Unmet Need for Symptom Management in a Newly Diagnosed Population of Lung and Colorectal Cancer Patients (412-C)

6035 Background: Patient transitions during the early phases of cancer care from initial diagnosis through oncology consultation are often poorly coordinated resulting in unmet need, poor continuity, and resultant distress. It has been proposed that better coordination of care during this period would improve the care experience from the patient’s perspective. We designed a randomized trial to test a community based nursing lead coordination of care intervention in newly diagnosed breast and colorectal cancer patients. Methods: Cluster randomized control trial in 193 newly diagnosed breast and colorectal cancer patients enrolled through surgical practices within 7 days of cancer surgery in Toronto, Canada. Surgical practices were randomized between a standardized nursing intervention and a control group involving usual care practices. The intervention consisted of a standardized in person supportive care assessment with ongoing supportive care by telephone or in person that included linkage to community services using protocol specified guidelines according to identified needs. The primary outcomes measured at 8 weeks were validated patient reported outcomes (PROs) of 1) unmet need (SCNS) and 2) continuity of care (CCCQI). Secondary outcomes included 1) quality of life (EORTC QLQ-C30), 2) health resource utilization, and 3) level of uncertainty with care trajectory (MUIS) at 8 weeks. Results: 121 breast and 72 colorectal patients were randomized through 28 surgical practices. The intervention group had a median of 6 nursing contacts over the study period. There were no differences between groups on PROs of unmet need, continuity of care, quality of life, or uncertainty. Health service utilization did not differ between groups. Conclusions: A specialized oncology nursing intervention early in the care trajectory did not result in improved supportive care outcomes for patients. [Table: see text]

Download Full-text

Association of lower patient ratings of physician communication with need for symptom management in lung and colorectal cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.153 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 153-153

Author(s):

Anne M. Walling ◽

Nancy Lynn Keating ◽

Katherine Leslie Kahn ◽

Sydney Morss Dy ◽

Jennifer Malin ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Symptom Management ◽

Unmet Needs ◽

Unmet Need ◽

Primary Data ◽

Physician Communication ◽

Management Interventions ◽

Communication Score ◽

Colorectal Cancer Patients

153 Background: Symptoms are prevalent among cancer patients, but little is known about how often patients’ needs for symptom management are met or what factors are associated with unmet needs. Methods: Patients with lung and colorectal cancer from the diverse nationally-representative Cancer Care Outcomes Research and Surveillance cohort completed a survey approximately 4-6 months following diagnosis (n=5,422). We estimated the prevalence of unmet needs for symptom management during the 4 weeks prior to the survey, with unmet needs defined as patients reporting that they wanted but did not receive help for at least one symptom (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, diarrhea). Using a pre-specified conceptual model, we identified patient factors associated with unmet need using multivariable logistic regression with random effects (fixed slopes model with random intercepts for each Primary Data Collection Research site). We also tested whether clinical visits before the interview were associated with unmet need. Results: Overall, 15% (791/5,422) of patients had at least one unmet need for symptom management. Adjusting for patient sociodemographic and clinical factors, African American race, being uninsured or poor, having lung cancer versus colorectal cancer, early- vs. late-stage disease, and the presence of moderate to severe symptoms were associated with greater unmet need (all p<.05). Patients who rated their physicians communication score below 80 (on 1-100 scale) had adjusted rates of unmet need that were more than twice those of patients who rated their physicians with a perfect communication score (23.0% v. 10.0%, OR=3.05, p<0.001). Neither visits with specialty physicians (medical oncology, radiation oncology, surgery, or primary care) nor the total number of outpatient visits in the 28 days before the interview were associated with unmet need (all p>.05). Conclusions: A significant percentage of newly diagnosed lung and colorectal cancer patients report unmet needs for symptom management. Interventions to improve symptom management should consider the importance of physician communication to the experience of disease.

Download Full-text

Whole body MRI is effective for identifying metastatic disease in colorectal cancer patients

BMJ ◽

10.1136/bmj.l5453 ◽

2019 ◽

pp. l5453

Author(s):

Rob Cook ◽

Peter Davidson ◽

Rosie Martin

Keyword(s):

Colorectal Cancer ◽

Diagnostic Accuracy ◽

Cancer Patients ◽

Metastatic Disease ◽

Health Technology ◽

Whole Body ◽

Newly Diagnosed ◽

Whole Body Mri ◽

Health Technology Assessment Programme ◽

Colorectal Cancer Patients

The studyTaylor S, Mallett S, Beare S et al. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterol Hepatol 2019;4:529-37.This project was funded by the NIHR Health Technology Assessment Programme (project number 10/68/01).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000797/identifying-metastatic-disease-in-colorectal-cancer-with-whole-body-mri

Download Full-text

Association between pretreatment Fusobacterium nucleatum and cancer pain at six months postsurgery in newly diagnosed colorectal cancer patients: Results from the ColoCare Study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.3581 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 3581-3581

Author(s):

Anita Roselyn Peoples ◽

Biljana Gigic ◽

Jennifer Ose ◽

Andreana Natalie Holowatyj ◽

Patrick M. Mallea ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Pain ◽

Cancer Patients ◽

Fusobacterium Nucleatum ◽

Tumor Stage ◽

Life Questionnaire ◽

Newly Diagnosed ◽

European Organization ◽

Post Surgery ◽

Colorectal Cancer Patients

3581 Background: Pain is a prevalent, debilitating symptom in more than half of cancer patients. Accumulating evidence suggests a bi-directional relationship between gut microbiota and pain, potentially via inflammation and oxidative stress. Fusobacterium nucleatum (Fn), a pro-inflammatory anaerobic bacterium, is frequently detected in colorectal cancer (CRC) patients. To date, no study has identified a relationship between Fn and cancer pain in CRC patients. We investigated the associations between pre-treatment Fn and cancer pain at 6 months post-surgery in CRC patients. Methods: We utilized pre-surgery stool samples collected from 80 prospectively followed, newly diagnosed CRC patients recruited from the German site of the international ColoCare Study. Eligible patients were neo-adjuvant treatment naïve and did not use antibiotics for at least 1 month before stool collection. Fn DNA was assessed via quantitative real-time polymerase chain reaction. Patients were median split into Fn-high (>17.27; n=40) or Fn-low (≤17.27; n=40). Cancer pain was assessed using the 2 pain symptom items from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core-30 (lower score=lower pain) at pre- and 6 months post-surgery. Results: Before surgery, 48% of all patients reported any pain. At 6 months post-surgery, we observed a decrease in cancer pain by 33% for Fn-low, while there was an increase in cancer pain by 41% for Fn-high. After controlling for pre-surgery cancer pain in ANCOVA model, we observed significantly higher mean cancer pain at 6 months post-surgery in the Fn-high group vs. the Fn-low group (24.07 vs. 13.44; effect size, ES=0.45; p=0.04). These results were maintained even after controlling for age, sex, tumor stage and site, adjuvant chemotherapy, BMI, physical activity, and any pain medications (29.11 vs. 16.55; ES=0.53; p=0.03). Conclusions: These findings suggest that high Fn is an independent predictor of cancer pain at 6 months post-surgery in colorectal cancer patients. Further research is needed to confirm and understand the mechanisms of these results. Funding: NCI U01 CA206110.

Download Full-text