Brunetti1, L. Galli1, S. Ricci1, A. Falcone1
1Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana. Istituto Toscano Tumori, pisa, Italy
Introduction: Oncologic patients often need supportive care for cancer treatment related toxicities and their comorbidities.
Objectives: To present the supportive care model of Pisa medical oncology.
Methods: Symptoms management and supportive care in cancer patients undergoing anticancer therapies during late 2012.
Results: We applied a model of integrated and early supportive care activity for cancer patients. The day hospital outpatients care was improved with a new visit room; this activity, held by two physicians (faculty and post-doctoral) and one dedicated nurse is provided to manage chemotherapy and targeted therapy toxicities (‘classical’ adverse events and ‘new’ as cutaneous rash, hypertension, etc.). Mainly patients with relevant unplanned clinical problems can contact the supportive care team calling the medical oncology reception or the emergency mobile phone number. When feasible, toxicities, comorbidities and others symptoms (e.g. pain) are handled directly by phone; if it is necessary, the patient can directly access to the supportive care room for visiting, collection of blood samples, intravenous administration of fluids and drugs. There are institutional linked activities with other specialists to solve clinical acute problems (e.g. anesthesiologist for severe drug-related adverse event like allergy). In addiction, psychologist and chaplain give their service daily inside the day hospital for all patients that need.
Conclusions: This is a global care offer for all patients during active oncological treatments and make the possibilities to reduce their hospital admissions. Regarding that, we started a prospective database to better describe the reasons of unplanned visits to medical oncology and to improve early supportive care integrated with anticancer therapies.
MASCC-0652
Supportive care in cancer unit (SCCU) at the national cancer institute (NCI) of Milan
C. ripamonti 1, P. Rondelli1, M.A. Pessi1
1Supportive Care in Cancer, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Introduction: “Supportive care” is the prevention and treatment of the oncological therapy-related complications as well as the maintenance of physical, psychosocial, spiritual well being of the patients thus to improve their adherence to treatment protocols in terms of dose-intensity and interval of administration.
Objectives: The aims of the SCCU of the NCI of Milan (born on June 2009) are mainly four: to collaborate with the individual specialists of NCI through integrated and ancillary activities by means of specific pharmacological interventions; to assess all patients’ needs through Italian validated tools (physical and emotional symptoms, hope, existential/search of meaning/religious and communication needs) in order to ensure early care of the patient in a holistic approach; to support family members, survivors and healthcare professionals; and to promote research (pharmacological and not) and educational programs.
Methods: Pharmacological intravenous therapies consists of: blood product transfusions, infusion of immunoglobulins, human albumin, human plasmatic protein, antibiotics, antifungals and antivirals, iron, analgesics, diuretics, steroids, octreotide, H2-antagonist, glutathione, antiemetics, antihistamines, bisphosphonates (with prevention and treatment of ONJ), hydration post high-dose chemotherapy, for acute and chronic renal failure, electrolyte supply, and/or multivitamin, protein, lipid supply, in patients with compromised ability to eat and drink properly, or with toxicity due to radiotherapy or chemotherapy (i.e., diarrhea, nausea, vomiting and oropharyngeal high-grade mucositis).
Results:
Figure 1 shows the trend of activity from June 2009 till December 2012 at the SCCU
Conclusions: Supportive Care Units are necessary in each Oncological Center.
MASCC-0653
Prevalence of pain in elderly cancer patients
V. Zafferri 1, A. Brunello1, A. Roma1, S. Lonardi1, U. Basso1, F. Bergamo1, P. Fiduccia1, M. Corrias2, E. Capovilla2, L. Trentin3, V. Zagonel1
1Division of Medical Oncology 1, Istituto Oncologico Veneto-IOV IRCCS, Padova, Italy, 2Psycho-Oncology Service, Istituto Oncologico Veneto-IOV IRCCS, Padova, Italy, 3Palliative Care Unit, Istituto Oncologico Veneto-IOV IRCCS, Padova, Italy
Introduction: Information among prevalence of pain in elderly cancer patients (ECP) are limited.
Objectives: To evaluate, in ECP, prevalence of pain, intensity, correlation between pain and stage of cancer, correspondence between patients’ self-reported pain and oncologist assessment.
Methods: Consecutive ECP referred to our Oncology Unit from January 2011 to January 2013 were enrolled. Pain was assessed through a semi-structured interview, McGill Pain Questionnaire, Brief Pain Inventory; pain was also assessed through numerical rating scale (NRS) by the physician.
Results: Enrolled ECP are 531, median age 76 years (range 70–92); 43.9 % males. Main tumor types are: gastrointestinal (42 %), breast (27 %), urological (13.8 %), other sites (17.2 %).
ECP with early stage disease experience lower interference (Mean ± SD: 2.94 ± 2.32), compared to those with advanced cancer (Mean ± SD: 3.82 ± 2.24, p = 0.008).
Self-reported pain is stated by 212 ECP (39.9 %), whereas oncologists’ reporting of pain is present for 118 ECP (55.6 %) and in 63 (53.4 %) pain is related to cancer. For patients with both evaluations (n = 100) a significant difference in NRS intensity is observed between ECP self-reported pain (median: 5, range 0–10) and oncologists’ assessment (median: 3, range 1–10, p < 0.001.
Conclusions: Almost 40 % of ECP reported pain, but oncologists’ assessment was present in only about half of the cases (22.3 %). When present, pain was cancer-related in about half of cases. Overall, pain was of low-intermediate intensity. Our data show that there is under-estimation of prevalence and intensity of pain in ECP by physicians.
References: Jackson M. (2002) Pain: the fifth vital sign. New York: Crown.
MASCC-0654
Burnout in medical oncology fellows is high even before the program starts
D. Cubero 1, R.R.L. Fumis1, F.M. Cruz1, P.X. Santi1, T.H. Sa2, A.A. Dettino3, F.O. Costa4, F.M. Peria5, B.M.V. Eyll6, C.A.M. Beato7, J. Altino8, S.J. Azevedo9, D.R. Filho10, A.A. Mota11, A.E.R. Lessa12, M. Moreira12, A.E.R. Del Giglio13
1Oncology and Hematology Department/CEPHO, ABC Foundation School of Medicine, Santo André, Brazil, 2School of Public Health, University of Sao Paulo, Sao Paulo, Brazil, 3Oncology Department, Hospital A. C. Camargo, Sao Paulo, Brazil, 4Oncology Department, Unicamp, Campinas, Brazil, 5School of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil, 6Oncology Department, Instituto Arnaldo Vieira de Carvalho, Sao Paulo, Brazil, 7Hospital Amaral Carvalho, Hospital Amaral Carvalho, Jaú, Brazil, 8Faculdade de Medicina de São José do Rio Preto, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil, 9Oncology Department, Hospital das Clinicas de Porto Alegre, Porto Alegre, Brazil, 10Oncology Department, Instituto do Cancer do Ceara, Fortaleza, Brazil, 11Oncology Department, Hospital São Rafael, Salvador, Brazil, 12Oncology Department, Hospital Santa Isabel, Salvador, Brazil, 13Oncology and Hematology Department/CEPHO, ABC Foundation School of Medicine, Santo Andre, Brazil
Introduction: Burnout is high among practicing oncologists. Medical oncology fellows (MOFs) are exposed to similar risk factors for burnout, however few data are available in this population.
Objectives: To evaluate prevalence of burnout in Brazilian MOFs during their first year of fellowship.
Methods: This is a prospective cohort study of Brazilian MOFs in 2010 and 2011. We evaluated burnout, stress and depression prevalence at the start, 6 and 12 months after the beginning of medical oncology program. We applied Maslach Burnout Inventory, Lipp Inventory and Beck Depression Inventory.
Results: We included 53 MOFs from 11 institutions. The mean age was 29 (95 % CI 28.2–29.7 years old), 53.7 % were men, 80.8 % were single and 67.3 % had family support. The majority of them hadn’t had psychiatric or psychotherapeutic treatment (90.4 % and 73.1 %, respectively). At the beginning of the medical oncology program, the majority of fellows already presented severe burnout (emotional exhaustion score ≥ 27 in 49 %; depersonalization score ≥ 10 in 64.7 % and lack of personal accomplishment score ≤ 33 in 17.7 %). At this same point, 36.7 % of fellows were stressed and 34 % had depression. During the first year of medical oncology fellowship, severe burnout prevalence increased significantly, mainly for Maslach EE (p = 0.0032) and Maslach DP (p = 0.0088).
Conclusions: Burnout is already high at the beginning of medical oncology fellowship. Previous intensive internal medicine residency activities may have contributed to this finding and the medical oncology fellowship experience may intensify pre-existing burnout even more.
MASCC-0655
Effects of exercises on fatigue in patients underwent hematopoietic stem cell transplantation
V.D.S. Carlucci1, R.C.C.P. Silveira 1, F.T.M.M. Braga1, L.M. Garbin1, P.E.D. Reis2
1General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil, 2Nursing, University of Brasília, Brasília, Brazil
Introduction: Patients who underwent hematopoietic stem cell transplantation (HSCT) have several side effects. The fatigue is shown by physical, mental and emotional symptoms and decrease of the patient’s functional condition ability. This effects and symptoms are revealed by sleep disturbance, anxiety, physical exhaustion and disorder nutritional condition. Under this context, physical exercises can improve healthy and quality of life.
Objectives: To identify recent reports related to physical exercises in patients underwent to chemotherapy followed by HSCT.
Methods: A literature narrative review was conducted in the Pubmed, Cinahl, Lilacs and Cochrane Library databases.
Results: Seven controlled and randomized clinical trials were identified, in which was raised the relation between the physical exercises and the improvement of effects and symptoms of fatigue. Among some physical exercises performed by low impact were: stretch in the bed with elastic string, breathing relax, multimodal activity with progressive relaxing associated to psychologist education that consisted on behavior therapy and cognitive techniques; and prescribed in accordance with the ability of the analyzed patients. The impact of these activities was analyzed by laboratorial exams, anxiety, depression and fatigue level identification. The measurement of such variables occurred in three different periods of time: before the exercises beginning, during the transplantation and up to 6 months after HSCT. The results identified the well being and quality of life improvement, decrease of anxiety and depression levels and functional ability improvement.
Conclusions: Physical exercises is a relevant intervention to fatigue and can be adopted during the patient daily care.
MASCC-0656
Effects of a psycho-educational intervention on mood in colorectalcancer and anal cancer patients and their next-of-kin: a randomized controlled trial
M. Andersson1, B. Andershed 2, U. Nilsson3, E. Ohlsson-Nevo3
1Department of Surgery, Örebro University Hospital, Örebro, Sweden, 2Department of Nursing, Gjøvik University College Gjøvik, Gjøvik, Norway, 3School of Health and Medical Sciences, Örebro University Örebro, Örebro, Sweden
Introduction: Colorectal-cancer is common in both men and women with an estimated incidence of 1.2 million new cases per year. The disease can affect the physical and psychological wellbeing of both the patients and the next-of-kin. Psycho-social interventions are known to reduce the impact of the disease, reduce distress and increase abilities to cope for both the patients and the next-of-kin.
Objectives: The aim of this study was to test if a psycho- educational program had an effect on mental wellbeing in persons treated for colorectal or anal cancer and their next-of-kin.
A randomized controlled trial in a surgical clinic at a university hospital in the middle of Sweden.
99 colorectal-cancer patients and 71 next-of-kin particpated in the study.
Methods: The psycho-educational program included 7 meetings with 60 min professional lectures followed by 60 min of separate reflections with others patients/next-of-kin led by one registered nurse in each group. The overall mood was measured with the Mood Adjective Check List (MACL) including three dimensions; activation, pleasantness and calmness. MACL was measured 1 month after the discharge from the hospital and 1 month, 6 and 12 months after the end of psycho-educational program.
Results: The psycho-educational program increased the patient’s overall mood, calmness and pleasantness 1 month after the end of the psycho-educational program However, the program did not the overall mood or activation, pleasantness and calmness among the next-of-kin.
Conclusions: The psycho-educational program has an effect on the patients overall mood but not in next-of-kin. Further studies are needed to confirm the results.
MASCC-0657
Single brain metastases: radiotherapy alone or combined with neurosurgery?
D. Ivanova 1, S. Georgieva1, A. Dimov1
1Radiation Oncology, Tokuda Hospital Sofia, Sofia, Bulgaria
Introduction: Most patients with single brain metastases die from progression of extracranial tumor activity, which makes it uncertain what is the best combination of treatment for this cranial disease.
Objectives: The objective is to determine if the addition of surgical extirpation prior to whole brain radiotherapy (WBRT) increases survival, neurological function, and quality of life compared with radiotherapy alone in patients with single brain metastases.
Methods: We conducted aretrospective study of 53 patients who received WBRT from November2009 to December 2012. Mean age was 60.8 years (31–82). Pathology ofprimary tumor included lung (29), breast (13), melanoma (5) and others (6). The patients were divided in twogroups: neurosurgery plus WBRT (28 patients) vs. WBRT alone (25patients). In both groups radiotherapy was given to the whole brainin 3 Gy fractions per day for a total dose of 30Gy in 2 weeks.
Results: The combined treatment led to an increased overall survival (15 vs. 10 months). This was mostly pronounced in patients with stable extracranial disease (median survival 17 vs. 13 months). Patients with progressive extracranial disease had a median overall survival of 7 months irrespective of received treatment. Improvement in neurological functional status occurred more rapidly and for longer periods of time in patients after neurosurgical excision and radiotherapy than after radiotherapy alone.
Conclusions: Patients with single brain metastases and controlled or absent extracranial tumor activity show benefit both in overall survival and neurologic status from the addition of neurosurgery prior to WBRT, while for patients with active extracranial disease radiotherapy alone appears to be sufficient.
MASCC-0658
Multicentre, prospective observational study of pegfilgrastim primary prophylaxis (PP) in patients at high risk of febrile neutropenia (FN) in Poland
W. Jurczak 1, E. Kalinka-Warzocha2, E. Chmielowska3, R. Duchnowska4, E. Wojciechowska-Lampka5, K. Wieruszewska6
1Dept of Hematology, Jagiellonian University, Krakow, Poland, 2Dept of Oncology, Regional Oncology Center, Lodz, Poland, 3Oncology Clinic, Oncology Centre, Bydgoszcz, Poland, 4Dept of Oncology, Military Institute of Medicine, Warsaw, Poland, 5Department of Lymphoproliferative Diseases, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute, Warsaw, Poland, 6Medical Development, Amgen Biotechnologia Sp z oo, Warsaw, Poland
Introduction: Pegfilgrastim is a once-per-cycle granulocyte-colony stimulating factor (G-CSF) registered for PP of FN in patients receiving myelosuppressive chemotherapy. Guidelines recommend it in all patients with high (≥20 %) overall FN-risk.
Objectives: Primary objective was to determine the most important reasons contributing to physicians’ decision to use pegfilgrastim PP in patients with high overall FN-risk; secondary objectives included estimating FN incidence and monitoring PP safety.
Methods: Patients with lymphoma or breast, lung, or ovarian cancer and an investigator-assessed high overall FN-risk were eligible. All patients received pegfilgrastim prophylaxis from the first chemotherapy cycle.
Results: One thousand six eligible patients were enrolled from 03/2009–03/2011 (431 breast, 110 ovarian, 108 lung, 263 NHL, 94 Hodgkin lymphoma). Median age was 55 years (range 18–86), 74 % of patients were female, 76 % had advanced (stage III/IV) disease. Most patients received chemotherapy with intent to cure (66 %) or prolong life (29 %), with 5 % palliative. Investigator-assessed chemotherapy FN-risk was high in 69 %, intermediate in 18 %, and low in 3 % of patients (10 % missing). The most commonly selected first important reason for pegfilgrastim prophylaxis in cycle 1 was high FN-risk chemotherapy (72 %); the most commonly selected second important reason was advanced disease (28 %). Overall FN incidence was 4 %; most events occurred in NHL patients (26/44). Bone and muscle/joint pain were the most common adverse drug events (both 6 %), with none serious.
Conclusions: The most important reasons for pegfilgrastim PP were high-risk chemotherapy and advanced disease. FN rates were relatively low in patients at high overall FN-risk with pegfilgrastim PP.
MASCC-0659
Community acquired pneumonia: our centers experience in oncologic patients
C. Ribeiro 1, F. Gomes1, R. Pereira2, S. Oliveira1, P. Barata1, A.C. Trindade1, R. daLuz1, A. Castro2, L. Batarda1
1Medical Oncology, Centro Hospitalar Lisboa Central, Lisboa, Portugal, 2Internal Medicine, Centro Hospitalar Lisboa Central, Lisboa, Portugal
Introduction: Community Acquired Pneumonia (CAP) is an important cause of morbidity and morbility and hospital admissions for CAP have markedly increased over the last decade, particularly in elderly patients.
Objectives: With this study, our aim was to compare the severity and outcome of respiratory infections in patients with previous diagnosis of neoplasms with the ones without, in our hospital.
Methods: We reviewed of all cases of “Pneumonia” in hospitalized patients between January 1st and December 31st of 2010.
Results: A total of 320 patients (80 oncologic) were admitted with CAP in 2010. There were no significant differences regarding age between both groups (68 versus 71 years, p = 0.133). Oncologic patients had a higher mortality rate (14.7 % versus 28.8 %, p = 0.003) and more severe disease (SOFA score)(p = 0.021). Among patients with oncologic disease, 40 had active disease in the past year, but we only found a tendency for lower survival when comparing these patients with the ones with disease not considered active (343 versus 193 days, p = 0.054). Of our patients, 23 had been treated with chemotherapy on the previous 3 months, in a median of 19 days before the admission with CAP. Only 11 patients did chemotherapy after the CAP admission, in a median of 32 days.
Conclusions: Despite all the limitations of being a small, retrospective study, with this report we hope to alert for how important it is to better understand respiratory infections in oncologic patients in order to improve treatment and prognosis.
References: British thoracic Society guidelines for the management of CAP.
MASCC-0660
Bereavement care after patients’ immediate death and postmortem care in Japan
S. Jahana 1, M. Kamizato1
1Adult Nursing, Okinawa Prefectural College of Nursing, Naha, Japan
Introduction: Postmortem care has been reconsidered as a care for the bereaved family in Japan. However, there are few studies about postmortem care as bereavement care.
Objectives: To clarify how bereavement care is provided for the family by nurses after patient’s death until the discharge and to examine the interaction between the bereaved family members and nurses.
Methods: This study was an exploratory study to collect data primarily through ethnographic observations and interviews. Participants were 49 bereaved family members of 19 terminally ill cancer patients and 19 nurses in Japan. Study period was 7 months in 2010. A researcher participated patients’ death and postmortem care with the nurses and observed attitudes and responses of the family and the nurses. Data analysis was conducted by using a qualitative descriptive method. After an ethics review by the College and hospitals, the research was conducted.
Results: After the patients’ breathing stopped, the nurses provided the bereaved family members time with the patients for about an hour as grief care before death pronounced by the doctor.
During the period of Postmortem Care, the nurses not only gave showers, got dressed on and put makeup on the deceased patients with the bereaved family members, but also the nurses listened to the family members about good memories of patients. Inaddition, the nurses helped the family to find the meaning about what they did for the patients.
Conclusions: The nurses provided grief care to the bereaved family members during the period immediately, following the patients’ death and postmortem care.
MASCC-0661
Experiences of having a urinary catheter post radical prostatectomy for prostate cancer
J. Hegarty 1, S. Curran1
1School of Nursing and Midwifery, University College Cork, Cork, Ireland
Introduction: Continued investigation into the health concerns of men post treatments for prostate cancer is required. Interestingly, the experience of men with urethral catheters has received little attention in the research literature. Leakage of urine around a catheter is not uncommon in patients. Aetiological factors for leakage of urine around a catheter include partial blockage of catheter, bladder spasms, constipation, urinary infections, and inappropriate catheter/balloon size.
Objectives: To provide a retrospective picture of men’s experiences of having a urethral catheter post prostatectomy.
Methods: A qualitative, descriptive design was employed. Ethical approval was obtained. A volunteer sample (n = 20) of men post radical prostatectomy were interviewed. Data was analysed using qualitative thematic content analysis.
Results: The urinary catheter was associated with restrictions in mobility and some discomfort and pain. Men attributed their discomfort to constipation, bladder spasms, movement of the catheter tube and leakage of urine around the catheter. Men were embarrassed when leakage of urine occurred. Men described the overwhelming feelings of relief when the catheter was removed.
In the longer term men made a strong link between the penis being a key focus of male sexuality and the ability to engage in penetrative sexual activity being a fundamental constituent part of male gender identity.
Participants spoke at length in relation to their very real need for information and the need for peer, family and healthcare professional support.
Conclusions: This type of information is vital in order to tailor healthcare services to meet the unique needs of each patient.
MASCC-0662
Reflexology in breast cancer patients receiving chemotherapy: results from a single center pilot study
E. Cappai 1, S.M. Magno1
1Breast Center, Catholic University of the Sacred Heart, Rome, Italy
Introduction: A pilot study was conducted on a small series of breast cancer patients receiving chemotherapy between March 2011 and August 2012 at the Breast Center of the Catholic University of Rome.
Objectives: To evaluate the effectiveness of reflexology in reducing side effects of chemotherapy.
Methods: Thirteen women with a histologically proven diagnosis of breast cancer, undergoing weekly cycles of a Taxan-based chemotherapy regimen (80 mg/m2) were recruited in the study. Weekly questionnaires were submitted to assess the presence and intensity of chemotherapy side effects. Patients were randomly assigned to receive 45 min weekly courses of foot reflexology (seven patients), or to be included in the control group (four patients). Adherence to chemotherapy plan and granulocyte stimulating factors prescription were monitored for each patient.
Results: A decreased incidence and/or reduced intensity of hot flushes and insomnia was observed in the reflexology group, together with a reduced consumption of drugs for nausea and pain and better adherence to weekly chemotherapy cycles.
Conclusions: Despite the small size of the sample tested, the present study homogeneity in patient’s recruitment standards (age, pathology, chemotherapic schedule, treatment Center, and reflexology therapist) contribute to endorse reflexology as a promising therapeutic option both for its safety and effectiveness in breast cancer patients treated with chemotherapy. The promising trends shown in this pilot study are to be confirmed in a larger trial.
MASCC-0663
Clinical standards of care on diagnosis, prevention and treatment of (CHEMO)radiation-induced dysphagia in head and neck cancer patients: a MASCC/ISOO survey results
P. Bossi 1, B. Murphy2, E. Russi3, R.J. Bensadoun4, A. Merlotti5, I.M. Verdonck-de Leeuw6, L. van-der Molen7, J. Raber-Durlacher8, A. Barasch9
1Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, 2Medical Oncology, Vanderbilt-Ingram Cancer Center, Nashville, USA, 3Radiation Oncology, General Hospital S Croce e Carle, Cuneo, Italy, 4Radiation Oncology, CHU de Poitiers, Poitiers, France, 5Radiation Oncology, Azienda Ospedaliera Busto Arsizio, Busto Arsizio, Italy, 6Otolaryngology/Head & Neck Surgery, VU University Medical Cancer Center, Amsterdam, Netherlands, 7Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, Netherlands, 8Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, Netherlands, 9Dental Medicine, Winthrop University Hospital, Mineola, USA
Introduction: Although dysphagia is a common side effect in head and neck cancer (HNC) patients, standards for assessment, prevention and treatment are lacking.
Objectives: To assemble information regarding patterns of care related to dysphagia in HNC patients.
Methods: MASCC/ISOO members and HNC specialists were asked to complete an electronic survey querying patterns of dysphagia care at their institution.
Results: One hundred thirty surveys, mainly from Europe and North America, were returned. Supportive care issues were considered at HNC tumor board in 80 % of institutions. Pre-treatment dysphagia and weight loss were often/always discussed in 61 % and 71 % of teams, respectively. A dedicated speech pathologist (SLP) and a dietician were present in 45 % and 55 % of the institutions, respectively. Instrumental evaluation was mainly performed by flexible endoscopy (58 %), usually after development of dysphagia or aspiration signs/symptoms. Among signs and symptoms that should trigger referral for assessment by an SLP, weight loss was included by 47 % of responders. A feeding tube was placed prophylactically in 31 % of patients, usually due to pre-existing weight loss and/or swallowing disorders. 66 % of responders did not use patient reported outcome (PRO) measures routinely. Dysphagia care and nutritional support were deemed satisfactory by 51 % and 71 % of the responders, respectively. The main problem with dysphagia care was lack of SLP availability.
Conclusions: Dysphagia care is inadequate at many institutions treating HNC. Dedicated SLP services and PRO measures should be made available in order to improve the patient’s support. Standards for assessment, prevention and treatment of dysphagia in HNC are needed.
MASCC-0664
Clinical and molecular predictors of late patient-reported dysphagia in oropharyngeal cancer treated with intensity modulated radiotherapy concurrently with chemotherapy
P. Bossi 1, A. Mirabile1, R. Miceli2, E. Orlandi3, E. Iannacone3, N. Denaro4, A. Schindler5, N. Pizzorni5, L. Gianello6, E. Russi6, L. Licitra1
1Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, 2Statistics and Biometry, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, 3Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, 4Medical Oncology, General Hospital S Croce e Carle, Cuneo, Italy, 5Otolaryngology, University of Milan, Milano, Italy, 6Radiation Oncology, General Hospital S Croce e Carle, Cuneo, Italy
Introduction: The impact of late dysphagia in patients treated with chemoradiation for head and neck cancer is generally underreported, with limited data about clinical and molecular predictive factors.
Objectives: To evaluate late patient-reported dysphagia.
Methods: Stage III-IV oropharyngeal cancer without evidence of disease, treated since more than 6 months with IMRT and concurrent chemotherapy, with/without induction chemotherapy (IC) were selected. Clinical data were collected together with p16 tumoral status as marker of HPV positivity. We analyzed the MDADI and FACT total scores administered in a cross sectional study.
Results: In 3 months we selected 83 pts, having the characteristics in Table 1.
In multivariable analysis, lower MDADI total score was significantly related to high risk group (p16 negative tumors), higher xerostomia and short time from treatment end; similarly, FACT-HN global score showed a significant association with xerostomia and time from treatment end.
Table 1:
Age, Sex | Mean 60 year (43–78), M 82 %, F 18 % |
Stage | T3-4 51 %; N2-3 81 % |
Induction chemotherapy | Yes 31 %, No 69 % |
p16 | Pos 75 %, Neg 25 % |
Risk | High (p16 negative) 21 %, intermediate 43 %, low 36 % |
Late xerostomia | G0 41 %, G1 35 %, G2 24 % |
Time from treatment end | ≤ 24 months 47 %; > 24 months 53 % |
Mean RT dose | 70 Gy |
MDADI global score | Mean 75 (40–100) |
FACT-HN global score | Mean 108 (56–148) |
Conclusions: Globally, treatment with IMRT and chemotherapy has a reduced burden of patient-reported dysphagia, with further improvements after 24 months of follow up. HPV status and late xerostomia are the main predictors of perceived late dysphagia symptoms.
MASCC-0665
The experience of being diagnosed with prostate cancer and having a radical prostatectomy
J. Hegarty 1, S. Curran1
1School of Nursing and Midwifery, University College Cork, Cork, Ireland
Introduction: Radical prostatectomy remains the first choice of treatment for many men. Thus, continued investigation into the health concerns of men prior to and post treatments for prostate cancer is required.
Objectives: The objective of this study was to provide a retrospective picture of men’s experiences of surgery for prostate cancer from initial diagnosis, through their surgery and 2 weeks beyond.
Methods: A qualitative, descriptive design was employed. Ethical approval was obtained. A volunteer sample (n = 10) of men 2 weeks post radical prostatectomy were interviewed. Data was analysed using qualitative thematic latent content analysis.
Results: Men identified a number of themes related to their prostate cancer journey. These included: the process of being diagnosed (the existential meaning attributed to the word cancer), experience of having surgery, side-effects of treatments (pain, feeling sick, bit wobbly, constipation), the emotional challenges on the cancer journey, difficulties with the urinary catheter and the need for information and support.
The word “cancer” engenders fear in individuals and does not reflect the knowledge of the 21st century but alternatively reflects fears, uncertainties and a perceived certainty that death is somehow accelerated by the fact of the diagnosis. Words really do matter because they influence out thoughts and behaviours.
Conclusions: In a healthcare system which increasingly values the ‘patients view’ this type of information is vital in order to tailor healthcare interventions to meet the unique needs of each patient.
MASCC-0666
Development of a simple assessment tool for the elderly cancer patients based on relationships between comprehensive geriatric assessment items and performance status
S. JUN 1, J.Y. Kim2, K.U. Park2
1Collegle of Nursing, Keimyung University, Daegu, Korea, 2Department of Hematology/Oncology, Keimyung University Dongsan Hospital, Daegu, Korea
Introduction: The Comprehensive Geriatric Assessment (CGA) is the multidisciplinary evaluation of older patients. Recent studies have reported its efficacy to predict morbidity and mortality in elderly cancer patients, but it requires resources and relatively long time to complete it. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) has been widely used to predict response to systematic treatments or overall survival in various cancer patients, but provides very limited information.
Objectives: To explore what items of CGA are highly correlated with ECOG-PS and represent 5 domains of CGA in Korean elderly cancer patients.
Methods: Patients aged ≥65 years with cancer (n = 153) were evaluated by ECOG-PS and a set of 5 CGA scales: Instrumental Activities Daily Living (IADL), Mini Nutritional Assessment (MNA), Hospital Anxiety and Depression Scale (HADS), Charlson's Comorbid Index (CCI), Mini-Mental State Examination (MMSE). The Functional Assessment Cancer Therapy-General (FACT-G) was used a reference test.
Results: Demographic and CGA characteristics of the patients were described in Table 1. Age, educational years, IADL, HADS, MNA and MMSE were significantly correlated with ECOG-PS (p values, 0.01 to <0.001). The FACT-G showed similar patterns with ECOG-PS in the correlation tests. Ten items were selected from the CGA based on their correlations with ECOG-PS (3 items from IADL, 3 items from HADS, 3 items from MNA and 1 item from MMSE; p-values, 0.01 to <0.001).
1. Demographic and CGA Characteristics of the Patients
Characteristics | Number of patients, n (%) (n = 153) | Values |
Age, range | 65–89 | |
65–69 | 41 (26.8) | |
≥ 70 | 112 (73.2) | |
Sex | ||
Male | 99 (64.7) | |
Female | 54 (35.3) | |
ECOG* | ||
0-1 | 109 (71.2) | |
≥2 | 41 (26.8) | |
Years of education* | ||
≤ 6 | 43 (28.1) | |
> 6 | 109 (71.2) | |
Marital status | ||
Partnered | 114 (74.5) | |
Non-partnered | 39 (25.5) | |
Cancer type* | ||
Lung | 23 (15.0) | |
GI | 70 (45.8) | |
Hepatobiliary | 27 (17.6) | |
Hematologic | 12 (7.8) | |
Breast | 6 (3.9) | |
Others | 14 (9.2) | |
FACT-G | 70.37 (16.78) | |
Comprehensive Geriatric Assessment | ||
IADL, mean (sd) | 15.85 (5.29) | |
MNA, mean (sd) | 21.3 (4.28) | |
HADS-A, mean (sd) | 4.18 (4.33) | |
HADS-D, mean (sd) | 7.17 (5.28) | |
CCI | ||
1 | 2 (1.3) | |
2 | 36 (23.5) | |
3-5 | 46 (30.1) | |
≥6 | 69 (45.1) | |
MMSE | ||
Definite normal | 108 (70.6) | |
Questionable dementia | 32 (20.6) | |
Definite dementia | 13 (8.5) | |
*missing values in the data
Conclusions: This result indicates that the 10 items of CGA may play a role as a short version of CGA in this population.
MASCC-0667
Pro-angiogenic and wound healing potency of virgin coconut oil
A. Ibrahim 1, S. Al-Rawi2, S. Abdul Majid3, O. Al-Habib1, A. Abdul Majid2
1Biology, University of Zakho Faculty of Sciences., Zakho Kurdstan Rigion., Iraq, 2Pharmacology, Universiti Sains Malaysia School of Pharmaceutical Sciences, Pinang, Malaysia, 3Integrative Medicine, Universiti Sains Malaysia Advanced Medical and Dental Institute, Pinang, Malaysia
Introduction: Angiogenesis, the formation of new blood vessels is crucial in the initial development of embryonic growth, wound healing, tissue development and in many diseases including stroke. Wound healing occurs as a cellular response to injury and involves activation of keratinocytes, fibroblasts, endothelial cells, macrophages and platelets. Virgin Coconut Oil (VCO) an edible form of coconut oil, widely utilized in South Asian region for various applications including food, medicine and industry application. Fermented form of VCO (FVCO) meticulously extracted through bacterial fermentation process.
Objectives: This study evaluates the potency of FVCO in angiogenesis and wound healing.
Methods: Rat aortic assay was employed to evaluate proliferation of blood vessel formation using six different concentrations. Wound healing was evaluated using in vivo wound excision model in Sprague Dawley rats, supported by in vitro assays using human umbilical vein endothelial cells (HUVEC), human fibroblast cells (CCD-18) and retinal ganglion cells (RGC-5). The proliferation, migration and morphological changes of these cell lines using Hoechst fluorescent dye were also investigated.
Results: FVCO significantly stimulated the growth of new blood vessel at different concentrations as compared with negative control. The excision wound model shows that VCO demonstrated higher percentage of wound contraction compared to the control group. Shorter closure time and epithelialisation (16 days) was observed using FVCO compared to 20 days for the control group indicating better wound healing activity. FVCO was significantly active on wound healing, CCD18 and RGC-5 cell proliferation at concentrations of 12–25 μg/mL respectively.
Conclusions: These findings suggest that FVCO might be a good pro-angiogenic agent.
MASCC-0668
Mucositis prevention and treatment in head and neck cancer patients treated with (CHEMO)radiation: report of an Italian survey
E. Russi 1, P. Bossi2, G. Numico3, M. Mazzer4, G. Saibene4
1Radiation Oncology, General Hospital S Croce e Carle, Cuneo, Italy, 2Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, 3Medical Oncology, Azienda USL Valle d’Aosta, Aosta, Italy, 4Pharmacy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Introduction: There is a limited number of therapies reaching an high level of recommendation for mucositis, while several strategies are employed with a limited evidence for efficacy.
Objectives: To assess standard of care of Italian Centers in prevention and treatment of chemoradiation induced mucositis in head and neck cancer patients.
Methods: We conducted a 21 items electronic survey among Italian radiation and medical oncologist, aimed to assess preventive and therapeutic strategies regarding mucositis in HNC, involving also nutritional aspects and pain treatment employed.
Results: We collected 111 answers (51 % medical and 49 % radiation oncologists). CTCAE scale is employed by 55 % of the physicians in assessing mucosal toxicity. The highest predictive factors for mucositis development are considered active exposure to oral stressors (smoke, alcohol), planned radiotherapy on oral cavity and oropharyngeal mucosa, concurrent use of radiosensitizing chemotherapy. Gastrostomy is prophylactically placed in less than 10 % of the patients, mainly due to weight loss before treatment. Preventive antibiotic or antibiotic are prescribed by 46 % of the responders (mainly local or systemic antimicotic drugs). Alkalinizing mouthwashes or coating agents are frequently adopted (70 % of the cases). Among therapeutic intervention, systemic fluconazole is administered by 80 % of the physicians, while the antibiotics chosen are penicillins, cephalosporins or fluoroquinolones (20 % each). Mucositis induced pain is mainly treated by weak followed by strong opioids. Pain during swallowing is considered as breaktrough pain by 69 % of the responders.
Conclusions: Pattern of mucositis prevention and treatment varies among Italian Centers, with some uniform conducts in nutrition, use of antimicotic and painkillers.
MASCC-0669
Pain in children with cancer
E.R.K. Abdel Khalek 1
1Pediatric Oncology Unit, Faculty of Medicine - Zagazig University, Cairo, Egypt
Introduction: Most of children with cancer suffer some pain during the course of their illness. Despite there has been large number of studies in adult, little has been written in children with cancer.
Objectives: This work is directed to study the causes and scoring of pain in children with cancer, as well as to determine the response of pain treatment to analgesics and Non Pharmacological Methods.
Methods: The characteristics of pain, was recorded on 120 children with proved cancers, using behavioral, pulse and Ouhart techniques. The response of the pain to analgesic drugs and non—pharmacological Methods was recorded in each case after 4 hours.
Results: It was found that, the diagnostic procedures constituted the main causes of pain (60 %), followed by pain due to therapy(52.5 %) which included painful mucositis, post-operative pain and post-lumbar puncture headache. Whereas, the disease itself was responsible for 27.5 % cases. Concerning the scoring of pain, it was found that the majority of pain was moderate (90 %), mild pain were 30 %, while a minority was complaining from a severe form of pain (20 %). Response to management was recorded for all children.
Conclusions: Pain in children with cancer is often underestimated and one that is inadequately evaluated and treated in many cancerous centers. One should consider Adjuvant analgesics therapy as well as behavioral & physical Methods at all stages of pain control.
MASCC-0670
Palliative care perspectives on QOL assessment tools
B. Alt-Epping 1, M. Jansky1, F. Nauck1
1Palliative Medicine, University Medicine Göttingen, Göttingen, Germany
Introduction: Although restoring or maintaining best possible quality of life (QoL) is one of the most important goals in palliative care, structured assessment of QoL by using validated tools is still uncommon, unlike in oncology (study) settings and supportive care.
Objectives
Methods: Review of relevant literature and conceptual considerations from a palliative care perspective.
Results: Several reasons were identified that might impede palliative care institutions to use QoL assessment tools: 1) a tradition in palliative and hospice care that focuses on personal relationship, verbal communication and listening, 2) a high number of disoriented or confused patients, not being able to follow complex questionnaires, 3) a relevant burden for palliative care patients in filling out multiple item QoL questionnaires, with consecutive research on single item tools, and 4) a reasoning about the general nature of the term ‘quality of life’, its dimensions beyond symptoms and functioning like its psychosocial context and existential grounds.
On the other hand, there is increasing awareness that for determining structural traits of palliative care, for reimbursement of services, or for palliative care research, structured QoL assessment seems to be imperative. This becomes even more true in the advent of “early integration” of palliative care into oncology.
Conclusions: Review of relevant literature and conceptual considerations from a palliative care perspectiveThe use of QoL assessment tools in palliative care may be considered ambivalent, with clear arguments for and against operationalized recording of a feature that becomes more and more complex at the end of life. With respect to “early integration” concepts, Methods of QoL assessment that are already well validated in supportive care will have to be considered.
MASCC-0671
What can specialized palliative care provide for supportive care in cancer?
B. Alt-Epping 1, F. Nauck1
1Palliative Medicine, University Medicine Göttingen, Göttingen, Germany
Introduction: The early integration of palliative care into ‘active’ oncology concepts, as validated by Temel 2010 and demanded in national and international guidelines, and the developments in modern medical oncology, will lead to an increase in the number of patients that will both receive specialist palliative care support as well as active anticancer treatment. Symptoms and needs early in the course of an incurable disease will not necessarily be distinguishable as disease related or treatment related problems. Therefore, it has to be asked, besides others,
- to what extend specialized palliative care services with its 24 h availability and home care offers would have to address also treatment related needs that has been traditionally considered as a supportive care domain
- what particular offers in specialized palliative care might prove helpful for patients under active anticancer therapy
- what expertise in supportive care would be necessary to learn by palliative care providers (and vice versa), in order to treat symptomatic cancer patients receiving anticancer therapy adaequately,
- to what extend early palliative care could also be a task provided by supportive care facilities, also with respect to the high number of patients recently diagnosed as having incurable cancer, and the comparably low number of specialised palliative care providers.
This congress contribution will try to provide a balanced view on palliative care and supportive care interactions, based on the altered viewpoint of early palliative care and on the conceptual and pharmaceutical developments in oncology and supportive care
Objectives
Methods
Results
Conclusions
MASCC-0672
Haemoglobin outcomes in the management of chemotherapy-induced anaemia in cancer patients with biosimilar epoetin alfa (Binocrit®): first results from the French oncobos observational study
J. Fayette 1, C. Aubron-Olivier2, R.F. Soumoudronga2, B. Narciso3
1Medical Oncology, Centre Léon Bérard, Lyon, France, 2Biotech-Hospital Division, Sandoz Biopharmaceuticals, Paris, France, 3Oncology, Hôpital Bretonneau, Tours, France
Introduction: OnCoBOS is an ongoing, prospective, multicentre, observational study of the use of Binocrit® (biosimilar epoetin alfa) for the treatment of chemotherapy-induced anaemia (CIA). Here we present first data from 444/2000 patients treated in France.
Objectives: To evaluate evolution in haemoglobin (Hb) outcomes in cancer patients with CIA treated with Binocrit®.
Methods: We analysed 444 cancer patients with CIA treated with Binocrit® in 75 centres in France. Data were collected at treatment start and 3–4 weeks (W3-4) and 12 weeks (W12) later.
Results: Median age was 67y; 59.3 % were male; mean ± SD Karnofsky score was 77.9 ± 13.2. 77.5 % of patients had solid tumours, including lung (22.1 %), breast (13.4 %), and colorectal cancer (12.8 %), mainly stage 3 or 4 (59.3 %); 22.5 % had haematological malignancies including 55.0 % with non-Hodgkins lymphoma and 24.0 % with multiple myeloma, mainly stage 3 or 4 (77.7 %). Mean ± SD Hb at Binocrit® initiation was 9.6 ± 0.9 g/dL. Mean ± SD Binocrit® starting dose was 32793 ± 5147 IU/week; the dose at W12 was 32605 ± 6359 IU/week. At W3-4 11.9 % of patients received I.V. iron. Mean ± SD Hb increased to 10.6 ± 1.4 g/dL at W3-4 and 11.2 ± 1.5 g/dL at W12 (p < 0.001). Also at W12, 65 % of patients had Hb increase ≥1 g/dl. 81.3 % of patients were able to continue their chemotherapy without delays or dose reduction. Only three patients experienced an adverse drug reaction (none serious).
Conclusions: This analysis indicates the real-world clinical effectiveness and safety of managing CIA with Binocrit®. The results reflect the ability to safely correct anaemia and maintain Hb, in line with current recommendations, using a weekly dose regimen.
MASCC-0673
Chamomilla recutita mouthwash development for buccal mucositis treatment
F.T.M.M. Braga1, R.C.C.P. Silveira 1, E.C. Carvalho1
1General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
Introduction: Chamomilla recutita has flavonoid (powerful anti-inflammatory) and may contribute to the mucositis treatment which physiopathology involves a bunch of steps interceded by cytokine proinflammatory
Objectives: To develop a mouthwash containing Chamomilla, performing an organoleptical analysis and identifying the possible side effects.
Methods: The mouthwash was developed with Chamomilla fluid extract in a water-based formula in three different dosages (0,5; 1 and 2 %). Physical-chemical and microbiological analysis and apigenin-7-glycoside dosage (flavonoid species marker) were done. 30 patients in hematopoietic stem cell transplantation were randomly allocated into three groups, according to the offered doses; they performed the mouthwash organoleptical assessment (flavor, scent, refresh), after rinsing the mouth with one of the formulas during 1 min, twice a day.
Results: The physical-chemical and microbiological analysis evidenced the quality (density 1,003; pH 5,24 to 5,70; total bacteria and fungi <10 UFC/g) and the active ingredient integrity (apigenin-7-glycoside percentage: dose 0,5 %—0,054 mg/mL; 1 %—0,108 mg/mL and 2 %—0,216 mg/mL). Most of them classified the flavor as very pleasant or pleasant and sweet and refreshing, apart of the group. The scent was considered unpleasant for one patient (dose 2 %) and very unpleasant for the other (dose 0,5 %). Four patients had side effects: seldom nauseas (n = 3), mouth burning low frequency (n = 2) and frequent vomit (n = 1).
Conclusions: The physical-chemical profile analysis evidenced the mouthwash quality, also well evaluated by the patients and considered as a safe product since no moderate or severe adverse effect was identified.
MASCC-0674
Location and prevelance of pain in a cohort of women up to 4 years after treatment for breast cancer
M. Cooney 1, R. Galvin2, E. Connolly3, E. Stokes1
1Physiotherapy, Trinity College Dublin, Dublin, Ireland, 2HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland, 3Breast Care Department, St. James’s Hospital, Dublin, Ireland
Introduction: More than 75 publications address pain following treatment for breast cancer yet the incidence remains unknownand little is known about where pain is experienced by women treated for the condition.
This study was part of a broader study to validate the ICF Core Set for breast cancer (WHO,2001)
Objectives: The aim was to determine prevelance and anatomical location of pain experinced by women treated for breast cancer.
Methods: A self-report postal survey was sent to women with primary breast cancer who were >6 months and <4 years after surgery, fluent in English, >18 years (n = 441). All treatment types were included and the sample were screened for comorbid conditions affecting function.
Results: A response rate of 67 % was achieved (n = 296). Average age was 57 (±12.6 years), time since surgery was 23.4 months. Surgery types: mastectomy 40 %, bilateral mastectomy 3 %, lumpectomy 46 %, no answer 11 %, radiation83%, chemotherapy 66 % and hormonal therapy 66 % (31 % currently).
Since surgery 86 % had experienced pain and 71 % reported on-going pain. Joint pain was experienced by 53 %, followed by arm/shoulder pain 48 %, back 46 %, Chest trunk 41 % and lower limbs 32 %. Twenty seven per cent of respondents had pain in two locations and 40 % had pain in three or more locations.
Findings suggest that pain is not being adequately managed. Prospective surveillance and active intervention is required. Widespread pain (>3 locations) has been associated with a twofold increase in mortality in the cancer population (Mc Beth et al.,2003).
Conclusions: Knowledge of the locations where pain is experienced can be used to both assess for presence and evaluate intervention.
MASCC-0675
Use of Chamomilla recutita in the prevention and treatment of oral mucositis in patients undergoing hematopoietic stem cells transplantation: phase II randomized controlled clinical trial
F. Titareli Merizio Martins Braga 1, R.C.C.P. Silveira1, A.C.F. Santos2, E.C. Carvalho3
1General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil, 2Bone Marrow Transplantation, Hospital Amaral Carvalho, Jaú, Brazil, 3General and Specialized Nursing Departament, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
Introduction: Oral mucositis is a common inflammatory complication manifested by patients undergoing hematopoietic stem cell transplantation (HSCT). The Chamomilla recutita is rich in flavonoids, especially apigenin 7-glucoside which has excellent anti-inflammatory activity.
Objectives: To identify the dose of fluid extract of this plant in mouthwash to reduce the incidence and severity of oral mucositis in adult patients undergoing allogeneic HSCT.
Methods: This is a phase II randomized controlled clinical trial. 40 patients were included from January to August 2011, undergoing allogeneic HSCT, aged ≥18 years. The mouthwash was standardized to apigenin 7-glucoside; were submitted to physical-chemical and microbiological analysis that showed its quality. Eligible patients were randomized to receive the mouthwash (doses of 0.5, 1 or 2 %; respectively 0.054 mg/ml, 0.108 mg/ml and 0.216 mg/ml of apigenin 7-glucoside) or for the control group (care routine). The daily evaluation of the buccal cavity was performed by WHO scale. The statistical analysis compared each dose mouthwash group with the control group.
Results: Patients who received the 1 % mouthwash solution had a lower incidence (p = 0.01), intensity (p = 0.01) and duration of oral mucositis (p = 0.01) when compared to control group. The formulation was well tolerated by the patients and it was not identified any moderate or severe adverse effect.
Conclusions: The results suggest that mouthwash containing Chamomilla, at a dose of 1 %, acts in reducing the incidence, intensity and duration of days of mucositis in patients undergoing allogeneic HSCT. These findings provide subsidies for the execution of a phase III clinical trial.
MASCC-0676
Screening of venous thrombosis in advanced cancer patients: does D-dimer has role?
S. Oh 1, S.J. Park1, S.J. Cho2
1Internal Medicine, Seoul Medical Center, Seoul, Korea, 2Hospice Team, Seoul Medical Center, Seoul, Korea
Introduction: The incidence of venous thromboembolism (VTE) in advanced cancer patients is reported up to 30–40 %. D-dimer is used as screening test for VTE because it is cheap and highly sensitive. But, it is frequently elevated by other cause like infection or malignancy.
Objectives: To assess role of d-dimer in advanced cancer patients to screen VTE.
Methods: Patients with incurable cancer and swollen leg or other factors (according to Well’s clinical DVT model) undergo d-dimer test at admission according to policy of our hospice team. This report is retrospective analysis of patients who admitted in Hospice & palliative care ward from July to December 2012.
Results: Among 125 incurable cancer patients, 103 patients were Well’s score ≥2 at admission. Among 103 patients, only 5 patients had normal d-dimer (<0.5 μg/mL) and majority (n = 79, 76.7 %) was above 2.0 μg/mL. Basically, patients with d-dimer level ≥2.0 μg/mL should be recommended for Doppler ultrasonography or contrast-enhanced CT angiography. However, such radiologic workups were done at only 11 patients, because diagnosis of VTE could rarely beneficial to patients. Seven patients (63.6 %) had VTE in radiologic workup among 11 patients. Mean d-dimer level of VTE patients was 4.9 ± 3.2 μg/mL and in 11.6 ± 7.9 μg/mL patients without VTE (p = 0.070). All of the patients with VTE had d-dimer level of >2.0 μg/mL.
Conclusions: In advanced cancer patients, d-dimer may lack its screening value for VTE. Patients without VTE also have high level of d-dimer. A novel cost effective tool is necessary for screening of VTE
References: Cancer-associated thrombosis: updates and controversies. Am Soc Hematol Educ Program. 2012:626
MASCC-0677
Development of a walker 256-TC tumour-bearing rat model to study lapatinib-induced mucosal injury
W.N.I. Wan Mohamad Zain 1, J. Bowen2, E. Bateman1, D. Keefe1
1School of Medicine, University of Adelaide, Adelaide, Australia, 2School of Medical Sciences, University of Adelaide, Adelaide, Australia
Introduction: Development of tumour-bearing animal models is important to investigate toxicity of cancer treatments. In this study, the effects of lapatinib, a small molecule agent which targets EGFR and ErbB2 and is known to cause mucosal injury were investigated on a Walker 256-TC cell line.
Objectives: To test lapatinib activity against EGFR and ErbB2 in Walker 256-TC cells in order to develop an animal model to investigate mechanisms of lapatinib-induced mucosal injury.
Methods: Cytotoxic effects of lapatinib on Walker 256-TC cells were determined using the XTT assay.
