scholarly journals OS3.2 Relevant topics for brain tumor patients in the Distress Thermometer, first results of the HEAT study

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii8-iii9
Author(s):  
M Renovanz ◽  
J Coburger ◽  
G Tabatabai ◽  
F Ringel ◽  
C Wirtz ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Cancer Patients ◽  
Rating Scale ◽  
Emotional Problems ◽  
Well Being ◽  
Distress Thermometer ◽  
Problem List ◽  
Tumor Patients ◽  
Female Ratio ◽  
Patient Reported

Abstract BACKGROUND Patient-centered assessments and disease-adjusted patient-reported outcome measures (PROMs) are crucial in neuro-oncology. The Distress Thermometer (DT) is a well-accepted screening tool for cancer patients including a numerical rating scale (1–10, cut-offs indicating relevant distress ≥4–6) and 40 items describing possible problem categories (emotional, social, physical, practical and spiritual). The aims of the first part of the “Adaption of the Distress Thermometer in patients with intracranial tumors” (HEAT) study were to evaluate the importance and relevance of items for brain tumor patients (BTP). MATERIAL AND METHODS The multicenter study included three University hospitals. After given informed consent patients were prospectively evaluated either during their hospital stay or in the outpatient setting using DT as well as the 40 item problem list. Clinical and demographic data were recorded. We performed an analysis regarding frequency of indicated topics and evaluated their relevance for patients’ psychosocial well-beings via Pearson correlations with the DT score. RESULTS Data of n = 670 patients were analyzed. Mean age was 52 years (SD = 14, range 18–81), most of the patients harbored WHO°I tumors (37%) and WHO°IV tumors (28%). Male to female ratio was 1:1, 17% were assessed preoperatively, 40% postoperatively and 43% during adjuvant therapy or follow-up. 14% of the patients faced a tumor recurrence at assessment. Mean score of DT was 5.23 (SD = 2.9, range 0–10). Applying a cut-off score ≥ 4, 61% reported distress (≥ 5: 46% and ≥ 6: 37%). Regarding the relevance of the problem list for BTP, emotional problems (e. g., anxiety, depression) were most frequently reported. A total of 14/40 (35 %) of items were endorsed by less than 10% of patients. With exception of emotional problems all areas were reflected: practical problems (e. g., problems with child care or insurance), social problems (e. g., problems with children), spiritual concerns (e. g., loss of faith), and physical problems (e. g., breathing, fever). However, some of these rarely reported problems were of relevance for patients’ psychosocial well-being as indicated by significant correlations between the respective item and the DT score. This was, for example, the case for problems with childcare (r = .106; p < .01) or breathing (r = .125; p = .001). CONCLUSION Tools developed for cancer patients do not yet perfectly reflect all needs of BTP. Based on our data, we suggest further adjustments of available tools. Yet, it should be taken into account that subgroups of BTP may require different problem lists in the DT, as we observed some topics (e.g. breathing) probably be related to BTP under chemotherapy or steroids only. Moreover, our data require cross-cultural validation as especially results regarding practical problems and insurance might differ in cultures with different social security systems.

scholarly journals 2214 Nutritional outcomes in pediatric oncology patients less than 3 years of age

2018 ◽  
Vol 2 (S1) ◽  
pp. 84-84
Author(s):  
Daniel Runco ◽  
Ann Mertens ◽  
Karen Wasilewski-Masker
Keyword(s):  
Weight Loss ◽  
Brain Tumor ◽  
Cancer Therapy ◽  
Cancer Patients ◽  
Pediatric Cancer ◽  
Rating Scale ◽  
Treatment Intensity ◽  
Tumor Patients ◽  
Feeding Difficulties ◽  
Pediatric Cancer Patients