Results were confirmed via trypan blue exclusion method. EGFR and ErbB2 expression were examined using real-time PCR.
Walker 256-TC cells were then injected into the right flanks of female albino Wistar rats and grown over 3 weeks. This correlates with the peak of lapatinib-induced diarrhoea in Wistar rats [1].
Results: Lapatinib was shown to inhibit Walker 256-TC cell growth, with an IC50 value of 8.2 μM ± 0.26. Real time-PCR data showed increased mRNA expression levels of EGFR and ErbB2 in Walker 256-TC cells.
A concentration of 1 × 107 cells/mL resulted in consistent tumour growth. Tumours were measurable by day 4 and reached 10 % of body weight 25 days post-inoculation, without metastasis to distant sites.
Conclusions: Increased expression of EGFR and ErbB2 in the Walker 256-TC cell line might contribute to the cytotoxic effect of lapatinib on these cells. The animal model now provides a framework which will enable the study of lapatinib-induced diarrhoea in tumour-bearing animals.
References: [1] Cancer Biol Ther, 2012, 13 (13): 1269–75
MASCC-0678
Pinnacle study: epidemiology and characteristics of febrile neutropenia, FN, in oncological patients in Spain
A. Casas Fernandez de Tejerina 1, C. Font2, E. Aranda Aguilar3, J.J. Cruz4, L. Calera5, B. Masutti Sureda6, C. Camps7, R. López López8, N. Calvo9, F.J. Rebollo Laserna10, J. de Castro Carpeño11
1Oncology dpt, H. Virgen del Rocio, Sevilla, Spain, 2Oncology dpt, H. Clinic i Provincial, Barcelona, Spain, 3Oncology dpt, H. Reina Sofía de Córdoba, Córdoba, Spain, 4Oncology dpt, H. Clinico Universitario de Salamanca, Salamanca, Spain, 5Oncology dpt, H. Miguel Servet, Zaragoza, Spain, 6Oncology dpt, H. General de Alicante, Alicante, Spain, 7Oncology dpt, H. General de Valencia, Valencia, Spain, 8Oncology dpt, H. Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain, 9Oncology dpt, Hospital de Sant Pau, Barcelona, Spain, 10Medical dpt, Sandoz Farmaceutica, Madrid, Spain, 11Oncology dpt, H la Paz, Madrid, Spain
Introduction: Chemotherapy-induced FN is one of the most important causes of morbidity and mortality in patients receiving chemotherapy. The study aims to updated data about this event in Spain that will help define the real burden of FN in cancer patients.
Objectives: Depict incidence of hospital admissions for FN and the clinical characteristics, treatment of events and their evolution in these patients.
Methods: Epidemiological, retrospective, descriptive, multicentric study. 10 sites included an average of 12 cancer patients admitted for FN recruited in retrospective chronological order. Additionally centres recovered the number of FN events in patients treated with chemotherapy in the last 3 months.
Results: One hundred nineteen patients with FN were included in the study with an average age of 59 years. The most frequent type of tumours were lung (28,5 %), breast (21,8 %) and colorectal (11,7 %) and 21 % of these patients were treated prophylactically with CSFs. The incidence of FN was 4.10 % and drove to a reduction and delay of treatment in 11,8 % and 40 % of those patients respectively. Regarding related adverse events, the incidence of anaemia, transfusion use and mucositis were 42.3 %, 16.9 % and 19.5 % respectively. Mean length of hospitalization was 8.7 days with a trend of longer length of hospitalization (p = 0.052) in patients who did not receive G-CSF prophylaxis, 9.3 days. Eight patients with FN died (6,7 %), out of them 2 due to FN.
Conclusions: FN still remains an important problem in the management of oncology patients. There is a trend of higher hospitalization stay in patients who did not receive G-CSF prophylaxis
MASCC-0679
Effect of adjusting the PH by mixing steroid for venous pain in CRC patients receiving oxaliplatin through peripheral vein. Randomized phase II study (Apollo)
A. Toyokawa 1, T. Hata2, M. Kobayashi3, M. Tsuda4, Y. Tokunaga5, K. Takase6, M. Miyake7, S. Morita8, J. Sakamoto9, H. Mishima10
1Surgery, Yodogawa Christian Hospital, Osaka, Japan, 2Gastroenterological Surgery, Osaka University, Suita, Japan, 3Cancer Treatment Center, Kochi University, Kochi, Japan, 4Gastroenterology and Hepatology, Hyogo Cancer Center, Akashi, Japan, 5Surgery, Kyoto Teishin Hospital, Kyoto, Japan, 6Surgery, Kobe Rosai Hospital, Kobe, Japan, 7Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan, 8Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama, Japan, 9Director, Tokai Central Hospital, Hihgashijima, Japan, 10Cancer Center, Aichi Medical University, Nagakute, Japan
Introduction: Administration of oxaliplatin through peripheral vein can cause venous pain. One of possible reasons is pH. The pH level of oxaliplatin solution is about 4.8 and that of buffered by steroid is around 7.0.
Objectives: To investigate the hypothesis that adjusting the pH of oxaliplatin solution by mixing steroid can reduce venous pain, we have conducted the randomized control study to compare pH adjusted oxaliplatin solution with unadjusted xaliplatin solution.
Methods: Colorectal cancer patients receiving oxaliplatin through peripheral vein were randomly assigned to arm A (oxaliplatin 130 mg/m2 with dexamethasone 1.65 mg) or arm B (the same, without dexamethasone). Venous pain was evaluated by CTCAE (ver. 4.0) and the verbal rating scale (VRS). Assessments were conducted every 3 weeks until cycle 4.
Results: A total of 53 patients were enrolled. Of these, 48 evaluable patients were randomized to either arm A (n = 24) or arm B (n = 24). Incidence of venous pain (grade ≥ 2) was 33.3 % in arm A and 58.3 % in arm B (relative risk 0.57). Incidence of venous pain (VRS score ≥ 3) was 12.5 % in arm A and 37.5 % in arm B (relative risk 0.33). No difference was observed in efficacy and safety.
Conclusions: Adjusting the pH of oxaliplatin solution by adding low doses of dexamethasone reduced severe venous pain without influence on efficacy and safety.
MASCC-0680
A multicenter clinical trial on skin reactions and translational research in patients with locally advanced head and neck cancer undergoing definitive radioimmunotherapy: the HICARE trial
K. Potthoff 1, G. Habl2, M. Haefner2, A. Abdollahi3, J. Hassel4, J. Debus2
1Medical Oncology, National Center for Tumor Diseases, Heidelberg, Germany, 2Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany, 3Molecular and Translational Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany, 4Dermatology, University of Heidelberg Medical Center, Heidelberg, Germany
Introduction: The most frequent side effects of radioimmunotherapy are skin reaktions, i.e. radiation dermatitis and cetuximab-induced acneiform rash. Incidence and severity of these frequent, often overlapping and sometimes limiting skin reactions, however, are not well explored and molecular analyses in correlation with clinics and outcome have never been analyzed prospectively before.
Objectives: The objectives of the HICARE trial are to differentiate skin reactions caused by radiation from those caused by the monoclonal antibody cetuximab, to evaluate the incidence and severity of these skin reactions and to correlate them with outcome parameters. Besides, the translational research program will help to identify and confirm novel peripheral blood based molecular predictors and surrogates for treatment response and resistance.
Methods: The HICARE study is a national, multicenter, prospective phase IV study. 500 patients with locally advanced head and neck cancer will be enrolled in 40 participating sites in Germany. Radioimmunotherapy will be applied according to SmPC. For translational research HPV status of the tumor samples and genomic and proteomic analyses of blood samples will be carried out at several time points.
Results: As of January 2013, 70 patients were recruited and evaluable for safety analysis. Application of cetuximab and radiation therapy was well tolerated. 2 patients died due to severe comorbidities. QoL was maintained in all patients alive
Results of an interim analysis will be presented
Conclusions: The radioimmunotherapy with cetuximab is feasible, safe and effective. Skin reactions can be differentiated and adequately treated. Due to promising initial results active accrual will be continued.
MASCC-0681
Experiences and support needs of adolescent patients with cancer form the perspectives of nurses in Taiwan
W. Wu 1, S. Cheng1, J. Lee1
1Department of Nursing, National Taipei University of Nursing & Health Sciences, Taipei, Taiwan
Introduction: Cancer treatment have a dramatic improvement resulting in a decreased mortality rate in pediatric patients. However, the unique experiences and support needs of adolescent patients with cancer (APC) seem to be overlooked. Nurse among health care professionals is the most closed one with APC and therefore would be appropriate to declare adolescent patients’ illness experiences and support needs.
Objectives: The objective was to understand the experiences and support needs of APC from the perspectives of nurses.
Methods: Ten nurses who were head nurses or leaders in pediatric hematology/oncology wards in teaching hospitals in Taiwan have been recruited and interviewed with semi-structured questions. They were experienced nurses and worked in pediatric hematology/oncology wards at least 5 years. Data were analyzed by Colaizzi method and Nvivo 8.0 qualitative software.
Results: Results indicated that adolescents experienced greater symptom occurrence and severity. They depended on parents’ care in their physical symptoms; however, they seldom talked their psychological concerns with parents. Friends/peers would be the ones they would like to share life experiences with via social networks, such as Facebook. They also have cancer-related knowledge’s needs. They were used to searching health-related information via the Internet.
Conclusions: Cancer significantly affect the physical and psychosocial well-being. APC have information needs in self care. The Internet would be an appropriate media to perform the mission. Social network provides the efficient and convenient way for them to reconnect with friends and peers and would be a feasible way to fulfill their social and support needs.
MASCC-0682
Patient-oncologist communication in office-based practices in Germany
C. Riese 1, W. Baumann1
1health services research/quality improvement, WINHO - Scientific Institute of the Office-Based Hematologists and Oncologists, Cologne, Germany
Introduction: Taking the special needs of patients into account, good communication between cancer patients and physicians is a key factor for good cancer care.
Objectives: The aim of the study was to measure how oncologists meet patients’ expectations in the different fields of communication. Furthermore, the study focused on the physician-patient relationship in reference to the socio-economic status of patients.
Methods: This survey was based on the KOVA questionnaire by Farin, Gramm & Koziol (2009). The instrument distinguishes between four different fields: patient-participation and patient-orientation, effective and open communication, emotional-supportive communication and communication about personal issues. The KOVA includes 32 items. Additionally, patients were asked to evaluate the general satisfaction with the delivery of care. Psycho-social characteristics were raised as well.
The in-house survey was conducted in 109 practices including 267 doctors (16,020 paper-based questionnaires) in total. The data was analysed with SPSS.
Results: In total, we received 12,778 questionnaires (RR 79.76 %). The results indicate an appropriate physician-patient communication in cancer care in most practices. Significant differences were especially noticed in the correlation between the patients’ level of stress and the doctors’ communication behavior. With regard to the social-demographic characteristics of the patients, only few significant differences in the communication relationship can be shown.
Conclusions: The results show a broad range of communication relationships in outpatient oncology care. Most oncologists meet patient communication needs properly. The survey allows us to benchmark practices and to identify settings where oncologists bear stronger challenges in communicating with patients.
References: References can be requested by the author.
MASCC-0683
The relation among socio-economic status, health behaviors, and quality of life in cancer survivors
J. Sim 1, Y.H. Yun1
1College of Medicine, Seoul National University, Seoul, Korea
Introduction: Recently, the ‘socio-economic status(SES)’ has been widely studied in health research. However, there are some limitations that the relationship between SES, health behaviors and quality life among cancer survivors does not much studied yet.
Objectives: This study investigates the direct and/or indirect pathway among socio-economic status (SES), the 10 health behavior factors and the quality of lives (QOL) of Korean cancer survivors. Furthermore, this study also aims to examine the degree of socio-economic status affect the 10 health behavior factors and health related quality of life.
Methods: In this cross-sectional study,r. the 668 cancer patients ecruited from 6 large hospitals in Korea were given quesionnaire to estimate the significance of the 10 health behaviors on the QOL. The variables of socioeconomic factors in this study are education, income level, and of the patients and the estimation of the quality of life was based on the self-reported information of the short form 36-item questionnaires.
Results: The socio economic status was not the ultimate determinant of quality of cancer survivors’ lives. Rather, the ten Health behaviors such as regular exercise, proactive living, regular check-ups, living with people who you love have higher significance in determining the quality of the lives of cancer survivors.
Conclusions: The level of health behaviors has higher significance in determining the quality of lives of cancer survivors than that of the level of income and education.
References: Paula M et al., Socioeconomic Factors, Health Behaviors, and Mortality. JAMA, 1998; 279:1703–1708:
MASCC-0684
Cancer survivorship in old age: which quality of life?
B. Muzzatti1, A. Surbone2, L. Giovannini1, C. Flaiban1, M. Annunziata 1
1Unit of Oncological Psychology, Centro di Riferimento Oncologico - National Cancer Institute, Aviano (PN), Italy, 2Oncology, New York University, New York, USA
Introduction: In this last decade great effort has been made to describe quality of life and functioning of people surviving cancer. However, scarce data are still available on elderly cancer survivors. Since ageing itself modifies persons’ quality of life and functioning, investigation tailored to older survivors is relevant both to clinical care and research.
Objectives: In this study the quality of life of elderly Italians, who had been free from cancer and its treatments for at 5 years, has been analyzed.
Methods: Seventy-eight elderly (age range: 65–80 years) long-term cancer survivors (survival length range: 5–31 years) compiled the Short Form 12 Health Survey Questionnaire, the State-Trait Anxiety Inventory, and the Zung Self-rating Depression Scale.
Results: 28.8 % and 19.7 % of the sample showed respectively a moderate and severe reduction in physical health status, whereas 22.7 % and 9.1 % displayed a moderate or severe reduction in mental health status. In addition, 11.9 % and 17.9 % of the sample were possible and probable cases of anxiety, whereas 13.0 %, 15.6 % and 7.8 % displayed, respectively, mild, moderate and severe depression. Physical health status was associated with marital status (p < 0.001) and state anxiety was associated with gender (p < 0.05). Conversely, no associations between the four tested variables and education, cancer type, other health issues, survival length were found.
Conclusions: Despite its limitations, this study supports the multi-disciplinary approach to cancer survivorship in old age too and encourages further research, aimed to extend the study to other relevant dimensions (e.g. pain, fatigue, cognitive functioning, fear of relapse).
MASCC-0685
Development of a prognostic index to predict survival of Egyptian palliative care patients with advanced cancer
G.A. Abdel Salam 1, Y.S. Abdel Kader2, M.E. Ramadan1, S.A. Alsirafy3
1Clinical Oncology Department, Faculty of Medicine - Beni-Suef Universty, Beni-Suef, Egypt, 2Clinical Oncology Department - Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine - Cairo University, Cairo, Egypt, 3Palliative Medicine Unit - Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine - Cairo University, Cairo, Egypt
Introduction: Prediction of survival is important for improving end-of-life care for patients with advanced cancer. Some clinical, biological and disease-related parameters were found to be of prognostic significance in patients with advanced cancer.
Objectives: To develop a survival prediction tool for Egyptian patients with advanced cancer using clinical parameters.
Methods: We prospectively assessed the predictive value of 14 clinical variables in 170 Egyptian patients with advanced solid tumors managed in a cancer center-based palliative medicine unit. Multivariate analysis was performed to identify independent predictive variables to develop a prognostic score.
Results: Four variables predicted shorter survival independently, Eastern Cooperative Oncology Group (ECOG) performance score 3–4 (p < 0.014), presence of delirium (p < 0.011), moderate to severe dyspnea at rest (p < 0.001) and clinical prediction of survival <24 weeks (p < 0.002). Using these four variables a prognostic index was developed with a total score ranging from 0 to 7. Patients were divided into three groups: Group 1 (score ≤3), Group 2 (score 3 to ≤5) and Group 3 (score > 5). The median survival differed significantly between the three groups and was 155 days for Group 1, 70 days for Group 2, only 14 days for Group 3 (p < 0.001).
Conclusions: The presence of delirium, dyspnea at rest, ECOG performance score 3–4, and clinical prediction of survival <24 weeks independently predict shorter survival among Egyptian patients with advanced solid tumors. The newly developed prognostic scoring system based on these four clinical parameters needs further validation in a different set of patients.
MASCC-0686
Randomized, controlled intervention trial to evaluate the effects of supervised progressive exercise training in breast cancer patients during adjuvant radiotherapy: the best trial
K. Potthoff 1, M. Schmidt2, J. Wiskemann3, O. Klassen3, J. Oelmann4, S. Wessels4, H. Hof4, A. Koffka4, H. Hauswald4, C. Ulrich3, J. Debus4, K. Steindorf2
1Medical Oncology and Radiation Oncology, National Center for Tumor Diseases and University of Heidelberg Medical Center, Heidelberg, Germany, 2Unit of Physical Activity and Cancer, German Cancer Research Center, Heidelberg, Germany, 3Department of Preventive Oncology, National Center for Tumor Diseases, Heidelberg, Germany, 4Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany
Introduction: Fatigue is one of the most distressing and most frequent complication in breast cancer patients during and after radiotherapy. It often is associated with a significant impact on quality of life. Physiological and immunological mechanisms induced by training might be relevant for prognosis but they are largely unknown. First hints on positive effects of resistance training have already been published.
Results of randomized controlled trials, however, are still missing.
Objectives: The objective of the BEST trial is to evaluate the effects of a 12-week high intensity and supervised progressive resistance training versus a group-based progressive muscle relaxation training. Primary endpoint is cancer-related fatigue. Secondary objectives are to assess the effects of the different training Methods on fatigue, quality of life and outcome as well as on molecular, immunological and inflammatory biomarkers.
Methods: The BEST study is a prospective, randomized, controlled intervention trial for tertiary prevention of breast cancer. 160 patients with breast cancer undergoing adjuvant radiotherapy will be recruited and randomized 1:1 for a 12-week high intensity and supervised progressive resistance training or a group-based progressive muscle relaxation training. Recruitment started in February 2011.
Results: As of February 14th, 2013, 147 patients. The interventions in both arms were safe and feasible. Relevant side effects did not occur. There was a very good adherence to the intervention in patients undergoing adjuvant radiotherapy
Conclusions: The BEST study is the first randomized, controlled trial comparing progressive resistance training with muscle relaxation training in breast cancer patients during radiotherapy. Due to promising interim results accrual will continue.
MASCC-0687
Managing psychological distress in oncology: a brief intervention
M. Annunziata 1, B. Muzzatti1, L. Giovannini1, S. Mella1, F. Bomben1, C. Flaiban1, A. Surbone2
1Unit of Oncological Psychology, Centro di Riferimento Oncologico - National Cancer Institute, Aviano (PN), Italy, 2Oncology, New York University, New York, USA
Introduction: Due to its prevalence, pervasiveness, and negative effects on quality of life, constant monitoring and management of psychological distress are widely recommended.
Objectives: To describe a routine clinical activity performed in accordance to the international guidelines, in order to inform oncological patients of the importance of taking care of their emotions (as well as of their diseased bodies), and to alert them to the presence of a psychology service in our cancer center to facilitate holistic self-care.
Methods: The intervention consisted of three consecutive steps: psychological distress screening; clinical interview, which is conducted according to Rogers’ client-centered model; collection of data regarding appreciation of the initiative and codification of interview contents.
Results: The intervention was administered to 484 consecutive new inpatients. Amongst them, the prevalence of psychological distress and its components of anxiety and depression were comparable to those found in the literature. The low percentage of participants who refused the screening (15.4 %) and of those who do not wish to have the results returned to them (3.1 %), together with the high scores regarding the usefulness and effectiveness given to the intervention (all > 80/100), indicated a highly positive reception of this activity. Lastly, the analysis of the contents of the exit interview showed a wide range of themes, multifaceted and heterogeneous, which go beyond anxiety and/or depression symptoms.
Conclusions: Even though this was a clinical and not a research activity, it still offers important descriptive data.
MASCC-0688
Trajectories of distress in women diagnosed with breast cancer
P. Bidstrup 1, J. Christensen2, B.G. Mertz3, S.O. Dalton1, N. Kroman3, C. Johansen1
1Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark, 2Statistics Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark, 3Breast Surgery Clinic, Rigshospitalet, Copenhagen, Denmark
Introduction: Psychological distress among women diagnosed with breast cancer are often reported to decline within the first year. Still, little is known on whether subgroups of women have different patterns of change in distress over time.
Objectives: In this study, we aim at identifying distinct patterns of distress in women diagnosed with breast cancer.
Methods: In 2008–2009, 357 women with newly diagnosed primary breast cancer participated (84 %) in a study at a breast surgery clinic at a university hospital in Denmark. Questionnaire data was obtained before operation, after 4 and 8 months (N = 322) and distress was measured using the distress thermometer. Data analyses are in progress. The distress trajectories are explored visually and the TRAJ finite mixture model procedure applied. The final number of trajectories are selected based on the Bayesian information criterion and Akaike information criterion. Factors associated with distinct distress trajectories will be examined in a logistic regression model.
Results: Preliminary results show four distinct groups of distress trajectories. 8 % of the women had a high level of distress at baseline which decreased to a moderate level after four months. 53 % had a continuously moderate level of distress. 29 % had a moderate level of distress at baseline which decreased to a low level after 4 months. 9 % had a continuously low level of distress.
Conclusions: We identified four distinct trajectories of distress which provide important knowledge about the timing of distress in the first 8 months after breast cancer diagnosis. We plan to identify factors that are associated with belonging to the high distress trajectory.
MASCC-0689
Cancer in the context of social political and economic upheavals in Sub-Saharan Africa
D. Kinyanjui 1, L. Gichini1
1Cancer Program, Aga Khan University Hospital Nairobi, Nairobi, Kenya
Introduction: Caring for patients and families facing a diagnosis of cancer in Africa presents unique challenges. Economic and physical, access to specialist healthcare for cancer patients compounded by cultural and political barriers present major threat to patient’s sense of security and ability to cope with a cancer diagnosis.
Objectives: Describe the psycho-social impact of a cancer diagnosis in politically and economically unstable environments.
Methods: A desk review, practice observations and interviews with key frontline caregivers on the psychosocial impact of cancer on patients and families as seen in African in the context of social, economic and political upheavals.
Results: A diagnosis of cancer has a devastating effect on family dynamics. In Africa where the incidence is predicted to triple in the next 15 years, the cancer epidemic is happening in the context of wars, poverty and other social economic challenges. Poor people with cancer suffer disproportionate physical, emotional psychological, and social distress
Conclusions: Formal and informal carers must take cognizance of the fact that cancer patients in Africa maybe facing double tragedy of being refugees, slum dwellers or an internally displaced. These factors have a major influence on the patients ability to cope and must be considered in designing psychosocial interventions. The impact of a cancer diagnosis on individuals and families cannot be looked at from a psychological or emotional perspectives alone. It should be seen in the context of how the patient interacts with his social, economic and political environment.
MASCC-0690
A dramatic case of BRONJ in maxilla- 1 year follow up
K. Bektas-Kayhan 1, C. Özbek1, M. Ünür1
1Oral and Maxillofacial Surgery, ?stanbul University Faculty of Dentistry, Istanbul, Turkey
Introduction: Bisphosphonate related osteonecrosis of the jaws (BRONJ) is a growing problem in dental area. These drugs are commonly prescribed for treatment of osteoporosis, bone metastasis of cancers and multiple myeloma. The use of various forms of the drug especially intravenous forms plus prolonged use as in multiple myeloma cases increases the BRONJ risk.
Objectives: This report is a focus on a prolonged use of bisphosphonates (7 years of zolendronic acid/monthly intervals) and the conservative treatment of a very severe case of maxillary necrosis. A 60 year- old female was referred to oral and maxillofacial surgery clinic with pain and discomfort in her dentures. She was edentulous for more then 10 years and she was suffering from pain in her maxilla. The clinical examination revealed BRONJ in maxilla.
Methods: Therapy started with ampisilin 1 g plus metronidazole 500 mg for 2 weeks and then with doxycycline 100 mg (for 6 months). These antibiotics were supported by antimicrobial rinses and irrigation of exposed hard tissues with saline three times a day.
Results: The respond of this conservative protocole was spectecular. No side effects due to prolonged use of antibiotics or alterations of in hematologic tests were observed. After 1 year sequestration was observed in all maxillary structures and premaxilla was totally re-epitelizied after the loss of bony structure.
Conclusions: The conservative approach to BRONJ cases seems to be related with sufficient outcomes with less discomfort when compared to surgical resections. The need of further studies that support the role of conservative treatment is mandatory.
MASCC-0691
Continuous palliative sedation in terminal cancer
P. Gagnon1, G. Lim2, J. Le Moignan3, F. Tardif 4, O. Desilets5
1Pharmacy, Laval University, Quebec City, Canada, 2Cancer Research Center, Laval University, Quebec City, Canada, 3Équipe de recherche Michel-Sarrazin en oncologie psychosocial et soins palliatifs, CHU de Québec, Quebec City, Canada, 4Psycho-oncology and Palliative care, CHU de Québec, Quebec City, Canada, 5Medicine, Maison Michel-Sarrazin, Quebec City, Canada
Introduction: Continuous palliative sedation (CPS) is used for refractory symptoms at the end of life. However, it is sometimes seen as a controversial option and more empirical data are needed on its use in naturalistic studies.
Objectives: To describe the use of CPS in terminal cancer.
Methods: The charts of 1764 patients admitted to a terminal cancer care hospice over 7 years were reviewed to retrieve CPS cases. Benzodiazepines, opioids, and antipsychotics doses were converted into equivalent units (oral lorazepam, morphine, and haloperidol).
Results: 5 % (n = 91) of patients received a CPS, which lasted on average 43 h. The administration of CPS was always approved by a multidisciplinary treating team. The mean age of patients who received CPS was 62.7 years and 43.5 % of those had lung cancer. No significant differences were observed in the length of stay between patients who received CPS and those who did not (22 days vs. 21 days). Indications for the administration of CPS were respiratory problems (67 %), delirium (43 %), psychological distress (34 %), and pain (34 %), with 84 % having 2 indications or more. 44 % of patients who received CPS needed a dose adjustment because of agitation, while 89 % showed no sign of agitation at the time of death. On average, the doses administrated during sedation were 177 mg/24 h of morphine equivalent, 17.7 mg/24 h of lorazepam equivalent, 4.7 mg/24 h of haloperidol equivalent, and 3.7 mg/24 h of scopolamine.
Conclusions: CPS was used in 5 % of terminal cancer deaths over a 7 year period. The main indications were respiratory problems and delirium.
MASCC-0692
Palliative surgery for advanced gastric cancer
D. Simlesa 1, J. Cosic1, G. Santak1, L.J. Begic1, Z. Glavic1
1Digestive Surgery, General Hospital Pozega, Pozega, Croatia
Introduction: Effective palliative surgery is often the only option for advanced gastric cancer.
Objectives: Comparing the results of gastric resection and gastrectomy with less aggressive surgical procedures in patients with advanced gastric cancer.
Methods: Between 2000. and 2010. 159 patients with gastric cancer underwent surgery at the Department of Digestive Surgery, General Hospital Pozega. Patients who had had palliative surgery were identified.
Results: Fifty-nine patients underwent palliative surgery which makes 37 % treated for stomach cancer. There were 39 men (66 %) and 20 (34 %) women with average age of 68,1 years. In the majority of patients (31 or 52 %) cancer was localized in the lower third oh the stomach. Incidence of postoperative complications, mortality and survival of the two groups of patients were compared; those who underwent palliative gastrectomy or resection (24 or 40,7 %) with those who only underwent gastroenterostomy, gastrostomy or just exploration (35 or 59,3 %). In the first group there were 7 (29,2 %) patients with postoperative complications and postoperative mortality equaled 2 (8,2 %). In the second group postoperative complications occurred in 6 (17,1 %) patients, and postoperative mortality rate was 5 (14,5 %). Patients who underwent resection or gastrectomy had longer average survival of 10,8 months, compared to the patients in the second group who survived an average 5,3 months.
Conclusions: In patients with advanced gastric cancer, in a case of a good general condition, palliative resection could be the method of choice and can provide better survival apart from less radical surgery.
MASCC-0693
Risk assessment of pressure ulcers by Braden skin score in acute care palliative medicine
S. Thomas 1, D. Walsh1, S. Shrotiya1, A. Fitz1
1Palliative Medicine, Cleveland Clinic, Cleveland, USA
Introduction: Pressure ulcers amplify morbidity; affect health care cost. Prevention is the key and high nursing care priority. Braden Skin Score (BSS) is a validated tool to assess predictability of pressure ulcer risk.
Objectives To assess impact of hospital admission on BSS in palliative inpatients. We compared BSS at admission and discharge.
Methods Retrospective chart review of 50 patients admitted and discharged from acute palliative unit. Data entered into REDCap (secure web application for data capture; REDCap Software - Version 5.1.3 - © 2013 Vanderbilt University) and analyzed.
Results:
N = 50 (Cancer diagnosis = 38)
Median age (25th, 75th quartiles) = 73 (62–80) years
Median length of stay (25th, 75th quartiles) = 10 (6–17) days
BSS:
(i) Admission = 32 no risk, 7 high risk, 6 low risk,5 moderate risk; Mean Score 17 (low risk)
(ii) Discharge = 19 no risk, 16 high risks, 7 low risks, 5 moderate risks; Mean score 14 (high risk)
BSS sub-scores analysis:
Number of patients at risk increased in each of the four areas from admission to discharge: (i) Sensory Perception (ii) Activity (iii) Poor Nutrition
(iv) Friction and Shear
Conclusions:
1. BSS increased between admission and discharge.
2. All BSS sub-scores deteriorated during hospital admission.
3. Negative factors were multifactorial (e.g.: cachexia, immobility due to patient preference, disease progression, symptom issues).
4. Prevention of pressure ulcers can be a challenge in palliative population despite interventions.
MASCC-0694
Immunogenicity of lipegfilgrastim and pegfilgrastim in breast cancer patients: analysis from phase II/III trials
A. Abdolzade-Bavil 1, L. Zou2, C. Sadhu3, A. Buchner4, P. Liu5
1Bioanalytical Development, BioGeneriX GmbH, Ulm, Germany, 2Global Bioassay and Technology, Teva Pharmaceuticals, Rockville, USA, 3Biotechnology, Teva Biopharmaceuticals, Washington D.C., USA, 4Biosimilars, Teva ratiopharm, Ulm, Germany, 5Bioanalytical Sciences and Technologies, Teva Pharmaceuticals, Rockville, USA
Introduction: Lipegfilgrastim is a novel glycoPEGylated granulocyte-colony stimulating factor (G-CSF) under review for the prevention of neutropenia in patients receiving chemotherapy. Like any biological product, lipegfilgrastim could potentially elicit an anti-drug antibody (ADA) response, which could cause adverse events (AEs) or lack of efficacy.
Objectives: To assess the immunogenicity of lipegfilgrastim compared with pegfilgrastim from a Phase II and III study in patients receiving chemotherapy for breast cancer and correlate laboratory results with clinical events.
Methods: Serum samples from patients with breast cancer receiving a subcutaneous injection of lipegfilgrastim or pegfilgrastim on Day 2 of each of four doxorubicin/docetaxel chemotherapy cycles were taken before each cycle, at the end of the study (Day 85), and twice during the follow-up period. Samples were analyzed using multi-tiered ADA assays based on Mesoscale Discovery (MSD) technology. Screening reactive samples were confirmed by immunocompetition. All confirmed ADA-positive (ADA+) study samples were further characterized and subsequently analyzed for neutralizing activity using NFS-60 cell proliferation assay.
Results: The incidence of ADAs is summarized in the table below.
Drug/study | Confirmed ADA+ samples (number of patients) | |
Phase II (n/N) | Phase III (n/N) | |
Lipegfilgrastim | 1.3 % (2/154) | 1 % (1/100) |
Pegfilgrastim | 1.85 % (1/54) | 1 % (1/101) |
ADA+ samples did not exhibit neutralizing activity against lipegfilgrastim, pegfilgrastim, or endogenous G-CSF. Unexpected AEs or lack of efficacy was not observed for patients with confirmed positive ADA
Conclusions: Immune response following lipegfilgrastim administration was comparable to pegfilgrastim and not considered clinically relevant. Serum ADA status did not appear to impact the clinical safety and efficacy of lipegfilgrastim.
MASCC-0695
Feasibility and benefits of a physical activity (PA) program for cancer survivors in an underprivileged community
L. Zelek 1, A. Festa2, E. Barbeau2, J.M. Descotes3, T. Bouillet3
1Oncology, Hopital Avicenne, Bobigny, France, 2Supportive Care, Oncologie 93, Bobigny, France, 3Physical Activity, Cancer Arts Martiaux et Information, Bobigny, France
Introduction: Benefits of PA have been reported in several studies and it is widely admitted that PA should be part of a cancer survivorship plan. However, numerous barriers impede the practice of PA.
Objectives: To evaluate the feasibility of PA in an area faced with poverty and deprivation (two thirds of the population), in which cancer is a leading cause of premature mortality.
Methods: Over an 8 months period, among 152 cancer patients, 20 were enrolled in a tailored PA program. Twelve had early stage cancers (breast: 11 pts, lung: 1 pt) and underwent semi-structured interviews. Vulnerability was evaluated using an 11-item standardized score *.
Results: A majority of patients (7/12) did not practice PA on a regular basis before enrolment. Only 1 pt was included in the program by his oncologist and 11 pts were included by caregivers. Six pts had an elevated vulnerability score; surprisingly, they were more attentive toward PA and planned to continue the program beyond the initial 6 months. Main benefits were not only improvement of psychological and physical wellbeing, but also, in the same extent, restoration of relationships with other people. For all patients, accessibility with public transportation was regarded as essential.
Conclusions: We showed that, in an underprivileged community, PA programs are feasible in selected cancer survivors (mainly breast cancer pts). Besides benefits previously reported, an effect on social functioning was observed in these pts. Raising physicians’ awareness and making PA more accessible for vulnerable cancer survivors are critical issues.
References: * Sass C et al. Santé Publique 2006.
MASCC-0696
Are validated symptom assessment instruments comprehensive? “orphan” and “champion” symptoms
S. Thomas 1, D. Walsh1, A. Aktas1
1Palliative Medicine, Cleveland Clinic, Cleveland, USA
Introduction: Cancer patients experience multiple symptoms which vary in prevalence, severity, distress and negative impact on life. Comprehensive assessment is essential. Many validated assessment instruments are used. They have limitations; varied content, clinical utility, completion rates, and acceptability.
Objectives:
1. Compare common cancer multisymptom assessment instruments to a comprehensive checklist
2. Identify commonly assessed (“champions”) and frequently neglected (“orphans”) symptoms
3. Examine the clinical importance of “orphan” symptoms
Methods: A 46-symptom checklist was developed from available evidence. This was compared against the content of 6 commonly used, validated, multisymptom instruments. Those with ≤2 symptoms, cancer site-specific, and tumor response instruments were excluded.
Results: Symptom numbers varied in the 6 instruments; median (range) 19 (3–32). Of the 46 checklist symptoms, only 28 were present in ≥1 of the instruments.
“Orphans”: 18 of the 46 were not evaluated in any of the 6 (e.g. confusion, agitation, early satiety, indigestion, tremors). 12 of the18 had prevalence rates >10 %. These symptoms are also often rated moderate/severe (≥ 30 %) and distressful (≥ 30 %).
“Champions”: Only 4 checklist symptoms (pain, fatigue, dyspnea, anorexia) were present in all 6 instruments.
Conclusions:
1. Eighteen “orphan” symptoms (severe/distressing) not captured.
2. Four “champion” symptoms were present in all six validated instruments.
3. Unreported symptoms bias our view of the cancer symptom experience.
4. This challenges the validity and reliability of current symptom assessment instruments in clinical research.
MASCC-0697
Neuromuscular complications after haematopoietic stem cell transplantation
S. Koeppen 1, A.T. Thirugnanasambanthan1, M.K. Koldehoff1
1Neurology, Universitätsklinikum Essen, Essen, Germany
Introduction: Early or delayed neurological complications usually associated with graft-versus-host disease (GvHD) occur in 50–60 % of allogeneic haematopoietic stem cell transplantation (HSCT) recipients. The most commonly recognized manifestations include polyneuropathy (PNP), followed by myopathy and myasthenia gravis. Improved survival of patients undergoing allogeneic HSCT shifts the focus of neurologic involvement towards long-term complication.
Objectives: To analyze the occurrence of neuromuscular symptoms in 20 recipients of allogeneic HSCT for treatment of malignant haematopoietic disease.
Methods: During follow-up visits clinical and electrophysiological findings were correlated to the presence of auto-/alloantibodies in blood samples.
Results: Five patients (25 %) were identified with PNP, 10 patients (50 %) with combined PNP and myopathy, 4 patients (20 %) with myopathy or polymyositis (PM) and one patient (5 %) with myasthenia gravis. Immune mediated sensorimotor PNP after HSCT is characterized by a predominantly axonal lesion. The latency between HSCT and development of PM varied between 60 days and 60 months. PM occurs parallel to a GvHD after tapering of immunosuppressive medication. Typical clinical features are proximal bilateral limb weakness with muscle atrophy. Autoantibodies were detected in 14 patients, myositis-specific antibodies only in one patient. In patients with progressive neurological symptoms, an increase in the CD4/CD8 ratio was observed.
Conclusions: GvHD-related myositis appeared similar to idiopathic myositis regarding clinical and electromyographical findings. As outcome measure sequential analysis of lymphocyte subpopulations in peripheral blood seems to be more suitable than autoantibody measurements. Whereas peripheral neuropathies are commonly observed in the early phase after HSCT, myasthenia gravis is a rare complication in the post-HSCT phase.
MASCC-0698
Post-mastectomy pain syndrome treated with the capsaicin 8 % patch: a case report
J. López-Millán 1, C. Sánchez Blanco1, D. Díaz Rodríguez1, E. Peralta1, M.L. Berraquero1
1Anesthesiology Critical Care and Pain Unit, Virgen Macarena University Hospital, Seville, Spain
Introduction: Post-mastectomy pain syndrome (PMPS) can affect women who have received mastectomies due to breast cancer. PMPS can be difficult to treat and prolonged; however, the capsaicin 8 % patch, EU-approved for treatment of peripheral neuropathic pain in non-diabetic adults, offers a therapeutic option.
Objectives: We present a case study of a PMPS patient, successfully treated with the capsaicin patch.
Methods: Assessments were made using the Visual Analogue Scale (VAS), douleur neuropathique 4 (DN4) questionnaire, Lattinen Index (LI) and Patients’ Global Impression of Change (PGIC).
Results: Following a total mastectomy (2008) and reconstructive surgery (2011), the 55-year-old female experienced symptoms in the left upper limb that included reduced shoulder mobility, pins and needles, and allodynia. Her pain medications—amitriptyline, pregabalin and oxycodone—were associated with systemic side effects and low efficacy; she had VAS and DN4 scores of 10/10 and 6/10, respectively, and LI of 16. She was diagnosed with intercostobrachial syndrome and received four capsaicin patch treatments to the left upper limb over 1 year.
Post-treatment, 50 % reductions in VAS (5/10) and DN4 (3/10) were reported, as was an LI decrease (14). The patient experienced increased shoulder mobility, reduced allodynia area and rescue medication intake, and improved mood. However, she rated 5 on the PGIC, indicating partial treatment satisfaction.
Conclusions: In this patient, the capsaicin patch was used successfully to treat PMPS, reducing pain intensity and allodynia area. Despite a favourable response, the partial satisfaction perceived by the patient suggests a need to manage expectations in addition to pain itself.
MASCC-0699
International classification of functioning (ICF) core set for breast cancer—can it serve as a surveillance tool to identify rehabillitation needs?
M. Cooney 1, E. Stokes1, E. Connolly2, R. Galvin3
1Physiotherapy, Trinity College Dublin, Dublin, Ireland, 2Breast Care Department, St. James Hospital, Dublin, Ireland, 3HRB Centre for Primary Care, Royal College of Surgeons, Dublin, Ireland
Introduction: The rehabillitation needs of the breast cancer population are currently not being met (Schmitz et al., 2012). Many instruments exist that measure aspects of health of this population but none assesses the total range of health affected. The ICF Core Set for breast cancer was designed to do just that. Eighty categories of health describe alterations in function, structure, activities and participation and envronmental factors.
Objectives: The aim was to test the content validity of the Core Set from the perspective of women with the condition.
Methods: A mixed methodology study involving focus groups, followed by a postal questionnaire (sent to 441 women) was undertaken. Inclusion criiteria: women with primary breast cancer >6 months <4 years after surgery, fluent in English >18 years. All treatment types were included, the sample was screened for comorbid conditions affecting function.
Results: The 7 focus groups (N = 34) confirmed most of the 80 categories and identified 30 additional categories that warranted consideration, these were included in the questionnaire. Response rate was 68 % (n = 296). Women confirmed all the categories of the Core Set plus the additional categories.
The information generated identified several categories of health that remained altered but are amenable to rehabillitation and it identified areas of information needs that are currently unmet.
Conclusions: The range of categories confirmed by women in this study can be used as a patient-administered surveillance tool to identify rehabillitation needs.
References: Schmitz K.H. et al.,(2012). Prevalence of breast cancer treatment sequelae over 6 years follow-up : the Pulling Through Study. Cancer,118(8 Suppl), 2217–2225.
MASCC-0700
The capsaicin 8 % patch as a treatment for chemotherapy-induced neuropathy
A. Bhaskar 1, G. Beirne2
1Critical Care Directorate, The Christie NHS Foundation Trust, Manchester, United Kingdom, 2Pain Medicine, The Christie NHS Foundation Trust, Manchester, United Kingdom
Introduction: Chemotherapy-induced neuropathy (CIN) is a side effect of many chemotherapeutic agents, which is often debilitating, difficult to manage and can result in dose limitation or even discontinuation of both curative and palliative chemotherapy. The capsaicin 8 % patch, EU-approved for peripheral neuropathic pain treatment in non-diabetic adults, provides an effective treatment option for patients with CIN.
Objectives: We present a representative case study of successful CIN treatment with the capsaicin patch.
Methods: The capsaicin patch was applied to both feet (sole, heels, dorsum, digits) for 30 min.
Results: The 21-year-old male, diagnosed with acute lymphoblastic leukaemia (ALL) in October 2010, developed painful small-fibre neuropathy after receiving vincristine chemotherapy on the UKALL 2003 trial. The patient’s pain was severe (8–9 on an 11-point scale) and difficult to control despite receiving pregabalin, oxycodone, amitriptyline and morphine. Owing to his CIN, chemotherapy was deferred in November 2010.
In February 2011, the patient received a single capsaicin patch treatment. After 4 weeks, good analgesia was achieved in both feet, resulting in the patient re-starting vincristine chemotherapy in May 2011. Intake of opioids and systemic neuropathic agents was also reduced. Six months post-treatment, the patient remained in an improved state. This patient is representative of a population with CIN who received capsaicin patch treatment at The Christie Hospital (n = 42), where 80 % of patients achieved ≥50 % reduction in pain post-treatment.
Conclusions: Successful capsaicin patch treatment enabled this patient with previously poorly managed CIN to recommence life-saving chemotherapy, which had been deferred due to painful neuropathy.
MASCC-0701
Observational study of ferric carboxymaltose (FCM) in France (Oncofer study; interim analysis)
A. Toledano 1, E. Luporsi2, J.F. Morere3, F. Scotté4, L. Zakin5, L. Mahi5, R. Bugat6
1Oncology, American Hospital of Paris, Neuilly-sur-Seine, France, 2Oncology, Centre Alexis Vautrin, Vandoeuvre-Les-Nancy, France, 3Oncology, Hôpital Avicenne, Bobigny, France, 4Oncology, Hôpital Européen Georges Pompidou, Paris, France, 5Medical, Vifor Pharma, Neuilly-sur-Seine, France, 6Oncology, Institut Claudius Regaud, Toulouse, France
Introduction: Iron deficiency with anemia is a frequent complication in cancer patients.
Objectives: This French multicenter observational study aims to describe Ferric carboxymaltose use in patients with hematological malignancies or solid tumors.
Methods: Two cohorts of patients (1:1) are enrolled. Cohort 1 (retrospective): patients treated in 2010 with any intravenous iron (IV) or red blood cell transfusion if no IV iron; Cohort 2 (prospective): patients treated with FCM after July 1st 2011. Patient characteristics were collected for a period of 3 months pre and post intervention. Outcomes of the first 100 patients are described below.
Results: Fifty patients were analyzed in each cohort (mean age, 62 and 66; solid tumors, 84 % and 100 %; metastatic, 61 % and 63 % for Cohorts 1 and 2, respectively). In Cohort 1, 16 patients received intravenous iron (iron sucrose (IS)) and 34 were transfused. The mean total iron dose was 706 for IS and 959 mg for FCM; the mean number of infusions was 3.8 and 1.8 for IS and FCM respectively. In cohort 2, 69 % of the administrations were done at home. In patients receiving FCM without erythropoietin stimulating agents (ESA), mean Hb (g/dL) increased from 10.9 to 12.1, from baseline to Month 3. ESA use was 44 % in cohort 1 vs 22 % in cohort 2 during observational period. No serious adverse events related to IS or FCM were observed.
Conclusions: Preliminary results showed that FCM was well tolerated and seemed effective in treating iron deficiency anemia but this need to be confirmed by the final analysis.
MASCC-0702
Quality of life among adult haematological cancer survivors
A.S. immanuel 1, J.A.N.E. Hunt2, E. van Teijlingen3
1Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom, 2School of Health and Social Care, Bournemouth University, Bournemouth, United Kingdom, 3Centre for Midwifery Maternal & Perinatal Health, Bournemouth University, Bournemouth, United Kingdom
Introduction: Cancer is a devastating disease that can negatively affect a person’s health-related quality of life (HR-QoL) (Padilla & Ropka, 2005; Fortner et al., 2004; Crighton, 2004). This research focuses on patients who have completed all treatment for a lymphoid malignancy. Those who do survive the side-effects of treatment and who go on to experience prolonged remissions following treatment, must often continue to live with decreased functioning and decreased HRQoL over time.
Objectives:
· To identify factors influencing the quality of life among survivors of haematological cancer
· To assess the impact of demographic variables on the quality of life among haematological cancer survivors
· To compare the quality of life in patients treated with a curative or a non-curative intent
Methods: This study comprises two distinct phases. The first quantitative phase, will use validated questionnaires to explore health related quality of life in the sampled population (QLQ-C30). The target population in this study are adults who have been diagnosed with a lymphoid malignancy which are a type of blood cancer and have completed treatment 1–5 years prior to the commencement of this study.In depth semi-structured interviews will be conducted for the second part of the study. Qualitative data will be collected until data saturation is achieved.
Results: Awaiting.
Conclusions: Awaited.
References: • Crighton, M., 2004. Dimensions of neutropenia in adult cancer patients: Expanding conceptualizations beyond the numerical value of the absolute neutrophil count. CancerNursing, 27(4), 275–284.
MASCC-0703
Receipt of care for depression and perceived barriers to psychological treatment in community radiotherapy departments: results from RTOG 0841
D. Bruner 1, S.P. Pugh2, W.J.S. Small3, J.K. Kirshner4, K.S. Sidhu5, M.B.J. Bury6, A.S.D. DeNittis7, T.E.A. Alpert8, B.T. Tran9, B.F.B. Bloom10, J.M. Mai11, L.I.W. Wagner12
1School of Nursing, Emory University, Atlanta, USA, 2Statistician, R T O G, Philadelphia, USA, 3Co-Chair, GYN, Chicago, USA, 4Co-Chair, C C O P, East Syracuse, USA, 5SE Cancer Control Consortium, C C O P, Winston Salem, USA, 6Oncology, Grand Rapids Clinical Oncology Program, Grand Rapids, USA, 7Radiation Oncology, Main Line C C O P, Philadelphia, USA, 8Hematology Oncology, Hematology Oncology Associates of CNY C C O P, East Syracuse, USA, 9Oncology, Northern Indiana Cancer Research Consortium C C O P, South Bend, USA, 10Oncology, North Shore Universit Hospital C C O P, Manhasset, USA, 11Radiation Oncology, Mercy Hospital, St. Louis, USA, 12Study Chair, Northwestern University, Chicago, USA
Introduction: Primary results of RTOG 0841 of 454 patients (mostly women [66 %] with breast cancer [45 %]) undergoing definitive or palliative radiotherapy (RT) for first diagnosis of cancer showed 16 % self-reported depressive symptoms and 3 % met diagnostic criteria for major depression.
Objectives: Report receipt of care for depression and perceived barriers to psychological treatment among subset interviewed.
Methods: Patients exceeding cutoff scores on Hopkins Symptom Checklist (HSCL-25), Patient Health Questionnaire (PHQ-9), and a sample who screened negative, completed telephone interviews of Structured Clinical Interview for DSM-IV (SCID) Mood Disorder and questions regarding depression care.
Results: Sixty-eight percent of 35 community/2 academic RT sites had mental health services on site and reported providing distressed patients on-site support (48 %), outside referrals (21 %), or oncology team notified (31 %). 70 patients were interviewed: 37 who screened positive, 33 who screened negative on HSCL-25/PHQ. Among those who screened positive or negative, 14 (38 %) and 1 (1.4 %) respectively, met SCID criteria for major depression. 70 % of patients who received psychological help in the past were currently receiving help. Patients sought help from nurse/oncologist (34 %), psychiatrist/psychologist/counselor (29 %), family physician (16 %), or other. Moderate/extreme barriers to seeking help included logistical concerns: daily responsibilities (28 %), getting off work (6 %), pain/fatigue (18 %); and emotional concerns: believing problems not severe enough for counseling (20 %), discomfort with being seen as emotional (20 %), discomfort/concern about counseling (55 %).
Conclusions: Patients with depression treated at community RT sites participating in clinical trials receive moderate to high levels of psychological care, a third provided by the oncology team.
MASCC-0704
Functional status and quality of life of disease free cervical cancer survivors in India
S. Veeraiah 1, V. Elangovan1, S. Ganesan2
1Psycho-oncology, Cancer Institute (WIA), Chennai, India, 2Radiation-oncology, Cancer Institute (WIA), Chennai, India
Introduction: Cervix cancer is one of the comenest cancer in India. However the quality of life of these patients during their survival are under reported in India.
Objectives: To determine the functional status and quality of life of cervical cancer survivors in India
Methods: Three year or more DFS Cervical cancer survivors (N = 103) from January 2011 (average years of survival = 3.85, age range = 27 to 70 years, Mean age = 49.68 years) were administered Cancer Institute Quality of Life Questionnaire (CI-QOL), EORTC QLQ CX24 and Distress Thermometer with their consent. Disease stage (Stage I & II N = 77, and stage III N = 26), type of treatment and year of survival were considered for analysis.
Results: Analysis revealed that the level of distress was found to be less (M = 3.88) which ranged from 0 to 10 (0–4(52.4 %); 5–7(38.9 %) and 8–10(8.7 %). Similarly QOL reported to be better among 33.9 %. While 66.1 % reported poor QOL, factors contributed to poor QOL were not attributable to disease or treatment. Further, majority (79.6 %) of them found to have better body image, no peripheral neuropathy (81.6) and no menopausal symptoms (96.1 %). The disease stage (t = .303; p < .762) and treatment (t = .551; p < .583) did not differ significantly on the QOL during their survival. Similarly these patients did not differ significantly in body image, symptom experience scale and sexual/vaginal functioning. These findings further support that the physical symptoms, disease or treatment did not influence QOL.
Conclusions: The cervical cancer survivors experience better quality of life and free from distress.
MASCC-0705
Treatment of a patient with chemotherapy-induced neuropathy using the capsaicin 8 % patch
A. Bhaskar 1, G. Beirne2
1Critical Care Directorate, The Christie NHS Foundation Trust, Manchester, United Kingdom, 2Pain Medicine, The Christie NHS Foundation Trust, Manchester, United Kingdom
Introduction: Chemotherapy-induced neuropathy (CIN) is a side effect of many chemotherapeutic agents and can disrupt life-saving treatment. The capsaicin 8 % patch, EU-approved for peripheral neuropathic pain in non-diabetic adults, provides a treatment option.
Objectives: A representative case study of a patient with CIN who received capsaicin patch treatment is presented.
Methods: The capsaicin 8 % patch was applied to both feet for 30 min.
Results: The 54-year-old female was diagnosed with breast cancer and received eight cycles of oxaliplatin and trastuzumab. She began experiencing CIN after her fourth oxaliplatin cycle, 20 months before pain clinic referral. On presentation, she reported tingling in both feet, allodynia, poor mobility, and inability to wear shoes. Her only pain medications were codeine and paracetamol, following poor tolerance to anticonvulsants, opioids and amitriptyline.
The patient received a single capsaicin patch treatment, which was well tolerated during application. However, delayed treatment-associated discomfort occurred with the onset of a burning sensation in the feet 6 h post-treatment, which persisted for 3 days. After 4 weeks, the patient reported no pain, could wear shoes and had sleep improvement. The pain remained resolved at 12 weeks, with improved mobility, despite some numbness. Efficacy was, however, not fully appreciated due to a focus on the treatment-associated discomfort.
Conclusions: At 12 weeks following capsaicin patch treatment, this patient with CIN reported no pain and experienced improved mobility. However, her perception of capsaicin patch treatment efficacy was influenced by treatment-associated discomfort, indicating the importance of providing patients with realistic expectations and management techniques.
MASCC-0706
The Edmonton symptom assessment system (ESAS) as a screening tool for depression and anxiety in non-advanced patients with solid or haematological malignancies on cure or follow-up
C. Ripamonti 1, E. Bandieri2, M.A. Pessi1, A. Maruelli3, L. Buonaccorso4, P. Rondelli1, G. Miccinesi5
1Supportive Care in Cancer, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, 2Oncological Unit, Azienda Usl Modena (CeVEAS), Modena, Italy, 3Psychology Unit, LILT and Center for Oncological Rehabilitation-Psychology Unit LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy, 4Psychology Unit, AMO Association of Oncological Patients from nine towns and villages located in the Northern area of Modena, Modena, Italy, 5Clinical Epidemiology Unit, ISPO-Institute for the Study and Prevention of Cancer, Florence, Italy
Introduction: Symptoms’ assessment should be considered a routine clinical practice in all stages of cancer.
Objectives: The main objective of the study was to assess the performance of Edmonton Symptoms Assessment System (ESAS) items on anxiety, depression and not well being in detecting Hospital Anxiety Depression Scale (HADS) ‘cases’.
Methods: Cross-sectional study carried out on 194 non advanced patients with solid (108) or hematologic (86) malignancies on cure or follow up, with Karnofsky Performance Status ≥70 and life expectancy >6 months. Patients were assessed by means of ESAS and by HADS.
ROC analysis of ESAS anxiety, depression and not wellbeing items versus cases of moderate (cutoff 8) or severe (cutoff 11) anxiety and depression according to HADS specific subscales was performed.
Results: Depression and anxiety ESAS items correlated strongly each other (.707, Spearman); not well-being item correlated more than anxiety and depression with all the other six ESAS items. Area under the curve ranged between 0.78 and 0.84 for the three ESAS items when detecting moderate anxiety or depression according to HADS subscale (cutoff = 8). When detecting severe anxiety or depression HADS cases (cutoff = 11) it ranged .84–.96 for anxiety and depression items, but 77-.81 only for not well being. Moderate ESAS anxiety or depression (cutooff = 4) detected quite well the severe depression HADS cases (Sensibility = 75-Specificity = 84, Sensibility = 87-Specificity = 90, respectively).
Conclusions: Moderate anxiety or depression reported through the corresponding ESAS items (cutoff = 4) can be considered an useful screening tool for anxiety and depression in non-advanced patients with solid or haematological malignancies.
MASCC-0707
Patient-centred management of chemotherapy-related nausea and vomiting (CINV): survey and patient charter
A. Young1, P. Dielenseger2, P. Fernandez Ortega3, D. Fernandez Perez4, P. Jones5, E. Lennan6, E. O’Donovan7, S. Sharp8, A. Whiteford9, L. Wiles10
1Warwick Medical School, University of Warwick, Coventry, United Kingdom, 2Clinical Research and Early Clinical Trials Unit, Institut Gustave-Roussy, Paris, France, 3Institut Catala d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain, 4Complejo Hospitalario de Ourense, Ourense, Spain, 5Greater Midlands Cancer Network, Wolverhampton, United Kingdom, 6University Hospital Southampton, Southampton, United Kingdom, 7Irish Cancer Society, Dublin, Ireland, 8Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom, 9Macmillan Cancer Support,, United Kingdom, 10Beating Bowel Cancer,, United Kingdom
Introduction: Patients scheduled for chemotherapy frequently cite CINV as one of their greatest fears,1 yet its prevalence is underestimated by healthcare professionals.2
Objectives: A group of specialist cancer nurses, some from patient advocacy groups, reached consensus on optimal CINV management, and how to empower patients to request guidelines-based care.3
Methods: Telephone/web-based meetings were convened. Subsequently, patients’ views on CINV were investigated via an internet questionnaire.
Results: The nurses agreed that although evidence-based guidelines are available on CINV prophylaxis,3 patient care is this setting is often suboptimal.1 They compiled a series of questions on CINV that patients may wish to ask their nurse or doctor, e.g. who can I contact if I develop CINV outside of clinic hours? The survey was then completed by 369 patients in France, Germany, Italy, Spain and the UK, all of whom had experienced CINV. It showed that the top three concerns prior to chemotherapy were hair loss, vomiting and nausea. CINV was cited at the number one concern by 15 %.
Conclusions: The question list has been compiled into a CINV Patient Charter, which is to be translated (from English) into several European languages and circulated via patient and professional groups, with a view to empowering chemotherapy recipients in their discussions of potential CINV.
References:
1. Young A et al. Ecancermedicalscience 2013, in press.
2. Salsman JM et al. J Natl Compr Canc Netw 2012; 10, 149–57.
3. MASCC (2011) MASCC/ESMO antiemetic guideline 2011 (Hillerød: Multinational Association of Supportive Care in Cancer).
MASCC-0708
Management of gastrointestinal adverse events associated with afatinib, an oral erbb family blocker
J. Köhler 1, J.C.H. Yang2, N. Reguart3, J. Barinoff4, M. Uttenreuther-Fischer5, U. Stammberger6, D. O’Brien7, J. Wolf8, E.E.W. Cohen9
1Medical Oncology, West German Cancer Center University Hospital Essen, Essen, Germany, 2Medical Oncology, National Taiwan University Hospital, Taipei, Taiwan, 3Medical Oncology, ICMHO Hospital Clinic Barcelona, Barcelona, Spain, 4Department of Gynecology and Gynecological Oncology, Klinikum Essen-Mitte, Essen, Germany, 5Therapeutic Area Oncology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany, 6Clinical Development & Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany, 7Global Safety Evaluations, Boehringer Ingelheim Pharmaceuticals, Ridgefield, USA, 8Department of Internal Medicine, Center for Integrated Oncology University Hospital Köln, Köln, Germany, 9Medicine, University of Chicago Medical Center, Chicago, USA
Introduction: Afatinib, an irreversible ErbB Family Blocker, inhibits signalling from EGFR (ErbB1), HER2 (ErbB2), ErbB3 and ErbB4, and is in Phase III investigation in NSCLC, breast and head and neck cancers. Similar to reversible EGFR TKIs, diarrhoea is common with afatinib.
Objectives: To provide management strategies for afatinib-associated diarrhoea.
Methods: Pooling all unblinded Phase II/III afatinib monotherapy trials in patients with solid tumours provided a large (n = 2281) dataset (cut-off September 2011). This annual snapshot generated a dataset of individuals with a similar duration of drug exposure, irrespective of selection criteria. An advisory board of medical oncologists reviewed diarrhoea AEs of afatinib and proposed management algorithms.
Results: Incidences will be presented. Expert algorithms included for evaluation: history of diarrhoea, stool number/characteristics, assessing serious AE risk, diet and previous anti-diarrhoeal treatment compliance. Recommendations were given for Grade 1–2 diarrhoea, Grade 2 diarrhoea >48 h despite loperamide, and Grade 3–4 diarrhoea. Alongside early identification and proactive management, treatment included loperamide, prevention of dehydration and other symptomatic treatment of diarrhoea. For Grade 1–2 diarrhoea, continue afatinib at the same dose; for Grade 2 diarrhoea >48 h despite loperamide, or Grade 3–4 diarrhoea, interrupt afatinib until resolution to Grade ≤1, then restart afatinib at a 10 mg reduced dose (20 mg minimum).
Conclusions: Awareness, early identification, timely management and ongoing assessment will help prevent aggravation of diarrhoea, afatinib dose reductions or discontinuation, allowing patients to obtain the maximum benefit from afatinib.
MASCC-0709
Management of dermatological adverse events associated with afatinib, an oral erbb family blocker
D. Schadendorf 1, M.E. Lacouture2, C.Y. Chu3, M. Uttenreuther-Fischer4, U. Stammberger5, D. O’Brien6, A. Hauschild7
1Dermatology, Universitätsklinikum Essen, Essen, Germany, 2Dermatology, Memorial-Sloan Kettering Cancer Center, New York, USA, 3Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, 4Therapeutic Area Oncology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany, 5Clinical Development & Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany, 6Global Safety Evaluations, Boehringer Ingelheim Pharmaceuticals, Ridgefield, USA, 7Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
Introduction: Afatinib, an irreversible ErbB Family Blocker, inhibits signalling from EGFR (ErbB1), HER2 (ErbB2), ErbB3 and ErbB4, and is in Phase III investigation in NSCLC, breast and head and neck cancers. Similar to reversible EGFR TKIs, dermatological AEs are common with afatinib.
Objectives: To provide management strategies for afatinib-associated dermatological AEs.
Methods: Pooling all unblinded Phase II/III afatinib monotherapy trials in patients with solid tumours provided a large (n = 2281) dataset (cut-off September 2011). This annual snapshot generated a dataset of individuals with a similar duration of drug exposure, irrespective of selection criteria. An advisory board of afatinib-experienced dermatologists reviewed dermatological AEs and created management algorithms.
Results: Incidences will be presented. The following treatment options were recommended: For papulopustular (acneiform) rash, topical and oral steroids or antibiotics; for paronychia, topical antibiotics or antiseptics and silver nitrate applications; for pruritus, topical oral agents (steroids, antihistamines or GABA agonists); for xerosis, topical steroids, ammonium lactate and moisturizing creams. Patients with an intolerable Grade 2/Grade ≥3 dermatological AE should be referred to a dermatologist; these patients may have afatinib treatment interruption for <28 days. Afatinib can be reintroduced at a lower dose following recovery to Grade ≤2 within 28 days after interruption. Afatinib should be permanently discontinued if a Grade ≥3 dermatological AE persists, despite intervention and afatinib interruption.
Conclusions: Patient education, with early, timely and proactive management of afatinib-associated dermatological AEs, may facilitate continuous treatment and help maximize clinical benefit from afatinib.
MASCC-0710
Impact of bone metastases (BM) on patients with castration-resistant prostate cancer (CRPC)
G. Hechmati 1, J. Arellano2, I. Haynes3, A. Rider4, A. Worsfold4
1Health Economics, Amgen (Europe) GmbH, Zug, Switzerland, 2Health Economics, Amgen Inc., Thousand Oaks, USA, 3International Research and Development, Amgen Ltd., Uxbridge, United Kingdom, 4Real World Research & Disease Programmes, Adelphi Real World, Macclesfield, United Kingdom
Introduction: Prostate cancer is the most prevalent form of cancer in men and in the majority of cases, will become castration-resistant; a progressive state whereby most patients develop BM. BM are associated with pain, increased risk of skeletal complications (e.g. fracture, need for radiation) and impact on quality of life.
Objectives: To evaluate the impact of BM on performance status and pain as well as the use of pain relief medication in patients with ‘high risk’ CRPC.
Methods: Data were extracted from the Adelphi Prostate Cancer Disease-Specific Programme© (DSP), a cross-sectional survey of 348 urologists/oncologists and their prostate cancer patients, conducted December 2009–May 2010 in France, Germany, Italy, Spain and the UK. Each physician reported on 10 patients receiving treatment for prostate cancer.
Results: A total of 1,180 patients with CRPC were included: median time since prostate cancer diagnosis was 35.8 months; 146 (12 %) patients were ‘high-risk’ for developing BM (defined as PSA doubling time ≤6 months, or most recent PSA of ≥8 ng/mL, or Gleason score ≥8, or having received local therapy in addition to systemic medication); 680 (58 %) patients had BM.
High risk patients (n = 146) | BM patients (n = 680) | p-value | |
Age (median) | 72.0 | 72.0 | – |
Mean Karnofsky status (0–100) | 85.1 | 72.7 | <0.0001 |
Current bone reported, n (%) | 11 (8 %) | 400 (59 %) | <0.0001 |
Analgesic use (including Over The Counter), n (%) | 26 (18 %) | 347 (51 %) | <0.0001 |
Conclusions: BM are associated with a significant reduction in performance status and increased pain burden for the patient including the need for more analgesic use. There is a need for treatments to prevent or delay the onset of BM, thereby delaying their associated pain burden and impact on quality of life.
MASCC-0711
Burden of bone metastases (BM) in patients with castration-resistant prostate cancer (CRPC): findings from a prospective routine practice study in 13 medium-sized european countries
G. Hechmati 1, P. Vrouchou1, J. Arellano2, J. Cristino1, I. Haynes3, A. Liede2, A. Rider4, A. Worsfold4, V. Crossland4
1Health Economics, Amgen (Europe) GmbH, Zug, Switzerland, 2Health Economics, Amgen Inc., Thousand Oaks, USA, 3Research and Development, Amgen Ltd., Uxbridge, United Kingdom, 4Real World Research & Disease Programmes, Adelphi Real World, Cheshire, United Kingdom
Introduction: Patient and physician burden of BM has not been widely reported
Objectives: To evaluate the patient and physician burden of BM in CRPC
Methods: Oncology and urology specialists completed a 5-day workload form, an interview and an average of 7 patient records forms (PRFs; October 2012-ongoing as of February 2013). Preliminary interview and PRF data are reported.
Results: Eight hundred fifty-two PRFs were included in this analysis; 393 patients had non-metastatic CRPC at ‘high risk’ of developing BM per the treating physician (92 % had a PSA doubling time (PSADT) ≤6 months); 366 patients had CRPC with BM alone; 93 patients had CRPC with bone and visceral metastases. Patients with BM only had a worse Eastern Cooperative Oncology Group (ECOG) performance status than those at ‘high risk’ of developing BM (p < 0.0001). Those with bone and visceral metastases also had a poorer ECOG status versus those at ‘high risk’ (p = 0.0002).
Physician interviews (completed by 84 oncologists, 60 urologists) showed that 92 %, 63 % and 62 % of the physicians believed the greatest patient impact of BM are spine pain, fractures and reduced ability to perform daily activities (from a predetermined list), respectively. The biggest impact of BM on treating physicians was seeing patient deterioration (73 %), inability to propose effective treatment (55 %), managing complex regimens (28 %) and transferring patients for respite/hospice care (24 %)
Conclusions: Preliminary results highlight the burden of BM in patients with CRPC and the perceived impact on physicians treating this population. There is an unmet need for treatments to delay BM and their associated burden.
MASCC-0712
Lipegfilgrastim—a long-acting, once-per-cycle, glycopegylated recombinant human filgrastim
C. Scheckermann 1, K. Schmidt2, A. Abdolzade-Bavil3, H. Allgaier4, U. Mueller5, W. Shen6, P. Liu7
1CMC Project Leader - Downstream Processing, BioGeneriX GmbH, Ulm, Germany, 2CMO-Management, BioGeneriX GmbH, Ulm, Germany, 3Bioanalytical Development gB&T, BioGeneriX GmbH, Ulm, Germany, 4Biopharmaceutical Ops Network, BioGeneriX GmbH, Ulm, Germany, 5Global Medical Affairs, Teva Pharmaceuticals, Ulm, Germany, 6Biologics Development, Teva Pharmaceuticals, West Chester, USA, 7Bioassays, Teva Pharmaceuticals, West Chester, USA
Introduction: Lipegfilgrastim is a once-per-cycle fixed-dose glycoPEGylated granulocyte-colony stimulating factor (G-CSF) under development for the prevention of severe neutropenia in cancer patients receiving chemotherapy (CTx). Covalent attachment of polyethylene glycol (PEG) has been shown to prolong the half-life of therapeutic proteins, allowing for less frequent dosing, improved patient compliance, and potentially lower production costs. However, traditional PEGylation Methods rely on chemical conjugation through amino acid reactive groups, which may reduce protein activity and result in non-uniform chemical and pharmaceutical properties.
Objectives: To describe a highly site-specific glycoPEGylation technology for site-directed PEGylation and summarize preclinical findings of lipegfilgrastim versus pegfilgrastim (Neulasta®).
Methods: Glycosylation sequon scanning was used to identify the glycoPEGylation site with the least impact on protein activity. Escherichia coli-expressed G-CSF was selectively glycosylated at the natural O-glycosylation site (Threonine 134) and a PEG sialic acid derivative attached using a sialyltransferase (glycoPEGylation technology). Biologic activity of lipegfilgrastim was assessed in an NFS-60 cell line proliferation assay versus filgrastim and pegfilgrastim. Pharmacokinetic (PK) and pharmacodynamic properties were studied in healthy and neutropenic animal models.
Results: GlycoPEGylation produces long-acting G-CSF with improved PK profiles. In vitro, lipegfilgrastim had binding affinity and specific activity comparable to pegfilgrastim. Similar increases in leukocytes, neutrophilic granulocytes, and monocytes were seen with lipegfilgrastim and pegfilgrastim in rats and monkeys and were consistent with the effects expected for a long-acting G-CSF.
Conclusions: GlycoPEGylation technology platform is used to produce lipegfilgrastim–a novel, biologically active G-CSF with greater structural homogeneity and comparable pharmacologic properties to conventionally PEGylated G-CSFs
MASCC-0713
Epidemiology of castration-resistant prostate cancer (CRPC) in 13 medium-sized European countries: data from a prospective routine practice study
G. Hechmati1, P. Vrouchou 1, J. Arellano2, A. Liede2, J. Cristino1, I. Haynes3, A. Rider4, A. Worsfold4, V. Crossland4
1Health Economics, Amgen (Europe) GmbH, Zug, Switzerland, 2Health Economics, Amgen Inc., Thousand Oaks, USA, 3Research and Development, Amgen Ltd., Uxbridge, United Kingdom, 4Real World Research & Disease Programmes, Adelphi Real World, Cheshire, United Kingdom
Introduction: Epidemiology of CRPC represents a growing public health concern that has not been adequately quantified, particularly in medium-sized European countries.
Objectives: The aim of this study was to characterise the epidemiology of CRPC in these countries using real-world data as provided by treating physicians.
Methods: A prospective routine practice study involving oncology and urology specialists across 13 medium-sized European countries with a focus on CRPC patients was initiated in October 2012 (ongoing as of February 2013). Each specialist completed an interview, a 5-day workload form and an average of 7 CPRC patient records forms. Preliminary workload data are reported here.
Results: Figure 1 provides a breakdown of the CRPC population groups seen by 74 oncologists and 44 urologists that completed the workload in routine clinical practice.
On average, patients with prostate cancer account for 19 % of a physician’s daily workload, with more patients seen by urologists (24 % vs 16 % seen by oncologists). 46 % of the patients had CRPC and the majority of them were treated by oncologists (65 % treated by oncologists, 27 % treated by urologists). Among the CRPC population, 53 % had bone metastases only (BM); 22 % had BM and visceral metastases; and 5 % had visceral metastases only
Conclusions: Although urologists treat more patients with prostate cancer than oncologists, as disease progresses to CRPC, patients are generally treated by oncologists. CRPC most commonly metastasises to bone and given the high incidence, there is a need for novel therapies that could prevent their occurrence.
MASCC-0715
International prevalence of non-metastatic (M0) castration-resistant prostate cancer (CRPC)
A. Liede 1, J. Arellano2, G. Hechmati3, B. Bennett4, S. Wong4
1Center for Observational Research, Amgen Inc., San Francisco, USA, 2Health Economics, Amgen Inc., Thousand Oaks, USA, 3Health Economics, Amgen (Europe) GmbH, Zug, Switzerland, 4Health Economics, Plan A Inc, Mountain View, USA
Introduction: CRPC represents a growing public health concern that has not been adequately quantified. In the absence of metastases, CRPC represents a transitional disease state defined by increases in serum prostate-specific antigen (PSA) despite castration levels of androgens during androgen-deprivation therapy (ADT)
Objectives: We developed a model to estimate M0 CRPC prevalence in selected countries
Methods: A patient-flow model was developed to estimate 5-year limited-duration prevalence of prostate cancer (PC) and M0-PC in each country, each year (2008 to 2028) using age-specific incidence and survival data from population cancer registries from 28 countries in North (US, Canada, Mexico) and South (Brazil) America, Europe (18 countries), Asia (5 countries), and Australia. The proportion of men with M0-PC treated with ADT was based on literature and survey research with PC-treating physicians. PSA relapse rates from literature were used to estimate CRPC among ADT treated men.
Results: PC prevalence is driven by size and aging of populations, with notable increases predicted within 15 years in regions other than US, Canada, EU5 (table). The prevalence model, which utilized country-level data, indicates that M0-CRPC represents a relatively small proportion (2–7 %) of the total PC population. Nonetheless, widespread screening and demographic changes dictate that prevalence of CRPC will increase over the next 15 years, assuming current ADT rates.
Conclusions: PC incidence trends are dependent on PSA screening, which is projected to lead to an increase in M0-PC and PC prevalence in most regions. The number of men treated with ADT and who ultimately develop CRPC will increase accordingly, as demonstrated in the model.
MASCC-0716
Postoperative rehabilitation in operations for lung cancer—a randomised clinical trial with blinded effect evaluation: rationale and design (PROLUCA)
M. S. Sommer 1, K. Trier1, M. Missel2, K. Richter3, J. Vibe-Petersen4, J. H. Pedersen2, H. Langberg5
1Research Unit, Copenhagen Centre for Cancer and Health, Copenhagen, Denmark, 2Thoracic Surgery RT, Rigshospitalet, Copenhagen, Denmark, 3Pulmonary Department L, Bispebjerg Hospital, Copenhagen, Denmark, 4Head of Center, Copenhagen Center for Cancer and Health, Copenhagen, Denmark, 5Faculty of Health Science and Municipality of Copenhagen, University of Copenhagen, Copenhagen, Denmark
Introduction: The rationale of Postoperative Rehabilitation in Operations for LUng CAncer (PROLUCA) is to identify the optimal postoperative rehabilitation in patients with non-small cell lung cancer (NSCLC).
Objectives: The purpose is, in a non-hospital setting, to investigate the efficacy of early postoperative rehabilitation in patients with operable lung cancer—with focus on exercise.
Methods: We are planning a trial of a continuous response variable (VO2peak) from independent experimental and control participants (1:1). One hundred and seventy participants (85 in each group) with histological evidence of NSCLC at disease stage I-IIIa, referred for surgical resection at Department of Cardiothoracic surgery RT, Rigshospitalet, will be randomly assigned to postoperative rehabilitation initiated either (1) 2 weeks after surgery or (2) 14 weeks after surgery. The rehabilitation program consists of a supervised group exercise program comprising resistance and cardiovascular training 2 h weekly for 12 weeks (intensity at 60–90 % of VO2peak and 60–80 % of 1RM) and individual counseling. The primary endpoint is VO2peak (direct measurement). Secondary endpoints include: Perioperative complications, 6 MWT, 1 RM, patient-reported outcomes (e.g., quality of life, fatigue, depression, lifestyle), hospitalization time, sick leave, work status, and survival. All endpoints will be assessed (1) baseline (the day before surgery), (2) 2 weeks (only 6MWD), (3) 14 weeks, (4) 26 weeks and (5) 52 weeks postoperatively.
Results: The results of PROLUCA will identify the optimal postoperative rehabilitation for NSCLC patients with focus on exercise initiated as early as 14 days post surgery.
Conclusions: This study will contribute to establish rehabilitation guidelines for operable NSCLC patients.
MASCC-0717
Antihypertensive drugs with the potential to prolong the QT interval
L. Lemos1, S. Morgado2, M. Morgado 2
1Health Sciences Faculty, University of Beira Interior, Covilhã, Portugal, 2Pharmaceutical Services, Hospital Centre of Cova da Beira, Covilhã, Portugal
Introduction: Regulation No. 173/CD/8.1.7. from the Portuguese Authority of Medicines and Health Products (INFARMED), dated 02/08/2012 and titled “Ondansetron—dose constraint for injectable drugs”, recommends that “care must be taken when administering this antiemetic associated with other drugs that prolong the QT interval”. Antihypertensive drugs are an example of drugs that may prolong the QT interval due to its potential to cause hypokalemia. To effectively implement this recommendation, it was thought advisable to point out, in the computerized hospital drug database, all antihypertensive drugs that prolong the QT interval.
Objectives: To review all antihypertensive drugs available in the Portuguese pharmaceutical market to identify those with the potential to prolong the QT interval, in order to allow hospital pharmacists to quickly and efficiently implement the above-mentioned recommendation
Methods: Literature review based upon all Summary of Product Characteristics (SPC) of antihypertensive drugs available in Portugal and 35 literature sources from the PubMed, found by intersecting the terms “antihypertensive-induced prolongation of the QT interval” and using the limit time interval from January/2003 to September/2012.
Results: A total of 63 antihypertensive agents currently available in Portugal were analyzed. Agents with the potential to prolong the QT interval are: furosemide, indapamide, hydrochlorothiazide, nebivolol e lacidipine. Substantial evidence supports the conclusion that indapamide, isradipine and nicardipine have a possible risk of torsades de pointes (TdP) when used as directed in SPC.
Conclusions: The produced database is a valuable tool to Portuguese hospital pharmacists that dispense antihypertensive drugs, contributing to implement one of the recommendations of the above-mentioned regulation.
MASCC-0718
Program of physical activity after a localized breast cancer : patient’s compliance to a free physical reconditioning
L. copel 1, C. hiegel2, B. boistard1, C. boiron1, S. dolbeault1
1Disspo, Curie, Paris, France, 2Siel Bleu, Groupe Associatif, Paris, France
Introduction: A regular and dynamic physical activity (PA) reduced the risk of recurrence for localized breast cancer (LBC) and has also shown its effectiveness in terms of improving quality of life in the post cancer period. Courneya made recommendations on the level of PA needed.
Objectives: To help women behavior of living adequate recommendations, we make a systematic proposal to each patient to join the “Program Activ” 'This one is free and involves an initial assessment on the individual PA with recommendations that can be broken into3 proposals : autonomy (patient sufficiently active),12 collectiv lessons or 14 individual lessons.
Methods: During this proposal, a questionnaire on the PA level of patients is distributed.
Results: Three hundred ninety-five patients received the proposal. Among them 80, called to make an appointment(groupA) and 315 did not express(groupB).
In groupA: only 12,5 % of patients reported a PA > Courneya’s recommendations while in groupB they represented 27 %. Parallely 69,5 % of patients in groupA had a PA lower than recommendations against 55 % in groupB (18 % of patients in each group were unassessable). Group A’s patients were younger, from a higher-level social bracket and followed by an motivated oncologist.
Among patients who made the initial assessment, 60 % have integrated a course of training.
Six months after the end of training, 83 % continued PA (53 % with an activity equal or superior to recommendations).
Conclusions: Despite the potential for significant outcomes, patients had difficulty entering a free program of physical reconditioning.
MASCC-0719
Efficacy and safety of balugrastim in chemotherapy-induced neutropenia: integrated analysis of two randomized phase III studies
O. Gladkov 1, C. Volovat2, S. Barash3, A. Buchner4, N. Avisar5, P. Bias4, U. Mueller4
1Clinical Oncology, Chelyabinsk Regional Clinical Oncology Dispensary, Chelyabinsk, Russia, 2Oncology, Centrul de Oncologie Medicala, Iasi, Romania, 3Biopharmaceuticals, Teva Biopharmaceuticals USA, Rockville, USA, 4Biosimilars, Teva ratiopharm, Ulm, Germany, 5Clinical Pharmacology & Experimental Medicine, Teva Pharmaceuticals, Netanya, Israel
Introduction: Balugrastim is a recombinant fusion protein composed of human serum albumin and human granulocyte-colony stimulating factor, which allows for once-per-chemotherapy cycle, fixed dose administration.
Objectives: To present the results of a combined analysis of two randomized Phase III studies comparing the efficacy and safety of balugrastim versus pegfilgrastim in breast cancer patients receiving myelosuppressive chemotherapy (CTx).
Methods: All patients were treated with i.v. doxorubicin 60 mg/m2 followed by docetaxel 75 mg/m2 on Day 1 of a 21-day cycle for up to four cycles. For each cycle, patients received a single s.c. injection of balugrastim approximately 24 h after the administration of CTx. The primary endpoint was duration of severe neutropenia (DSN) in Cycle 1. Safety of balugrastim was assessed by type, frequency, and severity of adverse events (AEs); changes in laboratory parameters and vital signs; and immunogenicity over time. Analyses were performed in the per-protocol population.
Results: Balugrastim demonstrated non-inferiority versus pegfilgrastim for reduction in DSN. Mean DSN in Cycle 1 was 1.1 ± 1.11 days in balugrastim patients (n = 236) and 1.0 ± 1.14 days in pegfilgrastim patients (n = 234). Patients treated with balugrastim had a significantly shorter time to ANC recovery in Cycle 1 versus pegfilgrastim. No other significant differences in treatment effects were observed between groups. The safety profile was similar for both drugs, with the most frequent AEs consistent with the underlying medical condition and administration of myelosuppressive CTx.
Conclusions: Balugrastim is a non-inferior, safe and effective alternative to long-acting pegfilgrastim for reducing DSN in breast cancer patients receiving myelosuppressive chemotherapy.
MASCC-0720
Experiences of uncertainty and disruption to continuity of care in cancer of unknown primary
R. Foster1, R. Wagland 2, J. Symons3, C. Davis4, L. Boyland5, C. Foster1, J. Addington-Hall2, A. Richardson6
1Macmillan Survivorship Research Group, University of Southampton, Southampton, United Kingdom, 2Cancer Palliative and End of Life Care Research Group, University of Southampton, Southampton, United Kingdom, 3Jo’s Friends, Cancer of Unknown Primary Foundation, Newbury, United Kingdom, 4Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, 5Oakhaven Hospice, Oakhaven Hospice Trust, Lymington, United Kingdom, 6Cancer Palliative and End of Life Care Research Group, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Introduction: In 2010, Cancer of Unknown Primary (CUP) was the fifth most common cause of cancer death in the UK. Despite this, it is a neglected and poorly understood disease. There is little evidence about the experiences of living with CUP or caring for CUP patients.
Objectives: To investigate experiences of living with CUP from the perspectives of patients, informal carers and health professionals.
Methods: Case study methodology was employed. In-depth interviews with patients, their informal carers and their health professionals were conducted in 2011 and 2012. NHS patients’ medical records provided additional data. Patients were recruited from three NHS Trusts and via the CUP Foundation. Other interviewees were nominated by patients.
Results: Forty-four interviews with 17 CUP patients, 14 informal carers and 13 health professionals were carried out. Uncertainty was a prominent feature of patients’ and informal carers’ experiences, often leading to anxiety regarding diagnosis, prognosis, treatment and possible recurrence. Health professionals reported concerns about the impact of uncertainty on CUP patients and some described experiencing a “test or treat” dilemma. Disruption in continuity of care was described by some interviewees and there was evidence of “MDT tennis”, where patients were “bounced” between MDTs.
Conclusions: Uncertainty in CUP has negative consequences for patients, informal carers and health professionals. It contributes to the poor outcomes of this patient group. Disruption in continuity of care was linked to uncertainty. Reducing uncertainty by minimising disruption in continuity of care and improving information could lead to better experiences for patients and families.
MASCC-0721
Post-operative pain management after single port laparoscopic oncologic surgery
S.W. Byun1, K. Lee 1, J.S. Park1
1OBGYn, Catholic University of Korea, Seoul, Korea
Introduction: As a minimally invasive surgery, single port laparoscopic surgeries were introduced in many of oncologic surgery. Post-operative pain would be reduced by means of single port surgery but compared to single port laparoscopic benign surgery, property of post-operative pain management was not accessed in single port laparoscopic oncologic surgery.
Objectives: We are aim to show the post-operative pain management after single port laparoscopic oncologic surgeries.
Methods: Eight cases of single port laparoscopic oncologic surgery including borderline tumor were reviewed in term of postoperative pain control and prescription patterns of pain-killer in oncologic surgeries were compared to that in benign surgeries.
Results: Eight cases of.
Conclusions: Post-operative pain control after single port laparoscopic oncologic surgeries were varied and were not adequately transferred to the patients compared to that for benign disease. Considering the operative field in oncologic surgery, prescription patterns of pain killers should be modified to relief the post-operative pain.
MASCC-0722
Pilot study of a new model of breast cancer survivorship care
D. Stan 1, S. Pruthi1, D. Wahner-Roedler1, M. Destro-Borgen1, K. Ghosh1
1Internal Medicine, Mayo Clinic, Rochester, USA
Introduction: Breast cancer survivors are faced with multiple physical and psychological sequelae of cancer diagnosis and treatment.[1–5] Survivorship care can be fragmented and inefficient. The Institute of Medicine recommends new models of care that address physical and psychological concerns and provide each cancer survivor with an individualized ‘Survivorship Plan of Care’ (SPOC).[6]
Objectives: To assess the feasibility and benefits of a breast cancer survivorship care model inclusive of the above components.
Methods: We designed a pilot study of 16 breast cancer survivors within 6 months from ‘active’ treatment completion. See Fig 1 for study description.
The ‘Survivorship Visit’ included:
· assessment of physical and psychological sequelae and referral as needed
· development of an individualized SPOC (summary of cancer type, treatment, potential treatment sequelae, follow-up and wellness recommendations)
· optional wellness-oriented appointments in physical therapy, acupuncture, massage, wellness coaching, stress management class
Outcomes:
· feasibility
· pre- and post-intervention knowledge survey
· post-intervention satisfaction survey
Results: To recruit the 16 patients, we approached 22. Currently, 14 participants have completed the survivorship visit and are undergoing the optional appointments.
The following number of patients signed up for the optional wellness appointments: acupuncture-12, massage-14, physical therapy-14, wellness-13, stress management-11.
Completion of SPOC took in average 30 min.
The survey results will be available in March 2013.
Conclusions: Breast cancer survivors are interested in participating in a comprehensive model of breast cancer survivorship care that includes components of both traditional and alternative medicine. The model of care is feasible, although resource intensive.
References:
1. Cheville, A.L. and J. Tchou, Barriers to rehabiliation following surgery for primary breast cancer. Journal of surgical oncology, 2007. 95(5): p. 409–18.
2. Denmark-Wahnefried, W., et al., Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2001. 19(9): p. 2381–9.
3. Karki, A., et al., Impairments, activity limitations and participation restrictions 6 and 12 months after breast cancer operation. Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation medicine, 2005. 37(3): p.180–8.
4. Przezdziecki, A., et al., My changed body: breast cancer, body image, distress and self-compassion. Psycho-oncology, 2012.
5. Rotonda, C., et al., Factors Associated With Fatigue After Surgery in Women With Early-Stage Invasive Breast Cancer. The oncologist, 2013
6. Hewitt, M.G., S; Stovall, E, Committee on Cancer Survivorship: Improving Care and Quality of Life National Cancer Policy Board. From Cancer Patient to Cancer Survivor: Lost in Transition. Institute of Medicine and National Research Council of the National Academies (ed). Washington, D.C.: The National Academies Press, 2005.
MASCC-0723
Integrating pediatric palliative care in the community- a model for homa bay county
P. Were 1, F. Emali2, M. Liru3, J. Lynnette4, W.A. Aketch4, C.A. Kasera4
1Nursing, Moi Teaching and Referral Hospital, Eldoret, Kenya, 2Public Health, Homa Bay District Hospital, Eldoret, Kenya, 3Pediatric, Homa Bay District Hospital, Eldoret, Kenya, 4Nursing, Homa Bay District Hospital, Eldoret, Kenya
Introduction: The number of children diagnosed with life limiting condition has increased tremendously since the introduction of Burkitt’s lymphoma treatment at the Homabay District Hospital. Lack of awareness, early detection and diagnosis is one factor that makes many parents present to the health facilities with late disease leaving them with no option but Palliative care. Due to high level of poverty and unaffordable Hospital bills, most parents have no option but to keep their children at home where their care is compromised.
Western Kenya has only two academic hospitals able to provide limited treatment to oncology patients. Moi Teaching and referral Hospital is situated in Eldoret, 200kms away while Jaramogi Oginga Odinga Teaching and referral Hospital is situated in Kisumu, 100kms from Homabay so access to care is limited
Objectives: This papers highlights the combined activities initiated by Homabay District hospital within this region to improve pediatric Palliative care in the region.
Methods: Eighty Community Health workers drawn from 3 locations have attended 2 sessions on basic skills for palliative care volunteers. Topics covered include communication with children, pain control, wound care and basic drug administration. Theory sessions have been covered and accompanied home visits to the families with children having life limiting conditions. Children visited had Kaposi Sarcoma, Down’s syndrome and other related conditions
Results: Twenty households have been reached regularly.
Information dissemination through community meetings.
Conclusions:
Challenges:
Poor road network.
Lack of essential pain control drugs.
Capacity building to empower them do more.
Collaborators to help support this project.
MASCC-0724
Nausea causes more discomfort in respect to vomiting during the first 3 cycles in naïve- patients treated with moderate/high emetogenic chemotherapy: preliminary data
C. Ripamonti 1, A. Necchi2, P. Bossi3, R. Buzzoni4, D. Raggi2, P. Giannatempo2, C. Resteghini3, N. Zilembo4, M.A. Pessi1
1Supportive Care in Cancer Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, 2Department of Medicine Medical Oncology 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, 3Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, 4Department of Medicine Medical Oncology 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Introduction: International Guidelines (IGs) for Antiemetic Treatment of Chemotherapy (CT)-Induced Nausea and Vomiting are published. Data are lacking on the frequency/severity of nausea and vomiting during inter-cycle phases.
Objectives: To assess the frequency, severity and discomfort of nausea and vomiting before and 15 days after CT.
Methods: In an observational, prospective study we considered 93 consecutive CT naïve adult pts with lung, pleuric, head and neck and male genito-urinary-tract cancers. Exclusion criteria: use of strong opioids, cannabinoids, steroids, alcohol (C.A.G.E. ≥ 2). The most used CT schemes were: MVAC (9 %); PEB (34.6 %), TPF (37.2 %). Patients received antiemetics according to IGs.
The Edmonton Symptom Assessment System (ESAS) was administered before the first CT infusion during the patients’ hospitalization and then by phone call (from 14th° to 16th° day) after each of the 3 consecutive cycles. Vomiting was added as tenth symptom. At the end pts were asked about which of the two symptoms had created more discomfort during all the treatment period.
Results: Of 93 pts enrolled (mean age 51, 84 % male, ECOG PS 0 = 93.4 %) 50 completed the study. Fifty per cent of pts self-reported nausea and vomiting of low-mild severity during inter-cycles and 72 % referred nausea as the most discomforting symptom in respect to vomiting (6 %) during all the period under investigation.
Conclusions: Compared to vomiting, nausea is the most discomforting symptom. Further studies are necessary to investigate CT-induced nausea during the treatment period, because no specific IGs are available for its prevention and treatment.
MASCC-0725
An all-ireland population-based study of immediate and current physical and psychological side-effects of prostate cancer treatments
F. Drummond 1, H. Kinnear2, L. Sharp1, A. Gavin3
1Research, National Cancer Registry Ireland, Cork, Ireland, 2Research, Northern Ireland Cancer Registry, Belfast, Ireland, 3Director, Northern Ireland Cancer Registry, Belfast, Ireland
Introduction: Prostate cancer (PCa) is the most common male cancer in Europe. Recommendations that men be involved in treatment decision-making requires high-quality information on treatment side-effects. However, such data is limited.
Objectives: This all-Ireland study investigated physical and psychological side-effects of PCa treatments up to 15 years post-diagnosis.
Methods: Six thousand nine hundred thirty-seven men diagnosed with primary, invasive, PCa, identified through cancer registries in Northern Ireland (NI) and Republic of Ireland (RoI), received a postal questionnaire during 2012. This asked about treatment(s) and side-effects (incontinence/impotence/sweats/hot flashes/loss of sexual desire/bowel problems/depression) and whether these were experienced (1) immediately after treatment and (2) currently.
Results: Fifty-five percent of men responded. Differences in prevalence of treatments were betwen RoI and NI. Temporal changes in treatments were observed. Pre-treatment urinary symptoms were common (5 % reported depression/17 % impotence/36 % urinary incontinence).
Immediate treatment side-effects were common (64 % impotence/62 % loss of sexual desire/48 % incontinence/26 % bowel problems/22 % depression and 27 % hot flashes). Prevalence varied by treatment modality (29 % of RP patients reported current urinary incontinence compared to 14 % treated by radiotherapy/ADT). Hot flushes/changes in breast tissue were more common with ADT than other treatments. Levels of regret were higher in men treated by RP/watchful waiting and who reported current incontinence.
Conclusions: This large study quantifies, for the first time on population-basis short and longer-term side-effects of PCa treatments. Such information is valuable for informing men’s decision-making processes and identifies those likely to require additional support.
MASCC-0726
Real life experience with palonosetron in a two or three drug antiemetic regimen in breast cancer patients receiving (NEO)adjuvant AC chemotherapy
J. Schilling 1, H.J. Hindenburg2, K. Kittel3, P. Jungberg4, D. Guth5, S. Busch6, M. Konias7, I. Diel8, P. Feyer9, P. Ortner10
1Headquarter, BNGO e.V., Schöneiche b. Berlin, Germany, 2Practice, Gynaeco-Oncology Practice, Berlin, Germany, 3Practice, Praxisklinik Krebsheilkunde, Berlin, Germany, 4Practice, Gynaeco-Oncology Practice, Chemnitz, Germany, 5Practice, Gynaeco-Oncology Practice, Plauen, Germany, 6Practice, Gynaeco-Oncology Practice, Mühlhausen, Germany, 7Practice, Gynaeco-Oncology Practice, Oranienburg, Germany, 8Practice, Gynaeco-Oncology Practice, Mannheim, Germany, 9Clinic of Radiooncology and Nuclear Medicine, Vivantes Klinikum Neukölln, Berlin, Germany, 10Headquarter, Pomme-med, Munich, Germany
Introduction: Anthracycline/cyclophosphamide (AC) chemotherapy for breast cancer is regarded as highly emetogenic in modern guidelines (1). They recommend a three drug combination of a 5-HT3-receptor-antagonist (5HT3RA), dexamethasone (DEX) and a neurokinin1-receptorantagonist (N). Palonosetron (P) is a modern 5HT3RA that has shown high efficacy in the prevention of emesis in moderate (MEC) and high (HEC) emetogenic chemotherapy.
Objectives: To evaluate the real life experience with palonosetron (P) plus dexamethasone (DEX) +/- NK1-Antagonist (N) as antiemetic prophylaxis in breast cancer (BC) patients (pts) receiving adjuvant or neoadjuvant AC-chemotherapy (CT) in practices of Gyneco-Oncology in Germany.
Methods: 653 BC patients who had received 4 cycles of an AC-containing CT and an antiemetic prophylaxis with P-DEX or P- DEX-N were recorded in an online documentation system assessing severity, frequency, duration and onset of nausea (N) and vomiting (V). Efficacy criteria : complete control (CC: no V, no rescue, only mild N); complete response (CR: no V, no rescue) and rescue
Results: 653 pts from 45 institutions were included, median age 55 years, in 74 % of pts the anthracycline component of the CT schedule was epirubicin. Response was evaluated after cycle 4 of CT. 251 pts. had P-Dex, 402 (P-Dex-N). Overall efficacy (5 days): P-Dex: CC: 59,0 %, CR 83,3 %; P- Dex-N: CC 74,13 %, CR 84,3 %. Delayed nausea was well controlled in both groups
Conclusions: Antiemetic prophylaxis with the three drug combination P-DEX-N resulted in higher rate of complete control of N/V.
References: Basch E J Clin Oncol. 2011 Nov 1;29(31):4189–98.
MASCC-0727
Patterns and predictors of workforce participation in cancer survivors 6 and 12-months post-diagnosis: a longitudinal study
L. Sharp 1, D. O’Driscoll1, K. Higney1, C. Bradley2
1Research, National Cancer Registry Ireland, Cork, Ireland, 2Healthcare policy and research, Virginia Commonwealth University, Richmond, USA
Introduction: Most cancer patients in work at diagnosis take time off for treatment and recuperation. Return to work post-cancer is important for survivors, their families, employers and society. Although evidence is accumulating on factors positively and negatively associated with post-cancer work participation, most studies have been cross-sectional.
Objectives: To investigate, in a longitudinal, population-based study, patterns and predictors of survivors’ workforce participation at 6- and 12-months post-diagnosis.
Methods: People with incident breast, prostate and colorectal cancer, aged 18–64 and employed/self-employed at diagnosis, were identified from the National Cancer Registry Ireland. Structured telephone interviews were conducted at 6- and 12-months post-diagnosis. Preliminary analyses involved Wilcoxon signed-rank and chi-square tests.
Results: Six hundred twenty-five subjects (breast 53 %; prostate 30 %; colorectal 17 %) were recruited and completed 6-month interviews; 12-month interviews will be completed end March 2013. At 6-months post-diagnosis, 38 % of survivors were working: 12 % did not stop working and 26 % had resumed working after a period of absence. Workforce participation at 6-months varied significantly by site (breast 22 %; prostate 65 %; colorectal 40 %; p < 0.001) and sex (males 52 %; females 23 %; p < 0.001). At 6-months, survivors worked on average 6 h/week less than pre-diagnosis (p < 0.001). Few (3 %) had changed jobs since diagnosis, but for one quarter their work duties had changed. Multivariate analyses and 12-month results will also be presented.
Conclusions: Better understanding of patterns of workforce participation, and the factors that affect this, could help health professionals to advise patients appropriately and patients to make treatment decisions and plan for time away from work.
MASCC-0728
Utilization of intravenous bisphosphonates (IVB)S in patients with bone metastases (BMET)S secondary to breast, lung, or prostate cancer (BC, LC, PC)
M. Hagiwara 1, Z. Cong2, K. Chung2, T.E. Delea1
1Senior Research Consultant, Policy Analysis Inc. (PAI), Brookline, USA, 2Global Health Economics, Amgen Inc., Thousand Oaks, USA
Introduction: Cancer patients with BMets are predisposed to skeletal complications. Bone targeted therapies such as denosumab or IVBs reduce risks of these complications.
Objectives: The objective of this study was to characterize patterns of IVB use in these patients.
Methods: This was a retrospective, observational study using the Thomson MedStat MarketScan® Commercial and Medicare databases (9/02 - 6/11). Subjects were all persons with ≥1 claim with a diagnosis (Dx) of BC, LC, or PC and ≥1 claim with a Dx of BMets. The date of first BMet Dx claim was the ‘index date’. Key exclusion criteria were Dx of other primary cancer, receipt of IVB pre-index, or <6 months continuous enrollment pre-index. Cumulative incidence of treatment initiation (first IVB claim, death as competing risk), interruption (gap of >60 days between IVB claims, discontinuation as competing risk), and discontinuation (last IVB claim) were analyzed.
Results: Cumulative incidence of IVB initiation at 12 months post-index was greatest for BC followed by PC and LC (Table). IVB treatment interruption at 12 months ranged from 16 % (LC) to 31 % (PC). IVB treatment discontinuation at 12 months ranged from 46 % (BC) to 83 % (LC). Cumulative incidence of IVB initiation at 12 months declined with age in all tumor types: e.g., in BC, from 62 % at age <50 years to 47 % at age 75+ years.
Conclusions: IVBs are used more frequently in patients with BMets secondary to BC than PC or LC. Many patients interrupt or discontinue IVB therapy within 12 months. of initiation, potentially impacting effectiveness.