OBJECTIVES/SPECIFIC AIMS: Brain tumors are the most common solid tumor diagnosed in children and their location predisposes patients to oromotor dysfunction leading to feeding difficulties. Brain tumor patients experience feeding difficulties more frequently than other pediatric malignancies, largely due to central nervous system directed chemotherapy, radiation, and surgery. Treatment increases the risk of malnutrition and increases risk for infection, ICU admissions, and death. Infants and children (less than 3 years of age) are at higher risk for malnutrition due to rapidly changing nutritional requirements and the underdevelopment of motor skills. Incidence and prevalence of malnutrition in pediatric cancer patients is not well known. METHODS/STUDY POPULATION: This is an observational, retrospective study of our center’s pediatric cancer patients. Patients are classified by diagnosis, treatment intensity (ITR-2), vital status, and heights and weights (with standardized Z-scores) will be recorded with through 2 years after diagnosis. Adaptation of Intensity of Treatment Rating ITR-2. Nutrition consultation, ICU admissions, and use of parenteral or enteral nutrition will be recorded. Weight loss greater than a 5-percentile point change or Z-score decrease greater than 0.5 will be treated as a binary outcome and considered significant weight loss. RESULTS/ANTICIPATED RESULTS: Preliminary analysis has identified 465 eligible subjects as described above: brain tumor (n=45) and nonbrain tumor patients (n=420). Patient Schema. This study is still in progress and aims to better identify incidence of malnutrition during pediatric cancer therapy. It is expected that a greater number of nonbrain tumor patients compared with brain tumor patients will be malnourished as defined by decrease in Z-score greater than 0.5 at any point in therapy or falling below the 5th percentile of weight for age. Weight loss will be associated with higher number of ICU admissions and higher treatment intensity score. Finally, we expect to find that patients with a larger decrease in Z-score for age will be more likely to die during therapy. DISCUSSION/SIGNIFICANCE OF IMPACT: In addition to this study being valuable in better defining incidence of malnutrition, this data will serve as preliminary data in defining target populations for focused nutritional intervention during cancer therapy. Using this established and published intensity rating scale, we may be able to identify better methods of identifying and preventing malnutrition during cancer therapy.

The study of cancer patients’ distress

2014 ◽  
Vol 21 (2) ◽  
pp. 51-56 ◽  
Author(s):  
Ūla Lunevičiūtė ◽  
Egidija Masteikienė
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Physical Problem ◽  
Distress Thermometer ◽  
Problem List ◽  
Distress Score ◽  
The Mean

Background. Distress of cancer patients is often left unnoticed and it induces various problems: it is harder for patients to adjust to the illness, the quality of life is poorer, it causes much distress for the team of oncologists. 1 year before in the VU Institute of Oncology the Distress Thermometer was started to be used for all patients in the hospital. Purpose. To explore distress prevalence and features of cancer patients’ in the hospital. Participants and methods. There were 488 participants. The Distress Thermometer (DT) was used to evaluate distress of the participants. DT consists of a Likert type scale from 0 to 10 that assesses the strength of experienced distress, and a problem list that includes practical, family, emotional, spiritual and physical problem groups. Results. The mean score of distress of all participants was 3.47 (SD = 2.47). 82% of participants pointed from 0 to 5 scores, 18% of participants indicated from 6 to 10 scores. There was a statistically significant corellation between the distress score and the number of problems (r = 0.43, p 

Defining mild, moderate, and severe fatigue in cancer patients and survivors: E2Z02, a trial of the Eastern Cooperative Oncology Group.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9099-9099
Author(s):  
Xin Shelley Wang ◽  
Fengmin Zhao ◽  
Michael Fisch ◽  
Tito R. Mendoza ◽  
Ann M. O'Mara ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Rating Scale ◽  
Performance Status ◽  
Fatigue Management ◽  
Severe Fatigue ◽  
Patient Reported ◽  
Fatigue Severity ◽  
Colorectal Cancer Patients