BC ( N = 11670) | PC ( N = 7596) | LC ( N = 10982) | |
Age, Y, Mean (SD) | 59 (13) | 73 (11) | 64 (11) |
Follow-up, mos, Mean (SD) | 16.5 (15.4) | 15.5 (14.4) | 7.7 (8.3) |
Cumulative Incidence, % (95 % CI) | |||
Initiation of IVB | |||
6 months | 54 (53–55) | 37 (35–38) | 32 (31–33) |
12 months | 59 (58–59) | 42 (40–43) | 34 (33–35) |
Among patients with IVB | N = 6936 | N = 3294 | N = 3654 |
Interruption of IVB | |||
6 months | 21 (20–22) | 24 (22–25) | 13 (12–14) |
12 months | 29 (28–30) | 31 (29–32) | 16 (15–17) |
Discontinuation of IVB | |||
6 month | 29 (28–30) | 36 (35–38) | 65 (63–67) |
12 month | 46 (45–47) | 56 (54–58) | 83 (82–84) |
MASCC-0729
Antiemetic switch in pediatric patients with acute myeloid leukemia
J.L. Freedman 1, J. Faerber2, T.I. Kang3, D. Dai4, B.T. Fisher5, Y.S. Huang4, K. Torp6, Y. Li6, R. Aplenc7, C. Feudtner8
1Pediatric Hematology/Oncology, Children’s Hospital of Philadelphia, Philadelphia, USA, 2Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, USA, 3Pediatric Oncology/Palliative Care, Children’s Hospital of Philadelphia/University of Pennsylvania, Philadelphia, USA, 4Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, USA, 5Pediatric Infectious Diseases/Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia/University of Pennsylvania, Philadelphia, USA, 6Pediatric Oncology, Children’s Hospital of Philadelphia, Philadelphia, USA, 7Pediatric Oncology/Center for Clinical Epidemiology & Biostatistics, Children’s Hospital of Philadelphia/University of Pennsylvania, Philadelphia, USA, 8Pediatrics/Center for Pediatric Clinical Effectiveness/Center for Clinical Epidemiology & Biostatistics, Children’s Hospital of Philadelphia/University of Pennsylvania, Philadelphia, USA
Introduction: Patient demographic/sociocultural factors associated with chemotherapy-induced nausea/vomiting (CINV) are not well described in the pediatric population. Whether additional successive days/cycles of chemotherapy augment a child’s risk of CINV is also unknown.
Objectives: To elucidate patient/treatment factors associated with switching 5HT3-antagonist antiemetics in children with Acute Myeloid Leukemia (AML), where antiemetic switch is a clinical surrogate for problematic CINV.
Methods: Retrospective cohort study of 748 hospitalized pediatric patients with AML (mean age: 8.56y, male: 396/female: 352) from the Pediatric Health Information System database (42 hospitals, 1999–2010). Clinically detailed administrative data analyzed for exposures: chemotherapy and antiemetics. Outcome: any observed switches in 5HT3-antagonists. Association of patient and treatment characteristics with odds of antiemetic switch assessed through logistic regression.
Results: Controlling for hospital, chemotherapy, and restricting to first 10 days of chemotherapy per cycle, odds of antiemetic switch were 4.6 (95 % CI 2.76–7.71) times higher on chemotherapy days vs. non-chemotherapy days. Within cycles, each additional consecutive day of chemotherapy decreases odds of antiemetic switch 12 % (OR 0.88, P < 0.01). Odds of antiemetic switch do not differ across cycles or with additional non-chemotherapy days. With increasing age, odds of switch increase (P < 0.01). Odds of antiemetic switch are not associated with insurance, sex, or patient race, though Asian and Black patients may have lower odds (P = 0.06 and 0.08, respectively).
Conclusions: Pediatric patients are at increased odds of antiemetic switch on chemotherapy days and as they age, and decreased odds with each successive chemotherapy day in a cycle. Odds of switch do not vary amongst cycles.
MASCC-0730
A prospective study about pain in breast cancer survivors
V.T.K. Ferreira 1, M.A.E. Prado2, E.C.O. Guirro3, A.M. Almeida2
1Faculty of Medicine Ribeirão Preto/Department of Rehabilitation and Functional Performance, University of Sao Paulo, Ribeirão Preto, Brazil, 2Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil, 3Department of Rehabilitation and Functional Performance, University of São Paulo at Ribeirão Preto, Ribeirão Preto, Brazil
Introduction: Pain after breast cancer treatment is common, may have several causes, this sympton is characterized by an important reduced functional and emotional.
Objectives: Describe the pain in women with breat cancer, identify factors of improvement and worsening of pain in the lives of women, identify and locate the pain of women undergoing treatment for breast cancer (TBC).
Methods: Thirty women undergoing TBC, attending a rehabilitation center during the period February to August of 2008, and responding to a form of the disease, treatment and pain. An image was applied to identify the location of the pain.
Results: Most women were aged over 50 years. There is an equitable distribution between mastectomy and lumpectomy. The pain began after the breast surgery in 46.7 % of the women, daily frequency, and constantly, interfering with sleep and mood. Movements related to increased pain were reaching, pusching, pulling and supporting. The place mostly chosen by women to identify the pain were demonstred in Figure 1.
Conclusions: To know, recognize and deal with the symptom allows therapeutic alternatives for its relief, minimizing the physical and emotional effects that the pain may cause in the relief of these women.
References: Andersen KG, Kehlet H. Persistent pain after breast câncer treatment: a critical review of risk factors and strategies for prevention. Journal of Pain. 2011; 1–22. Lauridsen MC, Overgaard M, Overgaard J, Hessov IB, Cristiansen P. Shoulder disability and late symptoms following surgery for early breast cancer. Acta Oncologica. 2008; 47 (4): 569–575.
MASCC-0731
The lived experience of cancer in female body: adjusting to and accepting an altered self
C. Laranjeira 1, P. Ponce Leão2, I. Leal3
1Higher School of Health Sciences, Piaget Institute, Viseu, Portugal, 2University Institute of Applied Psychology, ISPA, Lisbon, Portugal, 3University Institute of Applied Psychology, Ispa, Lisbon, Portugal
Introduction: Cancer survival rates for different forms of cancer have increased substantially in recent decades. As a result, there is a growing body of research focusing on psychosocial issues faced by cancer survivors on a daily basis. Previous research has show that gynaecological cancer is connected to particular adaptation needs relating to unique sexuality, identity, reproductive and femininity demands. Through understanding women’s experiences, multidisciplinary health care strategies can be developed to meet the needs of this population.
Objectives: The goal of this study is to present and discuss from a phenomenological and feminist perspective findings from a qualitative study of how Portuguese female cancer survivors experience their lived body and life world after cancer.
Methods: Data was collected through in-depth interviews with ten cancer survivors who had completed pos-adjuvant treatment and were considered disease-free. The interviews were analysed using a phenomenological hermeneutical interpretation (Ricoeur, 1995).
Results: The cancer survivors’ experiences of their bodies were characterised by reflective, distressing, and, in part, unintelligible changes during the onset and the process of recovery from cancer. Their experiences can be synthesised under three major themes: body action, body image and body sensation.
Conclusions: Female cancer survivors experience great changes in their bodies over a long period, perhaps for the rest of their lives. Understanding the complex bodily changes that follow cancer is mandatory to help cancer survivors reintegrate and “re-own” their bodies and adjust to the implications of the changes.
References: Ricoeur, P. (1995). Hermeneutics and the human sciences: Essays on language, action and interpretation. Cambridge University Press.
MASCC-0732
Efficacy and safety of amphotericin b versus micafungin as an empirical antifungal therapy for neutropenic fever in haematologically malignant patients in local hospal settings
Y.H. Chan1, W.Y. Li1, K. Zhou 1, S.M. Wong2, S.L. Chan3, S.Y. Leung3, Y.M. Ma3, S.C. Lee4
1School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong China, 2Medicine & Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong China, 3Pharmacy, The Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong China, 4Pharmacy, Prince of Wales Hospital, Shatin, Hong Kong China
Introduction: Fungal infection in neutropenic patients continues to be a frequent cause of morbidity and mortality. Micafungin is often chosen over amphotericin B as the first line agent in recent years. Yet, the efficacy and safety of using micafungin in the empirical management of neutropenic fever is limited.
Objectives: To evaluated the efficacy and safety of amphotericin B and micafungin as empirical antifungal treatment for neutropenic fever in patients with haematological malignancy in local hospitals.
Methods: All patients received chemotherapy for haematological malignancy and received amphotericin B or micafungin as an empiric antifungal for neutropenic fever at the Pamela Youde Eastern Hospital and the Prince of Wales Hospitals between 2009 and 2011were included. Retrospective reivew of patient records were done. Successful outcome was defined as the fulfillment of the three-part composite endpoint.
Results: Efficacy was evaluated in 167 patients. The overall treatment success rate were 51.8 % for amphotericin B and 71.4 % for micafungin group (p = 0.094). More patients receiving amphotericin B had breakthrough fungal infection (14 patients [16.9 %]) than those receiving micafungin (1 patient [1.2 %]) (p = 0.001) and more patients receiving micafungin (71.4 %) than amphotericin B (55.4 %) achieved resolution of fever (p = 0.032). Micafungin was better tolerated than amphotericin B. Fewer patients in the micafungin group had an event associated with nephrotoxicity (22.9 % in amphotericin B vs. 1.2 % in micafungin, p < 0.001), or discontinuation therapy due to drug-related events (31.1 % in amphotericin B vs. 1.2 % in micafungin, p < 0.001).
Table 1. Demographic Characteristics of the Patients
Characteristics | Amphotericin B (N = 83) | Micafungin (N = 84) | P value |
Female (sex)–no. (%) | 40 (48.2) | 49 (57.6) | 0.189 |
Age–yr | 0.772 | ||
Median | 52 | 55 | |
Range | 71 | 69 | |
Age group–no (%) | 0.772 | ||
≤ 17 year | 1 (1.2) | 0 (0) | |
18–40 year | 23 (27.7) | 18 (21.2) | |
41–65 year | 46 (55.4) | 48 (56.5) | |
> 65 year | 13 (15.7) | 18 (21.2) | |
Primary diagnosis–no. (%) | |||
Acute myelogenous leukemia | 48 (57.8) | 64 (75.3) | 0.131 |
Acute lymphocytic leukemia | 8 (9.6) | 1 (1.2) | 0.020 |
Hodgkin’s lymphoma | 3 (3.6) | 5 (5.9) | 0.480 |
Non-Hodgkin’s lymphoma | 19 (22.9) | 4 (4.7) | 0.002 |
Others* | 6 (6) | 10 (11.8) | 0.317 |
Mean duration (day) of neutropenic fever (standard deviation) | 20.17 (14.891) | 18.81 (8.507) | 0.499 |
Median dosage (mg/day) | 30 | 100 | – |
Mean duration (day) of antifungal (standard deviation) | 10.44 (9.765) | 10.54 (6.509) | 0.940 |
Mean duration (day) of neutropenic fever before initiation of antifungal agent (standard deviation) | 7.37 (6.535) | 6.57 (4.067) | 0.350 |
Prior antifungal prophylaxis#–no. (%) | 23 (27.7) | 24 (28.2) | 0.902 |
Mean duration (day) of hospitalization (standard deviation) | 34.07 (20.101) | 28.69 (13.142) | 0.057 |
#Antifungal prophylaxis was allowed in the study. Fluconazole 200 mg daily and Itraconazole 200 mg daily were used.
*This category included chronic myelogenous leukemia, multiple myeloma, solid tumors, and the myelodysplastic syndrome
Table 2. Efficacy of Empirical Antifungal therapy using Amphotericin B versus Micafungin
Endpoints | Amphotericin B (N = 83) (%) | Micafungin (N = 84) (%) | Pvalue |
Observed components of primary end points | |||
Resolution of fever (defined as a temperature below 38 °C for at least 48 h) during neutropenia | 46 (55.4) | 60 (71.4) | 0.032 |
Any breakthrough fungal infection during therapy or within 7 days after the completion of therapy | 14 (16.9) | 1 (1.2) | 0.001 |
Survival for 7 days after the completion of therapy | 73 (88) | 67 (79.8) | 0.151 |
Overall treatment success rate | 43 (51.8) | 60 (71.4) | 0.094 |
Conclusions: Micafungin is found to be as effective as and better tolerated than amphotericin B.
MASCC-0733
The relationships between patients’ bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer
M. Landers 1, E. Savage1, G. McCarthy1
1Nursing and Midwifery, University College Cork, Cork, Ireland
Introduction: Patients experience problematic bowel symptoms following sphincter-saving surgery for rectal cancer yet limited research exists on the relationship between patients’ symptom experiences and self-care strategies used postoperatively.
Objectives: To investigate the relationships between bowel symptom experiences and self-care strategies used following sphincter-saving surgery for rectal cancer.
Methods: The research was underpinned by the Symptom Management Theory. A quantitative correlational design with a convenience sample of 143 patients aged 30 to over 70 years was used. Data were collected using the Illness Perception Questionnaires, the Difficulties of Life Scale and a Self-care Strategy Measure.
Results: Respondents experienced an average of four bowel symptoms following sphincter-saving surgery. Respondents with a higher identity score were more likely to use the self-care strategy proximity/knowing the location of a toilet at all times (OR = 1.48, 95 % CI: 1.04 to 2.11). Females (OR = 7.13, 95 % CI: 2.56 to 19.89), respondents with high timeline cyclical scores (OR = 1.73, 95 % CI: 1.03 to 2.92) and with high physiological responses scores (OR = 11.91. 95 % CI: 3.30 to 42.96) were more likely to use protective clothing. Respondents with higher identity (OR = 1.40, 95 % CI: 1.07 to 1.83) and social responses scores (OR = 1.87, 95 % CI: 1.11 to 3.14) were more likely to use bowel medication. Females were more likely to use incontinence pads (OR = 3.55, 95 % CI: 1.48 to 8.52).
Conclusions: Supportive care for patients following sphincter-saving surgery for rectal cancer should be comprehensive and tailored to meet their individual needs.
MASCC-0734
Chemotherapy medication errors: causes, errors and measures
O. Aslan 1
1Department of Fundamentals of Nursing, Gülhane Military Medical Academy, Ankara, Turkey
Introduction: Chemotherapy medication errors are very important for the safety of patient, health care professionals and care environment.
Objectives: To describe the causes, errors and preventive measures regarding chemotherapy administration process by using scientific literature.
Methods: Articles and research studies from Medline and Pubmed databases were evaluated.
Results: According to the scientific literature, causes of these errors were mostly stress, insufficient number of staff, lack of knowledge and experience, unclear orders. Errors included 3 main groups: 1)order writing, transcribing, 2)nurse or pharmacy dispensing errors, 3)nurse administration errors. These errors were administering under-overdosing, timing errors, wrong drugs, infusion-rate errors, omission of drugs/hydration, administration to wrong patients, improper drug preparation, improper drug storage, confusing medication names, memory problems, etc. Preventive measures were as follows: being familiar with look or sound like medications, establishing pop-up alerts in computer, placing eye-catching labels on storage bins, using a reliable method to confirm patient identity, establishing an error prevention system.
Conclusions: Chemotherapy medication errors can be preventable if an appropriate drug administration system including an interdisciplinary approach with well-educated health care professionals is established. This initiative can eliminate medication problems which interrupt supportive care in cancer process.
References:
1.Daouphers M, Magali A et al, Knowledge Assesment and Information Needs of Oncology Nurses Regarding Inpatient Medication, Clin J Oncol Nurs, 16(2), 2012,pp.182–187.
2.Schulmeister L, Look-alike, Sound-alike Oncology Medications, Clin J Oncol Nurs, 10(1), 2006, pp.35–41.
3.Griffin E, Safety Considerations and Safe Handling of Oral Chemotherapy Agents, Clin J Oncol Nurs, 7(6 Suppl), 2003, pp.25–29.
MASCC-0735
Cancer survivor epiphany: a phenomenological perspective
C. Laranjeira 1, P. Ponce Leão2, I. Leal2
1Higher School of Health Sciences, Piaget Institute, Viseu, Portugal, 2University Institute of Applied Psychology, Ispa, Lisbon, Portugal
Introduction: A diagnosis of cancer can yield uncertainty in the lives of patients and family. Through the process of reflection and self-discovery, the survivor often uses spirituality as an integral component of coping. The concept of epiphany describes the developmental process through which cancer survivors can attain a sense of support and nurturance to develop a “new normal”. Spirituality may promote connectedness, an integral component of epiphany that leads to a sense of self-determination and mastery
Objectives: To explore the cancer patients perceived needs for spiritual care
Methods: This study is founded on a phenomenological lifeworld perspective. A purposeful sample of ten female cancer survivors was invited to participate and subsequently interviewed. Data was transcribed and reviewed to identify themes related to spiritual care.
Results: Surviving cancer entails living with profound life-changes; strong relationships emerged between inner strength, knowing one’s personal spirituality and creating a “new normal” after cancer. For a majority of participants these themes support the concept of epiphany, particularly connectedness by nurturing supportive relationships with self, family, friends, and a spiritual power.
Conclusions: Cancer survivors have a positive self-concept which enhances quality of life. The experience of epiphany is an effective process to examine expressed needs and concerns of cancer survivors. Application of data to this process may provide the healthcare provider with cues to nurture development of spirituality; it is also a process that can guide the choice of interventions to enhance self-determination and mastery of a “new normal” following a cancer diagnosis may improve quality of life and self-management.
MASCC-0736
Challenges in patient recruitment during KODIAC-06, a randomized, placebo-controlled, double-blind, multicenter, phase 3 trial of naloxegol in patients with neoplasia and opioid-induced constipation (OIC)
J.H. Von Roenn1, J. Tack 2, P.N. Barker3, E.S. Lowe3, C. Fleischmann3, M. Sostek3
1Department of Internal Medicine Division of Hematology-Oncology, Northwestern University, Chicago, USA, 2Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium, 3Research and Development, AstraZeneca Pharmaceuticals, Wilmington, USA
Introduction: KODIAC-06 (NCT01384292) aimed to evaluate the efficacy and safety of naloxegol, an oral, peripherally-acting, μ-opioid receptor antagonist for treatment of OIC in patients with cancer-related pain. Low patient recruitment led to early discontinuation of enrollment.
Objectives: To present safety data and discuss recruitment challenges specific to patients with cancer-related pain.
Methods: Patients with neoplasia causing pain, confirmed OIC, life expectancy ≥3 months, and a stable opioid regimen were randomized to naloxegol 12.5 mg, 25 mg, or placebo once daily for 4 weeks, with an available active-treatment 12-week extension. Consultations with study investigators, site staff, and external advisors were undertaken to identify reasons for slow recruitment.
Results: Only 14 (4 %) of the planned 336 patients were randomized over 10 months (Figure). Enrollment challenges included low site interest in participating in an OIC study, complex inclusion/exclusion criteria, and requirements too burdensome for the target population (Table). Mean age was 54.1 years and 71.4 % were women; WHO performance status was 0 (n = 3), 1 (n = 8) or 2 (n = 3). Adverse events (AEs) were reported by 2/4, 3/5, and 2/5 patients in the placebo, naloxegol 12.5- and 25-mg groups, respectively, during the core study and 5/9 patients in the extension. Gastrointestinal AEs were most common. No serious AEs or deaths occurred.
Conclusions: Unique approaches are needed to recruit adequate numbers of patients with cancer pain requiring opioid treatment and increase investigator interest in OIC studies. In this limited data set, naloxegol at doses up to 25 mg was well tolerated and safe in patients with OIC and cancer pain.
Figure. Site participation and enrollment.
MASCC-0737
Efficacy and safety of naloxegol in patients with opioid-induced constipation (OIC): results from 2 identical phase 3, prospective, randomized, multicenter, double-blind, controlled trials
J. Tack 1, R. Gralla2, L. Webster3, M. Sostek4, J. Lappalainen4, P.N. Barker4, W.D. Chey5
1Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium, 2Medical Oncology, Albert Einstein College of Medicine Jacobi Medical Center, New York, USA, 3Clinical Research, CRI Lifetree Research, Salt Lake City, USA, 4Research and Development, AstraZeneca Pharmaceuticals, Wilmington, USA, 5Department of Internal Medicine, University of Michigan Health System, Ann Arbor, USA
Introduction: OIC is a major challenge in palliative care medicine for patients taking opioid analgesics with persistent constipation occurring despite available treatments. Naloxegol is an investigational, oral, peripherally-acting, μ-opioid receptor antagonist for OIC.
Objectives: To evaluate the efficacy and safety of 2 doses of naloxegol.
Methods: In KODIAC–04 (NCT01309841) and KODIAC–05 (NCT01323790), patients with OIC who did not have cancer and were taking 30–1,000 morphine equivalents/week for pain were randomized to once-daily naloxegol 12.5 mg, 25 mg, or placebo. Primary end point was percentage of responders over 12 weeks, defined as having ≥3 spontaneous bowel movements (SBM)/week with ≥1 SBM/week increase over baseline for ≥9 weeks and ≥3 of the last 4 weeks.
Results: There were significantly more responders with the 25-mg dose in both studies versus placebo (Table 1). The 12.5-mg dose significantly increased the responder rate only in KODIAC-04. Respective median times to first postdose laxation for placebo, naloxegol 12.5 mg, and naloxegol 25 mg were 35.8, 20.4, and 5.9 h (KODIAC-04; both P < 0.001) and 37.2, 19.3, and 12.0 h (KODIAC-05; both P < 0.001). Pain scores and opioid doses did not increase. Adverse events were more frequent with the 25-mg dose (Table 2); abdominal pain, diarrhea, nausea, flatulence, and vomiting were most common. Major cardiovascular events were rare and similar across treatment groups.
Conclusions: Naloxegol significantly improved stool frequency with a rapid onset of action and without reducing opioid-mediated analgesia. Naloxegol was generally well tolerated and safe. Ongoing research aims to establish naloxegol safety and efficacy in patients with cancer pain.
Table 1. Primary end point (intention-to-treat [ITT] population)
Study | Treatment | n | Responders, n (%) | Difference vs placebo, % | Relative risk | 95 % Cl | P -value |
KODIAC-04 | Placebo | 214 | 63 (29.4) | ||||
Naloxegol 12.5 mg/d | 213 | 87 (40.8) | 11.4 | 1.38 | 1.06, 1.80 | 0.015* | |
Naloxegol 25 mg/d | 214 | 95 (44.4) | 15.0 | 1.51 | 1.17, 1.95 | 0.001* | |
KODIAC-05 | Placebo | 232 | 68 (29.3) | ||||
Naloxegol 12.5 mg/d | 232 | 81 (34.9) | 5.6 | 1.19 | 0.91, 1.55 | 0.202 | |
Naloxegol 25 mg/d | 232 | 92 (39.7) | 10.3 | 1.35 | 1.05, 1.74 | 0.021* |
*Statistically significant under the multiple testing procedure mandating a critical P value <0.025 for ≥1 of the doses vs placebo for statistical significance.
Analysis via Cochran Mantel-Haenszel test, stratified by baseline laxative response.
11 Patients in KODIAC-04 and -05, found to have been randomized and participating at different centers within the program in parallel are excluded from the ITT and safety analysis sets.
Table 2. Safety
KODIAC-04 | KODIAC-05 | |||||
Patients with event, n (%) | Placebo n = 213 | Naloxegol 12.5 mg/d n = 211 | Naloxegol 25 mg/d n = 214 | Placebo n = 231 | Naloxegol 12.5 mg/d n = 230 | Naloxegol 25 mg/d n = 232 |
Any AE | 100 (46.9) | 104 (49.3) | 131 (61.2) | 136 (58.9) | 137 (59.6) | 160 (69.0) |
Discontinuation due to AEs | 12 (5.6) | 9 (4.3) | 22 (10.3) | 12 (5.2) | 12 (5.2) | 24 (10.3) |
Deaths | 0 | 2 (0.9) | 0 | 0 | 0 | 0 |
Serious AE | 11 (5.2) | 11 (5.2) | 7 (3.3) | 12 (5.2) | 14 (6.1) | 8 (3.4) |
AE = adverse event.
MASCC-0738
Emergency cancer unit for the management of acute symptoms in cancer patients
M. Merad-Toufik1, A. Alibay1, K. Yacouben1, C. Larue2, M. Monhonval2, M. DiPalma1, S. Antoun 1
1Ambulatory care, Institute Gustave Roussy, Villejuif, France, 2Epidemiology and Biostatic, Institute Gustave Roussy, Villejuif, France
Introduction: Advances in cancer patient treatment and supportive care have improved specific survival rates. Unfortunately many cancer patients still experience treatment and-disease-related symptoms that lead them to emergency units (EU).
Objectives: Our purpose was to describe acute onset symptoms (AOS) that brings these patients to a specialized emergency unit and the outcome of these consultations
Methods: Our EU manages the AOS of cancer patients being treated at our institute. All patients were included prospectively during 6 month- survey. Symptom types were recorded and for patients presenting with more than 3 symptoms, we selected the 3 most severe ones.
Results: A total of 3,019 patients went to the EU: age (years) median: 58 [16–98]. Variations by time ranged from the lowest number of visits in the night and the peak in the mid-day: 47 % of patients were seen between 10 am and 2 pm. The patients were sent to the EU by: their oncologist (24 %), another hospital (5 %), their general practitioner (4 %) and it was their own decision in 66 % cases. The most common symptoms were pain (21 %), fever (17 %), gastrointestinal issues (12 %) and respiratory problems (8 %). According to patients’ situation, 58 % of patients were admitted in inpatients units.
Conclusions: The occurrence of acute onset symptoms is frequent and severe enough to require hospitalization for more than 50 % of patients. These results justify the existence of emergency units dedicated to cancer patient evaluation and care.
MASCC-0739
Late-onset neutropenia in (NEO)adjuvant chemotherapy in breast cancer patients
F. Morgado Gomes 1, C. Ribeiro1, L. Parreira2, S. Oliveira1, L. Costa1, P. Barata1, R. Luz1, M.P. Custódio1, M. Sousa1, M.L. Batarda1
1Medical Oncology, Centro Hospitalar Lisboa Central, Lisbon, Portugal, 2Medical Internship, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
Introduction: Chemotherapy isn’t normally administered if the neutrophil count is <1.5 × 109/L (late-onset neutropenia-LON), to decrease the probability of infectious complications.
Objectives: To identify the incidence, severity (grade 2–4) and recurrence of LON, and to evaluate the benefit of secondary prophylaxis with G-CSF.
Methods: A retrospective study including 151 breast cancer patients (pts) who began (neo)adjuvant chemotherapy between January/2011 and August/2012. The chemotherapy used consisted of 8 cycles: 4xAC plus 4xDTX with trastuzumab if HER2 positive. A total of 1,057 cycles were evaluated for LON at D18-21 before each cycle.
Results: LON was registered in 43 % of pts but only during the AC regime, and in 84.6 % of pts it occurred within the first two cycles. Most LON were grade 2 (69 % vs. 7 % grade 4). Half of the febrile neutropenia (FN) registered had a LON previously. Secondary prophylaxis with G-CSF was initiated in 80 % of pts experiencing at least one episode of LON. In those cases, pegylated filgrastim and filgrastim were used with a fifty-fifty percentage, and filgrastim was used mostly (69.2 %) only between D3-5. Under prophylaxis the recurrence was 17.3 %, in 89 % of those with filgrastim (vs. 77.4 % without G-CFS).
Conclusions: The incidence of LON, although high, was generally low grade. The use of G-CSF effectively reduced the risk of LON and therefore infectious complications. Filgrastim was associated with higher recurrence suggesting that the use only between D3-5 is insufficient. There was no LON identified during DTX probably because of the high prevalence of secondary prophylaxis already begun.
MASCC-0740
Randomized controlled study of yoga versus strengthening exercises in breast cancer survivors with persistent fatigue
D. Stan 1, A. Cheville2, I. Croghan3, S. Pruthi1
1Internal Medicine, Mayo Clinic, Rochester, USA, 2Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, USA, 3Primary Care Internal Medicine, Mayo Clinic, Rochester, USA
Introduction: Fatigue is prevalent in breast cancer survivors and negatively impacts quality of life (QOL). [1] Yoga is a mindful exercise shown to improve fatigue and QOL in breast cancer survivors.[2, 3] The availability and affordability of instructor-led yoga classes preferentially selects higher-income people from larger, metropolitan areas; attending an exercise class after cancer treatments can be challenging due to time constraints and fatigue. Moreover, studies of yoga in cancer survivors rarely used an exercise control group. [4]
Objectives: To study the feasibility and effects of a home-based, DVD-led yoga vs. strengthening program in a cohort of breast cancer survivors experiencing fatigue.
Methods: We designed a RCT of DVD-based yoga versus strengthening exercises, in 70 women with stage 0–2 breast cancer, who experience fatigue (score ≥4 on a scale from 0 to 10).
Outcomes (baseline, post-intervention and 6 months from baseline):
· Feasibility
· Fatigue—Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF)
· QOL—Functional Assessment of Cancer Therapies, Breast (FACT-B)
Results: The study is open to recruitment. Since December 2012, 200 patients were invited; 54 responded; we enrolled 19, excluded 24 and 11 are awaiting screening. Of the five who completed at least 2 weeks of the intervention, 4 were compliant and one was not.
See Fig 1 for eligibility, flow through the study and preliminary results.
Conclusions: So far, the response rate and recruitment are consistent with that reported in literature (40 % and 10 %, respectively) [5–8] and compliance appears good. More results to come over the next few months.
1. Cella, D., et al., Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2001. 19(14): p. 3385–91.
2. Cohen, D.L., et al., Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial. Evidence-based complementary and alternative medicine : eCAM, 2011. 2011: p. 546428.
3. Bower, J.E., et al., Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer, 2012. 118 (15): p. 3766–75.
4. Stan, D.L., et al., The evolution of mindfulness-based physical interventions in breast cancer survivors. Evidence-based complementary and alternative medicine : eCAM, 2012. 2012: p. 758641.
5. Courneya, K.S., et al., Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003. 21(9): p. 1660–8.
6. Courneya, K.S., et al., Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007. 25(28): p. 4396–404.
7. Irwin, M.L., et al. Recruiting and retaining breast cancer survivors into a randomized controlled exercise trial: the Yale Exercise and Survivorship Study. Cancer, 2008. 112(11 Suppl): p. 2593–606.
8. Segal, R., et al., Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2001. 19(3): p. 657–65.
MASCC-0741
Effects of combined aerobic and resistance exercise on quality of life and fitness of individuals who are post cancer treatment
M.E. O’Neill 1, M. Lemonde1, K. Power2
1Faculty of Health Science, University of Ontario Institute of Technology, Oshawa, Canada
2Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, Canada
Introduction: The number of individuals living with cancer is growing. Many treatments exist that have long-lasting side effects. What can be implemented following treatments to reduce the side effects? One option is exercise
Objectives: This study evaluated the effects of an eight-week individualized aerobic and resistance exercise program on physical functioning and quality of life (QOL) in individuals who are post cancer treatment.
Methods: Participants were recruited through a local non-profit cancer support centre; eight participants met the inclusion criteria, and approved to participate by physicians through a PARmed-X. Four assessments were performed and an eight-week exercise program. The pre-, post- and 3 month follow-up assessments consisted of an interview, related questionnaires, as well as body composition, cardiovascular and musculoskeletal testing. A questionnaire was also administered at the 4-week point of the exercise program. The exercises prescribed were based on results from the pre-assessment. Groups of three to five participants attended exercise training sessions twice a week for 8 weeks. Training included a warm-up, prescribed cardiovascular and resistance training, and stretching.
Results: Preliminary results indicate trends towards improvements in QOL and decreased levels of fatigue
Conclusions: A combined resistance and aerobic training program may be beneficial for those post cancer treatment. This research will help provided evidence-based knowledge on the effects of exercise on individuals that are 2–12 months post treatment. Future research should focus on benefits of individualized exercise programs at any stage of cancer on QOL, fatigue and physical functioning.
MASCC-0742
Does anti-igf1r therapy contribute to decreased muscle mass in metastatic pancreatic cancer?
D.R. Fogelman1, M.A. Khalil1, M. Hasan1, N. Garg2, M. Javle1, M.H.G. Katz3, H. Holmes 4, J. Abbruzzese1
1Gastrointestinal Medical Oncology, UT MD Anderson Cancer Center, Houston, USA, 2Diagnostic Imaging, UT MD Anderson Cancer Center, Houston, USA, 3Surgical Oncology, UT MD Anderson Cancer Center, Houston, USA, 4General Internal Medicine, UT MD Anderson Cancer Center, Houston, USA
Introduction: IGF-1 plays a role in the growth of multiple tumor types, including pancreatic cancer. IGF-1 also serves as a growth factor for muscle.
Objectives: To determine if patients receiving anti-IGF1R therapy have additional muscle mass loss as compared to patients on standard chemotherapy.
Methods: We evaluated muscle mass at L3 in patients enrolled in a randomized phase II study of MK-0646 (M), a monoclonal antibody directed against the IGF1R protein, in patients with metastatic pancreatic cancer (MPC). We used Slice-o-matic to measure muscle area (cm2) at baseline and after treatment. Patients received either gemcitabine with erlotinib (GE), GEM, or GM. Differences were compared using t-tests.
Results: Fifty-eight58 patients had imaging available for analysis. 44 received M and 14 had GE only. Baseline muscle mass was similar (146 vs. 142 cm2, P = 0.47). After 2 months of treatment, both groups demonstrated muscle mass loss (8 vs. 6 %). Of 37 patients with PR or SD, there was a non-significant increase in muscle mass among M patients (7.8 vs. 4.5 %, P = 0.31). At 4 months, remaining M patients lost 6 % of muscle compared to 3 % among GE patients (P = 0.54). Each 1 % loss of muscle increased dropout risk by 13 % (P = 0.03) and predicted poor survival (HR 1.08, P = 0.02).
Conclusions: MPC patients lose muscle mass even while having clinical benefit from chemotherapy. Muscle loss correlates with study drop-out and death. There was a non-significant trend towards greater muscle mass loss in patients on anti-IGF1R therapy. It is unclear if this loss translates into functional differences between patients.
MASCC-0743
Febrile neutropenia following (NEO)adjuvant chemotherapy in breast cancer patients
F. Morgado Gomes 1, C. Ribeiro1, L. Parreira2, S. Oliveira1, P. Barata1, L. Costa1, M.P. Custódio1, M. Sousa1, R. Luz1, M.L. Batarda1
1Medical Oncology, Centro Hospitalar Lisboa Central, Lisbon, Portugal
2Medical Internship, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
Introduction: Febrile neutropenia (FN) is a feared complication of cancer treatment and occurs most frequently during the nadir of the chemotherapy regimens. Faced with a FN it’s essential to evaluate the risk of complications.
Objectives: To identify the incidence, severity and the subsequent approach of FN.
Methods: A retrospective study including 151 breast cancer patients (pts) who began (neo)adjuvant chemotherapy between January/2011 and August/2012. The chemotherapy used consisted of 8 cycles: 4xAC plus 4xDTX with trastuzumab if HER2 positive. The MASCC risk score for FN was used to stratify the approach to FN.
Results: The global incidence of FN was 12.4 %, however during DTX the incidence was 20.6 %, because it’s responsible for 80.8 % of all recorded FN, of which 61.5 % in its 1st cycle. The average day for the incidence of FN during AC was the 14th, while with DTX it was earlier, on the 8th day. Yet the median level of neutropenia at diagnosis for both regimes was grade 4. A total of 42.3 % FN had <21 points in the MASCC risk score, resulting in hospitalization for a median period of 1 week. There were no microorganisms isolated or deaths.
Conclusions: In these chemotherapy regimens infectious complications are uncommon, and there is no recommendation for primary prophylaxis since FN incidence is <20 %. As the highest incidence of FN occurred with DTX, primary prophylaxis with G-CSF may be considered during its cycles. However, the majority of FN were considered low risk and even the ones hospitalized had no major complications.
MASCC-0744
‘Silent heroes’: the importance of informal caregivers in supportive care of survivors of head & neck cancer
A. Timmons 1, R. Gooberman-Hill2, E. O’Sullivan3, P. Butow4, L. Sharp1
1Research, National Cancer Registry Ireland, Cork, Ireland, 2School of Clinical Sciences, University of Bristol, Bristol, United Kingdom, 3Oral Surgery, Cork Dental School & Hospital, Cork, Ireland, 4Medical Psychology Research Unit, University of Sydney, Sydney, Australia
Introduction: Head and neck cancer (HNC) is associated with severe limitations to physical, emotional and social functioning. Evidence from various healthcare systems suggest that the supportive care needs of survivors are not adequately met by existing services. Studies of other cancers suggest Informal caregivers (family members/friends) often fill this gap.
Objectives: To describe the: (1) roles of informal carers in HNC supportive care and (2) implications of caregiving for carers, survivors, and the health services.
Methods: In-depth, semi-structured, interviews were conducted with health professionals (HPs) involved in HNC care in Ireland (consultants, clinical nurse specialists, and allied health professionals). Interviewees were asked about survivors’ support needs post-treatment, if needs are met, barriers to meeting needs, and any other issues. The interviews were analysed using a content analysis approach.
Results: Thirty-one HPs were interviewed. Although not specifically included in the topic guide, the role of informal caregivers in supportive care was a major theme. HPs revealed that the health services rely heavily on informal carers to provide medical and psychological support to HNC survivors, but that this support is usually not clearly acknowledged. Taking on these roles has a significant impact on caregivers and families; several factors exacerbate this impact. HPs considered that caregivers had significant needs, and that these should be met. Several barriers to meeting these needs were identified.
Conclusions: Given the health services’ reliance on the informal support/care provided by family members/friends, these findings suggest HNC services should provide more supportive services for caregivers.
MASCC-0745
Self discovery of a breast symptom: key issues concerning women’s help seeking behaviour(HSB)
M. O’Mahony 1, J. Hegarty1, G. McCarthy1
1Nursing & Midwifery, University College Cork, Cork, Ireland
Introduction: Early diagnosis of breast cancer is associated with more favourable outcomes. However, some women postpone presenting to a health care professional with a self-discovered breast symptom.
Objectives: To describe women’s help seeking behaviour and the associated influencing factors following self-discovery of a breast symptom.
Methods: A descriptive correlational design was used. Following ethical approval, data were collected from women (n = 449) attending the breast clinics of two urban hospitals within the Republic of Ireland.
Results: The majority of women (69.9 %; n = 314) sought help within 1 month, 30.1 % (n = 135) delayed help seeking for more than 1 month, following symptom discovery. Within the delay group, 16.7 % (n = 75) waited for 3 months or more (eight of whom waited for 1 year and more) before seeking help from a health care professional. Delayed help seeking was significantly associated with women’s symptom knowledge; ignoring the symptom and hoping it would go away and women’s belief that the symptom would persist for a long time. Fear on symptom discovery indicated less delay. Analysis of qualitative comments highlighted the panic and fear that some women associated with discovery of a breast symptom.
Conclusions: This study highlights that despite the continued emphasis on early presentation of breast symptoms some women continue to delay. Additionally, symptom discovery is a stressful time for women. Oncologists and oncology nurses have a vital role to play in supporting women to seek help promptly for self-discovered breast symptoms and in supporting women throughout their symptom evaluation journey.
MASCC-0746
Incidence of chemotherapy induced diarrhoea in colorectal cancer patients: a retrospective analysis
C.S. Lee1, B. Nolan1, D. Fennelly1, H. Mulcahy1, G. Doherty1, E. Ryan 2
1Centre for Colorectal Disease, St. Vincent’s University Hospital, Dublin, Ireland, 2School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
Introduction: Chemotherapy induced diarrhoea (CID) is a common and extremely debilitating side effect of many chemotherapeutic regimens. Not only does CID negatively impact on cancer patients’ quality of life but also can cause delays in giving treatment or dose reductions; this can have an adverse effect on the overall treatment efficacy and ultimately patient survival. Patients with more severe CID require hospitalisation and this greatly increases the number of patient admissions and has a significant impact on the cost of providing cancer care. Therefore, CID represents both a significant clinical and, importantly, economic burden in oncology.
Objectives: Our objective was to ascertain the extent of CID at our centre in a retrospective analysis, additionally if there are certain risk factors and the effect of CID on overall survival.
Methods: We performed a retrospective chart review. We included all patients with Stage II or III colorectal cancer who received adjuvant chemotherapy at our centre during the period 2006–2008. Location of tumour and pathological stage, chemotherapy regimen and the number of cycles received, hospitalisations, drug reductions and incidence of CID and other toxicities were noted. We also documented the 5 year survival rate of the patients.
Results: To be completed
Conclusions: To be completed
MASCC-0747
Why are supportive care needs of survivors of head & neck cancer not being met? Barriers perceived by health professionals
A. Timmons 1, R. Gooberman-Hill2, E. O’Sullivan3, P. Butow4, L. Sharp1
1Research, National Cancer Registry Ireland, Cork, Ireland, 2School of Clinical Sciences, Bristol University, Bristol, United Kingdom, 3Oral Surgery, Cork Dental School and Hospital, Cork, Ireland, 4Medical Psychology Research Unit, University of Sydney, Sydney, Australia
Introduction: Head and neck cancer (HNC) survivors may experience significant morbidity resulting in ongoing needs for support post-treatment. Accumulating evidence suggests that survivors’ needs are not always adequately met by existing services. The reasons for this are unclear
Objectives: To explore, using qualitative Methods, the barriers faced by health professionals in meeting the supportive care needs of HNC survivors.
Methods: In-depth, semi-structured, interviews were conducted with health professionals involved in HNC care in Ireland (consultants, clinical nurse specialists, and allied health professionals). Interviewees were asked about survivors’ support needs post-treatment, if needs are being met, and any barriers they face in meeting needs. The interviews were analysed using a content analysis approach.
Results: Thirty-one health professionals were interviewed. Health professionals considered that HNC survivors have considerable unmet supportive care needs in a range of areas. The barriers faced by health professionals in meeting the survivors’ needs fell under two broad themes each with several sub-themes: (1) health service barriers (healthcare/hospital systems; resources, quality-of-care issues; factors related to health professionals, and information/training); (2) barriers related to survivors (factors related to survivors; willingness to use services; stigma; and information). Health professionals suggested that appropriate and adequate post-treatment supportive care should be available for survivors who need it, and made recommendations to help achieve this.
Conclusions: This study advances understanding of the barriers to meeting HNC survivors support needs. This, together with recommendations/suggestions from health professionals, could be used to help improve existing supportive care services for survivors.
MASCC-0748
Venous thromboembolism in hospitalized cancer patients, single centre experience
A. Besen 1, M. Ulas2, F. Kose1, S. Muallaoglu1, O. Ozyilkan1
1medical oncology, Baskent University, Adana, Turkey, 2Internal Medicine, Baskent University, Adana, Turkey
Introduction: Venous thromboembolism (VTE) is common in cancer patients and associated with certain risk factors such as previous surgery, type of malignancy, cancer stage and the antineoplastic agents used in the treatment of underlying malignancy.
Objectives: Our aim was to investigate the frequency of VTE in hospitalized cancer patients and associated risk factors in a certain period of time.
Methods: We searched medical charts of the patients admitted to oncology clinic from January 2012 to January 2013 with a diagnosis of venous thrombosis and pulmonary embolism. The data including demographics, type of thromboembolism, type of chemotherapy and co morbidities were analyzed.
Results: There were 830 hospitalizations in study period. Fifty-six (6.7 %) patients were identified as having VTE. The mean age of the patients was 56 years (range 20–82) and 41 % were female. Twenty (35 %) patients had co morbid conditions. Twenty-five (44 %) and twenty-nine (51 %) patients were diagnosed to have PTE and deep vein thrombosis (DVT) respectively. Two patients (5 %) had catheter related thrombosis. Lung cancer (34 %) and the pancreatic cancer (16 %) were the most common types of tumours associated with thrombosis. The majority of the patients had advanced stage of cancer. Among patients 40 (71 %) were treated with chemotherapy and 20 of them (50 %) were given regimens containing cisplatin.
Conclusions: VTE is a common complication among patients with cancer. Predictors of VTE include cancer type, advanced cancer stage, cisplatin containing chemotherapy.
MASCC-0749
Radical gynaecological oncology surgery: to site or not to site?
Y. Anderson 1, R.L. ODonnell1, H. Wilson1, G. Marples2, A. Guest1, C. Ang1, K.A. Godfrey1, E. RJ1, R. Naik1, A. Kucukmetin1, K. Roberts2
1Gynaecology Oncology, Northern Gynaecological Oncology Centre, Newcastle upon Tyne, United Kingdom, 2Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
Introduction: Bowel surgery, with or without stoma formation, is necessary in a proportion of patients with advanced ovarian cancer but accurately predicting who will need this is not always possible. Subsequently all women receive bowel preparation and are sited for stomas pre-operatively. This is time-consuming and has physical and psychological consequences.
Objectives: To explore the frequency of bowel surgery and assess if stoma formation was predictable.
Methods: Data regarding pre-operative siting and subsequent stoma formation was prospectively collected over 12 years.
With the implementation of Enhanced Recovery, a smaller sub-study was undertaken. Using a standard proforma senior surgeons were asked to predict the liklihood of stoma formation.
Results: On average 260 women undergo stoma siting and bowel preparation annually with only 16 % requiring stoma formation.
During our study period stoma formation was predicted for 50 patients. 43 women have undergone surgery. Of the 12 women predicted as ‘likely’ to require stoma formation 1 required this and a further 3 women underwent bowel surgery with anastomosis, (PPV 33 %). Of the 31 women predicted as ‘unlikely’ only 3 women required stomas, (NPV 90 %).
Conclusions: Stoma formation is infrequent however a significant proportion of patients undergo the side-effects and psychological distress of pre-operative stoma preparation. The need for a stoma is difficult to predict however by using clinical judgement we can reduce morbidity for many patients and focus resources on those with greatest need. These results are valuable for provision of accurate counselling for our patients.
MASCC-0750
The effect of palifermin on hand-foot syndrome (HFS) in hematopoietic stem cell transplant patients
J. Joo1, D. Pon 2
1College of Pharmacy, Western University of Health Sciences, Pomona, USA
2Pharmacy, City of Hope National Medical Center, Duarte, USA
Introduction: HFS, an adverse reaction associated with certain chemotherapeutic agents, is characterized by dysesthesias in hands and feet. No cases of HFS with total body irradiation (TBI) or etoposide (VP16) have been reported in the literature, but a few cases have been reported with palifermin.
Objectives: To determine the incidence, onset, duration, severity and risk factors for HFS in patients receiving TBI/VP16±palifermin, and to evaluate the effects of palifermin on development of HFS.
Methods: Institutional review board approved cohort study of adult allogeneic HSCT patients at City of Hope receiving TBI/VP16 (control) and TBI/VP16/palifermin (palifermin) was conducted during 2 time periods. Occurrence of HFS was determined through review of medical records
Results: Incidence of HFS was 38 % and 40 % in control and palifermin groups (Fisher’s exact, p = 0.85). Mean duration of HFS was 16.8 and 11 days (t-test, p = 0.015). Mean onset of HFS occurred on day +7.6 and +3.7 (t-test, p = 0.0001). Severe HFS occurred in 43 % and 13 % (Fisher’s exact, p = 0.07). Severity of HFS was associated with duration in the palifermin group (Spearman r = 0.85, p < 0.0001). Females and patients who developed early skin reactions to palifermin were more likely to develop HFS (Fisher’s exact, p = 0.01 and p = 0.04). Age, donor type, and palifermin dosing schedule were not risk factors for development of HFS.
Conclusions: TBI/VP16 was associated with a 38–40 % incidence of HFS. Palifermin significantly reduced time to onset and decreased duration of HFS and offers a previously unreported benefit in this patient population. Female gender and early skin reaction to palifermin were risk factors for HFS.
MASCC-0751
Prognostic characterization in the terminal phase of cancer
P. ermacora 1, M. Mazzer1, G. Aprile1, M. Cattaruzza2, A. Orlando2, M. Isola3, G. Gregoracci3, G. Pascoletti4, D. Collini4, F. Puglisi4, G. Fasola4
1Oncology, Udine Hospital, Udine, Italy, 2ASL Treviso, Hospice Casa dei Gelsi, Treviso, Italy, 3Statistics, University Hospital, Udine, Italy, 4Oncology, University Hospital, Udine, Italy
Introduction: To forecast life expectancy in terminal cancer patients, clinical prediction is often inaccurate and multidimensional scores are used.
Objectives: We carried out a prospective cohort study in two distinct palliative care Units to determinate 1) the accuracy of three different prognostic scores: the Palliative Prognostic (PaP) Score, the Objective Prognostic Score (OPS), and the Palliative Prognostic Index (PPI); 2) the accuracy of two differently experienced oncologists and one nurse in the clinical prediction of survival (CPS) and 3) the role of clinical factors in predicting survival.
Methods: At the time of admission, clinical and laboratoristic data of 238 advanced cancer patients were collected from April 2011 to August 2012. Pap Score, OPS and PPI were calculated and CPS was estimated by the study team. Survival was evaluated by Kaplan-Meier curves and accuracy was determinated by ROC analysis
Results: The median survival was 15 days (range 0–502). The PaP score was the most accurate instrument (AUC = 0.81) to predict 30-day survival. The CPS estimates’ accuracy was similar among physicians and nurses (AUC = 0.78 vs. 0.76); the nurses’ CPS had the greater correlation with the actual survival. Presence of anxiety (p = 0.009) and lower score in the Activity of Daily Living (ADL) (p = 0.0001) were adverse prognostic factors for survival.
Conclusions: The PaP Score showed the highest accuracy in the prognostic evaluation of terminally ill cancer patients. On admission, ADL e anxiety should be evaluate to better estimate prognosis.
MASCC-0752
Chromosomal abnormalities in children with hematological malignancies
B.B. Ganguly 1, S. Mandal1, M. Ghosh2, T. Dolai2, M. Bhattacharyya2, S. Chandra3, D. Banerjee3
1Genetics, Genetics Center, Mumbai, India, 2Hematology, NRS Medical College, Kolkata, India, 3Hematology, Clinical Hematology Services, Kolkata, India
Introduction: Acute lymphoid leukemia (ALL) is frequently reported among children with hyperdiploid condition with over 50 chromosomes as the most common abnormality and it has been reported to lead a favorable prognosis in B-lineage ALL. However, structural rearrangements alone or in combination with hyperdiploidy are known to cause an unfavorable prognosis.
Objectives: An attempt has been made to categorize chromosomal aberrations in childhood leukemia for better understanding of the clonal changes facilitating leukemogenesis in children.
Methods: A total of 148 children of 1–16 years of age have been included in the present study who were suffering from fever, hepatosplenomegaly and lymphadenopathy. Unstimulated bone marrow culture and conventional cytogenetic study in classified karyotypic form have recorded the chromosomal status in minimum 20 cells for each child.
Results: Solely hyperdiploid condition was observed in 26 % cases where a total of 58 % children were affected with both numerical and/or structural alterations. It is important to mention that many of these hyperdiploid clones also had complex unbalanced translocations. Moreover, 32 % children had myelogenous clonal changes, including t(9;22), t(4;11), t(9;21), t(9;11), t(13;19), t(15;17), t(1;14), t(2;5), t(11;17), del(6q), del(7q), del(5q), del(12p), del(13q), +5, +8, + 12, +21, inv(16) in solo or in multiple combination. Chromatid and chromosome breaks were frequently evidenced in these clones. It has been experienced that many of these cases with structural rearrangements had poor prognosis or could not survive.
Conclusions: Chromosomal study at whole genome level is important in diagnosis and management of hematological malignancies in children.
MASCC-0753
Vie aerio: french study on end of life in oncology. evaluation of practices
M. Lozach-Brugirard 1, E. Viel2, F.R. Ferrand3, E. Bonnet4, S. Lheureux5, P.E. Brachet6, A. Boespflug7, C. Delaruelle7, J. Dubreuil8, A. Barret2, O. Munier2, T. Flament2, V. Paulus9, C. Guy-Coichard10, C. Tournigand11
1Palliative Care Mobile Team, Hopital Necker Enfants Malades, Paris, France, 2Medical Oncology Unit, Hopital Bretonneau, Tours, France, 3Medical Oncology Unit, HIA Val de Grace, Paris, France, 4Medical Oncology Unit, Hopital Jean Minjoz, Besançon, France, 5Medical Oncology Unit, Centre François Baclesse, Caen, France, 6Medical Oncology Unit, CHU Caen, Caen, France, 7Medical Oncology Unit, CHU Lyon, Lyon, France, 8Medical Oncology Unit, CHRA Annecy, Annecy, France, 9Medical Oncology Unit, CH Vesoul, Vesoul, France, 10Centre d’Évaluation et Traitement de la Douleur, Hopital Saint Antoine, Paris, France, 11Medical Oncology Unit, Hopital Henri Mondor, Creteil, France
Introduction: Advanced cancer often lead the question of continuation specific treatments. The development of new therapies complicate oncologists decisions.
Objectives: Our study focuses on patients who received specific anti cancer treatment (SACT) in their last weeks of life.
Methods: This is a multicenter retrospective study, including patients who died in oncology unit over a period of 3 months.
Results: In 7 different simple or teaching hospitals were included 108 patients. Most patients had lung (28.7 %), breast (14.8 %), and colorectal cancer (9.3 %). Sixty four patients were men.
Sixty five (60.2 %) patients received SACT in the last 30 days of life, among them 34 (31.5 %) patients who received SACT in the last 2 weeks.
Among patients who received SACT in the last 2 weeks, median age was 63,2 at the time of the last treatment, and 10 (30.3 %) patients had a Karnofsky index lower than 30 %. The decision of treatment was discussed in 52.9 %, and 26 % of patients were followed by a palliative care team.
In univariate analysis, there is no difference between patients who received SACT in the last 2 weeks and them who did not concerning sex, age, Karnofsky index; there is difference concerning the oncology unit, family environment and palliative care team involvement
Conclusions: In this study, 30.3 % of patients who died in hospital received a SACT in the last 2 weeks, despite a bad performans status for a third of them. Their close and medical environment seems important in this choice. Is it possible to avoid those heavy useless treatments?
MASCC-0754
Rural palliative care network: use of a telemedicine interdisciplinary teaching conference to promote palliative care education across a rural state
U. McVeigh 1, J. Ely2, R. Mitchell1
1Palliative Care, University of Vermont-Fletcher Allen Health Care, Burlington VT, USA, 2Vermont Cancer Center, Fletcher Allen Health Care, Burlington VT, USA
Introduction: The complex physical, emotional and spiritual distress palliative care patients’ face is best supported by specialized skills of an interdisciplinary team (IDT). Rural communities may be challenged to support the array of professionals needed and a forum for IDT learning.
Fletcher Allen Health Care (FAHC) is the only tertiary care center in Vermont. The FAHC Rural Palliative Care Network was developed in 2009 to strengthen regional palliative care expertise. The main activity of the network is a weekly palliative care IDT telemedicine case conference.
Objectives: To describe the educational impact of a weekly telemedicine palliative care conference.
Methods: A retrospective review of conferences held in academic year 2012 was performed by review of sign in sheets and anonymous session and year-end program evaluations.
Results: Thirty-five conferences were held, 12 sites participated, mean attendance 18 (9–32). Disciplines: physicians, nurses, social worker, students, and clergy.
Two hundred seventy-four evaluations of individual sessions were submitted. 85 % affirmed the session met their educational needs, 77 % affirmed the program will change or improve their practice.
Year-end program evaluation asked learners (N = 25) to rate if conference increased knowledge of: | |||
Definitely | Somewhat | Not at all | |
Evidence based practice | 86 % | 28 % | 4 % |
Current medical literature | 84 % | 12 % | 4 % |
Spiritual impact of palliative care | 84 % | 16 % | 0 % |
Social impact of palliative care | 84 % | 16 % | 0 % |
Economic impact of palliative care | 32 % | 60 % | 8 % |
Conclusions: A weekly palliative care telemedicine case conference with rural palliative care providers is an effective method for meeting learners’ educational needs and self reported practice improvement.
MASCC-0755
Cancer-related fatigue (CRF) and psychological distress among lesbian, gay, bisexual and transgender (LGBT) cancer patients and survivors
C. Kamen 1, A. Peoples1, M. Tejani1, M. Janelsins1, L. Peppone1, G. Morrow1, K. Mustian1
1Department of Radiation Oncology, University of Rochester Medical Center, Rochester, USA
Introduction: Recent studies have suggested disparities post-cancer diagnosis between LGBT cancer patients and survivors compared to heterosexual peers. Psychological distress (i.e., depression and anxiety) is higher among LGBT adults in general. Studies have not examined CRF and its link with psychological distress in LGBT cancer patients/survivors.
Objectives: We examined prevalence of CRF and psychological distress and compared rates across LGBT and heterosexual patients/survivors.
Methods: The LIVESTRONG dataset, a cross-sectional U.S. national survey, sampled 289 LGBT and 4,782 heterosexual cancer patients/survivors (all cancer types, 63.5 % women, mean age 49). Fatigue was assessed with three dichotomous yes/no items (not having energy, feeling tired, and not feeling rested); psychological distress was assessed with two yes/no items (feeling depressed, feeling anxious).
Results: Over half of LGBT patients/survivors reported not having energy, feeling tired, and not feeling rested, with prevalence of 54.7 %, 62.1 % and 55.4 % respectively. Chi-square analyses indicated prevalence of not feeling rested was significantly higher among LGBT than heterosexual patients/survivors (p = 0.01). Prevalence of feeling depressed and feeling anxious among LGBT patients/survivors was 62.7 % and 43.0 %, respectively; chi-square analyses indicated both were significantly more prevalent among LGBT patients/survivors (both p < 0.05). Logistic regression indicated that the association between LGBT identity and fatigue was significantly mediated by endorsement of psychological distress (p < 0.01).
Conclusions: LGBT cancer patients/survivors report higher rates of certain indicators of fatigue than their heterosexual counterparts. This disparity may be due to increased rates of psychological distress. Research is needed to examine mechanisms linking distress to fatigue and to develop interventions to address these issues among LGBT patients/survivors.
MASCC-0756
Incidence of chemotherapy induced nausea and vomiting following prophylaxis with an I.V. 5-HT3-RA antiemetic and subsequent oral 5-HT3-RA dosing
R. Knoth 1, C. Faria1, A. Powers1, N. Nagl2, E. Chang3, M. Broder3
1Health Economics and Outcomes Research, Eisai Inc., Woodcliff Lake, USA, 2Medical Affairs, Eisai Inc., Woodcliff Lake, USA, 3Research Consulting, Partnership for Health Analytic Research, Beverly Hills, USA
Introduction: Chemotherapy-induced nausea and vomiting (CINV) is a significant adverse effect of chemotherapy. The 5-hydroxytryptamine-3 receptor antagonists (5-HT3-RA) are recommended for the prevention of CINV.
Objectives: This study compared the incidence of CINV after prophylaxis with palonosetron vs. another I.V. 5-HT3-RA (ondansetron, dolasetron, or granisetron) with subsequent dosing of an oral 5-HT3-RA. Patients in the other I.V.+oral 5-HT3-RA group received an infusion on day 1 of chemotherapy and filled a prescription for the oral 5-HT3-RA any time during the period 2 weeks prior to 5 days after chemotherapy.
Methods: A retrospective cohort analysis was conducted using the Optum LabRx database. Adult patients, treated with moderately or highly emetogenic chemotherapy, who received a 5-HT3-RA from 1/1/08 to 3/31/09, were identified. Of interest was the incidence of CINV by cohort in the first cycle of chemotherapy. CINV was defined by medical claims with a primary diagnosis of nausea, vomiting, fluid depletion or replacement, or use of a rescue antiemetic.
Results: A total of 4,818 patients were identified, 4,245 treated with palonosetron (88.1 %) and 573 (11.9 %) treated with another I.V.+oral. The mean age was 55.6 years and 79 % were female. Overall, 17.8 % of patients experienced CINV. However, patients treated with palonosetron had significantly less CINV (16.7 %) compared to those treated with the other 5-HT3-RA (26.0 %), p < .001.
Conclusions: The results of this study showed that patients who received prophylactic palonosetron prior to chemotherapy experienced significantly less CINV than those receiving the other I.V. 5-HT3-RAs with subsequent dosing of an oral 5-HT3-RA in the days following chemotherapy.
MASCC-0757
Oncoloy nurses’ use and effect of aromatherapy for cancer patients
M. Kamizato 1, S. Jahana1, R. Takamiya1, K. Tamaki1, Y. Aihara1, N. Tamai1, M. Taira1, K. Hamada1, K. Nagano1, K. Saeki1, K. Shimizu1, R. Yoshizawa1
1Nursing, Okinawa Prefectural College of Nursing, Okinawa, Japan
Introduction: The half of oncology nurses who work in some palliative care unit in Japan using aromatherapy for end of life care patients. However, low rate usage for general hospitals.
Objectives: To identify nurses’ use and effect of aroma therapy for cancer patients in Japan.
Methods: We provided oncology nurses essential oils and carrier oils for free to use for cancer patients in 5 general hospitals and 4 palliative care units in Okinawa for 1 year. After providing it, we evaluated oncology nurses’ use and effect of aromatherapy for cancer patients. The survey was conducted by a self-administered questionnaire without name for oncology nurses. Ethical approval was obtained from the college and hospitals. Descriptive statistics were used to analyze oncology nurses’ responses to each question with SPSS.
Results: The response rate was 57.4 %(166/289). The mean age of the nurses was 37.0(SD9.6, range 22–59 years); 87.2 % were female; nursing experience were 12.8(SD9.5, range 0–35).
Forty nigh percent of aroma massage, 36.7 % of carrier oil massage, 26.5 % of aroma fragrance, 23.5 % of aroma hand bath, and 30.1 % of aroma foot bath were used for cancer patients by nurses. Sixty one percent nurses felt effect of aromatherapy (2.5 % non-effect). Effect of using aromatherapy were relaxation, feeling of change, and enhance of communication between nurses and cancer patients. The reasons for not effect of aromatherapy were time concerns and fragrance difficulty.
Conclusions: Using aromatherapy for cancer patients will be effect for relaxation and enhance of communication.
MASCC-0759
The prevalence of hospitalizations, emergency department/urgent care visits for unrelieved symptoms during chemotherapy
K. Mooney 1, S.L. Beck1, B. Wong2, W.A. Dunson Jr.3, D. Wujcik4
1College of Nursing and Huntsman Cancer Institute, University of Utah, Salt Lake City, USA, 2College of Nursing, University of Utah, Salt Lake City, USA, 3Huntsman Cancer Institute and School of Medicine, University of Utah, Salt Lake City, USA, 4Vanderbilt Ingram Cancer Center, Vanderbilt University, Nashville, USA
Introduction: Unrelieved symptoms may lead to increased health resource use adding to the cost and fragmentation of cancer care.
Objectives: To describe the frequency of unscheduled hospitalizations (HOS) and emergency department/urgent care visits (ED/UC) during outpatient chemotherapy and their association with common symptoms.
Methods: In a descriptive sub-analysis, we evaluated unscheduled HOS/ED/UC visits in 358 cancer patients during chemotherapy. Patients called an automated telephone monitoring system daily reporting presence and severity of common symptoms (fever, pain, nausea/vomiting, fatigue, mucositis, numbness/tingling, difficulty thinking, depressed mood, anxiety, sleep disturbance, appearance concerns). Patients also reported on the frequency and nature of unscheduled HOS/ED/UC visits.
Results: Eighty-seven participants (24 %) reported 129 unscheduled events: 43 hospitalizations and 86 ED/UC visits (83 average study days/participant). 34 (79 %) of hospitalizations began as ED/UC visits. The average HOS/ED/UC participant was White (85 %), 57 years, female (83 %) with breast cancer (45 %) (no demographic difference between those without a HOS/ED/UC visit). 28 (65 %) unplanned hospitalizations were due to monitored symptoms including 17 (61 %) for fever, 12 (43 %) pain, 8 (35 %) nausea/vomiting, and 2 (7 %) fatigue (multiple symptoms could be reported). Of ED/UC visits, 49 (57 %) related to monitored symptoms including pain, 22 (45 %), fever, 14 (29 %), nausea/vomiting, 8 (16 %), and fatigue, 5 (10 %). Mixed modeling indicated both pain (p < .001) and fever (p < .001) were worsening during the week or spiked prior to HOS/ED/UC visit but various symptom patterns were present for nausea/vomiting and fatigue.
Conclusions: Unplanned HOS/ED/UC visits are common, especially for fever and pain and underscore the need for better models of emergent symptom care.
MASCC-0760
Randomized trials in nsclc investigating the selective androgen receptor modulator (SARM) enobosarm to prevent and treat muscle wasting: feasibility and characteristics of patients at baseline
J. Crawford2, C.M.M. Prado 1, M.A. Johnston3, M.L. Hancock3, J.T. Dalton4, M.S. Steiner5, R.J. Gralla6
1Nutrition Food and Exercise Sciences, Florida State University, Tallahassee, USA, 2George Barth Geller Professor of Research in Cancer, Duke University, Durham, USA, 3Medical Affairs, GTx Inc., Memphis, USA, 4CSO, GTx Inc., Memphis, USA,
5CEO, GTx Inc., Memphis, USA, 6Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, USA
Introduction: Although muscle-wasting and cancer cachexia occur in >80 % of patients w/advanced cancer, few well-powered scientifically-based trials have been conducted. Using enobosarm(SARM) we have now enlisted 650 patients(pts) w/advanced NSCLC in two phase3 trials. Recent studies indicate major advantages for supportive care in NSCLC at chemotherapy initiation(Temel,NEJM.2010).
Objectives: We examine the feasibility of pt enlistment at chemo initiation, the major characteristics of these pts, and trial design for the prevention/treatment of muscle-wasting.
Methods: Both double-blind, placebo-controlled, international trials evaluate the effect of enobosarm in NSCLC. ~300 pts w/Stage 3 or 4 NSCLC were randomized in each trial at initiation of first-line chemo(platinum + taxane(Power1) or platinum + non-taxane(Power2) to receive additionally enobosarm or placebo for 5mths. Pts were males and postmenopausal females ≥30y, ECOG ≤1. Co-primary endpoints (Day84) are physical function assessed by stair climb power(SCP) and lean body mass(LBM) by DXA.
Results:
Power1(n = 317) | Power2(n = 317) | |
Median Age(range) | 61(34–88) | 61(40–81) |
Male | 73 % | 71 % |
ECOG1 | 69 % | 70 % |
Stage | ||
3A | 14 % | 9 % |
3B | 16 % | 19 % |
4 | 70 % | 72 % |
%Wt-loss | −4.8 %(−33.8to + 16.1) | −5.6 %(−32.8to + 13.6) |
Docetaxel | 8.5 % | |
Paclitaxel | 91.5 % | |
Gemcitabine | 71 % | |
Pemetrexed | 17 % | |
Vinorelbine | 12 % | |
SCP(watts) | 156(26–435) | 163(30–485) |
LBM(kg/m2) | ||
Females | 14.5(1.8) | 14.8(1.7) |
Males | 17.3(1.9) | 17.2(1.9) |
Conclusions: These results indicate it is feasible to enlist pts receiving first-line chemo in trials designed to prevent or treat muscle-wasting/cachexia; their presenting characteristics are typical for NSCLC. Median weight-loss at baseline was 5 %. LBM and SCP were lower than typically observed in healthy individuals indicating significant functional decline before starting chemo for NSCLC. These Phase3 trials will determine the effect of enobosarm on preventing/treating muscle-wasting in NSCLC.
MASCC-0761
Serum levels of micronutrients (ferritin, copper, and zinc) in patients with oral cancerous lesions
M. Baharvand 1, H. Mortazavi1, R. Akkafan1
1oral and maxillofacial medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Introduction: It seems serum changes of micronutrients play a role in the pathogenesis of oral cavity malignancies
Objectives: The aim of the present study was to determine the serum levels of ferritin, copper and zinc in patients with oral cancerous lesions.
Methods: In this cross sectional study, 60 patients (35 men, 25 women) with oral malignancies, and 66 age and sex-matched controls (40 men, 26 women) were selected from patients referred to Cancer Institute of Tehran University of Medical Sciences and Shahid Beheshti University of Medical Sciences Dental School, Tehran, Ir\an. The serum levels of ferritin, copper and zinc were measured by means of Immunoenzymatic Kits (Pad-Tan Elm, Iran for ferritin and Grainer, Germany for copper and zinc) in patients and healthy individuals. SPSS software version 18 and Mann–Whitney U test were used to analyze the data.
Results: Serum levels of ferritin (mg/dl) were 267.4 ± 248.45 and 106.1 ± 72.96 in patients with oral cancer and controls respectively. Furthermore, copper levels (mg/dl) measured as 209.8 ± 160.3 and 114.2 ± 38.7 in the above groups. Finally, serum zinc levels (mg/dl) estimated to be 113.5 ± 52.3 and 64.5 ± 31.5 in the oral cancer patients and controls. The mean serum values of three micronutrients in the cancer people were significantly higher than controls (p < 0.001).
Conclusions: Serum levels of ferritin, copper and zinc were significantly increased in patients with oral cancer.
MASCC-0762
A comparison study of symptoms associated with cancer and non-cancer related lower limb lymphedema
S. ridner 1, M.S. dietrich1
1school of nursing, vanderbilt univeristy, Nashville, USA
Introduction: It is unknown if symptoms experienced by cancer survivors with secondary lower limb lymphedema (LLL) differ from those symptoms experienced by individuals with LLL not related to cancer.
Objectives: To compare number of symptoms and symptom intensity and distress among cancer related secondary (CRS), non-cancer related secondary (NCRS), primary, and unknown types of LLL.
Methods: A cross-sectional, web-based, descriptive study was conducted in 213 volunteers with LLL. Demographic and lymphedema data were collected. Patients completed the 36-item Lymphedema Symptom Intensity and Distress Scale-Leg. If a symptom was present, intensity and distress were rated on separate 1–10 point scales.
Results: CRS (n = 37), NCRS (n = 45), primary (n = 96), and unknown (n = 35). The groups differed demographically only on age (p < .001) with primary and unknown type being younger than CRS. Primary and unknown type LLL were more likely to have bilateral swelling (68 % and 56 % respectively) than others (<40 %, p = .001), less likely to have truncal swelling (~35 % vs. 69 % CRS, 53 % NCRS, p = .047), and less likely to perform self-care activities (39 % and 43 % respectively) than others (>55 %, p = .013). Eleven symptoms were present in >50 % of participants in each group. Strongest findings indicated CRS less likely to experience coldness in legs (p = .029), lack of self-confidence (p = .014), and feeling less sexually attractive (p = .049) than other groups. Patterns of intensity and distress from the symptoms coincided with the reported differences in prevalence.
Conclusions: Patients with cancer-related LLL experience problematic symptoms that require intervention. However, their symptom experience is somewhat less pronounced than those whose lymphedema is not cancer related.
MASCC-0763
Differentiation of benign versus malignant keratinizing skin tumors (KST) induced by BRAF-Inhibitors
V.R. Belum1, A.C. Rosen1, S. Dusza1, A.A. Marghoob1, M.P. Pulitzer2, A.C. Halpern1, K.J. Busam2, P.B. Chapman3, M.E. Lacouture 1
1Dermatology, Memorial Sloan-Kettering Cancer Center, New York, USA, 2Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA, 3Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
Introduction: BRAF inhibitors induce KSTs which include verrucae or verrucous keratosis (VK), keratoacanthomas (KA) and cutaneous squamous cell carcinomas (cuSCC). These may necessitate interventions, impact QOL and consistent dosing. While most lesions have a benign clinical and histological phenotype (e.g. VK, KA), a minority (KA/cuSCC) exhibit malignant features.
Objectives: To describe the clinico-morphological characteristics that differentiate KSTs induced by BRAF-inhibitors.
Methods: The clinical, dermoscopic, and histologic features of KSTs (n = 112) induced by vemurafenib/dabrafenib/XL281 (BMS-908662), were retrospectively analyzed. Features (5) were correlated with histopathology. Pearson’s chi-square, Student’s T-test were utilized.
Results: A majority (78 %) of the lesions were benign, whereas larger ones (p = <0.001), those with a central keratin plug (p = <0.001) or ulceration/crust (p = 0.04), adherent scale (p = 0.02), peripheral erythematous halo (p = 0.03), scaly ring (collarette; p = <0.001) corresponded to a KA/cuSCC (22 %). Filiform morphology was exclusive to benign lesions (32 %).
Characteristic | SCC/KA ( n = 25) | Verruca ( n = 87) | p value |
Size (mm) | 8.68 (3.4) | 5.2 (2.4) | <0.001 |
Morphology | |||
Nodule | 6 | 1 | <0.001 |
Filiform | 0 | 28 | |
Papule | 16 | 85 | |
Plaque | 3 | 1 | |
Keratin structures | |||
Mass/amorphous keratin | 17 (68.0) | 50 (57.5) | 0.34 |
Central keratin plug | 14 (56.0) | 5 (5.8) | <0.001 |
Central ulceration/crust | 4 (16.0) | 3 (3.5) | 0.04 |
Keratin domes/horns | 1 (4.0) | 11 (12.6) | 0.22 |
Adherent scale | 14 (56.0) | 26 (29.9) | 0.02 |
Periphery | |||
Erythematous halo | 13 (52.0) | 25 (28.7) | 0.03 |
Scaly ring | 17 (68.0) | 23 (26.4) | <0.001 |
Thrombosed vessels within keratin | 17 (68.0) | 38 (43.7) | 0.03 |
Pathology | |||
Verruca/VK | – | 83 (95) | – |
Verruca with KA features | – | 4 (5) | – |
KA | 6 (24) | – | – |
SCC, well-differentiated | 9 (36) | – | – |
SCC, well-differentiated with KA features | 10 (40) | – | – |
- Invasive SCC | 4 (16) | – | – |
Conclusions: We identified features that aid clinical differentiation of benign from malignant KSTs. These may be important in minimizing patient morbidity associated with KST treatment and BRAF-inhibitor dose modifications.
NA
MASCC-0764
Sexuality in nursing care for women with gynecological and breast cancer: recognizing the need to recast the assistance
S.M.A. Ferreira1, T.O. Gozzo 1, M.S. Panobianco1, A.M. Almeida1
1Public Health and Maternal-infant Department, Ribeirão Preto Nursing School University of São Paulo, Ribeirão Preto, Brazil
Introduction: In view of the problems faced by women after breast and gynecological cancer, the nursing staff must overcome the obstacles that prevent the approach of sexuality and reassess the care provided.
Objectives: To discuss the reformulation of nursing care related to sexuality, in the care of women with gynecological and breast cancer.
Methods: A qualitative study was conducted with 16 nursing professionals in two sectors at a university hospital located in the state of São Paulo, Brazil, in 2011. To identify and classify the participants’ answers, Content Analysis was used.
Results: According to professionals’ testimonies, the reformulation of the practices requires lineup changes in values, personal and professional, and the recognition of intervention possibilities. The lack of preparation affects the ability of communication and generates an uncomfortable when sexuality emerges in clinical practice. In relation to personal and professional values is necessary that health professionals recognize the importance of sexuality for the individual as well as assume its approach as an assignment. Nursing consultation led sexual health should be included in the planned actions to health care and should be combined with other activities and services.
Conclusions: The reformulation that aims undergoes a bold paradigm shift in healthcare. Cultural issues, both personal and professional training, must be rethought so that sexuality can be seen as essential to human and present in all life, even in a disease situation.
MASCC-0765
Improved physical functioning is associated with increased lean body mass (LBM): Findings from a phase II trial of the selective receptor modulator (SARM) enobosarm
J. Crawford2, C.M.M. Prado 1, M.A. Johnston3, M.L. Hancock3, J.T. Dalton4, M.S. Steiner5, R.J. Gralla6
1Nutrition Food and Exercise Sciences, Florida State Univeristy, Tallahassee, USA, 2George Barth Geller Professor of Research in Cancer, Duke University, Durham, USA, 3Medical Affairs, GTx Inc., Memphis, USA, 4CSO, GTx Inc., Memphis, USA, 5CEO, GTx Inc., Memphis, USA, 6Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, USA
Introduction: Muscle wasting and cancer cachexia are common and can begin early in malignancy. This trial was designed to test whether the SARM enobosarm can prevent or treat cancer cachexia and muscle wasting while improving physical functioning.
Objectives: To investigate associations between changes in LBM and physical functioning in this enobosarm trial.
Methods: This randomized, blinded study assessed enobosarm versus placebo for 16 weeks for muscle wasting and physical functioning. Subjects had a ≥2 % weight loss over 6 months, were males >45 years or postmenopausal females. Diagnoses included NSCLC, colorectal cancer, breast cancer, NHL, and CLL. Endpoints included change in LBM by DEXA scan and physical functioning measured by stair climb power (SCP). A substantially meaningful response in physical functioning was defined as ≥10 % improvement in SCP. We report physical functioning response based on changes in LBM.
Results: One hundred fifty-nine patients were enlisted; this analysis focuses on the 90 patients who had DEXA and SCP testing pre- and post-enobosarm/placebo.. Patients with ≥0.25 kg gain in LBM were more likely to have a substantially meaningful response in physical functioning (62 % versus 34 %, p = 0.017). These subjects also had improvement in percentage change in SCP, median +12 % versus +0.8 % (p = 0.017). Enobosarm and placebo were well-tolerated; adverse events included fatigue, anemia, nausea and diarrhea.
Conclusions: These results demonstrate that even small improvements in LBM are associated with improvements in physical functioning. This finding validates the value of these endpoints in the ongoing Phase III trials with enobosarm directed at treating and preventing muscle wasting.
MASCC-0766
Impact of 5-HT3 receptor antagonist selection on the incidence of delayed chemotherapy induced nausea and vomiting and resource utilization in patients receiving highly emetogenic chemotherapy
C. Faria1, L. Lamerato2, J. Jackson3, R. Knoth 1, A. Powers1
1Health Economics and Outcomes Research, Eisai Inc., Woodcliff Lake, USA, 2Public Health Sciences, Henry Ford Health System, Detroit, USA, 3Global Health Economics and Outcomes Research, Xcenda, Palm Harbor, USA
Introduction: The 5-hydroxytryptamine-3 receptor antagonists (5-HT3-RA) are recommended for the prevention of chemotherapy-induced nausea and vomiting (CINV), a significant adverse effect of chemotherapy.
Objectives: The purpose of this study was to evaluate the impact of 5-HT3−RA antiemetic selection on the incidence of chemotherapy-induced nausea and vomiting (CINV) and healthcare resource utilization in patients receiving prophylaxis with palonosetron or ondansetron prior to highly emetogenic chemotherapy (HEC) in an integrated healthcare system.
Methods: Patients diagnosed with cancer, treated with HEC, and who received either palonosetron or ondansetron were identified in the Henry Ford Health System from the period 7/1/2000 and 12/31/2009. Incidence of CINV was defined by a claim for nausea, vomiting, rehydration, and/or use of a rescue antiemetic on days 2–5 after chemotherapy. Health care resource utilization on days 2–5 following chemotherapy was also examined.
Results: A total of 553 patients were identified. Of these, 53.3 % were treated with palonosetron and 46.6 % were treated with ondansetron. Patients treated with palonosetron were significantly less likely to experience delayed CINV compared to patients treated with ondansetron (14.9 % vs. 22.9 %, respectively, p = .02). Analysis of resource utilization showed that patients treated with palonosetron vs. ondansetron were also significantly less likely to have a CINV-related visit (18.9 % vs. 29.5 %, respectively, p < .01) and lower CINV-related mean total costs per cycle ($559 vs. $924, respectively, p < .02.)
Conclusions: The results showed that patients receiving HEC who received palonosetron were significantly less likely to experience delayed CINV and had significantly lower CINV-related utilization and health care costs than those who were treated with ondansetron.
MASCC-0767
Subjective sleep problems predict survival in 240 patients with metastatic colorectal cancer
O. Palesh 1, G.A. Bjarnason2, C. Deguzman1, K. Haitz1, S. Giacchetti3, D. Spiegel1, F. Levi3, P. Innominato3
1Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA, 2Division of Medical Oncology Sunnybrook Odette Cancer Centrers", University of Toronto, Toronto, Canada, 3INSERM U 776 “Rythmes biologiques et cancers”, Hôpital Paul Brousse, Villejuif Cedex, France
Introduction: Previous studies have highlighted the importance of sleep in cancer patients’ quality of life (QOL). However, no study has evaluated the effect of sleep disruption on other clinical outcomes.
Objectives: This study aimed to clarify the relationship between sleep disruption and survival in patients with metastatic colorectal cancer (MCC).
Methods: Two hundred forty pts (37.1 % female, mean age = 58.5; SD = 11.0) treated for MCC in 1st to 5th line of 5-fluorouracil based chemotherapy completed the QOL Questionnaire (EORTC QLQ-C30). We considered sleep to be disrupted if patients reported little to severe trouble sleeping (scores >0). Multivariate Cox models included age, gender, stage at diagnosis, site of primary tumor, number of metastatic sites, performance status and prior chemotherapy.
Results: 65.4 % of the patients sleep disruption according to EORTC QLQ-C30. Patients with trouble sleeping had better overall survival as compared to those without sleep disruption (HR: 1.47 [1.11 to 1.95]; p = 0.008). Respective median survival times (months) were 14.2 [95%CI: 12.3 to 16.1] and 17.7 [10.0 to 25.3]. The survival benefit observed in patients without sleep disruption remained statistically significant after adjustment for other prognostic factors. The final multivariate prognostic model included subjective sleep disruption (HR: 1.49 [1.11 to 2.00]; p = 0.009), number of metastatic sites (p < 0.001), performance status (p = 0.023), and prior chemotherapy (p < 0.001).
Conclusions: Our findings show that patients reported sleep disruption is an independent prognostic factor for overall survival in metastatic colorectal cancer. Future research is needed to determine the mechanisms of sleep disruption and its effect on survival, and whether treatment of sleep disruption can improve survival.
MASCC-0768
Smileon: supporting innovative learning approaches through mobile integration in the workplace—oncology nursing
P. Fernandez 1, M. Montserrat1, A. Sedano1, A. Company1, M. Markova2, J. Fendrychová3, A. Milani4, K. Lokar5, M. Bernot5, M. Matkovic5, A. Blazeviciene6, A. Vaskelyte6, O. Riklikiene6, S. Kav7, A. Karahan7, E.A. Citak7
1Nursing, Institut Català d’Oncologia, Barcelona, Spain, 2Nursing, National Centre of Nursing and Other Health Care Professions, Brno, Czech Republic, 3Nursing, National Centre of Nursing and Other Heatlh Care Proffesions, Brno, Czech Republic, 4Nursing, European Institute of Oncology, Milan, Italy, 5Nursing, Institute of Oncology Ljubljana, Ljubljana, Slovenia, 6Nursing, Lithuanian University of Health Science, Kaunas, Lithuania, 7Nursing, Baskent University Faculty of Health Sciences, Ankara, Turkey
Introduction: Use of mobile technology can allow the learning process to be facilitated outside and beyond the classroom contexts in which most oncology nursing training currently takes place.
Objectives: The aim of the project is to develop a new approach to training using mobile devices to extend learning activity into daily practice. This methodology was supported by a toolkit designed for tablets that use the Android operating system. Using these devices, nurses will be able to communicate in real time in the work place and access relevant content according to their needs.
Methods: The project has involved needs analysis, development of appropriate learning methodology and mobile toolkit to support it. The approach will be piloted in each of the partner countries in two steps; first pilot focuses on the validation of the learning approach, the second pilot will also pay attention to exploitation and sustainability issues and the possible extension of the approach to other contexts.
Results: Needs analyses performed by semi-structured interview (n = 75) and quantitative survey among 201 nurses from Spain, Czech, Italy, Slovenia, Lithuania and Turkey. Pharmacotherapy, acute conditions and procedures in oncology nursing were listed as priority areas for learning. These integrated in a manual describing the approach and example activities to be used in the methodological implementation. The software toolkit, developed initially for Android-based devices. Sixty six nurses from partnering countries were involved into first pilot and have been using the system.
Conclusions: Nurses appear to benefit from the opportunity to discuss and explore what they are learning.
References: *Funded with support from the European Commission (518383-LLP-1-ES-LEONARDO-LMP)
MASCC-0769
Dental extractions in oncology patients receiving intravenous bisphosphonates. A case series report
E. Vardas 1, O. Nicolatou-Galitis1, E. Papadopoulou1, D. Galiti2, E. Galitis3, M. Kouri1, E. Razi4, N. Anagnostopoulos5, K. Megalakaki6, D. Bafaloukos7 1Dental Oncology Unit Clinic of Hospital Dentistry, School of Dentistry, Athens, Greece, 2Department of Oral Diagnosis and Radiology, School of Dentistry, Athens, Greece, 3Orofacial Pain Management Clinic, School of Dentistry, Athens, Greece, 43rd Oncology Department, Ygeia Hospital, Athens, Greece, 5Clinic of Hematology, Gennimatas Hospital, Athens, Greece, 6Clinic of Hematology, Metaxa Cancer Hospital, Athens, Greece, 7Clinic of Oncology, Metropolitan Hospital, Athens, Greece
Introduction: Dental extractions are reported as the main risk factor for osteonecrosis in patients receiving i.v. bisphosphonates.
Objectives: To present the clinical course of 42 dental extractions performed in oncology patients who received intravenous bisphosphonates.
Methods: Twenty five patients (mean age 61.8 years) receiving i.v. BPs (mean time of administration 36 months) for multiple myeloma (11), breast cancer (13) and lung cancer (1) were included in the study. Patients were informed about the risk of ONJ and gave their consent. Antibiotics were administered for > week before the extraction and until healing. Local ozone oil applications were performed in 17 patients.
Results: Twenty nine extractions were located in the mandible and 13 in the maxilla. All patients received zoledronic acid; 3 patients also received ibandronate or pamidronate. Twenty four dental extractions were performed because of pain, purulence, and tooth mobility compatible with ONJ stage 0. Five extractions were adjacent to ONJ stage II and the lesion subsided to stage I. Dental pathology was the cause for 13 extractions. Healing was observed in 35 extractions. Twenty patients did not receive BPs during the extraction and healing period. Patients with ozone oil applications had mean time of healing 4.9 weeks versus 15 weeks in the patients without ozon applications. Mean follow-up was 4.5 months.
Conclusions: The high healing rate (35/37, 94.59 %) following the extractions questions the dental extraction as the main risk factor for ONJ.
MASCC-0770
Low level laser therapy for trismus: a report of three cases
K. Bektas-Kayhan 1, D. Ayvalioglu2, B. Gokcen-Röhling2, G. Karagöz1, U.G.U.R. Erdemir3, M. Ünür1
1Oral and Maxillofacial Surgery, Istanbul University Faculty of Dentistry, Istanbul, Turkey, 2Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkey, 3Restorative Dentistry, Istanbul University Faculty of Dentistry, Istanbul, Turkey
Introduction: Trismus is a well recognized late side effect of head-neck radiotherapy. The intensity of trismus depends on the dose of radiation and the orofacial structures which are in the radiation field. The pterygoid muscles seems to be the most responsible structures in the field.
Objectives: Different therapeutic approaches were tested to solve the trismus. Low level laser therapy (LLLT) is a conservative and cost effective treatment modality with different degrees of success. In this report we would like to focus on three patients with severe trismus and their succesfull treatment outcomes.
Methods: The biostimulation of related muscles were performed in 4 courses with diode laser. Each course were 10 days long and between courses 10 days of resting period was left. First course was 320 MPV, 5 joule, 14 s, second course 320 MPV, 6 joule 16 s, third course 320 MPV, 7 joule, 19 s, and the last course 320 MPV, 6 joule, 21 s.
Results: First patient had a progression of 7 mm, second patient 3 mm and third patient 5 mm mouth opening which had improved their abilities of speaking, eating and oral hygiene.
Conclusions: LLLT is a promising therapy option for head neck cancer patients with trismus. For more reliable and evidence based outcomes its necessary to standardize the interventions for assesment of effect of LLLT in trismus.
MASCC-0771
The psychosocial issues of caregivers in cancer trajectory, a comparative analysis among urban and rural caregivers in central kerala
P.S. Satheeshkumar 1, M.P. Mohan1, J. Jacob1
1Oral Medicine, Mar Baselios Dental College, Cochin, India
Introduction: Caregivers experience heightened psychosocial issues as comparable to the cancer patients.
Objectives: To assess the caregivers’ psychosocial issues in different cancer trajectory stages and comparing among rural and urban population.
Methods: Semi structured interview based questionnaire was developed to assess the psychosocial issues’ of caregivers of patients diagnosed as cancer in different stages of cancer trajectory namely diagnostic, treatment, survival and bereavement stage. Twenty five caregivers from an urban population were compared to the 25 caregivers of rural population.
Results: The caregiver’s distress was higher in the diagnosed stage in both the urban and rural population, with both the group facing the financial problems as the most worrisome factor. In all other the stages both the urban population and rural population shared similar issues; information needs, side effects of cancer therapy, concern about other family members. Spending too much of his/her time leading to loss of job, cancer coming back was the main issue in the urban population, which was negligible in the rural population. Outcomes over the period (higher psychosocial issues ratio [IR], survival versus earliest diagnostic period: 0.62, p < 0.0001). (IR, Urban versus rural: 1.47, CI 1.23–1.76). Issues varied according to age group (p < 0.001), sex (IR, female versus male: 0.76, 95%CI: 0.72–0.81), Education (IR, rural versus urban: 1.23, CI 1.14–1.30) and socioeconomic status (IR, p < 0.02).
Conclusions: The factors mitigating the role of the difference in the psychosocial issues in population points to the cultural variants and the role of the society. Caregivers experience poor psychological, social, financial and physical well-being when staging cancer trajectories.
MASCC-0772
Postoperative complications in women with breast cancer after neoadjuvant chemotherapy
T.O. Gozzo 1, M.A.S. Prado1, T.G. Nascimento1, A.M. Almeida1
1Public Health and Maternal-infant Department, Ribeirão Preto Nursing School University of São Paulo, Ribeirão Preto, Brazil
Introduction: In the treatment of breast cancer, the surgical procedure is of great importance as it makes the local control of the disease, and help to define the indication for adjuvant treatment.
Objectives: To evaluate the complications presented by women after surgery for the treatment of breast cancer.
Methods: Retrospective study, with analysis of records of women diagnosed with breast cancer submitted to neoadjuvant chemotherapy with epirubicin and docetaxel followed by surgery, between the years 2003 and 2006.
Results: Seventy-two files were included, 28 % of women aged between 51 and 55 years and the clinical stage more observed was IIIa (34.7 %). Of the 72 women studied, two were not subjected to the surgical procedure, 14 had conservative surgery, 69 % had no history in their records as the complications and 29,2 % had some type of complications after surgery, and this 10 were obese and three had a diagnosis of diabetes. Complications presented were: eight surgical wound dehiscence; seven wound infection, one skin necrosis; six had seroma formation and four presented hematoma.
Conclusions: From the point of view of nursing, the implementation of a formal orientation program on postoperative care to surgical wound, and the use of systematic instrument, designed specifically for outpatient care, are important measures for control and prevention of surgical complications.
MASCC-0773
Phase 2 trial safety profile of single-agent carfilzomib in patients with relapsed and/or refractory multiple myeloma (RRMM)
D. Siegel 1, T. Martin2, A. Nooka3, R.D. Harvey3, R. Vij4, R. Niesvizky5, A.Z. Badros6, S. Jagannath7, L. McCulloch8, K. Rajangam9, S. Lonial3
1Myeloma Division, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack NJ, USA, 2Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco CA, USA, 3Winship Cancer Institute, Emory University, Atlanta GA, USA, 4Division of Medical Oncology, Washington University School of Medicine, St. Louis MO, USA, 5Departments of Medicine and Hematology/Oncology, Weill Cornell Medical College, New York NY, USA, 6Greenebaum Cancer Center, University of Maryland, Baltimore MD, USA, 7Hematology and Medical Oncology, Mount Sinai Medical Center, New York NY, USA, 8Onyx Pharmaceuticals Inc., Drug Safety and Pharmacovigilance, South San Francisco CA, USA, 9Onyx Pharmaceuticals Inc., Clinical Science, South San Francisco CA, USA
Introduction: Treatment of RRMM is complicated by comorbidities of the disease, many of which can be exacerbated by targeted agents and/or chemotherapy. Carfilzomib is a selective proteasome inhibitor recently approved as a single agent in the US for RRMM.
Objectives: Herein, we summarize the integrated safety data from 4 phase 2 trials: PX-171-003-A0, PX-171-003-A1 (both NCT00511238), PX-171-004 (NCT00530816), and PX-171-005 (NCT00721734).
Methods: Carfilzomib was dosed at 20–27 mg/m2 intravenously over 2–10 min on days 1, 2, 8, 9, 15, and 16 of a 28-day cycle for all studies except 005 (15–27 mg/m2). Adverse events (AEs) were graded by NCI Common Terminology Criteria for Adverse Events (CTCAE) v3.0.
Results: Safety data were analyzed for 526 patients. AEs ≥ Grade 3 in ≥15 % of patients were thrombocytopenia (23.4 %), anemia (22.4 %), and lymphopenia (18.1 %). Hematologic AEs were common, yet transient. Worsened renal function was reported in 13 % of patients; nearly half of which were transient. While cardiac failure events regardless of causality were reported in 7 % of patients, 73.6 % had a past medical history of cardiovascular events. Dyspnea was the most common respiratory AE (42.2 %); pneumonia was the most common pulmonary infection (12.7 %). While 71.9 % of patients had active peripheral neuropathy (PN) at baseline, new PN was reported infrequently (13.9 % overall). Dose reductions (14.6 %) and treatment discontinuations (14.8 %) due to AEs were infrequent.
Conclusions: Single-agent carfilzomib has an acceptable safety profile in heavily pretreated patients with RRMM. The AEs observed in these studies were manageable and resulted in few dose reductions and discontinuations.
MASCC-0774
Risk of unplanned presentations in colorectal cancer (CRC) outpatients (PTS) treated with chemotherapy. A case-crossover design
L. Foltran 1, P. Ermacora1, G. Aprile1, F. Pisa2, E. Poletto1, G.G. Cardellino1, N. Pella1, M. Giovannoni1, E. Iaiza1, M. Mazzer1, E.S. Lutrino1, L. Ferrari1, M. Casagrande1, G. Fasola1
1Oncology, University Hospital, Udine, Italy, 2Statistic, University Hospital, Udine, Italy
Introduction: Unexpected presentations of cancer pts cause pressure on oncology services. Chemotherapy pts frequently ask for unplanned visits particularly within 4 weeks from last chemotherapy (McKenzie, Support Care Cancer 2011; Aprile, Support Care Cancer 2012).
Objectives: This study aimed to evaluate a) the impact of chemotherapy on the risk for unplanned visit, b) causes for unplanned presentation and c) risk factors for hospital admission.
Methods: Clinical data of 229 consecutive CRC pts who unplannedly presented between 2006 and 2009 were collected. A case-crossover statistical design was applied to assess the association between exposure to the trigger event (chemotherapy) and the onset of an acute outcome (unplanned presentation) in three time windows (7, 15 and 21 days). A Cox model was used to assess the risk factors for hospitalization.
Results: Four hundred sixty-nine unplanned visits were registered. Most of pts (median age 70 years) had ECOG PS 0–1 (80 %) and advanced stage (78 %). 72 % of unplanned presentations occurred within 30 days since last therapy. The most frequent causes for presentation were: pain, fatigue, anorexia, nausea/vomiting and fever. 10 % of unplanned visits resulted in hospital admission, and predictors for hospitalization were number of symptoms >1 and ECOG PS >1.
Conclusions: Among CRC pts receiving systemic chemotherapy the risk for unplanned presentations is higher during the 2nd and 3rd week since the treatment. The management of those presentations may be cost- and time- saving and reduce pressure on oncology services.
Tab.1 Risk of unplanned presentation according to time window of exposure to chemotherapy
Time window (days) | Early stage | Advanced stage | ||||
OR | 95%CI | OR | 95%CI | |||
21 | 3,8 | 1,4 | 10,2 | 3 | 1,5 | 5,9 |
15 | 3,8 | 1,4 | 10,2 | 1,71 | 1 | 2,9 |
7 | 0,8 | 0,4 | 1,5 | 0,78 | 0,5 | 1,2 |
MASCC-0775
Oral potentially malignant disorders: an overview of more than 20 entities
H. Mortazavi 1, M. Baharvand2
1Oral and Maxillofacial Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2Oral and Maxillofacial Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Introduction: Cancer of the oral cavity accounts for approximately 3 % of all malignancies and found in 270.000 patients annually worldwide. Many oral squamous cell carcinomas develop from potentially malignant disorders (PMDs) which means the risk of malignancy being present in a lesion or condition either during the time of initial diagnosis or at a future date as defined by WHO.
Objectives: The aim of this review article was to update and improve the knowledge of healthcare providers about oral PMDs.
Methods: In order to achieve a comprehensive information regarding oral PMDs, the key words of precancerous conditions, mouth neoplasms, malignancy, and leukoplakia were searched in all relative databases, search engines, and indexing systems such as Pubmed, Pubmed central, Scopus, Copernicus and Google scholar without any time limitation. All entities were gathered and classified according to their pathogenesis.
Results: WHO classified PMDs into two subgroups: a)“precancerous lesion, a benign lesion with morphologically altered tissue which has a greater than normal risk of transforming into malignancy. b)” precancerous condition, a disease or patients’ habit that does not necessarily alters the clinical appearance of local tissues but is associated with a greater than normal risk of precancerous lesion or cancer development in that tissue”.
Each category includes several entities, which will be discussed in details
Conclusions: Sufficient awareness about signs and symptoms of oral PMDs among healthcare providers and even general population may help reach timely diagnosis as well as better prognosis.
MASCC-0776
From clinical trials to clinical practice: management of adverse events following carfilzomib administration to patients with relapsed and refractory multiple myeloma (RRMM)
L. McBride 1, C.O. Samuel2
1John Theurer Cancer Center, Hackensack University Medical Center, Hackensack NJ, USA, 2Lymphoma/Myeloma Center, MD Anderson Cancer Center, Houston TX, USA
Introduction: Carfilzomib is a selective proteasome inhibitor with favorable safety and efficacy as a single agent in phase 1 and 2 trials of RRMM. Carfilzomib was recently approved in the United States for RRMM, the treatment of which is challenging due to the heterogeneity of the disease, patient comorbidities, and treatment side effects.
Objectives: To provide recommendations on the prevention and management of AEs for patients being treated with carfilzomib.
Methods: Clinical trial safety data and nursing clinical practice experience are combined to provide recommendations for adverse event management before, during, and after carfilzomib administration.
Results: Prior to carfilzomib treatment, it is necessary to establish a patient baseline profile including evaluation of cardiac and renal function. Many of the more frequently reported AEs such as fatigue, dyspnea, and infections can be prevented with proper prophylactic measures including hydration, dexamethasone, and antiviral/antibacterials. During and immediately following carfilzomib administration, infusion-related and injection-site reactions are possible. Hematologic AEs, while common, are generally transient, infrequently dose limiting, and managed with conventional therapies. Carfilzomib-associated renal impairment is not typical, however transient increases in serum creatinine are observed between consecutive doses. Patients with cardiac risk factors should be identified before treatment and monitored. Similar to clinical trials, PN is rarely observed in the clinic.
Conclusions: AEs in varying frequencies occur in response to carfilzomib and are generally managed with prophylaxis and routine care. Maximizing carfilzomib efficacy while minimizing AEs and discomfort in patients can be achieved by utilizing the clinical practice experience with carfilzomib presented herein.
MASCC-0777
Neurocognitve dysfunction in newly diagnosed high-grade glioma patients: utilization of standardized computerized neurocognitive battery
K. Peters 1, S. Woodring1, M.L. Affronti1, A. Desjardins1, T. Ranjan1, G. Vlahovic1, H. Friedman1
1Medicine, Duke University Medical Center, Durham, USA
Introduction: High grade gliomas (HGGs) consist of WHO grade III and WHO grade IV primary brain tumors that are aggressive and are associated with a poor MOS at 1–3 year. Patients not only have an oncologic diagnosis but also a neurological diagnosis that can cause neurocognitive (NC) dysfunction.
Objectives: In order to understand NC burden that HGG patients experience, we evaluated NC functioning in newly diagnosed HGG patients using a computerized NC battery.
Methods: Eight-two HGG patients were identified and consented. Clinical and demographic information was obtained. NC testing was performed with computerized program CNS Vital Signsâ and included domains of executive functioning, psychomotor speed, verbal and visual memory. Descriptive statistics were performed along with regression analyses to evaluate factors associated with NC function. Mean standardized score for normative age-matched subjects for all NC domains is 100 and lower scores identify poorer NC performance.
Results: Sixty-eight (83 %) subjects completed NC testing. Mean age at testing was 56.8 year (sd = 12.6 year) and mean educational level was 15.1 year (sd = 2.6 year). Majority of patients had a KPS at time of testing ≥ 80 (85 %). Despite high performance status and high educational level, the mean standardized score on domains was below 100 (executive functioning = 67.9 (sd = 34.3), psychomotor speed = 79.8 (sd = 28.6), verbal memory = 81.8 (sd = 24.4), and visual memory = 89.7 (sd = 19.9). Performance on NC testing was independent of age, KPS, grade, education, and location.
Conclusions: Based on these results, we can conclude that most newly diagnosed HGG patients experience significant NC dysfunction at baseline and NC can be measured using a computerized battery.
MASCC-0778
Treatment and prevention of bisphosphonate-associated osteonecrosis of the jaws: 2009–2012
E. Papadopoulou 1, O. Nicolatou-Galitis1, E. Vardas1, T. Sarri1, E. Gatou1, M.C. Kyrtsonis2, P. Repousis3, E. Razi4, I. Athanasiadis5, D. Bafaloukos6
1Dental Oncology Unit Clinic of Hospital Dentistry, School of Dentistry, Athens, Greece, 21st Department of Propaideutic Clinic of Internal Medicine, Laiko Hospital Medical School, Athens, Greece, 3Clinic of Hematology, Metaxa Cancer Hospital, Piraeus, Greece
43rd Oncology Department, Ygeia Hospital, Athens, Greece, 52nd Oncology Clinic, Mitera Hospital, Athens, Greece, 6Oncology Department, Metropolitan Hospital, Athens, Greece
Introduction: ONJ if not diagnosed early can seriously affect patients’ quality of life.
Objectives: To present our 4-year experience in the treatment and prevention of bisphosphonate-related jaw osteonecrosis and compare it with our experience during 2005–2008.
Methods: Two hundred fifty seven patients were evaluated during 2009–2012. Underlying diagnosis was multiple myeloma (48.2 %), breast cancer (26.8 %), lung cancer (8.6 %) and other malignancies. Patients received zoledronic acid (71.6 %) and other bisphosphonates (median time 31.5 months). Ninety patients presented with osteonecrosis. Tooth extraction preceded osteonecrosis in 63.8 % of the cases. One hundred sixty five patients were referred for prevention of osteonecrosis, before/after the initiation of bisphosphonates. Oral care included clinical/rediographic evaluation, patient education and hygiene measures.
Results: The 90 osteonecrosis patients (stage 0:33, stage I:24, stage II:27, stage III:6) were treated with long-term antibiotics, continuous or with treatment-free intervals. Ozone oil applications were performed in 24 patients. Today, 13 patients (14.4 %) have healed, 25 (27.8 %) are stable, without pain and 44 (48.9 %) have no pain, but with minor mucosal inflammation. Of the 33 patients with clinical/radiographic signs compatible with ONJ stage 0, 11 progressed to ONJ stage I (3 following dental extraction), 9 healed (4 after dental extraction) and 11 showed partial remission. Of the 165 patients, who were included in the prevention protocol, 164 patients continue their bisphosphonate therapy, while 1 patient developed osteonecrosis (0.6 %) after dental extractions.
Conclusions: With increasing knowledge, low prevalence (0.6 %) of osteonecrosis can be achieved, compared with our previous series (2005–2008).
MASCC-0779
Determining possible cardiotoxicity risk modifiers (ACEI, Beta-blockers, and G-CSF) in breast cancer patients who received anthracycline and trastuzumab: a case–control study
M. Namura 1, H. Ishiguro2, K. Yamagami3, H. Abe4, S. Tsuyuki5, A. Yamauchi6, T. Inamoto7, N. Kan8, H. Yoshibayashi1, H. Suwa9, Y. Ichinose10, H. Kato11, N. Shinkura12, M. Toi13
1Breast Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan, 2Outpatient Oncology Unit, Kyoto University Hospital, Kyoto, Japan, 3Breast Oncology, Shinko Hospital, Hyogo, Japan, 4Surgery, Shiga University of Medical Science Hospital, Shiga, Japan, 5Breast and General Surgery, Osaka Red Cross Hosopital, Osaka, Japan, 6Breast Surgery, Kitano Hospital, Osaka, Japan, 7Breast Surgery, Tenri Hospital, Nara, Japan, 8Oncology, Kan Norimichi Clinic, Kyoto, Japan, 9Breast Surgery, Hyogo Prefectual Tsukaguchi Hospital, Hyogo, Japan, 10Breast Surgery, Takatsuki Red Cross Hospital, Osaka, Japan, 11Breast Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan, 12Breast Oncology, Sawai Kinen Nyusen Clinic, Kyoto, Japan, 13Breast Surgery, Kyoto University Hospital, Kyoto, Japan
Introduction: Anthracycline and trastuzumab are associated with cardiotoxicity. On the other hand, randomized clinical trials showed that beta-blockers and angiotensin converting enzyme inhibitors (ACEI) exhibit myocardial protective effects. Preclinical study also suggested that granulocyte colony-stimulating factor (G-CSF) protects cardiomyocytes from mitochondrial damage caused by doxorubicin.
Objectives: To determine the protective capacity of ACEI, beta-blockers, and G-CSF against cardiotoxicity in breast cancer patients who received anthracycline and trastuzumab without well-known cardiac risk factors (>70 years old, valvular disease, diabetes, radiation therapy to left breast, and cumulative epirubicin dose >900 mg/m2).
Methods: A questionnaire on the usage of ACEI, beta-blockers, and G-CSF in patients with chemotherapy-induced cardiotoxicity (reduced left ventricular ejection fraction [LVEF] <50 % or discontinuance of cardiotoxic chemotherapy due to decreasing LVEF) was sent to 44 institutions. The same questionnaire was sent to matched controls. Patients with well-known cardiac risk factors who received either anthracycline or trastuzumab were excluded from the analysis.
Results: Data for 24 patients with cardiotoxicity from 10 institutions and for controls from 7 institutions were obtained. Cardiotoxicity patients without well-known cardiac risk factors were defined as the cardiotoxicity group (n = 13). No difference was noted for age, cumulative epirubicin dose, and ACEI and beta-blocker usage between the cardiotoxicity group and the controls. A trend for a higher cumulative dose of G-CSF was evident among the controls (Figure).
Conclusions: G-CSF might have a cardioprotective effect. A further prospective study, ideally double-blinded randomized, is necessary to confirm this finding.
MASCC-0780
Symptoms and needs of neurooncological palliative care patients—the physicians’ perspective
E. Heilmann1, H. Rock1, F. Nauck2, H. Strik 1
1Neurology, Philipps University, Marburg, Germany, 2Palliative Care, Georg August University, Goettingen, Germany
Introduction: Symptoms and needs in the terminal phase of life of neurooncological patients and of patients with systemic cancer are different.
Objectives: Specific symptoms and distress of neurooncological patients and their caregivers were assessed with a survey among treating physicians.
Methods: Forty-six palliative-care physicians of various specializations in out- and inpatient instutions were asked with questionnaires for most frequent symptoms and distress-causing factors during the last phase of life of neurooncological patients.
Results: Palliative care structures were most often contacted earlier during the course of the disease (48 %) than directly at the beginning of the palliative care phase (39 %). General weakness, pain and nausea were regarded to be the three most frequent general symptoms, followed by therapy-induced symptoms—most often steroid-induced. Paresis, loss of cognitive functions and anxiety were named to be the three most frequent neurological symptoms. Depression was valued to be the most frequent psychiatric symptom, while paranoid symptoms and suicidal tendency were less frequent. The time needed by caregivers was estimated to be more than 20 % or even more than 50 % of the daily awake time. The direct financial burden for families was estimated intermediate, indirect burden as high.
Conclusions: The survey presented here indicates a number of specific symptoms during the terminal phase of neurooncological disease with a high incidence of psychiatric symptoms. The financial and time burden of the caring families is estimated intermediate to high. An extension of the survey to a larger number of colleagues and a parallel survey among caregivers is warranted.
MASCC-0781
GSTP1 EXON 5 polymorphism in colorectal cancer outcome using HYB-probe real-time PRC
M. Aghajany-Nasab 1, S. Samiee2, A. Movahedian3, M. Panjehpour3
1Biochemistry, Guilan Uni. of Medical Sci., Rasht, Iran, 2Biochemistry, Food and Drug Laboratory Research Center Ministry of Health and Medical Education, Tehran, Iran, 3Clinical Biochemistry, School of Pharmacy and Pharmaceutical Sciences Isfahan University of Medical Sciences, Isfahan, Iran
Introduction: Glutathione S-transferases (GSTs) play important role in cellular detoxification (1). The GSTP1 gene encods a protein of 209 amino acids(2).
There are ethnic variations in GSTP1 genotypes frequency which were investigated mainly by use of conventional PCR and follow by RFLP(3,4).
Objectives: The aim of this study was to evaluate the frequency of of the polymorphisms of GSTP1 result in amino acid substitutions in codons 104 (Ile/Val). GSTP1 single nucleotide polymorphism frequencies were done using probe-based real-time PCR as a one-step and reliable method to compare with other studies.
Methods: Genomic DNA was extracted from blood of colorectal cencer and normal individuals and amplified in LightCycler instrument. A set of hybridization probes and melting curve analysis were used for identification of amplified fragments
Results: The frequency of GSTP1 Ile/Ile was 21.7 % in left-sided tumors versus 48.7 % in rectal tumors, although it is different but didn’t reach to significant level (X 2 = 0.55, P value = 0.5, df = 1).No significant association between the GSTP1 genotypes was shown when tumor sites are considered as a colorectal outcome.
No significant trend was observed between GSTP1 Ile/Val genotype and tumor differentiation but there was a trend of increasing incidence of moderately differentiated tumors in GSTP1 Val/Val genotype individuals, OR = 3.35, 95%CI = 1.05–10.73.
Conclusions: GSTP1 may play a role in differentiation of colorectal tumors that need to confirm by further studies.
References:
1-Grando JP, Kuasne H. Clin Exp Med 2009; 9:21–8.
2-Griffiths-Jones, S., Khanna. Nucleic Acids Res.2004:, 32; D138–141.
3-Gurbben M.J.A.L., Braak C.C.M., Nagengast F.M., Peters W. Eur. J. Investigation 2006,36:188–192
MASCC-0782
Adherence to G-CSF-guidelines to prevent febrile neutropenia—a sample survey in Germany
H. Link 1, J. Nietsch2, M. Kerkmann2
1Internal Medicine I, Westpfalz-Klinikum, Kaiserslautern, Germany, 2MMF, MMF, Dortmund, Germany
Introduction: Primary G-CSF prophylaxis after chemotherapy is recommended in guidelines (GL), if the risk of febrile neutropenia (FN) is high (≥20 %), or intermediate (≥ 10 %–20 %) in case of additional risk factors.
Objectives: The aim of this sample survey was to evaluate, if G-CSF is used as proposed by GL, to identify determinants of GL implementation and adherence, and to analyze the oncologists’ behavior.
Methods: The sample size was calculated at 2 % of the incidence of malignant lymphoma, breast and lung cancer in Germany.
One thousand nine hundred twenty-eight patients who had received 3–9 cycles of chemotherapy with a FN risk ≥10 % were documented.
Results:
Lymphoma pts % | Lung cancer pts % | Breast cancer pts % | ||
Adherence to G-CSF GL | FN high risk chemotherapy 1st/2nd/3rd cycles | 82,4/77,8/82,9 | 11,1/13,3/15,5 | 72,6/77,4/78,3 |
FN intermediate risk chemotherapy 1st/2nd/3rd cycles | 71,2/67,9/70,8 | 26,8/29,3/31,2 | 69,3/69,9/71,5 | |
Physicians compliance with the EORTC G-CSF GL in high/intermediate FN-risk, Chemotherapy cycles % | 84,2/68,9 | 13,9/27,3 | 76,3/67,6 | |
Conclusions: Patient risk factors are underestimated therefore resulting in a possible underuse of G-CSF. Physicians may underestimate FN risk in pts who have an intermediate risk of FN and they overestimate their adherence to the GL.
MASCC-0783
Quality of life and physical activity in polish breast cancer survivors after 5 years of treatment
K. Hojan 1, O. Ozga-Majchrzak1, P. Milecki2
1Of Rehabilitation, Greater Poland Cancer Centre, Poznan, Poland, 2Chair and Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
Introduction: Physical activity is an important factor in prevention many disorders (including cancer). After breast cancer treatment in women is commonly used rehabilitation aimed at reducing the consequences of cancer treatment and improve quality of life.
Objectives: An assessment of physical activity and quality of life among polish women over 5 years from breast cancer treatment.
Methods: The study was conducted on 88 women (mean age 63,2 years old) after breast cancer treatment. The assessment of physical activity were used by Godin Leisure-Time Exercise Questionnaire and quality of life questionnaires using EORTC questionnaires (QLQ-C30, QLQ-BR23).
Results: 45.6 % of the women resulted in physical activity of low intensity (without fatigue during exercise), most of which were mild exercises (yoga, free fighting, bowling), while moderate exercise group ran 25.5 % of women (tennis, swimming, cycling, aerobics). 28.4 % of women did not perform any regular physical exercise. The mean ofTotal Quality of Life scale was 58 points. including functional score of 72 points.
Conclusions: Along the time from the end of breast cancer treatment in women lead less physical activity. This may result in reduced assessment the quality of life, especially by reducing the overall functional scale. Therefore, in order to increase cancer prevention and improving the quality of life should be made a regular meeting increasing physical activity in this group of patients.
References: Andrykowski MA, Beacham AO, Jacobsen PB. Prospective, longitudinal study of leisure-time exercise in women with early-stage breast cancer. Cancer Epidemiol Biomarkers Prev. 2007;16(3):430–8.
MASCC-0784
Safety and tolerability of lipegfilgrastim in breast cancer patients receiving chemotherapy: an integrated analysis of phase II and III studies
O. Gladkov 1, R. Elsaesser2, A. Buchner3, P. Bias3
1Oncology, Chelyabinsk Regional Clinical Oncology Dispensary, Chelyabinsk, Russia, 2Innovative R&D and Biosimilar, Teva ratiopharm, Ulm, Germany, 3Biosimilars, Teva ratiopharm, Ulm, Germany
Introduction: Lipegfilgrastim is a long-acting glycoPEGylated granulocyte-colony stimulating factor (G-CSF) under review for the prevention of neutropenia in cancer patients receiving chemotherapy (CTx).
Objectives: To report the safety and tolerability findings from an integrated analysis of two Phase II/III studies of lipegfilgrastim versus pegfilgrastim (Neulasta®) in CTx-naïve breast cancer patients.
Methods: All patients who received full-dose CTx (doxorubicin 60 mg/m2 + docetaxel 75 mg/m2) and either a single 6 mg s.c. injection of lipegfilgrastim or pegfilgrastim were included in this analysis. The incidence and severity of treatment-emergent adverse events (TEAEs) and those the investigator deemed related to study drug (TEADRs) over all 4 cycles were compared.
Results: TEAEs were consistent with the underlying medical condition and administration of CTx. Type, incidence, and severity of TEADRs are provided in the Table.
AE category, n (%) | Lipegfilgrastim 6 mg ( n = 151) | Pegfilgrastim 6 mg ( n = 155) |
· Any TEAE | 143 (94.7) | 138 (89.0) |
· TEADR | 46 (30.5) | 49 (31.6) |
· Serious TEADR | 2 (1.3) | 1 (0.6) |
· Severe TEADR | 1 (0.7) | 2 (1.3) |
· Death due to TEADR | 0 (0.0) | 0 (0.0) |
Most frequent TEAEs* | ||
· Alopecia | 120 (79.5) | 109 (70.3) |
· Nausea | 83 (55.0) | 76 (49.0) |
· Asthenia | 42 (27.8) | 38 (24.5) |
· Neutropenia | 30 (19.9) | 35 (22.6) |
· Bone pain | 24 (15.9) | 22 (14.2) |
· Diarrhea | 23 (15.2) | 19 (12.3) |
*Preferred term ≥15 % in any cohort
Conclusions: Lipegfilgrastim has a favorable safety profile consistent with the G-CSF class of molecules and is an acceptable alternative to pegfilgrastim for the prevention of neutropenia in cancer patients receiving chemotherapy.
MASCC-0785
The effect of breast prostheses on changes in paraspinal muscle bioelectrical activity in postmastectomy women
K. Hojan 1, F. Manikowska2, P.B. Chen2
1Of Rehabilitation, Greater Poland Cancer Centre, Poznan, Poland, 2Of Pediatrics Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
Introduction: External breast prostheses is an important part of improving static and kinematic trunk and shoulder as well as the quality of life in post-mastectomy women. Improper selection is the cause of the disorder of posture and back pain occurrence.
Objectives: Assessment of changes in erector spine activity in women after mastectomy and the impact of different types of external breast prostheses on the outside activity.
Methods: To the study were included 86 survivors after one side mastectomy. From the study were excluded patients with rheumatic diseases, trauma and spinal metastases. The study of bioelectric activity of muscles of the spine were performed using MyoTrace 400 (Noraxon, US) in accordance with the guidelines of the project SENIAM. Measurements prostheses were made of various weight using functional test for the lumbar spine.
Results: With the following months of mastectomy were observed increasing difference between muscle activity on right and left side of erector spine.
The introduction of external breast prostheses caused symmetry in bioelectric activity of muscles of the spine.
Conclusions: The use of breast prostheses for post-mastectomy women is an important factor in the improvement of static and kinematic body which can significantly reduce the likelihood of postural disorders and back pain.
References: 1.Glaus SW, Carlson GW. Long-term role of external breast prostheses after total mastectomy. Breast J. 2009;15(4):385–393.2.Piot-Ziegler C, Sassi ML, Raffoul W, et al. Mastectomy, body deconstruction, and impact on identity: a qualitative study. Br J Health Psychol. 2010;15(3):479–510.
MASCC-0786
Efficacy and safety of the granisetron transdermal system for chemotherapy-induced nausea and vomiting in elderly patients
D. Braccia 1, J. Howell2
1Medical Affairs, ProStrakan Inc, Bridgewater, USA, 2Clinical Development, ProStrakan Inc, Bridgewater, USA
Introduction: A previously reported phase 3 clinical study compared the efficacy and safety of a novel transdermal formulation of granisetron (the granisetron transdermal system [GTS]) with oral granisetron for preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately emetogenic and highly emetogenic multi-day chemotherapy (NCT00273468).
Objectives: The objectives of this retrospective analysis were to examine the efficacy and safety of GTS for CINV in various age groups, including elderly patients ≥65 years of age.
Methods: This was a phase 3, double-blind, placebo-controlled, non-inferiority study. Patients were randomized to oral (2 mg/day, 3–5 days) or transdermal granisetron (one GTS patch, 7 days), before receiving multi-day chemotherapy. The primary endpoint was complete control of CINV (CC; defined as no vomiting and/or retching, no more than mild nausea, and no rescue medication) from chemotherapy initiation until 24 h after the start of the last day’s chemotherapy.
Results: A total of 582 patients were included in the preliminary sub-analysis; 136 patients ≥65 years of age, 253 patients 50–64 years of age, and 193 patients <50 years of age. CC was similar between the GTS and oral treatment groups for all age groups, and was maintained irrespective of increasing age (Figure). GTS was well tolerated in all age groups, including elderly patients.
Conclusions: Based on a preliminary sub-analysis of a phase 3 study, the GTS was found to be safe and effective in various age groups, including elderly patients ≥65 years of age.
MASCC-0787
Effects of body mass index on the efficacy and pharmacokinetics of granisetron transdermal system
J. Gilmore 1, S. Haislip1, D. Braccia2
1Research Department, Georgia Cancer Specialists, Atlanta, USA, 2Medical Affairs, ProStrakan Inc, Bridgewater, USA
Introduction: Granisetron transdermal system (GTS) is indicated for the prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately or highly emetogenic chemotherapy for up to 5 consecutive days.
Objectives: Data from a single-center, open-label, phase 1 study (NCT00868764) and a double-blind, placebo-controlled phase 3 study (NCT00273468) were analyzed to determine effects of body mass index (BMI) on GTS pharmacokinetics and efficacy.
Methods: In the phase 1 study, GTS (3.1 mg/24 h) was applied for 7 days; pharmacokinetic testing occurred 8 h after application on Day 1 and for ≤9 days thereafter. In the phase 3 study, patients were randomized to oral (2 mg/day, 3–5 days) or transdermal granisetron (one GTS patch, 7 days), before receiving multi-day chemotherapy. The primary endpoint was complete control of CINV (CC; no vomiting/retching, no more than mild nausea, no rescue medication) from chemotherapy initiation until 24 h after final administration.
Results: In the phase 1 study, 30 healthy volunteers were divided by BMI <19.5 kg/m2 in men or <18.5 kg/m2 in women (n = 12), 30.0–39.9 kg/m2 (n = 12), and 20.0–24.9 kg/m2 (n = 6). No significant correlations were noted with BMI for maximum granisetron plasma concentration (Cmax), area under the concentration-time curve (time 0 to time point of last quantifiable concentration, AUC[0-z]), or average granisetron plasma concentration (Cavg24-168). An on-going sub-analysis of the phase 3 study will assess the impact of BMI on CC.
Conclusions: BMI does not affect GTS pharmacokinetics. Final results presented in a late-breaking abstract will examine the impact of BMI on GTS efficacy.
MASCC-0788
Comparison of the transdermal granisetron patch to oral granisetron for controlling chemotherapy-induced nausea and vomiting (CINV) in multi-day chemotherapeutic regimens for breast cancer patients
A. Brufsky 1
1Hematology/Oncology, UPMC Cancer Center Magee-Womens Hospital, Pittsburgh, USA
Introduction: While the granisetron transdermal system (GTS) is as effective as oral granisetron (OG) in controlling multi-day CINV across multiple tumor types, it is not clear if this is also true for individual tumor subsets such as breast cancer.
Objectives: To compare the rates of complete control (CC; no vomiting, mild nausea, no rescue medication), complete response (CR; no vomiting, no rescue medication), and need for rescue medication in a post-hoc subset analysis of breast cancer patients using either GTS or OG.
Methods: We conducted a randomized, active control, double-blind, parallel-group, phase 3 study (clinicaltrial.gov identifier: NCT00273468). Patients receiving either moderately or highly emetogenic chemotherapy (emetogenic potential of level 3–5 by Hesketh classification) for 3–5 days were randomized to either GTS (7 day application) or OG (2 mg/day). Data for this analysis were limited to patients with ‘breast’ listed as the primary tumor. Descriptive data are reported.
Results: The number of patients with metastatic breast cancer was similar between treatment arms. More GTS patients achieved overall CC and CR than in the OG group. Fewer GTS patients required rescue medication.
N | Complete control | Complete response | Rescue medication use | Metastatic breast cancer | |
Patch | 30 | 21/30 (70.0 %) | 21/30 (70.0 %) | 4/30 (13.3 %) | 13/30 (43.3 %) |
Oral | 35 | 17/35 (48.6 %) | 18/35 (51.4 %) | 9/35 (25.7 %) | 14/35 (40.0 %) |
Conclusions: This post-hoc subset analysis suggests that GTS may be more effective in treating multi-day CINV in breast cancer patients than OG. Statistical analyses for a late-breaking abstract will examine these findings, as well as differences in CINV risk factors (therapy duration, chemotherapy regimen, chemotherapy naivety, age), type and frequency of adverse events, and global satisfaction.
MASCC-0789
Types of quality of life trajectories and related factors in advanced lung cancer patients—exploration the first 6 months QOL from cancer diagnosis
Y.H. Lai 1, Y.C. Liao2, Y.H. Lee1, W.Y. Liao1, S.C. Shun1, C.J. Yu1, P.C. Yang1
1College of Medicine, National Taiwan University, Taipei, Taiwan, 2Department of Nursing, Yuanpei University, Hsinchu, Taiwan
Introduction: Quality of life (QOL) is one of the major indicators to reflect cancer patients’ condition. Limited information has been reported about the different types of QOL trajectories.
Objectives: Explore the potential types of QOL trajectories in advanced lung cancer patients during the first 6 month of diagnosis and related factors.
Methods: A prospective longitudinal study with 4 times of patient assessments (pre-treatment, 1, 3, 6 months from receiving first treatments, T1-T4) was conducted in a medical center in Taiwan. QOL trajectory was measured by the overall QOL item from the EORTC-QLQ-C30. Physical function, symptoms, depression, uncertainty and self-efficacy (confidence) in coping with cancer were assessed as potential related factors to predict each QOL. The Latent Class Growth Analysis (LCGA) was used to identify the potential QOL types.
Results: A total of 170 patients were recruited with types of QOL trajectories being identified. The first QOL type covered 41.8 % of patients which represented a “declining form moderate level of QOL to lower QOL and then back to moderate levels of QOL”. The second type of QOL covered those patients with higher level of QOL (19.6 %). The third type of QOL represented those patients with “steadily moderate level of QOL (39.6 %). Overall, physical function, pain, poor appetite, uncertainty, depression and self efficacy were those factors identified to most of these different types of QOL trajectories.
Conclusions: Tailoring interventions should be applied and tested of their effects on patients with different types of QOL. Acknowledgement National Health Research Institute (NHRI) in Taiwan.
MASCC-0790
Factors contributing to elevated distress in caregivers of individuals with head and neck cancer
C.C. Bornbaum 1, P.C. Doyle1, K. Fung2, J. Franklin2, A. Nichols2, J. Yoo2
1Health & Rehabilitation Sciences, The University of Western Ontario, London, Canada, 2Department of Otolaryngology - Head & Neck Surgery, London Health Sciences Centre The University of Western Ontario, London, Canada
Introduction: Head and neck cancer (HNC) presents a distinct set of challenges as treatment often results in deficits related to swallowing, communication and participation in daily activities. These challenges may create a crisis for not only those being treated, but also for their caregiver(s). The caregiver often plays a crucial role in the patient’s ability to address myriad concerns related to his/her disease and treatment.
Objectives: This study investigated the impact of HNC on caregiver quality of life (QOL) and perceived levels of distress.
Methods: The study was a cross-sectional, self-report, survey design. Adult participants (n = 117) completed questionnaires including the Distress Thermometer to measure distress, and the Caregiver Quality of Life Index—Cancer Scale to measure caregiver-specific QOL. Associations between these outcome measures and caregiver characteristics were assessed. Patient characteristics were used to predict caregiver distress.
Results: Elevated distress was observed among 45.2 % of participants and QOL concerns appeared related to elevated rates of caregiver distress (r = –0.533, p = 0.000). Data indicate that perceived level of burden (r = −0.631, p = 0.000) and disruptiveness to one’s life (r = −0.471, p = 0.000) were most distressing for caregivers. Further, caregivers of individuals undergoing active treatment were 5 times as likely to experience distress as those with loved ones not currently in active treatment (OR = 5.206, CI = 1.939–13.977).
Conclusions: Our findings support the growing evidence that not only the patient, but also members of his/her family are the appropriate recipients of comprehensive care. Additionally, caregiver distress screening during active treatment of individuals with HNC may provide an effective means of identifying distressed caregivers.
MASCC-0791
Brief behavioral therapy for insomnia (BBT-I) in breast cancer (BC) during chemotherapy: a randomized pilot study
O. Palesh 1, P. Innominato2, K. Mustian3, M. Janelsins3, E. Neri1, C. Koopman1, D. Spiegel1, G. Morrow3
1Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA, 2INSERM U, Hôpital Paul Brousse, Paris, France, 3Radiation Oncology, University of Rochester, Rochester, USA
Introduction: Up to 80 % of cancer patients will experience insomnia symptoms during chemotherapy. Current treatments are sometimes burdensome and sleep medications may have side effects.
Objectives: To examine the feasibility and acceptability and preliminary evidence regarding the efficacy of BBT-I, a brief form of Cognitive Behavioral Therapy for Insomnia adapted to BC patients receiving chemotherapy.
Methods: Forty-six BC patients (mean age = 50, SD = 7.9; 67 % Caucasian, 15 % Asian) who reported insomnia symptoms were randomized to either receive BBT-I (2 face to face sessions + 4 phone calls, 6 weeks) or a Sleep Hygiene Brochure (SHB). Patients completed the Insomnia Severity Index (ISI) at baseline, at the end of intervention (6 weeks), and 1-month post-intervention (10 weeks).
Results
Research: Hierarchical linear modeling analyses showed that patients who received BBT-I exhibited a clinically and statistically significant overall improvement in their symptoms, compared to those receiving SHB at 6 and 10 weeks p = 0.027, (Cohen’s d = 0.35 at 6 weeks and d = 0.43 at 10 weeks). At 10 weeks, only 12.5 % of the BBT-I still met insomnia criteria, compared to 60 % of the SHB condition. 83.3 % of patients who received BBT-I found it to be helpful for improving insomnia compared to 36.4 % in the SHB condition (p < .001). 80 % of patients who received BBT-I would recommend the intervention to others, compared to 54.6 % who received the SHB (p = 0.04).
Conclusions: BBT-I is an acceptable and feasible intervention for BC patients receiving chemotherapy that may improve insomnia. Further confirmatory studies are warranted to confirm the efficacy of BBT-I in ameliorating insomnia. NCI K07CA132916.
MASCC-0792
Chemotherapy-induced peripheral neuropathy: a new treatment option
J. Koerber 1, T. Vogt.2, B. Kaden3
1Internal Medicine, Klinik Nahetal, Bad Kreuznach, Germany, 2Neurology, Klinik und Poliklinik für Neurologie U Mainz, Mainz, Germany, 3Internal Medicine, Klinik Nordfriesland, Sankt Peter Ording, Germany
Introduction: Neurotoxic side effects of chemotherapy occur freuquently. Neuropathies cannot be treated and protective treatment strategies have not been effective.
Objectives: We developed a new treatment for therapy of drug induced peripheral neuropathy.
Methods: A total of 401 cancer patients (28%male, 72 % female, 38.4 % of patients had breast cancer, 22.4 % cancer of GI tract, 12.4 % Lymphoma) after chemotherapy in remission or stable partial remission were included into this prospective study. Patients with other causes of neuropathy were excluded. All patients underwent at admission (day1) and after therapy (day 20) a scripted interview and clinical examination. Patients had symptoms like paresthesias, numbness, tingling or pain in fingers and/or feet. Patients received 6 units of special ergotherapy, physiotherapy, high-frequency transcutaneous etectrical stimulation and alternative cold and warm foot bath in the follwing 2 weeks. Classifcation of results: severe, medium, low and none.
Results: 366 of 401 patients underwent all units. (nb/patients,%).
Symptoms | severe | medium | low | none |
Paresthesia | ||||
day 1 | 306(76.9) | 62(15.6) | 29(7.3 %) | 1 |
day 20 | 56(16.7 %) | 82(24.4 %) | 81(24.2 %) | 116(34.6 %) |
Tingling | ||||
day 1 | 79(24.6 %) | 101(31.5 %) | 51(15.9 %) | 90(28 %) |
day 20 | 20(6.3 %) | 43(13.6 %) | 54(17.1 %) | 199(63 %) |
Pain | ||||
day 1 | 49(13.5 %) | 91(25.1 %) | 95(26.2 %) | 128(35.3 %) |
day 20 | 38(11 %) | 62(17.9 %) | 59(17 %) | 188(54.2 %) |
Ataxia | ||||
day 1 | 91(26.1 %) | 76(21.8 %) | 71(20.3 %) | 111(31.8 %) |
day 20 | 23(6.6 %) | 67(19.2 %) | 107(30.4 %) | 152(43.6 %) |
Vibratory sensitivity (scale 0–4 are pathologic, 5–8 are normal) decreased in patients toes 166 (41.8 %) at day 1 and 133 (34.4 %) at day 20.
Conclusions: Non-drug treatment improves symptoms, ataxia and vibratory sensitivity in patients with chemotherapy-induced neuropathy.
References: VerstappenC.P.,(2003): Neurotoxic complications of chemotherapy in patients with cancer. Drugs;63;1549–1653
MASCC-0793
The role of an integrative oncology program in the care of lung cancer patients
T. Tran 1, G. Kasymjanova1, N. Swinton1, D. Vales1, F. Manceau1, T. Jagoe2, J. Agulnik1
1The Peter Brojde Lung Cancer Centre, Jewish General Hospital, Montreal, Canada, 2Cancer Nutrition Rehabilitation, Jewish General Hospital, Montreal, Canada
Introduction: Weight loss, fatigue and symptom distress correlate negatively with health-related QoL and functional status in lung cancer patients. Exercise, nutrition, acupuncture and relaxation techniques to maximise potential mind-body interactions and optimise symptom control and function have recently being used.
Objectives: We investigated the impact of these modalities in improving symptoms, physical function and well-being in lung cancer patients.
Methods: Sixteen patients attending the Peter Brojde Lung Cancer Centre Integrative Oncology clinic were evaluated. Each patient received acupuncture, physiotherapy and instruction in breathing relaxation techniques 1–2 times/week as well as nutritional counselling at baseline. Assessments were performed at baseline, 6 and 12 weeks which included Edmonton Symptom Assessment System (ESAS), 6-minute walk test (6MWT), sit-to-stand test (STS) and body weight.
Results: Sixteen patients (5 M, 11 F), mean age 62 (47–82) years with histologically confirmed adenocarcinoma (14), squamous carcinoma (1), or sarcomatoid carcinoma (1), stages 1A/2B (7), 3A/3B (6), 4 (3). 8/16 received acupuncture during their treatment. 8/16 after completion of standard treatment. Significant improvement was observed in symptoms of fatigue, strength, overall QoL and well-being (p < 0.05). Objective tests showed improvements in mean in 6MWT (from 413 m to 471 m (p = 0.005)), STS (from 4.3 s. to 3.4 s. (p = 0.004)) and weight (from 69.7 kg to 71.2 kg (p = .039)).
Conclusions: Our results show that a multimodal integrated program using nutrition, exercise, acupuncture and relaxation techniques is feasible in a mixed population of lung cancer patients. The improvements are encouraging, but further studies are needed to validate the impact of this approach in patients at different stages of their disease trajectory.
MASCC-0794
YOCAS©® Yoga: improved memory and memory-mediated improvements in fatigue and quality of life (QOL) in a nationwide phase III RCT
M. Janelsins 1, L. Peppone1, C. Heckler1, L. Sprod2, S. Mohile3, G. Morrow1, K. Mustian1
1Radiation Oncology, University of Rochester, Rochester, USA, 2Health and Applied Human Sciences, University of North Carolina, Wilmington, USA, 3Medical Oncology, University of Rochester, Rochester, USA
Introduction: Fatigue and cognitive difficulties are related and significant side effects of cancer treatments in which effective interventions are needed. The University of Rochester Cancer Center (URCC) Community Clinical Oncology Program (CCOP) and 23 affiliate CCOPs previously showed that YOCAS©® yoga significantly improved fatigue and QOL in cancer survivors.
Objectives: The current analyses assess the effects of YOCAS©® on memory and possible YOCAS©®-mediated effects of memory on fatigue and QOL.
Methods: Survivors between 2 and 24 months post adjuvant therapy were randomized to standard care (SC) or YOCAS©® (75 min./session; 2/week for 4 weeks) + SC. YOCAS©® includes breathing exercises, gentle Hatha and Restorative yoga postures and meditation. Participants (N = 358, mean age = 54, 75 % breast cancer) who provided pre-and post-intervention data on difficulty remembering things (MD Anderson Symptom Inventory), fatigue, and QOL (FACIT-F) were included. ANCOVA was used to determine the effects of YOCAS©® on memory at post-intervention. Path Modeling assessed mediating effects of memory on YOCAS©®-produced changes in fatigue and QOL.
Results: ANCOVA, controlling for demographic, and baseline memory and sleep scores, revealed a significant group effect of YOCAS©® on memory difficulty at post intervention (mean change: Yoga - Control = −0.44; p < 0.05) representing a 19.2 % improvement in the yoga group compared to a 5.4 % improvement in the control group. Mediation analyses identified changes in memory as a significant partial mediator for improved fatigue (p < 0.05) and QOL (p < 0.05).
Conclusions: YOCAS©® significantly reduces perceived memory difficulty in cancer survivors compared to SC; improved memory partially mediates improvements on fatigue and QOL.
References
Funding:U10CA37420, K07CA120025
MASCC-0795
Post-traumatic growth and social identification: a longitudinal study on liver transplant patients
M. Scrignaro 1, F. Sani2, E. Bianchi3, L. Gangeri3, V. Mazzaferro4, M.E. Magrin5
1Psychology, Università degli Studi di Milano-Bicocca, Milano, Italy, 2Psychology, University of Dundee, Dundee, United Kingdom, 3Psychology, IRCCS Foundation National Cancer Institute, Milan, Italy, 4Gastrointestinal and Hepato-Pancreatic Surgery and Liver Transplantation Unit, IRCCS Foundation National Cancer Institute, Milan, Italy, 5Psychology, Università degli Studi di Milano-Bicocca, Milan, Italy
Introduction: A growing literature documents that positive psychological changes may accompany the experience of cancer (Park et al., 2010) and defines them posttraumatic growth (Tedeschi & Calhoun, 2004). Further a recent literature on social identification and health (Haslam, 2009) highlighted the role of social capital as resilience resources.
Objectives: The aim was to verify the presence of growth in a group of liver transplant patients, Further, the casual relationship between the PTG scores and the social identification with liver transplant people has been tested.
Methods: A longitudinal study was conducted with a group of 170 liver transplant patients. Data were collected by means of a written questionnaire, at two time points (T1 and T29 that were 24 months apart. The questionnaire was composed by the Post-traumatic Growth Inventory (Tedeschi, Calhoun, 2004), and by the Family In-group identification scale (Doosje et al., 1995).
Results: Results show that the 35 % of patients grew highly and the 35 % grew moderately. The positive changes included an increased appreciation for life, an increased sense of personal strength, changed priorities, and a richer existential life. Further, we tested a cross-lagged model including PTG T1 and T2, and family identification T1 and T2, using structural equation modelling. This revealed an excellent fit of the model: χ 2 (1) = .91, ns; CFI = 1.00; RMSEA = .00, and confirmed that PTG exerted a significant effect on family identification over time but not vice-versa
Conclusions: The growth’s process fosters a crucial social resilience resources highlighting its salutogenic nature.
MASCC-0796
Parenteral nutrition surveyx
R. Simanek1, K. Nestor2, F. Bozzetti3, M. Chasen4, K. Fearon5, A. Jatoi6, S. Lundstöm7, M. Muscaritoli8, Y. Orrevall9, H. Watzke10, F. Strasser 2
15th Medical Department with Oncology and Palliative Care Unit, Hietzing Hospital, Wien, Austria, 2Department of Internal Medicine and Palliative Care Centre, Kanton Hospital St. Gallen, St. Gallen, Switzerland, 3Faculty of Medicine, University of Milan, Milan, Italy, 4Division of Palliative Care, University of Ottawa, Ottawa, Canada, 5Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom, 6Department of Medicine, Mayo Clinic, Minnesota, USA, 7Department of Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden, 8Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy, 9Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden, 10Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
Introduction: The role of parenteral nutrition (PN) in patients with incurable cancer and malignant bowel obstruction remains controversial.
Objectives: We aim to investigate current practice of PN by surveying selected groups from ESMO (ESMO-designated centers of integrated oncology & palliative care), MASCC (nutrition working group), ESPEN (special interest groups PN and cachexia) and EAPC.
Methods: Internet-based survey of clinicans with substantial involvement in decisions on PN in patients with malignant bowel obstruction. Two comprehensive case-vignettes explore participants’ views about indications for and goals of PN, their current practice (e.g., application, monitoring, setting), and outcomes. The analysis of the 113 categorical and open questions is descriptive.
Results: Between December 2012 and October 2012 the survey was accessed 143 times, 81 participants (56.6 %) completed the survey. Most of the participants were medical oncologist (34.5 %), palliative medicine specialists (26.4 %) and nutritionists (17.3 %) with a large experience treating patients with incurable cancer disease (> 10 years, 81.7 %). Frequently named conditions to decide about starting PN were knowledge about patient preferences (>90 %), life expectancy (>80 %), followed by physical function and comorbidities. As life expectancy (>3 months, 73 %) and Karnofsky Index (>50, 89 %) the definition of cachexia stages supported up to 66 % of the participants in their decision on PN, only 14 % would deliver PN in patients with refractory cachexia. Sixty percent ranked quality of life improvement as very important goal of PN, infections are the most common expected side effect (by 61 %).
Conclusions: Our data will allow catalyzing data-driven consensus processes leading to updated, multiprofessional guidelines.
MASCC-0797
Trajectories of social isolation in adult survivors of childhood cancer
A.F. Howard 1, J. Tan de Bibiana1, K. Smillie1, K. Goddard2, S. Pritchard3, R. Olson4, A. Kazanjian1
1School of Population and Public Health, University of British Columbia, Vancouver, Canada, 2Department of Radiation Oncology, BC Cancer Agency, Vancouver, Canada, 3Division of Hematology/Oncology, BC Children’s Hospital, Vancouver, Canada, 4Department of Surgery, University of British Columbia, Vancouver, Canada
Introduction: Long-term childhood cancer survivors may be at increased risk for poor social outcomes as a result of their cancer treatment, as well as physical and psychological health problems. Yet, important challenges, namely social isolation, are not well understood. Moreover, survivors’ perspectives of social isolation as well as the ways in which this might evolve through young adulthood have yet to be investigated.
Objectives: The purpose of this research was to describe the trajectories of social isolation experienced by adult survivors of a childhood cancer.
Methods: Data from 30 in-depth interviews with survivors were analyzed using qualitative, constant comparative Methods.
Results: Experiences of social isolation evolved over time as survivors grew through childhood, adolescence and young adulthood. Eleven survivors never experienced social isolation after their cancer treatment, nor to the present day. Social isolation among 19 survivors followed one of three trajectories; (1) diminishing social isolation: it got somewhat better, (2) persistent social isolation: it never got better, or (3) late and progressive social isolation: it hit me later on.
Conclusions: Knowledge of when social isolation begins and how it evolves over time for different survivors is an important consideration for the development of interventions that prevent or mitigate this challenge.
MASCC-0798
The attitudes of cancer patients about morphine usage for pain management
D. Çolak 1, A. Oguz2, D. Yazilitas3, G.I. Imamoglu1, M. Altinbas1
1Medical Oncology, Diskapi Yildirim Beyazit Education and Reserach Hospital, Ankara, Turkey, 2Medical Oncology, Kayseri Education and Research Hospital, Kayseri, Turkey, 3Medical Oncology, Konya Education and Research Hospital, Konya, Turkey
Introduction: Pain is a highly prevalent symptom and often a cause for severe distress in patients with cancer. In management of cancer pain, opioids have a special role.
Objectives: In Muslim majority countries opioid usage for pain management is low. Obstacles preventing opioid usage for pain management are not well defined.
In this study we aimed to study the attitude of the cancer patients about morphine usage for pain management and the factors that influence their decision to accept or refuse morphine to treat cancer pain.
Methods: Cancer patients were questioned if they had pain or not, the severity of the pain, their knowledge about morphine, what would be their decision if morphine was needed for pain management and their reasons if they were against to morphine usage.
Results: Of 488 patients, 217 had breast, 97 colorectal, 63 gastric, 37 lung cancer. The stages were; 180 early stage, 130 locally advanced and 171 metastatic.
The age (0,010) and the gender (0,038) and the knowledge about morphine had a statistically significant effect onthe preference of the patients (p = 0,000). The patients who definedmorphine as narcotic were less likely to use morphine (p = 0,015). There was no relationship between the patients’ preference and the diagnosis (p = 0.247), the stage (p = 0,552), the education status (p = 0,112) and the pain.
Conclusions: The risk of addiction to opioids remains a major obstacle preventing effective pain management.
MASCC-0799
Impact of socioeconomic status (SES) on the relationship between physical activity (PA) and sleep among children with cancer
A.D. Orsey 1, T.L. Ruiz BS2, D.B. Wakefield MS3
1Hematology/Oncology, Connecticut Children’s, Hartford, USA, 2Clinical Trials Unit, Connecticut Children’s, Hartford, USA, 3Center for Public Health & Health Policy, University of Connecticut Health Center, Farmington, USA
Introduction: Compared to healthy children, pediatric oncology patients have impaired sleep and less PA. Greater PA is associated with improved sleep.
Objectives: To examine the relationship of SES with sleep and PA measures in pediatric oncology patients.
Methods: Between 11/12/09 and 01/03/13, 45 pediatric oncology patients between 8 and 18 years of age completed the study. PA and sleep were assessed by actigraphy and diaries collected over 7 days. Fatigue was assessed using the Fatigue Scale1. SES was assessed by primary payer status: Medicaid (n = 16) or private (n = 28), and zip code median annual household income: <$70 K (n = 20) and >=$70 k (n = 25). Kruskal-Wallis tests evaluated the differences in sleep variables, fatigue, and PA by SES.
Results: Participants consisted of 28 children (8–12 year) and 17 adolescents (13–18 year). Children in the lower income group had lower 24-hr fatigue and lower 7-day fatigue scores than those in the higher income group. The difference in parent fatigue scores by income neared significance (p = .07). There were no differences in fatigue scores by insurance. Although there were no differences in PA by income, children on Medicaid had significantly higher PA.
Table 1: Differences in Physical Activity and Fatigue by SES
Income | Insurance | |||||
Variable mean (SD) | < 70 K (n = 20) | ≥ 70 K (n = 25) | P-Value | Medicaid (n = 16) | Private (n = 28) | P-Value |
24-hr Fatigue Score | 32.96 (10.58) | 39.71 (10.82) | 0.04 | 35.19 (11.69) | 37.30 (10.90) | 0.31 |
7-day Fatigue Score | 33.27 (12.28) | 39.32 (9.62) | 0.03 | 34.92 (14.64) | 37.28 (9.07) | 0.19 |
Total AC | 311,273.67 (91,302.70) | 272,570.94 (110,117.71) | 0.24 | 343,620.25 (85,510.91) | 261,061.08 (102,482.39) | 0.01 |
Average AC/min | 385.99 (112.20) | 320.16 (118.35) | 0.10 | 418.35 (108.14) | 312.65 (110.36) | 0.004 |
Maximum AC | 2645.29 (755.35) | 2,312.46 (808.40) | 0.22 | 2,805.30 (758.15) | 2263.27 (773.21) | 0.05 |
Conclusions: Pediatric oncology patients of lower SES had lower fatigue and higher PA scores. Since SES was not related to sleep quantity or quality, it does not explain the relationship between PA and sleep. Future randomized studies investigating biomarkers are needed to understand the relationships between sleep, PA and fatigue.
References: 1. Hockenberry MJ, Hinds PS, Barrera P, et al. Three instruments to assess fatigue in children with cancer: Journal of pain and symptom management 2003;25:319–28.
MASCC-0800
Correlation between measures of frailty and muscle mass in patients with newly diagnosed pancreatic cancer
H. Holmes 1, M.H.G. Katz2, M.A. Khalil3, J.K.A. des Bordes1, N. Parker2, R. Luo4, A.B. Cooper2, V. Gottumukala5, D.R. Fogelman3
1General Internal Medicine, UT MD Anderson Cancer Center, Houston, USA, 2Surgical Oncology, UT MD Anderson Cancer Center, Houston, USA
3Gastrointestinal Medical Oncology, UT MD Anderson Cancer Center, Houston, USA, 4Biostatistics, UT MD Anderson Cancer Center, Houston, USA, 5Anesthesiology & Perioperative Medicine, UT MD Anderson Cancer Center, Houston, USA
Introduction: Sarcopenia is associated with an increased risk of mortality in pancreatic cancer. Sarcopenia is a key feature of the frailty syndrome, which is also characterized by weight loss and exhaustion.
Objectives: We determined whether the frailty or measures of muscle function (gait speed and grip strength) were associated with objective measures of muscle mass in pancreatic cancer.
Methods: We enrolled consecutive patients with newly diagnosed, previously untreated pancreatic cancer. We evaluated patients for Fried’s criteria (grip strength, gait speed, weight loss, exhaustion, and physical activity). Baseline CT scans were used to calculate muscle mass at L3 in cm2, using Slice-o-Matic software, and corrected for body surface area. We used Spearman’s test to determine whether the Fried’s criteria score (0 to 5), grip strength, or gait speed correlated with adjusted muscle mass.
Results: Among 82 patients with pancreatic cancer and available muscle data, the mean age was 63.5 (+/−10.7) years, 28 % were female, 46 % had metastatic disease, 89 % had ECOG 0 or 1, and 77 % had at least 1 comorbidity; 21 (25.6 %) were frail. Fried’s score and grip strength correlated with muscle mass (r = −0.25, P = 0.02 and r = 0.64, P = 0.0001, respectively). Neither gait speed nor ECOG performance status correlated with muscle mass.
Conclusions: Frailty indices, and grip strength in particular, may be used to identify sarcopenia in pancreatic cancer patients. Further study is underway to determine the prognostic significance of frailty and sarcopenia.
MASCC-0801
The occurence and treatment of biphosphonates related osteonecrosis of the jaws in a Brazilian Dental School
L. Mathias-Duarte 1, H.B. Reis2, D.L. Cortizo2, L.L. Dib1
1Stomatology, Paulista University, São Paulo, Brazil, 2Implantology, Paulista University, São Paulo, Brazil
Introduction: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is an adverse effect of drugs used to treat bone metabolism diseases, such as osteoporosis and bone metastases.
Objectives: The aim of the study was to evaluate the clinical characteristics and evolution of BRONJ cases that were diagnosed and treated at a dental school.
Methods: The Stomatology clinic archives of the School of Dentistry at the Paulista University (UNIP) for the period from January 2004 to December 2011 were reviewed in search of records of cases diagnosed with osteonecrosis of the jaws caused by bisphosphonates.
Results: Thirteen patients met the criteria of the study among a population of 2342 patients with oral lesions. Of the 13 patients, 12 were females. Ten were intravenous bisphosphonate users, and nine had breast cancer as the primary disease. Eight mandibular cases were observed. Eight patients interrupted the use of the bisphosphonates temporarily during the treatment. Surgical treatment was conducted in 10 patients, which was associated with platelet-rich plasma in six cases, which led to a regression to Stage I in 50 % of these and cure in 33.3 %. Of the total sample, four (30.8 %) cases were cured, six (46.1 %) regressed to Stage I, and three (23.1 %) remained in Stage II after treatment. Dental rehabilitation occurred in seven patients.
Conclusions: Orientation and dental care on cancer patients is important once they are known as users of bisphosphonates drugs. Dissemination of knowledge among professionals is essential for prevention and early diagnosis of BRONJ. Dental schools must act as reference centers and participate in the multidisciplinary care of bisphosphonate users.
MASCC-0802
The analysis of the patients taking opioids with diagnosis of lung or gastric cancer
M. Altinbas 1, O. Aydin2, D. Colak1, U. Ersoy1, S. Urvay1, I. Hacibekiroglu1, G.I. Imamoglu1, E. Sari1, N. Kose1
1Medical Oncology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey, 2Internal Medicine, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
Introduction: Pain management is very important in comprehensive cancer care. Pain itself may cause hospitalization or expand the duration of hospitalization.
Objectives: We analyzed the duration of hospitalization of lung or gastric cancer, in the focus of opioids.
Methods: Between June-December 2012, totaly 490 patients were hospitalized in our clinic. Of them, 45 were lung cancer and 81 were gastric cancer. The electronic records and the files of these patients were examined. The analysis of the data was done with SPSS 18.0
Results: Of 45 patients with lung cancer, 23 were taking oral tramadol (50–200 mg/day), 10 fentanyl TTS (25–200 microgram/72 h) and 2 parenteral morphine. Of 81 patients with gastric cancer, 12 were taking oral tramadol (50–200 mg/day), only 1fentanyl TTS (125 microgram/72 h).
The median duration of hospitalization was 6.9 ± 4.9 days in the patients who were not taking opioid analgesics and 8.8 ± 5.7 days in the patients taking opioids (p = 0.061). The duration of hospitalization was longer in patients taking fentanyl TTS than taking tramadol (12.4 ± 6.5 vs 7.3 ± 4.6; p = 0.011). When we looked at the morphine equivalance of the opiods they were taking we found that the duration of hospitalization in patients taking more than 100 mg/day oral morphine equivalance were longer than the others (12.4 ± 7.2 vs 7.7 ± 4.6; p = 0.029). There was no difference in the duration of hospitalization between patients taking fentanyl.
Conclusions: In our study we found that the gastric or lung cancer patients who were taking high dose opioids were hospitalized longer than the others.
MASCC-0803
Post-operative pain management after single port laparoscopic oncologic surgery
S.W. Byun1, K. Lee 1, J.S. Park1
1OBGYn, Catholic University of Korea, Seoul, Korea
Introduction: As a minimally invasive surgery, single port laparoscopic surgeries (SPLS) were introduced in many of oncologic surgery. Post-operative pain would be reduced by means of SPLS, but compared to single port laparoscopic benign surgery, property of post-operative pain management was not accessed in single port laparoscopic oncologic surgery.
Objectives: We are aim to show the post-operative pain management after SPLS for ovarian cancers.
Methods: Cases of SPLS for ovarian cancer and borderline tumor were retrospectively reviewed in term of postoperative pain control and prescription patterns of pain killer in oncologic surgeries were compared to that in benign surgeries.
Results: Seven SPLS for ovarian cancer and 26 for ovarian benign tumor were compared. All of subjects were received IV patient-controlled analgesia. Additional IV pain killer were needed in 5 out of 7 oncologic and 17 out of 26 benign surgeries. But duration of PO pain killer was shorter in oncologic surgery compared to benign surgery (1.6 days vs. 1.9 days).
Conclusions: Post-operative pain control after single port laparoscopic oncologic surgeries were varied and were not adequately transferred to the patients compared to that for benign disease. Considering the operative field in oncologic surgery, prescription patterns of pain killers should be modified to relief the post-operative pain.
MASCC-0804
Do healthcare professionals and the public understand the same when it comes to palliative sedation?
E. López-Romboli 1, J. Porta-Sales1, S. Llorens-Torrome1, J. Gonzalez-Barboteo1, A. Calsina1
1Palliative Care Service, Institut Català D’Oncologia-IDIBELL, Hospitalet de Llobregat, Spain
Introduction: Palliative sedation (PS) has been defined by professional bodies, but there’s a sense that it doesn’t coincide with the public perception.
Objectives: Describe and compare beliefs about PS of health professionals [HP] and non-health professionals [NHP] regarding PS, as defined by the Spanish Society of Palliative Care (SECPAL).
Methods: We developed a self-administered questionnaire, using the current SECPAL’s definition and gave it to HP and NHP.
Results: We included 100 HP (doctors, nurses) and 149 NHP (relatives of patients, public). All HP and 80.7 % of NHP (P < 0.0001) had heard of PS, and 25.6%of the latter knew it as “sedation before death”. Degree of agreement was 76.7 % for HP and 55.9 % for NHP. Main points of disagreement were: HP) NHP11.2 % and4% HP believe that PS is intended to provide a quick and painless death, b) 54 % of NHP believe that the PS should be administered only for physical suffering and 36.2 % for physical and emotional suffering. 82.2 % of HP believe it should be used for both. c) PS must be requested by the patient or family (22.1%NHP vs 9.1 % HP), and the consent of patient and family, even in autonomous patients (30.9 % vs NHP 24, 8 % of HP). HP & NHP believe sedated patients don’t suffer, and PS isn’t euthanasia.
Conclusions: PS is widely known within this sample, confirming the disagreement between HP and NHP regarding SECPAL definition. Most think that patients don’t suffer.
MASCC-0805
Adherence to antiemetic guidelines in patients with malignant glioma: translating evidence into practice
M. Affronti 1, S.M. Schneider2, J.E. Herndon II3, S. Schlundt4, K.B. Peters1, A. Desjardins1, T. Ranjan1, S. Cheshire1, C. Cone1, K. Kalinowski1, J.Y. Kim1, H. Lay1, V. Poillucci1, C. Southerland1, J. Tetterton1, D. Levacic1, S. Lindhorst1, J.J. Vredenburgh1, H.S. Friedman1
1Surgery, Duke University Medical Center, Durham, USA, 2Duke School of Nursing, Duke University Medical Center, Durham, USA, 3Statistics, Duke University Medical Center, Durham, USA, 4Health System Technology, Duke University Medical Center, Durham, USA
Introduction: Poorly controlled chemotherapy-induced nausea and vomiting (CINV) reduce cancer treatment efficacy and significantly impair quality of life (QOL). Review of the Duke Brain Tumor Center’s usual practice demonstrates a high CINV incidence (45 %), despite short-acting 5-HT3 serotonin receptor antagonist (5-HT3-RA). National Comprehensive Cancer Network’s evidence-based guidelines recommend combining a long-acting 5-HT3-RA (palonosetron) and dexamethasone for the prevention of acute/delayed CINV with moderately emetic chemotherapy (MEC). Low guideline adherence (58 %) explained our high CINV incidence. A project was implemented to improve adherence to evidenced-base guideline antiemetic ordering by providers for glioma patients treated with MEC.
Objectives: To determine if a combination intervention including (a) an education session, (b) risk assessment tool with (c) computerized standard guideline order-sets with a monthly audit-feedback strategy improves the primary outcome: Adherence rate to guideline order-sets. Secondary outcomes: CINV complete response (CR- no emesis, or rescue antiemetic) rates; QOL.
Methods: A one-sample study design to compare historical and post-intervention adherence rates was conducted to detect a difference between a 60 % and 80 % order-set adherence and CINV CR rate. Validated tools assessed QOL: Osoba, FACT-BR/FACIT-Fatigue.
Results: Adherence to MEC antiemetics guideline increased significantly, to a sustained 90 % (55/61 order-sets; 95 % CI: 80, 96; p < 0.05). The acute (1 day post-treatment) and delayed (2–5 days post-treatment) CINV CR rate significantly increased to 75 % and 84 % of patients, respectively. QOL was maintained.
Conclusions: A combination intervention and audit-feedback strategy to translate evidence into an oncology practice improves and sustains antiemetic guideline adherence, nausea/vomiting efficacy, and preserves QOL.
MASCC-0806
Functional assessment in patient’s undergone treatment for odontogenic tumors
P.S. Satheeshkumar 1, M.P. Mohan1, A. Balan2
1Oral Medicine, Mar Baselios Dental College, Cochin, India, 2Oral Medicine, Government Dental College, Trivandrum, India
Introduction: Quality of life (QoL) is an important outcome in patient’s undergoing treatment for odontogenic tumors which is as comparable to malignant tumors of head and neck cancer. There is an increase in need for assessment of functional outcome in head and neck odontogenic tumors.To monitor the QoL in these patients we are assessing the functional outcome with the Malayalam FACT-H&N.
Objectives: To assess the functional outcome of patient’s undergone treatment for odontogenic tumors with the Malayalam FACT-H&N. The goal was to identify patients’ highest symptoms.
Methods: Ten personal interviews were conducted in order to explore patients’ opinions about the scale and its items in detail. The questionnaire was administered to 52 patient’s undergone treatment for odontogenic tumors. They were asked to respond to each statement in terms of their own degree of agreement or disagreement. Typically, they are instructed to select one of five responses: strongly agree, agree undecided, disagree, or strongly disagree.
Results: The FACT-H&N subscales and total score demonstrated good internal consistency (0.82–0.91). Most scores also demonstrated good responsiveness. Significant associations were observed. Associations were observed between subscales measuring physical and functional areas of performance, social functioning, and emotional well-being. Related symptoms endorsed as high priority by patients were selected. Overall, the FACT-H&N was a valid measure for monitoring QoL over time in patients with odontogenic tumors.
Conclusions: The FACT-H&N meets or extends all requirements for use in odontogenic tumors trials, in responsiveness of administration, reliability, validity, and adaptation in clinic
MASCC-0807
Addressing the needs of cancer patients and caregivers through multi-disciplinary psychosocial interventions
P.J. Atherton 1, M.I. Lapid2, T.A. Rummans3, M.M. Clark4, J.A. Sloan1
1Health Sciences Research, Mayo Clinic, Rochester, USA, 2Psychiatry and Psychology, Mayo Clinic, Rochester, USA, 3Psychiatry, Mayo Clinic, Rochester, USA, 4Phychology, Mayo Clinic, Rochester, USA
Introduction: Cancer patients experience symptom and quality of life (QOL) challenges. Caregivers experience associated burdens.
Objectives: This report describes a Mayo Clinic Comprehensive Cancer Center ten-year program of research utilizing multi-disciplinary interventions to improve QOL and alleviate burden
Methods: Multi-disciplinary psychosocial interventions were designed to address key patient QOL deficits and were tested in two randomized clinical trials with the primary endpoint being overall QOL post-intervention (4 weeks). Secondary endpoints were various QOL domains. Intervention content was refined utilizing systematic reviews of literature, study results, and patient feedback. Caregiver needs were identified. A caregiver-specific 6-session intervention is in development based on a supplementary survey assessing burden and benefits or barriers of using technology as a resource to enhance wellness and facilitate caregiving.
Results: Study 1 (JCO, 2006) provided 8 intervention sessions to 103 evaluable patients (49 Intervention, 54 Standard care). Intervention patients showed improvements in overall QOL (p = 0.047) and spirituality (p = 0.003) at week 4. Study 2 (Cancer,2013) utilized 6 sessions and enrolled 117 evaluable patient/caregiver pairs (54 Intervention, 63 Standard care). Patient overall QOL (p < 0.01), physicality (p < 0.01) and functionality (p = 0.04) were maintained at 4 weeks, as was caregiver spirituality (p = 0.048), mood (p = 0.02) and adaptation (p = 0.01). The current caregiver intervention proposal (Study 3) will be delivered via a web-based application, as indicated per caregiver survey responses, and will be tested in a subsequent clinical trial.
Conclusions: Multi-disciplinary interventions are an effective strategy to improve patient QOL and caregiver burden, and technology holds promise for its electronic delivery in the future.
MASCC-0808
Cancer anorexia-cachexia syndrome (CACS) is under-recognized among patients with metastatic non-small cell lung cancer (MNSCLC)
A. Benner 1, B. Hirsch1, A. Abernethy1
1Duke Clinical Research Institute, Duke University Medical Center, Durham, USA
Introduction: CACS is a debilitating condition that negatively impacts the quality of life and prognosis of cancer patients. Despite its severity, CACS is widely under-recognized.
Objectives: Determine the prevalence of CACS in mNSCLC population using established clinical criteria.
Methods: A retrospective study of patients diagnosed with mNSCLC between 5/2007–11/2010 at Duke University was conducted regarding the prevalence of CACS including (a) weight loss ≥5 % or BMI <20 and weight loss >2 % within 6 months of diagnosis, (b) ICD-9 codes of CACS, (c) self-reported severe loss of weight or appetite via patient reported outcomes (PRO) or (d) medications prescribed to treat CACS (dronabinol, megesterol, somatropin, oxandrolone). Records of identified mNSCLC patients were queried to collect data at predetermined time points.
Results: Of 495 patients with mNSCLC, 215 had weight documented at diagnosis, 3 and/or 6 months (Table). 49 % of these met one of the weight criteria for CACS. Of the overall cohort, 22 % were assigned ICD-9 codes of CACS and 5 % were prescribed medications to treat CACS. Of 41 % who completed at least 1 PRO survey, 13 % reported severe loss of weight or appetite.
Table – Weight loss 3 or 6 months after diagnosis | ||
3 months | 6 months | |
Weight loss >5 % | 42 % | 39 % |
BMI <20 & Weight loss >2 % | 8 % | 6 % |
Conclusions: CACS in patients with mNSCLC is under-diagnosed. Limitations to the study include variable documentation, a single institution perspective, and the retrospective approach. Earlier recognition of CACS and effective interventions may improve quality of life of cancer patients.
MASCC-0810
Nausea and disturbed sleep as predictors of cancer-related fatigue in breast cancer patients
A.R. Peoples 1, C.E. Heckler1, J.A. Roscoe1, C.S. Kamen1, L.J. Peppone1, K.M. Mustian1, M.C. Janelsins1, D.F. Moore2, C. Coles3, K.L. Hoelzer4, J.P. Williams1, G.R. Morrow1
1Radiation Oncology, University of Rochester Medical Center, Rochester, USA, 2Internal Medicine, Cancer Center of Kansas, Wichita, USA, 3Oncology, Metro-Minnesota Community Clinical Oncology Program, Minneapolis, USA, 4Hematology & Oncology, Springfield Clinic, Springfield, USA
Introduction: Cancer-related fatigue (CRF) is one of the most distressing side effects of cancer treatment, and its underlying pathophysiology is poorly understood. The relative contributions of disease, cancer therapies, and comorbid conditions (e.g., nausea, sleep disorders) remain unclear.
Objectives: These secondary analyses examine the association between post-treatment fatigue with nausea and disturbed sleep.
Methods: Analyses were performed on 549 breast cancer patients (mean age 54, 100 % female) from a RCT study examining antiemetic efficacy, who completed a three-day diary assessing nausea (1–7 scale) and disturbed sleep (0–10 scale) following initial chemotherapy. Fatigue at its worst during the prior week (0 = none to 10 = as bad as you can imagine) was assessed both prior to chemotherapy and on Day 4. To determine the associations between these variables, a linear regression was performed. Age, pre-treatment fatigue, pre-treatment nausea, and occurrence of vomiting (yes/no) were also included in the model.
Results: CRF was significantly associated with nausea (r = 0.37, p < 0.0001) and disturbed sleep (r = 0.44, p < 0.0001). Linear regression showed that one unit increases in nausea and disturbed sleep were associated with increases in CRF by 0.49, and 0.35, respectively, all p’s < 0.0001. Occurrence of vomiting was not significantly associated with CRF.
Conclusions: These findings suggest that nausea and disturbed sleep are important predictors of CRF. Given the current limitations in treating fatigue directly, interventions targeting nausea and disturbed sleep could be potential alternate approaches to reduce CRF.
MASCC-0811
Randomized controlled clinical study of exercise program on functional and emotional response in women with surgery breast cancer
L.M. Menzel1, V.T.K. Ferreira 2, H.H.A. Carrara1, I. Garavello3, T.O. Gozzo4
1Faculty of Medicine Ribeirao Preto/Department Obstetrics and Gynecology, University of Sao Paulo, Ribeirão Preto, Brazil, 2Faculty of Medicine Ribeirao Preto/Department of Rehabilitation and Functional Performance, University of Sao Paulo, Ribeirão Preto, Brazil, 3Faculty of Physical Therapy, University of Triangulo Mineiro, Uberaba, Brazil, 4Department of Maternal-Infant and Public Health Nursing, University of Sao Paulo College of Nursing, Ribeirao Preto, Brazil
Introduction: Physiotherapy acts preventively, before and after surgery in women with breast cancer and has as main objective to get the woman back to their daily activities, social and professional with minimal consequences.
Objectives: To evaluate the effectiveness of a supervised exercise program in women who underwent axillary dissection for breast cancer and the emotional impact of this practice in these women.
Methods: Women treated for breast cancer in the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP- USP) were invited to participate. They’re randomized in Study Group (GE) and Control Group (GC) that did not participate in supervised exercise protocol. This evaluation consisted of measurement of range of motion (ROM) of the scapular-humeral and the perimeter of the upper limbs. GE supervised exercises were conducted twice a week, but with guidance to perform them daily.
Results: The ROM of the scapular-humeral joint in GE improved significantly in all evaluations since PO1 regarding the movement of flexion, what was not observed in GC. In the evaluation of abduction the GE showed consistently higher measurements than the GC, but in some evaluations the difference between the two groups was not significant.
Conclusions: ROM of the scapular-humeral joint showed faster recovery in women undergoing axillary dissection for breast cancer when they participated in a supervised exercise protocol with early onset.
References: SPRINGER, B. A. et al. Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer. Breast cancer research and treatment, The Hague. 2010: 120 (1): 135–147.
MASCC-0812
After decades of antiemetic advances, the distress of chemotherapy-induced nausea and vomiting (CINV) remains
E. Rubenstein 1, L. Schwartzberg2, S.T. Sonis3, S.M. Weidner3, G. Alterovitz4
1Executive Administration, Inform Genomics Inc., Boston, USA, 2Hematology/Oncology, The West Clinic, Memphis, USA, 3Research & Development, Inform Genomics Inc., Boston, USA, 4Center for Biomedical Informatics, Harvard Medical School, Boston, USA
Introduction: Ondansetron (OND) became available more than 20 years ago, representing the first 5HT3-receptor antagonist (5HT3RA) in oncology. Palonosetron (PALO) and aprepitant (AP) for prevention of CINV were introduced approximately 10 years ago. Along with dexamethasone (Dex), these antiemetics have become standard-of-care. Yet, how well do they work in current oncology care in preventing CINV?
Objectives: Determine CINV incidence in patients receiving antiemetics prior to emetogenic chemotherapy (CT).
Methods: In order to develop Bayesian single nucleotide polymorphism networks predicting CINV and 5 other CT-induced side effects, we enrolled 383 patients with breast, colorectal, lung, ovarian, and prostate cancer in a prospective, multi-cycle, observational study. Patients reported side effects using a validated tool, Patient Care Monitor©. Nausea and vomiting were categorized: none = 0, Mild = 1–3, Moderate = 4–6, Severe = 7–10. Antiemetic regimens were catalogued. CINV rates were reported for first 3 cycles.
Results: Three hundred fifty-seven patients received combination CT: doxorubicin/cyclophosphamide-based (AC) [N = 110], oxaliplatin-based (Ox) [N = 72], other moderately-emetogenic chemotherapy (MEC) [N = 175]. Median age was 54 years, 82 % female. PALO-based regimens constituted ~89 % of antiemetics; 28 % received 5HT3RA + Dex + AP. Overall, 62 % reported CINV: 36 % had moderate to severe nausea, 11 % had vomiting. For AC, 71 % reported CINV. For 5HT3RA + Dex + AP, 36 % reported moderate to severe nausea; 10 % had vomiting. MEC and Ox regimens had CINV rates similar to the overall group.
Conclusions: Despite multiple-class antiemetic use, CINV burden remains significant for patients receiving emetogenic CT. Newer agents and strategies to identify at-risk, chemo-naïve patients are needed to reduce the impact of CINV.
MASCC-0813
Problems encountered during cultural adaptation of the epic questionnaire for prostate cancer into Punjabi and Chinese
T.K. Lee 1, S. Singh-Carlson2, G. Oshan3, W. Kwan3
1Radiation Oncology, British Columbia cancer Agency, Surrey, Canada, 2School of Nursing, California State University Long Beach, Long Beach, USA, 3Research assistant, British Columbia cancer Agency, Surrey, Canada
Introduction: EPIC(Expanded Prostate Inventory Composite) is a widely adopted quality of life assessment tool. It has been translated successfully into Spanish, Dutch, Japanese, and Korean.
Objectives: Our Objective is to develop and validate EPIC in Punjabi and Chinese.
Methods: Each language version has been translated into a prototype based on EORTC protocol. Two forward translations (FTs) were created by two translators, which were reviewed by our team members fluent in the corresponding language. Fifteen participants with prostate cancer fluent in Punjabi or Chinese will be recruited for each language version. Each participant will complete a prototype followed by a semi-structured interview, using qualitative methdology. Interviews are recorded digitally, translated and transcribed verbatim and analyzed. Validation will then take place to finalize the questionnaire.
Results: Eighteen and two modifications were needed during FT and BT for Chinese, mostly related to word order. Forty and seventeen modifications were needed during FT and BT for Punjabi. Most changes related to replacing difficult words with those used in common language to make it easy. Some questions in English EPIC could not be translated literally as the meaning was lost in translation. Punjabi version also required 4 FT and BT revisions compared to one revision in Chinese. The overall process took 4 months for Punjabi and 3 months for Chinese. Sixteen Punjabi patients were approached to date: eight agreed to participate. Three sixty-minute interviews are completed.
Conclusions: Translation/validation of the EPIC questionnaire is labour intensive. Unexpected cultural/social related problems encountered during process will be discussed.
MASCC-0814
Palliative therapy for lymphedema in metastatic breast cancer
V. Tlaker Zunter 1, T. Planinsek Rucigaj1
1Department of Dermatovenereology, University medical Centre Ljubljana, Ljubljana, Slovenia
Introduction: In metatstatic cancers, lymphedema can present as a very distressing condition that is hard to manage.
Objectives: The objective of our case report is to present therapy of severe lymphedema (stage III) in metastatic breast cancer, causing pain, lymphorrhea, skin ulcerations and pain.
Methods: The patient was treated with short-stretch adhesive and non-adhesive bandages, combined with manual lymph drainage by Vodder method.
Results: The therapy resulted in reduction of edema, lymphorrhea and skin ulceration, and improvement of the quality of life.
Conclusions: Supportive therapy of lymphedema, including appropriate bandaging and manual lymph drainage, successfully reduces burden of the end-stage metastatic disease in breast cancer.
References:
1. Thomson M, Walker J. Collaborative Lymphoedema Management: Developing A Clinical Protocol. Int J Palliat Nurs. 2001 May;17(5):231–8.
2. Clemens KE, Jaspers B, Klaschik E, Nieland P. Evaluation Of The Clinical Effectiveness Of Physiotherapeutic Management Of Lymphoedema In Palliative Care Patients. Jpn J Clin Oncol. 2010 Nov;40(11):1068–72. doi: 10.1093/jjco/hyq093. Epub 2010 Jun 17.
3. Hamner JB; Fleming MD. Lymphedema Therapy Reduces the Volume of Edema and Pain in Patients with Breast Cancer. Ann Surg Oncol 2007 Jun;14(6):1904–8. Epub 2007 Mar 8.
MASCC-0815
Detection of subclinical lymphedema; does a preoperative prediction model work?
A. Soran 1, A. Ibrahim1, L. DeGore1, M. Bonaventura1
1Surgical Oncology, MWH, Pittsburgh, USA
Introduction: Severe lymphedema (LE) development is associated with profound functional, psycho-social and medical consequences. Bioimpedance spectroscopy (BIS) has been demonstrated to be sensitive for subclinical LE (SLE) detection. A Nomogram for predicting the risk of arm LE after axillary dissection (ALND) was presented for early diagnosis of the disease.
Objectives: To test the preoperative prediction model in the diagnosis of SLE in ALND patients prospectively monitored by BIS.
Methods: One hundred twenty-three patients were monitored at 3–6 monthly intervals using an L-Dex® U400 after the preoperative measurements was obtained. The 5 year probability of LE after ALND for breast cancer was predicted by using web page. The discrimination of the nomogram was assessed by calculating the area under (AUC) the ROC; AUC values between 0.7 and 0.8 represent considerable discrimination.
Results: The mean age was 57 (27–90), and the mean BMI was 28.2 (17.1–48.2) kg/m2. Dominant hand and surgery side was the same in 59 % of patients. The mean number of LN dissection was 16 (6–49). Mastectomy represented the majority (63 %) of cases, 77 % of patients received RT, and 90 % of patients received chemotherapy. Since BIS monitoring began a total of 18 % (n = 22) patients were diagnosed with SLE and received early intervention. The AUC was 0.59. In the short-term follow-up, SLE patients being monitored remain stable with no worsening of LE.
Conclusions: The created nomogram is not accurate in predicting SLE. Periodic monitoring for LE, early detection of LE with BIS, and timely intervention for LE can minimize or eliminate more advanced LE among women undergoing ALND.
MASCC-0816
Impact of chemotherapy dose intensity and supportive care on survival of patients with advanced solid tumors
N. Kuderer 1, E. Culakova1, M.S. Poniewierski1, A.F. Wogu1, J. Crawford1, D.C. Dale2, G.H. Lyman1
1Medicine, Duke University and the Duke Cancer Institute, Durham NC, USA, 2General Internal Medicine Center, University of Washington, Seattle WA, USA
Introduction: The value of full-dose chemotherapy and supportive care for patients with advanced/metastatic solid malignancies remains uncertain.
Objectives: Evaluate the impact of chemotherapy dose intensity and supportive care on survival in randomized controlled trials (RCTs).
Methods: A systematic review was conducted of RCTs in which patients were randomized to receive chemotherapy with or without supportive care with G-CSF and overall survival was reported. Treatment effect was based on Mantel-Haenszel estimates of relative risk (RR) or absolute risk (AR).
Results: Of the 61 RCTs identified, 45 were in solid tumors including 22 in patients with stage IV disease. All-cause mortality was significantly reduced in patients with stage IV solid tumors randomized to chemotherapy with G-CSF support (RR = 0.95; 95 % CI: 0.92–0.98; P = .003). In subgroup analyses, reductions in mortality were observed in non-small cell lung cancer trials (RR = 0.90; AR = −7 %; P = .014) and in RCTs of patients with sarcomas (RR = 0.73; AR = −22 %; P = .004) and urothelial tract cancers (RR = 0.87; AR = −11 %; P = .016). Reductions in mortality were seen in RCTs of dose dense chemotherapy (RR = 0.88; AR = −10 %; P = .019) and trials adding one additional agent to the comparison regimen (RR = 0.95; AR = −4 %; P = .015). A trend was observed between greater reductions in mortality and longer duration of patient follow-up across trials (P = .071). Greater treatment effect was also observed in 11 RCTs where survival was the primary outcome (RR = 0.92; AR = −5 %; P = .001).
Conclusions: Pooled results of RCTs of patients with advanced and metastatic solid tumors demonstrate a modest but significant impact of greater chemotherapy dose intensity with G-CSF support with greater reductions in the risk of mortality.
MASCC-0817
The association of myelosuppression and survival in patients with advanced or metastatic solid tumors
G. Lyman 1, M.S. Poniewierski1, A.F. Wogu1, E. Culakova1, N.M. Kuderer1, J. Crawford1, D.C. Dale2
1Medicine, Duke University and the Duke Cancer Institute, Durham NC, USA, 2General Internal Medicine Center, University of Washington, Seattle WA, USA
Introduction: The value of full-dose chemotherapy and supportive care for patients with advanced/metastatic solid malignancies has recently been questioned. To address the impact of chemotherapy dose intensity and myelosuppression on subsequent survival, a systematic review was conducted.
Objectives: Evaluate association between chemotherapy-induced myelosuppression and subsequent survival.
Methods: A systematic review of clinical trials was conducted to assess the relationship of chemotherapy dose intensity associated with myelosuppression and subsequent survival in patients with advanced or metastatic cancer. Treatment effect was based on hazard ratios (HR) for mortality.
Results: Of the 25 studies identified, 11 were in patients with advanced or metastatic disease including 10 in patients with solid tumors. These included non-small cell lung cancer (5), gastric (3), colorectal (1), and breast cancer (1). Among the 7 studies in patients with solid tumors reporting survival outcomes, a consistent association between chemotherapy intensity resulting in myelosuppression and reduced all-cause mortality was observed in patients with advanced/metastatic solid tumors (HR = 0.69; 95 % CI: 0.61–0.77; P < .0001). A significant interaction between tumor type and myelosuppression was observed for mortality (P = .046) including significant reductions in mortality in patients with colorectal cancer (HR = 0.35; 95 % CI: 0.19–0.64; P = .001), gastric cancer (HR = 0.61; 95 % CI: 0.48–0.78; P < .001); and non-small cell lung cancer (HR = 0.73; 95 % CI: 0.64–0.84; P < .001). No difference in effect estimates were observed in studies using landmark analysis.
Conclusions: Chemotherapy treatment resulting in myelosuppression in patients with advanced solid tumors is associated with reduced mortality overall and across cancer types.
MASCC-0818
Implementation of short and brief interventions for alcohol and tobacco program in surgical oncological unit: analysis of pre and post-implementation process at 6 months
M.B. BARRAULT M 1, V.B. Barthelemy2, E.B. Bussieres E2, F.L. Lakdja F3, V.G. Garguil V4, M.A. Auriacombe M4
1Social Sciences and Humanities Group, Bergonie Institute, Bordeaux Cedex, France, 2Surgical Oncology Department, Bergonie Institute, Bordeaux Cedex, France, 3CARE Department, Bergonie Institute, Bordeaux Cedex, France, 4Addictology Department, Charles Perrens Hospital, Bordeaux Cedex, France
Introduction: Alcohol and tobacco reduce treatments efficacy, increase their side effects, may increase relapse and/or secondary cancers and affect quality of life of cancer patients. Because it represents a ‘teachable moment’, cancer may create a window of opportunity in which to intervene, to help patients identify behaviors at risk for poor health outcomes, and provide them with the support required. Despite scientific, clinical and political incentive, short and brief interventions (SBI) for alcohol in cancer settings are poorly implemented.
Objectives: This study aims to present the framework of specific implementation of a SBI for alcohol and tobacco linked with screening and management of psychological distress in a surgical oncological department, at 6 months.
Methods: The Consolidated Framework for Implementation Research, an integrative conceptual model has been used for the construction and in order to analysis in a mixed method, at 6 months, implementation brakes and facilitators. 25 health stakeholders’ knowledge, attitudes, practice and implication have been explored through focus groups and standardized questionnaires online.
Results: Lack of confidence in assuming a prevention role, insufficient knowledge and negative attitudes are key inhibitors of health stakeholders’ involvement in screening and brief interventions. Organizational limits have been described: the pilot team needs more interprofessional collaboration, communication and support from physicians and head leader.
Conclusions: SBI program in oncological setting coupled with distress screening could be an interesting clinical avenue to reduce risk behaviors. Implementing specific training courses may help health professionals placing the problem of alcohol in a new perspective and reduce fatalism and resignation which are so often observed.
MASCC-0820
Patients’ views on the timing and benefits of early palliative care: a qualitative study
B. Hannon 1, N. Swami1, A. Pope1, M.K. Krzyzanowska2, N. Leighl2, A. Oza2, M. Moore2, G. Rodin1, C. Zimmermann1
1Psychosocial Oncology & Palliative Care, Princess Margaret Hospital, Toronto, Canada, 2Medical Oncology & Haematology, Princess Margaret Hospital, Toronto, Canada
Introduction: Early palliative care referral can improve quality of life and satisfaction with care, and is increasingly encouraged. However, little is known about patients’ attitudes towards early referral.
Objectives: We conducted qualitative interviews seeking the opinions of advanced cancer patients regarding the timing of palliative care referral, and to determine whether patients referred early perceived a benefit.
Methods: We recruited participants from medical oncology clinics at a comprehensive cancer centre, following completion of a randomized controlled trial comparing early palliative care referral with standard oncology care. Forty-eight interviews (26 intervention and 22 control) completed interviews. Selective sampling was employed to ensure equivalent numbers of participants based on study arm, age, gender, high vs. low quality of life scores, and high vs. low satisfaction with care. A grounded theory approach was used to explore emerging themes.
Results: Control patients held a traditional view of palliative care services being relevant only at the end of life. Intervention patients favoured referral following a diagnosis of advanced cancer or in the presence of substantial symptom burden, irrespective of proximity to death, and identified several benefits of early referral. These included: prompt attention to symptom needs; timely, sensitive information about prognosis or end-of-life care options; destigmatization of palliative care through routine referral; and provision of a safety net or additional support.
Conclusions: Although early palliative care was not understood as relevant by those who had not experienced it, for those who had, it was perceived as a valuable adjunct to standard oncology care.
MASCC-0821
Study on a combined compounded therapy for oral mucositis
M. Pinto 1, T. Vasconcelos2, R. Palmeira de Oliveira1
1, CICS - Health Sciences Research Center Faculty of Health Sciences University of Beira Interior, Covilhã, Portugal, 2R&D department, Laboratory of pharmaceutical development BIAL Trofa Portugal, Covilhã, Portugal
Introduction: Mucositis is usually observed in oncology patients who have been exposed to radiotherapy and/or chemotherapy. It is a severe inflammation of the oral mucosa that can limit the cancer treatment and affect the quality of life of the patient, which justifies the need to identify the best therapy for oncology patients with this condition. According to a simple survey made in Portuguese hospitals, the most frequent therapeutic approaches to mucositis are cryotherapy, an antiseptic compounded formulation based on chlorhexidine and a compounded combination of sodium bicarbonate, lidocaine and nystatin. The later formulation proves to be very helpful in the management of mucositis and is largely used in Portuguese Hospitals because of its very easy and quick preparation process. However, due to the lack of stability data this formulation in only given 14 days of stability after preparation.
Objectives: To optimize the combined formulation and study its stability.
Methods: A new manufacturing process was studied and the formula was modified by including different viscosity-increasing agents. Formulations were studied regarding appearance, viscosity, pH, microbiologic quality and drug content.
Results: The inclusion of cellulose derivatives, in different concentrations, or xanthan gum did not alter the initial parameters apart from viscosity, in a concentration dependent manner, as expected. Overtime measurements are being performed in order to assess overall stability of the formulation.
Conclusions: A more economic and easy preparation was developed.It was also concluded that the inclusion of a viscosity-increasing agent may potentiate the adhesion of drugs to the mucosa, improving therapeutic efficacy.
MASCC-0822
Analysis of implementation process of collaborative care plans for palliative cancer patients in surgical oncology unit : systemic analysis of brake and facilitators factors
M.B. Barrault 1, V.B. Barthelemy V2, V.M. Mollo V3, A.P. Pernet A3, S.C. Colombani S4, A.F. Floquet A5, F.G. Guyon F2
1Social sciences and humanities Group, Bergonie Institute, Bordeaux Cedex, France, 2Oncological Surgery Department, Bergonie Institute, Bordeaux Cedex, France, 3MSH, Certop, Toulouse, France, 4Anesthesic Department, Bergonie Institute, Bordeaux Cedex, France, 5Oncological Department, Bergonie Institute, Bordeaux Cedex, France
Introduction: Implementing palliative care standards in surgical oncology remains a challenge. Most health providers report conceptual confusion between palliative and end-of-life stage. Effective teamwork and communication is a crucial determinant of cancer advanced patient safety. Communication failures are often underpinned by the inherent differences in professional practices across disciplines, and collaborative processes. In order to promote high standards for palliative cancer patients in surgical oncology unit, implementing collaborative care plans in clinical routine is needed.
Objectives: Describe the framework of the implementation of CCP for palliative cancers patients in surgical oncology unit (brakes and facilitators factors)
Methods: Analysis of factors facilitating and impeding this implementation at 6 months have been done with the systems analysis of clinical incidents (Taylor-Adams & Vincent, 2004). Before and after CCP implementation for all palliative cancer patients, 25 health stakeholders’ representations of collaborative care planning, interdisciplinary communication and teamwork have been explored by standardized online questionnaires.
Fifteen cases of cancer patients with high-complexity palliative surgeries were analysed. MMC reports, medical and nurse notes were analysed with a Structured Chart tool that defined measurable elements of good palliative care.
Results: Analysis of the evolution of stakehorlder’s mental representations of collaboration and palliative care underlines that CCP promote building of shared mental model about patient, interprofessional collaboration process and group cohesion.
Conclusions: Analysis of clinical cases shows a better anticipation of adverse events, effective communication with family. Nevertheless, intervening to improve interprofessional teamworking is challenging : specific training is needed.
MASCC-0823
Fertility preservation in prepubertal boys diagnosed with cancer
A. Meißner 1, A. de Melker2, A.M.M. van Pelt2, M.D. van de Wetering3, F. van der Veen2, S. Repping2
1Center for Reproductive Medicine and Department of Urology, Academic Medical Center, Amsterdam, Netherlands, 2Center for Reproductive Medicine Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, Netherlands, 3Department of Pediatric Oncology Emma Children’s Hospital, Academic Medical Center, Amsterdam, Netherlands
Introduction: Fertility preservation in prepubertal boys diagnosed with cancer might be possible by freezing a testicular biopsy before chemotherapy and propagating and autotransplanting spermatogonial stem cells (SSCs) from this biopsy when the child is mature but azoospermic.
Objectives: The long time period between biopsy and autotransplantation legitimates to now start the cryopreservation in a research setting.
After obtaining ethical approval we set up an interdisciplinary team consisting of pediatric oncologist, urologist-andrologist and clinical embryologist.
Methods: For every suitable patient the clinical research team alerts the pediatric oncologist who checks the in- and exclusion criteria and discusses with patient and parents the possibility of fertility preservation. If interested the boy is seen with his parents by the urologist-andrologist who also informs the clinical embryologist. The testicular biopsy is taken from one testis only in microsurgical technique under general anesthesia linked to central line placement for chemotherapy, so that no separate anesthesia is required. Postoperatively the patient who usually immediately after the surgery starts with chemotherapy is followed frequently for healing or late effects of the surgery.
Results: From 18-03-2011 until 31-01-2013 37 boys were included. In 24 of them a testicular biopsy was performed without any complications. 13 patients refused for conflicts with religious belief, acute aggravation of the cancer, fear of the procedure, found to be too experimental or logistic problems.
Conclusions: Fertility preservation in prepubertal boys with cancer should be offered in an adequate interdisciplinary setting at a limited number of centers to ensure worldwide coverage with sufficient expertise.
MASCC-0824
The efficacy of knee disarticulation in an elderly cancer patient: a case report
A. Ng 1
1Palliative and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
Introduction: 80-year-old female presented with right anterior knee mass with progressive worsening lower extremity edema. Biopsy of the mass showed soft tissue spindle cell sarcoma with mixed cellularity. She underwent chemotherapy and radiation treatment and subsequent right knee disarticulation.
Objectives: To highlight a case where knee disarticulation was considered in lieu of above knee amputation
Methods: A case report -the patient’s course in rehabilitation was followed and reported.
Results: She presented to acute rehab 11 days after knee disarticulation. Postoperatively, she complained of a burning sensation and was started on a small dose of Neurontin 100 mg po TID. Her pain is well controlled with a small minimal dose of gabapentin. She remained on the same dosage of Neurontin throughout her hospitalization. She had no phantom limb sensation or phantom limb pain. She tolerated ACE wrapping and shrinker application on the stump site. She tolerated bearing weight on the stump site. Since the initial date of surgery, she has had no complications to date. The sutures on her incision were removed on the day of discharge. Her wound continues to heal without any complications. Her overall hospital stay was 20 days, which included 9 days in inpatient rehabilitation.
Conclusions: Knee disarticulation is a rare type of amputation but should be evaluated as an option before above-knee amputation, regardless of age and etiology. Knee disarticulation in this patient resulted in little to no pain and improved tolerance to physical therapy.
References: Baumgartner RF. Knee disarticulation versus above-knee amputation. Prosthetics and Orthotics Internation, 1979, 3:15–19.
MASCC-0826
Psychological problems during systematic rehabilitation of patients with colorectal cancer. What we can do for support those people?
K. Pietkun 1, I. Glowacka2, J. Siminska1, K. Nowacka1, M. Nowacki3, W. Hagner4, W. Zegarski5
1Department of Health Science, Rehabilitation Clinic, Bydgoszcz, Poland, 2Department of Health Science, Surgical Oncology Clinic, Bydgoszcz, Poland, 3Faculty of Medicine, Tissue Engineering Department, Bydgoszcz, Poland, 4Department of Health Sciences, Rehabilitation Clinic, Bydgoszcz, Poland, 5Department of Health Sciences, Surgical Oncology Clinic, Bydgoszcz, Poland
Introduction: Rehabilitation of patients with colorectal cancer is mainly correlated with some specific psychological and behavioral problems. This problems are not only correlated with typical psychological problems of people suffered on cancer. The number of designed targeted supportive psychological procedures are still insufficient. Probably this problem is correlated with current short knowledge about psychological and behavioral changes in different groups of patient from each TNM clinical classification groups.
Objectives: The aim of the work was to present one university clinic analysis of psychological problems during systematic rehabilitation of patients with colorectal cancer with compressive analysis of used in our department innovative supportive psychological programs.
Methods: We have analyzed 3 groups of patients rehabilitated in our clinic in last 5 years (2008–2013) with colorectal cancer. The groups were constructed and based on the clinical staging and grading classification. All analyzed patients were previously operated. For the data collection we have used standard psychological procedures and standardized, individual questionnaire forms analysis.
Results: In our study we have analyzed 70 cases of patients from all selected and created groups (I,II,III). In our one center study we have created an suportive psychological program individualy designed for patients rehabilitated after colorectal cancer surgery.
Conclusions: Psychological problems during systemic rehabilitation of patients with colorectal cancer are very different in patients from each of TNM clinical classification group. Each group need a special program for psychological supportive care during all days of systemic rehabilitation especially in the first period of time after rehabilitation program beginning.
MASCC-0827
Does it matter whether it is online or offline: testing relative significance of alternative sources of supportive relations in cancer care of aging adults
G. Seckin 1
1Social Sciences, Isik University, Istanbul, Turkey
Introduction: Study of stress and coping has mainly emphasized the importance of offline supportive relationships in coping with cancer. This study is among the first to include offline and online social support as separate measures in assessment of appraisal of cancer experience and post-diagnosis self-appraisal.
Objectives: Whether online and offline social support a) are significantly associated with alternative appraisals of cancer experience and b) predict positive post-diagnosis self-appraisal.
Methods: This is a cross-sectional study of a 157 adults with cancer (Mage = 57; age range: 50–79). Comparisons of regression models and simple slope analyses were performed.
Results: (1) Online social support has a significant effect on positive self-appraisal subsequent to cancer diagnosis among older adults (β = .24, p < .01) (2) Online social support is perceived to be helpful if cancer is judged to be traumatic experience (β = .18, p < .05), or as a challenge that life presents (β = .23, p < .01) (3) Online social support is not perceived to be helpful if cancer is perceived to be an opportunity for personal growth (β = .10, p < .23) (4) Offline social support has no significant effect on self-appraisal (β = .04, p < .12) when it is entered into regression estimations simultaneously with online support. Offline support is not associated with appraisals of cancer experience either.
Conclusions: Supportive communication in online cancer groups can be a valuable resource for older people to draw upon when coping with cancer given that offline social support resources tend to decline in old age.
MASCC-0828
Impact of decompressive surgery in patients with metastatic spinal cord compression
J. ocaña 1, Y. Garcia1, E. Dalmau1, R. Pellejero2, M. Ferrer1, J. Pardo1, T. Bonfill1, M. Pampols1, E. Garcia1, I. Moya1, J. Soler3, F. Girvent2
1Oncology, Hospital de Sabadell, Barcelona, Spain, 2Spine Unit, Hospital de Sabadell, Barcelona, Spain, 3Radiotherapic Oncology, Hospital General de Catalunya, Barcelona, Spain
Introduction: There is evidence of benefit in recovery after decompressive surgery (DS) in patients with metastatic spinal cord compression (MSCC). There are no data on the impact of the DS in clinical improvement leading to chemotherapy with a possible survival benefit.
Objectives: To determine the outpatient group at discharge after DS in the MSCC and analyze the number of patients getting chemotherapy after DS
Methods: We retrospectively reviewed the medical records of all patients (n = 36) diagnosed with MSCC for solid tumors treated with DS plus radiotherapy between January 2001 and September 2012 in our institution. The characteristics were collected: age, sex, primary tumor type, performance status (PS) on admission, ambulatory status (EA) at admission, EA at discharge and PS at discharge.
Results: The median age was 67 years (range: 31–84, 25 M, 11 F). Primary tumors were lung (n = 17), breast (n = 5), kidney (n = 3), prostate (n = 4) and others (n = 7). Ambulatory patients at discharge were 23 (63.9 %). Patients receiving chemotherapy were 23 (63.9 %). The median overall survival was 227 days. We found a relationship between receiving chemotherapy with EA at discharge and PS at discharge (p = 0.001). No association between EA at admission y PS at admission (p > 0,05).
Conclusions: The DS in the MSCC has an impact on clinical improvement leading to chemotherapy with a possible survival benefit.
References: 1. Patchell R, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B: Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomized trial. Lancet 2005, 366:643–648.
MASCC-0829
Effect of YOCAS®© yoga on fatigue and circadian activity rhythms among breast cancer patients receiving hormone therapy: a URCC CCOP randomized, controlled clinical trial
L. Peppone 1, M.C. Janelsins1, C. Kamen1, A.R. Peoples1, C. Heckler1, J.J. Kirshner2, J.N. Atkins3, R. Gaur4, G.R. Morrow1, K.M. Mustian1
1Radiation Oncology, University of Rochester Medical Center, Rochester, USA, 2Oncology, Hematology Oncology Associates of CNY, Syracuse, USA, 3Oncology, Southeastern Medical Oncology Center, Clinton, USA, 4Oncology, Saint Luke’s Cancer Institute, Kansas City, USA
Introduction: Fatigue and disrupted circadian activity rhythms (CAR) are highly prevalent in breast cancer survivors (BCS) receiving hormone therapies; yoga is a promising therapy for these symptoms.
Objectives: To conduct a secondary data analysis of a multi-site, phase III RCT examining the efficacy of yoga for improving fatigue and to explore whether changes in CAR and fatigue are associated among BCS receiving hormone therapies.
Methods: The original RCT was conducted in the U.S. through the URCC CCOP Research Base and randomized BCS with any type of non-metastatic cancer and no previous yoga participation into 2 arms: 1) standard care monitoring [controls] or 2) 4-week yoga intervention (2x/wk; 75 min/session) plus standard care. The yoga intervention utilized the URCC Yoga for Cancer Survivors (YOCAS©®) program consisting of breathing exercises, 18 Hatha and Restorative postures, and meditation. Only BCS currently receiving aromatase inhibitors (N = 95) or tamoxifen (N = 72) were included in this analysis. Fatigue (MFSI and FACIT-F) and CAR (via actigraphy 12 & 24 h) were assessed pre- and post-intervention.
Results: Table 1 shows yoga participants demonstrated greater improvements in multiple dimensions of fatigue compared to controls. Linear regression shows significant associations between fatigue and CAR in the yoga group but not in the control group; as fatigue decreases in the yoga group 24 h and 12 h morning amplitudes increase and 12 h afternoon amplitude decreases (Table 2).
Table 1: ANCOVAs* for the effect of YOCAS yoga on fatigue
Control | Yoga | p-value | |
Change in MFI General | −0.6 | −2.9 | 0.002 |
Change in MFI Physical | −0.9 | −2.3 | 0.008 |
Change in MFI Emotional | −0.4 | −1.6 | 0.027 |
Change in MFI Mental | −1.1 | −1.7 | 0.217 |
Change in MFI Vigor | 0.1 | 1.5 | 0.016 |
Change in MFI Total | −3.0 | −9.9 | 0.001 |
Change in FACIT-F | 0.3 | 3.7 | 0.002 |
*Models adjusted for baseline score and age
Negative scores in the MFI signify decreased fatigue while positive scores in the FACIT-F signify decreased fatigue
Table2: Linear regression: Correlation between changes in fatigue and circadian rhythm in the yoga group
Change in FACIT-F Correlation* | p-value | Change in MFSI Correlation* | p-value | |
Change in 24-hour Amplitude | 0.271 | 0.04 | 0.221 | 0.05 |
Change in 12-hour Amplitude Morning | 0.267 | 0.04 | 0.222 | 0.05 |
Change in 12-hour Amplitude Evening | −0.102 | <0.20 | −0.233 | 0.09 |
*Model adjusted for baseline CPAR scores and age
Conclusions: The YOCAS©® intervention improved fatigue and changes in CAR amplitudes are associated with changes in fatigue. Funding: MRSG-13-001-01-CCE, NCIU10CA37420, K07CA120025 and OCCAM supplement.
MASCC-0830
Controlled clinical trial: effect of high voltage electrical stimulation (HVES) in the sensitivity tactile and blood flow of breast cancer survivors
V.T.K. Ferreira 1, B.P. Dias2, E.C.O. Guirro1
1Department of Rehabilitation and Functional Performance, University of Sao Paulo, Ribeirão Preto, Brazil, 2Physical Therapy, University of Sao Paulo, Ribeirão Preto, Brazil
Introduction: The surgical treatment of breast cancer, especially axillary lymphadenectomy (AL), can cause blood circulatory changes, also partial or total lesion of the sensory nerve intercostobrachial, often causing anesthesia or hypoesthesia in the corresponding dermatome ipsilateral upper limb surgery.
Objectives: To investigate the influence of high voltage electrical stimulation (HVES) in the blood flow and tactile sensitivity in nerve pathway intercostobrachial of women undergoing AL.
Methods: Sample of 10 volunteers, treatment (G1) and control (G2). The G1 and G2 were undergone 30 min of HVES during 14 sessions and were evaluated by means of continuous wave Doppler Ultrasound and the sensitivity tactile was accomplished through esthesiometer.
Results: The tactile sensitivity demonstrates reduction of 5.6 to 3.6 gf gf homolateral upper limb surgery. The Vmax artery and vein were 78.2 and 32.2 in the first evaluation and 89.2 and 28.2 in the final evaluation, respectively.
Conclusions: The results obtained on this study aim to justify therapies for intervention with that equipment in the treatment of morbidities caused by axillary linfadenectomy
References:
Gomes NCMC, Packer AC, Bigaton DR. Effect of cathodal high-voltage electrical stimulation on pain in women with TMD. RevBrasFisioter2012;16(1);10–5.
Garcia LB, Guirro ECO, Montebello, MIL. Effects of high-voltage electrical stimulation in postmastectomy bilateral lymphedema: case report. Braz J PhysTher2005;9(2);243–248.
Matheus, CM, Guirro, ECO. Change in blood flow velocity demonstrated by Doppler ultrasound in upper limb after axillary dissection surgery for the treatment of breast cancer. Breast Cancer Res Treat 2011;127:697–704.
MASCC-0831
Modern artificial nutrition products as a part of fast-track conception used in esophageal and gastric cancer oncological surgery—application analysis
K. Pietkun 1, K. Nowacka1, J. Siminska1, W. Hagner1, I. Glaza2, M. Nowacki3, W. Zegarski4, I. Glowacka4
1Department of Health Sciences, Rehabilitation clinic, Bydgoszcz, Poland, 2Faculty of Medicine, Department of Farmacology and Therapy, Bydgoszcz, Poland, 3Faculty of Medicine, Tissue Engineering Department, Bydgoszcz, Poland, 4Department of Health Sciences, Surgical Oncology Clinic, Bydgoszcz, Poland
Introduction: The esophageal and gastric cancer cases according to European statistics and meta-analysis are now still an important clinical and epidemiological problem. Surgical resection is one of the most common method of first choice treatment in operating cases. Patients with a cancerous tumor within the esophagus or stomach in various stages of clinical staging values of T and N, usually are characterized by a considerable degree of malnutrition, mostly as a protein—calorie type. Malnutrition in this patient group is a factor significantly influencing onto the quality of life and prognosis in the 5-year’s survival classification system.
Objectives: The analysis was designed to present the latest guidelines, recommendations, and specific producers examples of the use of artificial diet system products in patients with esophagus or stomach cancer, with indications for non-palliative surgical tumor resection, based on Fast-Track system conception
Methods: In the study, we have analyzed a group of scientific publications, guidelines and recommendations, selected from international gastroenterological, surgical, nutritional and dietary literature as well as material obtained in the selection of publicated material of the artificial diet system and clinical supplementation international producers.
Results: In our study we have strictly shown the curent data according to the new gudelines and recomendations corelated with modern nutritional alghoritms.
Conclusions: In our analysis and literature review we have shown, that the use of modern artificial diet products and systems under the Fast-Track conception in oncological surgery of patients operated due the esophagus and stomach cancer, is important and has a positive clinical effect.
MASCC-0832
Advanced cancer symptom data collection with modern mobile technology
S. Thomas 1, D. Walsh1, A. Aktas1, S. Shrotiya1, B. Estfan1
1Palliative Medicine, Cleveland Clinic, Cleveland, USA
Introduction: The HITECH (Health Information Technology for Economic and Clinical Health) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was implemented to improve health and management of complex conditions like cancer through appropriate technology. The ease and portability of iPads (© 2013 Apple Inc, Cupertino, California) is attractive for use in outpatients. REDCap (Research Electronic Data Capture; REDCap Software - Version 5.1.3 - © 2013 Vanderbilt University) allows users to build and manage secure online databases.
Objectives: To assess the feasibility and acceptability of an iPad as an electronic self-report symptom assessment instrument in Oncology outpatients.
Methods: Consent obtained from participants over the phone. Electronic symptom assessment instrument on iPad given to the participants prior to their first Oncology visit. The instrument with 34 questions (symptoms, quality of life) was adopted from European Palliative Care Cancer Symptom Study1. Responses downloaded to REDCap simultaneously. Printed assessment results given to the Oncologist for effective symptom management.
Results: Sample size = 10; Mean age = 65 year; Females = 50 %; College education of ≥4 years = 50 %; Completion rate = 100 %; Self-completed = 70 %; Mean time to complete = 8 min.
Conclusions:
1. Self completion = 70 % in an older population group with college education of 50 %.
2. Secure web-based data collection ensured compliance with patient privacy regulations.
3. New technologies may offer practical comprehensive symptom assessment in complex illness
References: 1. Hjermstad MJ, Lie HC et al. Computer-based symptom assessment is feasible in patients........multicenter study. EPCRC-CSA. J Pain Symptom Manage. 2012 Nov;44(5):639–54
MASCC-0833
Treatment complications in elderly with lung cancer
D.E. dilek erdem 1, B.Y. bahiddin yilmaz2, G.D. güzin demirag2, I.Y. idris yücel2
1Medical Oncology, Samsun Education and Research Hospital, Samsun, Turkey, 2Medical Oncology, Ondokuzmayis University, Samsun, Turkey
Introduction: Older patients with lung cancer have worse prognosis. Pre-existing comorbid conditions may severely affect treatment and recovery. Also, haematological and nonhaematological complications affect the outcomes.
Objectives: This study aims to identify the characteristics of lung cancer in older patients.
Methods: Three hundred thirteen lung cancer patients included in the study between 1997 and 2011. Several characteristics were described in a questionnaire. SPSS-16 was used.
Results: Among 313 patients, 102 were higher than or equal to 65 years old. Most crowded group consisted of patients between ages of 65 and 69 (n = 50, 49 %). Only one patient had age higher than 85 years. 9 female and 93 male patients were examined. In general, performance status was mostly ECOG II. Most of the patients had smoking status. The most common initial symptoms were hemoptysis, cough and dyspnea. Tumor was mostly included in the right lung. Stage IV was the most common stage at the diagnosis. Haematological toxicity was the major concern in this study. Among all of the older patients, most common toxicity associated with therapy was anemia which was followed by neutropenia. Second and third cycles of chemotherapy were two common cycles for anemia. Grade 3 and 4 toxicities were uncommon. Nonhaematological toxicities were also seen. Emesis, fatigue and poor appetite were three most seen toxicities.
Conclusions: Lung cancer is one of the most important issues in oncology practice. Older patients occupy a very different place among those patients. Aging, comorbid conditions may impair patients’ status during chemotherapy and may increase toxicities. More attention should be given about treatment- related toxicities in elderly.
MASCC-0834
Quality of life for ostomy patients in the republic of Moldova: changes through the years
N. Carafizi 1
1Hospice “Angelus”, Charity Foundation for Public Health “Angelus-Moldova”, Chisinau, Moldova
Introduction: From 2002 to 2012 in the prevalence structure of malignant tumors in the Republic of Moldova localization in rectum and colon have been achieved a significant growth, moving from the 6-th place to the first one. There is no accurate data about patients with applied stomas, but their total number is also in permanent increase. There is not a state program to support ostomy patients, as well as state centers where ostomy patients could get stoma bags and other accessories for stoma and skin care.
Objectives: To access the activity of the Charity Foundation for Public Health “Angelus-Moldova” in regards of the provided services for ostomy patients.
Methods: Review of the annual reports of the Charity Foundation for Public Health “Angelus-Moldova” about its activity for ostomy patients.
Results: Charity Foundation for Public Health “Angelus-Moldova” is one of the non-governmental organizations that has been providing palliative care services to incurable cancer and non-cancer adult patients and children in the capital of the country since November 2001. Simultaneously with the medical activity, it has been offering services for ostomy patients who live in different regions of the country. The main goal of these services is to improve quality of life of the ostomy patients, providing basic information about stoma and its care, medical consultations and psycho-emotional support.
Conclusions: Despite the fact that the national state program to support ostomy patients is not developed, the Charity Foundation “Angelus-Moldova” is the only provider of qualitative services for ostomy patients for the whole country.
MASCC-0835
Control of breast cancer: the nurses performance of primary health care
Y. Barbosa1, P. Rabêlo1, S. Ferreira1, T. Gozzo1, A. Almeida 1
1Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
Introduction: The nurses should be qualified for early diagnosis, since breast cancer is responsible for high mortality rates.
Objectives: To investigate the knowledge, attitude and practice of nurses regarding the early detection of breast cancer.
Methods: Partial results from cross-sectional study with completion scheduled for June 2013 in 42 Primary Health Services of São Luis/Brazil, using a structured questionnaire directed to the 94 Primary Care Nurses. The project was approved by the Ethical Committee in Research—2012.01.06.06-24 protocol. For partial analysis used the Epi Info 3.5.2.
Results: Thirty-five nurses of 16 Primary Health Services were interviewed of which 34.3 % has been working since 2 years at Primary Health Services, are specialists (85.7 %), mainly in the Family Health Strategy. 51.4 % didn’t received training about the actions recommended for the control of breast cancer. Most investigates the presence of risk factors for breast cancer at the time of collection of the Pap smear. The women at high risk are monitored for 6 months at less than 1 year (50 %). 97.1 % of nurses reported to the Clinical Examination of the Breasts, to 54.3 % the frequency is annual, 48.6 % in women under 35 years-old. If has changes, 65.7 % prioritize the routing of user. Mammography has annually (45.7 %) for more than 40 years-old (57.1 %). 71.4 % highlight the difficulty in scheduling the examination.
Conclusions: We identified the need for training with a focus on the actions of organized screening for breast cancer.
MASCC-0836
Cancer and cognitive impairments induced by chemotherapy: effects of cognitive rehabilitation
J. LE FEL 1, F. Joly2, K. Rovira3, V. Roy3, O. Rigal1
1Supporting care, Centre Henri Becquerel, Rouen, France, 2Supporting care, Centre François Baclesse, Caen, France, 3Psychology, University of Rouen, Rouen, France
Introduction: Cancer and chemotherapy can have adverse effects on cognitive functions and quality of life. To date, no specific prevention or treatments have been developed despite a large number of patients who report subjective cognitive changes related to cancer and its treatment.
Objectives: This abstract presents data from a pilot study of a cognitive rehabilitation program aimed at helping breast cancer patients manage cognitive dysfunction associated with adjuvant chemotherapy.
Methods: Participants were 19 women (mean age = 58) who were an average of 5 month after chemotherapy for breast cancer. All had reported complaints regarding memory and attention. Patients were randomized to one of three support groups. We compared the effects of rehabilitation using computerized software RehaCom® (n = 4), to those of a home rehabilitation with a workbook (n = 6). Both support were confronted with patients not receiving cognitive rehabilitation (n = 9).
Results: Results of the management indicate that computerized rehabilitation can improve cognitive function and quality of life in all patients who received chemotherapy compared to performance before support. This improvement is also found in patients receiving a support at home with a workbook. In contrast, subjects who were unable to participate in these two types of support indicate a stagnation or even a deterioration of their performance and this a few months after the end of chemotherapy.
Conclusions: This cognitive well-being is essential to the return of a professional activity for younger patients, or of maintaining independence for older patients. The results will be detailed at the congress.
MASCC-0837
Nursing care for chemotherapy-induced peripheral neuropathy: systematic review
A.P. Zandonai 1, N.O. Sawada1
1Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a significant, debilitating symptom directly related to the administration of neurotoxic chemotherapy (vinca alkaloids, taxanes, platinum analogs, thalidomide and bortezomib) for the treatment of cancer. CIPN compromises quality of life and results in physical pain or discomfort(1–3).
Objectives: Investigate the latest nursing care for CIPN.
Methods: The PRISMA Checklist (4) for reporting a systematic review was followed in this study to guide the search and synthesize the scientific literature. The research was conceived to study and report the nursing cares for CIPN. The databases LILACS, PUBMED, CINAHL, EMBASE, COCHRANE LIBRARY, SCOPUS, SCIELO and COCHRANE LIBRARY were consulted and ten relevant studies were selected.
Results: The nursing care for CIPN still consists in developing a screening and surveillance model for patients undergoing chemotherapy treatment with neurotoxic drugs; creating a baseline evaluation for CIPN or preexistent neuropathy; evaluating each chemotherapy session for CIPN; using validated tools to assess CIPN; informing patients about the risk of neuropathy and educating them to recognize early signs and symptoms; teaching strategies of adaptation to patients with functional impairment by CIPN; teaching safety precautions to prevent injuries associated with CIPN.
Conclusions: Currently, there is no specific intervention or nursing care to CIPN, however, nursing supports and educates CIPN patients and their families. Nursing plays a key role in the screening and assessment of the main signs and symptoms of CIPN and helps to measure and understand how it affects the performance of activities of daily living.
MASCC-0838
Survival patterns in squamous cell carcinoma of the head and neck: pain, depressed mood and fatigue as prognostic factors of survival
C. Reyes-Gibby 1, K.W. Merriman1, K.O. Anderson2, E. Hanna3
1Emergency Medicine, MD Anderson Cancer Center, Houston, USA, 2Symptoms Research, MD Anderson Cancer Center, Houston, USA, 3Head and Neck Surgery, MD Anderson Cancer Center, Houston, USA
Introduction: There is limited information on the influence of symptoms on survival outcomes of patients with squamous cell cancer of the head and neck (HNSCC).
Objectives: We assessed the importance of self-reported pain, depressed mood and fatigue in predicting survival outcomes of patients newly diagnosed with squamous cell cancer of the head and neck (HNSCC).
Methods: Pain, depressed mood and fatigue were assessed at initial presentation to the Cancer Center, prior to any cancer treatment. Kaplan–Meier survival curves and log-rank tests were used to evaluate the effect of these symptoms on 5-year survival. We also assessed the extent to which these symptoms influenced survival using multivariate Cox proportional hazards regression analysis, adjusting for age, race, sex, alcohol and smoking, comorbidities, TNM stage.
Results: The sample included 2,662 HNSCC patients (oral = 1349; pharynx = 800; larynx = 513) presenting to the Cancer Center. Five-year relative survival rates for the total sample were higher for those with non-severe symptoms of pain (non-severe = 50 %; severe = 34 %); depressed mood (non-severe = 50 %; severe = 38 %) and fatigue (non-severe = 56 %; severe = 34 %). Stratified by cancer site, multivariable Cox regression analysis showed that among those with oral cancer, severe pain (HR = 1.5; 95 % CI = 1.1,2.0) and fatigue (HR = 1.5; 95%ci = 1.1,2.0) were significantly associated with survival. Only severe fatigue was significantly associated with survival among those with pharyngeal (Fatigue HR = 1.5; 95%CI = 1.05,2.2) and laryngeal cancer (Fatigue HR = 1.5; 95 % CI = 1.05,2.2). TNM stage, smoking, alcohol intake, race, age and comorbidities were also associated with survival.
Conclusions: Our findings provied evidence on the importance of prompt treatment and control of symptoms in cancer patients.
MASCC-0839
How removing metastasis surgically will impact the course of rehabilitation
S. Elmi 1, S. McEwen1
1Research, St.John’s Rehab Sunnybrook Health Science, Toronto, Canada
Introduction: Improved cancer treatments have increased survivorship, and more patients are coming with metastasis after years of living with special cancer. These days we see more cases of patients who are going under operation to remove their metastasis. Little is known about this group of patients course in rehabilitation and outcome.
Objectives: To explore the difference between the outcome of rehabilitation in the patients who had their metastasis removed surgically and other patients with cancer (with or without metastasis) we recorded different characteristics of the patients admitted in the general Oncology Rehabilitation Program, St. John’s Rehab Hospital, Toronto, Canada (ORP-SJRH) over 4 years.
Methods: We extracted pre-admission and discharge FIM score(motor, cognitive, total Data elements included age, sex, cancer diagnosis, comorbidities, admis-sion and discharge Functional Independence Measure (FIMTM) scores, history of chemotherapy and/or radiation or surgery, type of surgery, CBC and electrolyte level, Berg score, urine incontinency and return to acute care.
Results: There were 310 eligible records. The patients’ age ranged from 38 to 97 years; 59.5 % were women, The most common diagnoses were colorectal cancer(28 %) metastatic disease (15.7 %), and cancer of the urinary organs (9.2 %). Patients improved an average of 17.1 points on the FIMTM but patients with metastasis resection had significantly lower improvement in their FIMTM score. Berg score was different in 2 groups.
Conclusions: FIM and Berg score and the presence of urine incontinence were different in 2 groups.
References: cEwen S, Elmi S, Waldman M, Bishev M. Inpatient oncology rehabilitation in Toronto: a descriptive 18-month retrospective record review. Support Care Cancer. 2012 Jul;20(7):1541–7
MASCC-0840
Oral rehabilitation after oral oncolgyc surgery with dental implants
J. Rosello 1, C. Arranz2, C. Ros3, R. Rodriguez3, E. Jane3, J. López3
1Oral Medicine, University of Barcelona, Hospitalet de Llobregat, Spain, 2Maxillo Facial Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain, 3Odontology in oncologic and immunocompromised patients Master, University of Barcelona, Hospitalet de Llobregat, Spain
Introduction: The treatment of OSCC is mainly based on surgical excision of the lesion. In many cases the diagnosis of malignancy does not occur in the early stages of the disease, so that the surgery carries significant mutilations that will be difficult to rehabilitate.
The microvascular grafts have revolutionized the techniques for tissue reconstruction in oral cancer patients.
Objectives: To achieve a good stability of the prostheses is possible to use osseointegrated implants which will help the patient to have a better quality of life.
Presurgical planning with the restoring prosthodontist is mandatory before implant surgery to get the best possible result. A surgical guide can be fabricated based on the information of the cone beam computed tomographic scans, the implant planning software and the prosthodontist’s estimation of the location of the reconstructed bone and his/her ideal locations for implant fixtures.
Methods: We report two cases of patients who have had important resections in the treatment of her oral cancers and have been rehabilitated using osseointegrated implant prostheses.
Results: The use of dental implants in oral cancer reconstruction has become an important aspect of the reconstructive plan for these patients.
Conclusions: With improvements in technology and sophistication in prostheses fabrication, extremely functional and cosmetic outcomes can be achieved. It is a heavy process for patients to endure, but the end result permits the patients to minimize the consequences, limitations, and stigmata of ablative cancer surgery.
MASCC-0841
Referral practices of paediatric oncologists to specialized palliative care
K. Wentlandt 1, M.K. Krzyzanowska2, N. Swami3, G. Rodin4, L.W. Le5, L. Sung6, C. Zimmermann4
1Psychosocial Oncology and Palliative Care, Toronto General Hospital UHN, Toronto, Canada, 2Oncology, Princess Margaret Hospital, Toronto, Canada, 3Palliative Care, Princess Margaret Hospital, Toronto, Canada, 4Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada, 5Biostatistics, Princess Margaret Hospital, Toronto, Canada, 6Hematology and Oncology, Hospital of Sick Children, Toronto, Canada
Introduction: Little is known regarding the practice patterns and attitudes of pediatric oncologists (PO) towards referral to specialized palliative care (SPC).
Objectives: To examine the SPC referral practices and attitudes of PO and compare them to those of adult oncologists (AO).
Methods: Physician members of the Canadian Association of Medical Oncologists, Canadian Association of Radiation Oncologists, Canadian Society of Surgical Oncology and Canadian members of the American Society of Pediatric Hematology/Oncology were invited to participate in an anonymous survey assessing SPC referral practices. Participants received two e-mailed and two mailed invitations.
Results: The response rate was 72 % (603/839) for AO (223 medical oncologists/haematologists, 302 radiation oncologists, 78 surgical oncologists); and 50 % (41/82) for PO. Fewer PO than AO had completed a palliative care rotation (26 % vs 51 %). Inpatient SPC consultations were available for 95 % of PO but only 31 % had access to a Palliative Care Unit (vs. 82 % AO) and only 27 % had access to an outpatient SPC clinic (vs 73 % AO). Eighty-nine percent of PO usually/always referred symptomatic patients with a short prognosis to SPC and 87 % referred at diagnosis of metastatic disease or during palliative chemotherapy. Attitudes of PO to palliative care and those perceived of their patients tended to differ from those of AO (Table 1).
Oncologists’ attitudes towards SPC | Pediatric Onc n(%) N = 48 | Adult Onc n(%) N = 595 | p -value 1 | |
Adds too many additional care providers | Strongly Agree/Agree | 8 (16.7) | 37 (6.6) | 0.002 |
Neutral | 9 (18.8) | 60 (10.7) | ||
Disagree/Strongly Disagree | 31 (64.6) | 466 (82.8) | ||
More likely earlier if it is renamed as Supportive Care | Strongly Agree/Agree | 28 (58.3) | 183 (32.6) | 0.0001 |
Neutral | 13 (27.1) | 180 (32.1) | ||
Disagree/Strongly Disagree | 7 (14.6) | 198 (35.3) | ||
Patients decline/refuse PC referral | Strongly Agree/Agree | 2 (4.2) | 43 (7.7) | 0.57 |
Neutral | 17 (35.4) | 100 (17.8) | ||
Disagree/Strongly Disagree | 29 (60.4) | 418 (74.5) | ||
Patients have negative perceptions of Palliative Care | Strongly Agree/Agree | 29 (60.4) | 242 (43.1) | 0.02 |
Neutral | 11 (22.9) | 177 (31.5) | ||
Disagree/Strongly Disagree | 8 (16.7) | 143 (25.4) | ||
Referral to PC is an abandonment of patients | Strongly Agree/Agree | 1 (2.1) | 12 (2.1) | 0.81 |
Neutral | 3 (6.3) | 25 (4.4) | ||
Disagree/Strongly Disagree | 44 (91.7) | 527 (93.4) | ||
Uncomfortable referring patients to PC until they are close to death | Strongly Agree/Agree | 3 (6.3) | 25 (4.4) | 0.41 |
Neutral | 4 (8.3) | 31 (5.5) | ||
Disagree/Strongly Disagree | 41 (85.4) | 506 (90.0) |
Conclusions: PO have less training in and less access to SPC than AO. Stated referral practices are similar, although PO are more likely to report their patients have negative perceptions of palliative care, and to favor renaming the specialty ‘supportive care.’
MASCC-0842
Presenting symptoms of primary non-hodgkin lymphoma in the oral cavity and jaws: analysis of 53 cases
Y. Zadik 1, F. Shokaier2, T. Neuman3, R. Zeltser4, K. Blal4
1Oral Medicine, Hebrew University-Hadassah School of Dental Medicine and Israel Defense Forces Medical Corps, Jerusalem, Israel, 2Oral Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel, 3Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel, 4Oral and Maxillofacial Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Introduction: Non-Hodgkin lymphoma (NHL) is the third most common oral malignancy; yet many cases are diagnosed late due to misleading and indistinctive disease features that may mimic other oral conditions.
Objectives: To review the presenting symptoms of all NHL diagnosed during one decade at our institute, aiming to evaluate reasons for late diagnosis.
Methods: We retrospectively collected all 53 cases of oral/jaw primary-NHL that were diagnosed at the Hadassah-Hebrew University Medical Center from 2002 to 2011. Patients’ demographics and complaints, and clinical, radiological, and morphological findings were analyzed.
Results: Mean patient age at diagnosis was 56.6 ±23.1 years; male-to-female ratio was 32:21. Morphologic diagnoses were diffuse large B-cell (41.5 %), follicular (22.6 %), marginal zone B-cell (11.3 %), and Burkitt (9.4 %) lymphomas. All lesions were symptomatic at time of diagnosis; with swelling (81.1 %), pain (24.5 %), B-symptoms (weight loss, fever, sweats; 13.2 %), and neuropathy (13.2 %) the most prevalent complaints at presentation. Prior to diagnosis, 13.2 % of patients sought dental care for “toothache”. However, vast majority of initial clinical-radiological differential diagnosis of the lesions, made by the oral and maxillofacial surgeon prior to biopsy, included malignant (and benign) tumors.
Conclusions: Although majority of lesions were clinically considered malignant, some lesions mimicked benign conditions. Of importance are lesions that masqueraded as toothache, infections, reactive lesions, and osteonecrosis (total of more of one-fifth of lesions), which may not be routinely subjected to histologic evaluation. Facial neuropathy in patient with no history of facial trauma should be carefully evaluated for malignancy. Clinicians should keep in mind that lymphoma has many faces, and it may mimic a wide variety of lesions.
MASCC-0843
Can be the osseointegrated implants an adjuvant treatment for the chronic oral candidiasis?
A. Rosello 1, J. Rosello2, J. Espejo1, P. Castañeda1, E. Jane1, J. López1
1Odontology in oncologic and immunocompromised patients Master, University of Barcelona, Hospitalet de Llobregat, Spain, 2Oral Medicine, University of Barcelona, Hospitalet de Llobregat, Spain
Introduction: Candidiasis is an opportunistic infection caused by fungi of gender Candida and the most common is Candida albicans. The transformation of a C. albicans into a pathogenic organism is determined by systemic and local predisposing factors.
We report a 59 year old caucasian white woman diagnosed with a chronic erythematous oral candidiasis and treated with various antifungal from 9 years ago. Currently candidiasis has become refractory to treatment.
Objectives: The dermatologist, who treats her candidiasis, suggests the possibility of raising an implant rehabilitation to minimize local factors that favorices the development and perpetuation of oral candididasis.
Methods: Given her advanced periodontal disease we decided to proceed with the extraction of the all remaining teeth and rehabilitate the patient with two implant supported fixed prostheses.
Results: Once the sanitation of the oral cavity was achieved, the patient has had no suffered significant outbreaks of candididasis.
Conclusions: We propose the possibility that teeth in poor condition and dentures act as a reservoir of candida and facilitate reinfection.
MASCC-0844
A phase ii pilot single arm prospective clinical trial of the stat rad workflow for osseous metastases: preliminary results
D. Wilson 1, A. Sim1, L. Handsfield1, Q. Chen1, L. Blackhall2, T. Showalter1, P. Read1
1Radiation Oncology, University of Virginia, Charlottesville, USA, 2Medicine - Division of Palliative Care, University of Virginia, Charlottesville, USA
Introduction: Patients with bone metastases often require multiple trips to the Radiation Oncologist for treatment. We developed a novel TomoTherapy-based workflow, called STAT RAD, which condenses standard of care simulation, planning, quality assurance, and conformal hypofractionated treatment delivery into 5–6 h for simulation and treatment initiation in a single day.
Objectives: Here we present the preliminary results of a pilot clinical trial to assess the effect of the STAT RAD workflow on pain, opioid use, and patient satisfaction in patients with painful bone metastases.
Methods: A prospective clinical trial was designed to enroll 30 cancer patients with 1–3 painful bone metastases. Patients were to receive 2–5 fractions of 5–10 Gy of conformal radiation therapy using the STAT RAD workflow. Pain, opioid use, and patient satisfaction was recorded prior to treatment and at 1, 4, 8, 12, and 24 weeks after treatment.
Results: Fifteen patients have enrolled since 11/2011. All were treated with the STAT RAD workflow and received kVCT simulation and conformal hypofractionated radiotherapy in the same day. Post-treatment pain scores at each time point were significantly lower than pre-treatment scores (p < 0.03). There was no si]gnificant difference between mean pre-treatment and post-treatment opioid intake at any time point (p > 0.12). At 6 months 83 % of patients were completely satisfied with the results of their treatment.
Conclusions: Preliminary results indicate that STAT RAD, a workflow that allows for same-day simulation, planning, and delivery of conformal hypofractionated radiotherapy for bone metastases, results in a significant reduction in pain scores and high patient satisfaction.
MASCC-0845
Relationship between genetic markers, quality of life (QOL) and fatigue (F) in cancer patients prior to treatment
J. Sloan 1, B. Diasio2, Q. Shi1, P. Yang1
1Health Sciences Research, Mayo Clinic, Rochester, USA, 2Oncology, Mayo Clinic, Rochester, USA
Introduction: Previous studies suggested potential relationships between certain drug metabolizing (DM) genes in metastatic colorectal cancer patients and QOL/F prior to receipt of chemotherapy (Sloan, Plenary Session ASCO 2004).
Objectives: This presentation summarizes subsequent studies in adjuvant colorectal and lung cancer patients in an attempt to expand and replicate previous findings.
Methods: Two studies involved 1,583 stage III colorectal cancer patients and 1,299 patients with non–small-cell lung cancer respectively. Genomic DNA and baseline QOL/F data via linear analogue self assessment (LASA) scales with QF were obtained. 53 DM SNPs and 470 SNPs respectively of three biologic pathways were assessed for association with QOL/F. Logistic regression with training/validation samples was used to test the association of SNPs with deficits in QOL/F.
Results: In the colorectal study, 14 relationships between DM genes and QOL were detected including those seen in our earlier study related to DPYD and TYMS (p < 0.05). GSTP1 I105V and OPRT 5’UTR 28 A>G markers related to fatigue scores (p = 0.04, 0.005, respectively). In the lung study, three SNPs in the MGMT gene (rs3858300; rs10741191 and rs3852507) from DNA repair pathway were associated with overall QOL. Two SNPs (rs2287396 [GSTZ1] and rs9524885 [ABCC4]) from the glutathione metabolic pathway were associated with fatigue. These relationships remained after adjusting for covariates.
Conclusions: Similar to the earlier study in metatastatic colorectal cancer patients, we observed possible relationships in patients with Stage III colorectal cancer patients and non-small cell lung cancer patients with regard to genes and QOL/fatigue. Further association studies are needed to clarify these relationships.
MASCC-0846
Prescribing practices of antiemetics using a computerized physician order entry system
K.C. Kadakia 1, A.D. Leal1, D.K. Seisler2, R. Qin2, K.C. Fee-Schroeder3, D.C. Grendahl4, K.M. Sorgatz3, C.L. Loprinzi4
1Division of Internal Medicine, Mayo Clinic, Rochester, USA, 2Department of Health Sciences Research, Mayo Clinic, Rochester, USA, 3Department of Oncology, Mayo Clinic, Rochester, USA, 4Division of Medical Oncology, Mayo Clinic, Rochester, USA
Introduction: Providing guideline-consistent chemotherapy-induced nausea and vomiting (CINV) prophylaxis is suboptimal
Methods to improve the appropriate use of prophylactic antiemetics are needed.
Objectives: The primary objective was to evaluate the degree of compliance to institutional guideline-directed CINV prophylaxis using a computerized physician order entry system. A survey of nurses was performed to evaluate how oncology practices, within a cooperative group, manage clinician orders for the prevention of CINV.
Methods: The electronic medical records of 100 consecutive patients were reviewed. The primary endpoint was the incidence of compliance to provide all aspects of institutional CINV prophylaxis for acute (Day 1) and delayed (Days 2–4) CINV for patients receiving minimal, low, moderate, and highly-emetogenic chemotherapy. Descriptive analyses were performed on the convenience sample. Logistic regression was applied to determine the influence of potential factors with noncompliance.
Results: On Days 1–4, the incidence of compliance was 94 % (See Figure 1). A high-degree of compliance to institutional guidelines for delayed CINV (97 %) was observed. Patients receiving doxorubicin/cyclophosphamide were numerically less likely to receive institutional guideline-directed CINV prophylaxis, compared to patients receiving other regimens (OR: 0.24 (0.04, 1.36), p-value: 0.05). No other factors were significantly predictive for noncompliance. The nurse survey demonstrated significant differences in the management of clinician orders for the prevention of CINV.
Conclusions: Computerized physician order entry is associated with impressive adherence to institutional guideline-directed CINV prophylaxis for the prevention of both acute and delayed CINV.
References
Figure 1. Compliance for Scheduled Antiemetics, by Day
MASCC-0847
How to successfully connect rural cancer patients and their supporters with supportive care: a culturally acceptable, online South Australian example
K.M. Gunn 1, D. Turnbull1, L. McWha1, M. Davies1, N. Bidargaddi2, I. Olver3
1School of Psychology, University of Adelaide, Adelaide, Australia, 2Mental Health Observatory Research Unit, Country Health SA, Adelaide, Australia, 3CEO, Cancer Council Australia, Sydney, Australia
Introduction: Rural cancer patients lack rural-specific information on how to cope with supportive care issues and their access to support services is often hindered by attitudinal barriers.
Objectives: A) to involve rural cancer patients in the development of online rural-specific, supportive-care cancer information, B) document the lessons learnt and C) evaluate the website for its ability to increase users’ help-seeking intentions and decrease self-perceived levels of isolation and distress.
Methods: Using a Participatory Action Research (PAR) framework, 11 rural cancer patients and one rural health professional/rural cancer patient’s carer, worked with the authors to develop http://www.countrycancersupport.com.au/. Academic literature also informed the website design (e.g. behaviour change theory). 111 rural South Australian cancer patients or their family, friends, carers (i.e. “supporters”) or health professionals, then participated in the online website evaluation.
Results: Participants reported a sense of empowerment from being involved in the development of the website. There were 3957 visits to the 84 page website in the first 5 months. Website evaluation participants reported it was easy to use, helpful and relevant, written by people who understood what they were going through and that it made them more motivated and confident to access professional psychosocial support services and/or travel for medical treatment (if relevant). 73.33 % of patients and supporters (to whom it was relevant) said using the website made them feel less isolated and 53.57 % felt less distressed.
Conclusions: This unique research demonstrates the efficacy of PAR in developing culturally acceptable interventions and provides a framework to inform the development and evaluation of other online, consumer-driven supportive-care interventions.
MASCC-0848
From consensus to bedside: is the staging of cancer cachexia clinically feasible and relevant?
A. Vigano 1, E. Del Fabbro2, J.A. Morais3, R.D. Kilgour4, M. Borod5
1McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, Canada, 2Palliative Care, Virginia Commonwealth University Medical Centre, Richmond VA, USA, 3Geriatric Medicine, McGill University Health Centre, Montreal, Canada, 4Exercise Science, Concordia University, Montreal, Canada, 5Supportive and Palliative Care, McGill University Health Centre, Montreal, Canada
Introduction: The clinical relevance of the Cancer Cachexia Stages remains to be established.
Objectives: To propose criteria for identifying the CCS and exploring their relevance, in the clinical setting.
Methods: Two hundred and nine patients with advanced non-small cell lung or gastrointestinal cancers were categorized as non-cachectic, pre-cachectic, cachectic, and in refractory cachexia through simple bed-side measures: presence/severity of anorexia, food intake, functional status, hand-grip strength, hemoglobin, albumin, c-reactive protein and white blood cell counts.
Results:
NC | PC | C | RC | |
n = 54 | n = 22 | n = 54 | n = 79 | |
aPG-SGA total score (0–36; 36 worst) | 1.8 (1.2–2.4)* | 7.1 (4.6–9.6) | 9.7 (8.2–11.2) | 13.9 (12.6–15.2) |
McGill QoL Total Score (0–10; 0 Worst) | 7.2 (6.7–7.6) | 5.5 (4.7–6.4) | 5.3 (4.6–5.9) | 5.0 (4.3–5.5) |
ESAS total score (0–90; 90 worst) | 21.9 (18.4–25.3) | 39.2 (30.4–48.0) | 37.8 (32.0–43.1) | 46.1 (42.4–49.8) |
# Hospital days/follow-up days (%) | 3.2 (2.1–4.4) | 10.5 (2.0–20.0) | 5.4 (2.0–8.8) | 30.2 (22.1–38.3) |
Chemotherapy Dose Reduction † | 5/18 (27.8 %) | 2/6 (33.3 %) | 7/17 (41.2 %) | 9/18 (50.0 %) |
Total fat mass by DXA (kg) | 25.8 (21.9–29.7) | 20.0 (12.2–27.8) | 17.0 (13.5–20.6) | 12.4 (9.1–15.7) |
Appendicular lean mass by DXA (kg) | 19.6 (17.6–21.7) | 19.5 (16.4–22.6) | 19.0 (17.4–20.6) | 18.2 (16.2–20.3) |
Survival (weeks) †† Median (95 % CI) | 67.1 (58.1–76.2) | 42.6 (10.9–74.3) | 36.0 (24.4–47.6) | 12.8 (8.2–17.5) |
* Mean (95 % CI). † Chi-square test: p = 0.16. †† Log-rank test: p < 0.01.
NC: non cachectic; PC: pre-cachectic; C: Cachectic; RC: refractory cachectic; aPG-SGA: abridged Patient-Generated Subjective Global Assessment; McGill QoL: McGill Quality of Life Questionnaire; ESAS: Edmonton Symptom Assessment System; DXA: Dual-energy X-ray absorptiometry.
Conclusions: Our study supports the clinical applicability and relevance of the CCS.
MASCC-0849
Making mouth care matter
C. Thamm 1
1Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
Introduction: Mucositis is one of the most dose limiting toxicities related to anticancer therapies such as chemotherapy or radiation therapy. Mucositis is a source of infection and pain and impairs a patients’ ability to obtain adequate nutrition during their treatment phase and beyond. A small exploratory study conducted by a student allied health professional at the Princess Alexandra Hospital in Brisbane, Australia found that patients’ mouths were not routinely being assessed by nursing staff. They also discovered that there were no clear guidelines for standard mouth care interventions across the division of cancer.
Objectives: A group of senior oncology nurses from inpatient, outpatient and radiation departments along with a pharmacist, therefore, developed a procedure to standardize mouth care across all departments in cancer services. To compliment this they also developed a form using the WHO grading tool, and matching interventions to assist nursing staff care for patients’ mouths safely.
Methods: This form and procedure were introduced concurrently with extensive education sessions, making sure nurses in each area given the opportunity to receive training.
Results: Early evaluation through auditing has shown mixed results of compliance, but that when used, mouths are being assessed regularly and graded correctly. Evaluation also shows that nurses are more aware of the importance of good mouth care and mucositis management.
Conclusions: Further evaluations are being conducted to correlate evidence of grading being linked to interventions and decreased complications related to mucositis.
MASCC-0850
Aprepitant for prevention of chemotherapy induced nausea vomiting (CINV) in anthracycline-based regimes for breast cancer
I. Ghosh 1, A. Dwary1, D. Dabkara1
1Medical Oncology, Tata Medical Center, Kolkata, India
Introduction: Anthracycline-cyclophosphamide combinations for breast cancer have a high risk of CINV and hence an aprepitant-based regime is recommended.
Objectives: To retrospectively analyze the efficacy of aprepitant-based regime for prevention of CINV in anthracycline-cyclophosphamide chemotherapy at our center.
Methods: We retrospective analyzed the records of breast cancer cases treated with anthracycline-cyclophosphamide combinations between October 2011 and Dec 2012. Recommended antiemesis regimen consisted of aprepitant 125 mg PO 1 h before chemotherapy and 80 mg PO D2-3, dexamethasone 12 mg IV 30 min before chemotherapy and 8 mg PO D2-4 and palonosetron 0.25 mg IV (or ondansetron 8 mg IV) 30 min before chemotherapy. Fosaprepitant was available for use after July 12. Complete response (CR) was defined as no vomiting and no use of rescue medications.
Results: We identified 189 such patients; 15 were metastatic. 765 cycles (3–6/patient) were administered; 59 % were fluourouracil-epirubicin-cyclophosphamide, 28 % adriamycin-cyclophosphamide, 8 % fluourouracil-adriamycin-cyclophosphamide and 5 % others. In cycle 1, 27 (14 %) patients did not receive aprepitant, 155 (82 %) patients received aprepitant and 7 received fosaprepitant (4 %). Combining all cycles, aprepitant was not used in 84 (11 %) cycles, oral aprepitant was used in 654 (85 %) cycles and fosaprepitant in 27 (4 %) cycles. Data regarding emesis and rescue medications were available for 709 cycles.
In cycle 1, CR rate was 62 % (acute 85 %, delayed 63 %) in aprepitant/fosaprepitant group versus 51 % (acute 73 %, delayed 54 %) in no aprepitant group. In subsequent cycles- CR rate was 61 % versus 51 % respectively.
Conclusions: Aprepitant showed significant activity in preventing CINV and the efficacy persisted over the entire course of chemotherapy.
MASCC-0851
The relationship between family caregivers’ psychological distress and empathic accuracy of perceiving cancer patients’ symptoms
C.T. Hung 1, B. Given2, L. Spence2
1School of Nursing, National Taiwan University, Taipei, Taiwan, 2College of Nursing, Michigan State University, East Lansing, USA
Introduction: Family caregivers play an important role in assisting patients’ symptom management at home. Davis’ Empathy suggests that family caregivers’ psychological distress can influence their accurate perception with patient symptoms.
Objectives: This study aimed to examine the levels of congruence of pain and fatigue severity and frequency between cancer patients, and the associations between caregivers’ psychological distress and symptom congruence.
Methods: This was a cross-sectional correlative study adopting the data from the study entitled Family Home Care for Cancer—A Community-Based Model (# R01CA-79280). Variables included the severity and frequency of pain and fatigue, caregiver depressive symptoms (Center for epidemiologic studies depression scale, CES-D), caregiver burden (Caregiver reaction assessment, CRA), and caregivers’ background information. Statistic analysis included Intra-class correlation coefficient and logistic linear regression.
Results: A total of 225 cancer dyads was at a fair-to-moderate level of congruence of pain severity and frequency (ICC = 0.3–0.5). Congruence of pain severity was predicted by more self-esteem, and also by a fewer caregivers’ depressive symptoms, a fewer patient symptoms, and living with patients. The underestimation of pain frequency, comparing to congruence, was more likely predicted by perceiving more schedule interruption. The underestimation of fatigue severity and frequency comparing to congruence, was more likely predicted by perceiving more patient symptoms.
Conclusions: Less congruence of symptom perception may be a common caregiving situation. Caregivers’ self-esteem indicates congruence, while their psychological distress indicates non-congruence of pain perception. The number of patients’ symptoms and caregivers’ living arrangement were also the important factors affecting congruence of symptom perception.
MASCC-0852
How office based gyneco-oncologists in Germany apply antiemetic guidelines during the first cycle of ac-containing (NEO)adjuvant chemotherapy
J. Schilling 1, H.J. Hindenburg2
1Vice president, German Professional Association of Gyneco-Oncology in Practices (BNGO), Berlin, Germany, 2President, German Professional Association of Gyneco-Oncology in Practices (BNGO), Berlin, Germany
Introduction: Supportive Care guidelines are an important instrument to maintain quality of treatment and quality of life in cancer patients. However, there are limitations in the application and adherence and changes of guidelines may not be implemented on short notice.
Objectives: The aim was to evaluate the awareness of modern antiemetic guidelines (GL) and their practical use in patients receiving anthracycline plus cyclophosphamide (AC)-containing chemotherapy. The ASCO GL (1) recommend prophylaxis with 5-HT3-receptorantagonist (RA), Neurokinin1-receptorantagonist and dexamethasone.
Methods: Thirty-six practices used the ODM Quasi® GYN system for documentation. Demographical data about institutions and patients and knowledge and practical application of antiemetic GL were documented. Antiemetic treatment documentation was performed from Oct. 2012 during 6 consecutive weeks in 150 breast cancer patients who received the first cycle of an AC chemotherapy (77 % adjuvant, 33 % neoadjuvant).
Results: Awareness of antiemetic GL: AGO* (71 %), ASCO (65 %), NCCN (22 %), MASCC (19 %), application of GL: AGO (49 %), ASCO (33 %); none (9 %), MASCC (7 %), others (2 %). 93 % were aware of the change of the emetic group of AC in the ASCO GL. Active use of triple drug antiemesis 74 %, planned use 17 %, no use 9 %.
Treatment documentation in 150 pts: 56/150 (37 %) received the triple drug schedule according to GL, 94/150 (63 %) received a combination of 5HT3-RA and DEX.
* AGO- German Working Group of Gynecologic Oncology
Conclusions: Only 37 % of pts received the triple combination according to the guidelines in the first cycle of AC.
References: Basch E et al. J Clin Oncol 2011;29(31):4189–98
MASCC-0853
Microbes, mucins and mmps in the pathobiology of mucositis
A. Stringer 1, N. Al-Dasooqi2, R. Logan3, R. Gibson4, J. Bowen4, D. Keefe4
1School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia, 2School of Medicine, University of Adelaide, Adelaide, Australia, 3School of Dentistry, University of Adelaide, Adelaide, Australia, 4School of Medical Sciences, University of Adelaide, Adelaide, Australia
Introduction: Chemotherapy-induced mucositis is characterised by weight loss and diarrhoea. Mucins (secreted by goblet cells) play a role in mucosal protection and may influence intestinal microbes, and matrix metalloproteinases (MMPs) degrade the extracellular matrix. All are thought to be involved in mucositis.
Objectives: To determine the relationship between microbes, mucins and MMPs in a rat model of irinotecan-induced mucositis.
Methods: Female DA rats received 200 mg/kg irinotecan, were monitored for diarrhoea and killed 0.5–72 h following administration. Samples of jejunum and colon, and faeces were collected for analysis. Alcian Blue/PAS staining, immunohistochemistry for Muc2, and MMPs -1, -3, -9 and -12, and quantitative real time PCR for bacteria were completed. Data were compared using Spearman correlation.
Results: In the jejunum, MMP-1 and MMP-12 expression were shown to be inversely correlated (p = 0.036). MMP-12 expression correlated with reduced weight loss, and goblet cell number (p < 0.03 for both). MMP-1 expression correlated with decreased goblet cells and Muc2 expression (p < 0.02 for both). Muc2 expression correlated with reduced weight loss and diarrhoea (p < 0.002 for both), and E. coli levels (p = 0.006). In the colon, MMP-3 expression correlated with decreased faecal Lactobacillus spp. levels (p = 0.047). MMP-9 expression correlated with decreased Muc2 expression and goblet cells (p < 0.03 for both). Muc2 expression correlated with reduced diarrhoea and weight loss, and levels of Bifidobacterium spp. (p < 0.005 for all). Bacteroides spp. levels correlated with goblet cells (p = 0.013).
Conclusions: MMPs have roles in regulating Muc2 expression. Muc2 expression and goblet cells are likely to have a role in regulating bacterial levels, which may be implicated in mucositis.
MASCC-0854
“What about me…it isn’t fair!” Establishing appropriate and sustainable cancer services that meet the needs of adolescents and young adults
L. Stone 1
1Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
Introduction: Adult and paediatric cancer care are worlds apart in terms of health care delivery, with increasing awareness and recognition of a unique patient group who fall into a gap that does not meet their needs for appropriate treatment, psychosocial support, education and outcomes.
Objectives: With a paucity of clinical research data and limited participation in clinical trials, hampered by delays in diagnosis and referral, there is an increasing need for age—appropriate, safe and effective services provided as locally as possible.
Methods: Given the Adolescent and Young Adult (AYA) group are neither children nor adults, they demonstrate characteristics that span across both groups, and some that do not fit into either. A state—wide AYA Cancer network is planned, to include age appropriate integrated care that better supports this at risk population across Queensland building on work that has been done locally in other states of Australia and internationally.
Results: Design and implementation of a Statewide AYA network of care provision that is fair and equitable and sustainable.
Conclusions: Navigation of gaps, improved physcial space and care provision to acieve better outcomes in the AYA patient with cancer.
References: (1) Burns KC, Boudreau C, Panepinto J. Attitudes regarding fertility preservation in female adolescent cancer patients. J Pediatr Hematol Oncol. 2006;28(6):350–4
MASCC-0855
Team nursing, what’s the point? Changing the model of care in a busy tertiary cancer inpatient ward
L. Stone 1
1Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
Introduction: Across the history of nursing care delivery, there seem to be four traditional care models that have dominated the inpatient care landscape. Functional and team nursing are task orientated and require a varied skill mix of nurses; the primary nursing model or total patient care are patient focused an operate using a Registered Nurse (RN) model.
Objectives: Care modeling does not necessarily relate to the way we deliver nursing care in the modern contemporary context, and often includes other healthcare professionals, and significant changes in nursing skill mix.
Methods: Team Nursing requires strong leadership and advanced communication skills, bringing together small groups of nurses, led by a shift coordinator, to work collaboratively and cooperatively in order to deliver a higher standard of care.
Results: The management team of our busy cancer inpatient ward felt that we could maximise staff potential and provide an environment that both allowed and encouraged staff to utilise their education and skills whilst working with others providing care under the supervision and direction of the RN.
Conclusions: According to Kalisch et al., (2009), where teamwork is effective nurses stay in nursing, they are more productive, errors are reduced, quality is improved and patients are more satisfied. This paper will discuss our journey to providing best supportive care to our cancer patients using an evidence based approach that improves patient satisfaction and outcomes.
References: Kalisch BJ, Weaver SJ, Salas E. What does nursing teamwork look like? A qualitative study J Nursing Care Quality. 2009;24(4):298–307
MASCC-0856
Paulinia cupana (guaraná) purified dry extract (PC-18) for chemotherapy related fatigue in patients solid tumors: an early discontinuation study
T.G.L.,C.S.G.,L.P., A.B. del Giglio 1
1Oncology, FMABC, 2Kyolab, Sao Paulo, Brazil
Paulinia cupana (guaraná) is an amazonicplant shown to be effective for chemotherapy related fatigue (CRF) in patientswith breast cancer. Purpose: to evaluate the efficacy of a purified dry extractof Paulinia cupana (PC-18) inpatients with various solid tumors treated with chemotherapy and to comparemaintenance with PC-18 versus placebo after an induction phase.
Methods: We includedpatients with solid tumors older than 18 years of age who had an increase intheir Brief Fatigue Inventory (BFI) scores after 1 week of systemicchemotherapy. PC-18 was given at 37.5 mg PO bid, starting after 1 week ofchemotherapy for 3 weeks (induction). Patients who had an improvement orstabilization of their BFI scores, were randomized to either maintain PC-18 atthe same dose or to placebo for the following 3 weeks (maintenance).
Results: We included 41 patients. After PC-18 treatment, BFI scores improved orstabilized in 37 out of the 41 patients (mean BFI score difference = 2.503;95%CI 1.690–3.315, p < 0.0001). After 3 weeks of randomization (16 patients to PC-18 and 17 to placebo) we observed no significant differences in BFI, FACIT, HADS and PSQI scoresbetween patients randomized to PC-18 versus Placebo.
Conclusions: We concludethat PC-18 is active for treatment of CRF in patients with a variety ofsolid tumors. An insufficient wash out period or a conditioning effect onpatients by the earlier PC-18 positive effects on CRF may explain the betterthan expected fatigue scores of the placebo treated patients.
MASCC-0857
The effectiveness of a brief telephone based intervention to reduce fatigue in prostate cancer: a feasibility study
J.A.,L.E.,J.J.,E.R. B. Langston 1,2
1King’s College London, 2Prostate Cancer UK, London, UK
Introduction: Cancer-related fatigue is a significant clinical symptom commonly experienced by men during and following treatment for prostate cancer. It is distressing, interferes with functioning, and is often under-acknowledged by healthcare professionals.
Objectives: To evaluate the effectiveness of a brief telephone-based intervention for fatigue delivered by Specialist Nurses at Prostate Cancer UK.
Methods: A randomised control trial design was adopted. Men experiencing fatigue during or following treatment for prostate cancer were eligible to participate and were randomly allocated between waiting list control group receiving usual care or the intervention. The intervention comprised psychological support, self-care education and goal setting for behaviour change. It was delivered using motivational interviewing via 4 telephone calls over 10 weeks. Outcomes were assessed at baseline and at trial completion using the BFI, FDS, HADS, NRS (fatigue management) and EORTC-QLQ-C30. Analysis consisted of Mann–Whitney Tests for between group comparisons.
Results: Seventy-Six men were recruited. Fatigue in study groups was equivalent at baseline. Post-trial between group analysis showed the intervention group reported improved global fatigue (p = .005), fatigue severity (p = .001), fatigue management (coping with fatigue in daily life) (p = .031), social functioning (p = .028) and fatigue symptoms (p = .018).
Conclusions: The findings show the effectiveness of brief a telephone intervention at improving fatigue, fatigue management and social functioning. This represents a sustainable model of intervention delivery which is acceptable to men with prostate cancer and is effective in producing positive outcomes.
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MASCC 2013 Abstracts. Support Care Cancer 21 (Suppl 1), 1–301 (2013). https://doi.org/10.1007/s00520-013-1798-3
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DOI: https://doi.org/10.1007/s00520-013-1798-3