9099 Background: Although mild, moderate and severe categories have been used in clinical guidelines for fatigue management in cancer patients, the optimal cutpoints on a 0-10 scale for delineating these categories have not been replicated. Methods: A multicenter ECOG study (E2Z02) enrolled breast, lung, prostate, or colorectal cancer patients with any treatment status. Fatigue and symptom interference were measured on the 0-10 numerical rating scale of the M. D. Anderson Symptom Inventory (MDASI). The optimal boundaries for categorizing fatigue severity were determined by the largest F ratios from MANOVA (Serlin’s criteria, 1995). Logistic regression with robust standard errors was used to identify risk factors for moderate/severe fatigue for cancer survivors (defined as patients with no evidence of disease and receiving no cancer treatment). Results: The optimal cutpoints that identified 3 distinct levels of fatigue severity for the 2341 patients were: ratings of 1-3 as mild, 4-6 as moderate, and 7-10 as severe. Known-group validity for these cutpoints was established by significant differences of fatigue severity by ECOG performance status and patient-reported quality of life (all P<0.001). Using these cutpoints, 45% (983/2177) of patients undergoing active therapy had moderate/severe fatigue, with significant more mild fatigue in breast and colorectal cancer patients, while more severe fatigue in lung cancer patients (p<.001). Among cancer survivors, 29% (150/515) had moderate/severe fatigue (breast 31%, colorectal 27%, prostate 22%, lung 33%). Younger age (OR=0.97, 95% CI=0.95-0.99) and poor performance status (OR=4.21, 95% CI=2.36-7.51) were associated with more moderate/severe fatigue in cancer survivors. Survivor time was also associated with moderate/severe fatigue in breast and colorectal cancer survivors (>=5yrs vs. <5yrs: OR=0.23, P<0.01 for breast, OR=9.3, P=0.03 for colorectal). Conclusions: This multicenter study confirmed the standard cutpoints for fatigue severity used in NCCN fatigue management guidelines. It also provides a profile of moderate to severe fatigue prevalence for actively treated cancer patients and for cancer survivors.

Capturing and addressing emotional well-being: Utilization of ASCO’s Quality Oncology Practice Initiative (QOPI) for performance improvement.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 207-207
Author(s):  
Patricia D. Hegedus ◽  
James D. Bearden ◽  
Bruce Grant
Keyword(s):  
Performance Improvement ◽  
Office Visit ◽  
Well Being ◽  
Psychological Services ◽  
Distress Thermometer ◽  
Improvement Project ◽  
Face To Face ◽  
Intervention Process ◽  
Patient Reported ◽  
Oncology Practice

207 Background: Palmetto Hematology Oncology (PHO) is the medical oncology practice of Spartanburg Regional Healthcare System (SRHS) and has participated in QOPI since 2009 and earned QOPI certification in September 2011. Emotional well-being assessments and documentation of interventions were selected for a performance improvement project based on QOPI measures from Fall 2009. Methods: Several articles were identified supporting the use of the NCCN Distress Thermometer following a comprehensive literature search and approval was obtained for use. The NCCN Distress Thermometer was administered to all new patients through inclusion in “new patient” paperwork packets. Two physician offices within the practice were piloted with the physicians reviewing the patient reported assessments and documenting any required interventions. All completed NCCN Distress Thermometer forms were also reviewed by the medical social work team, and for scores > 3, interventions by phone or face-to-face were completed by them and documented in the patients’ electronic medical records. Results: Due to the success of the pilot efforts the assessment/intervention process for emotional well-being was expanded throughout the PHO practice, the Gibbs Infusion Center, and Radiation Oncology. The QOPI emotional well-being indicator revealed an increase from the Fall 2009 to Spring 2012 of 36.25% to 96.25%. Conversely, our compliance with intervention by the second office visit decreased from 94.44% to 69.44%, respectively. Conclusions: Although PHO’s scores for the emotional well-being assessment have dramatically improved with implementation of the process improvement initiative, opportunity remains for improving emotional well-being intervention documentation. This initiative highlighted the lack of psychiatric/psychological services available to PHO patients. References: NCCN Clinical Practice Guidelines in Oncology: Distress Management, Version 3.2012; Available at: http://www.nccn.org/professionals/physician_gls/pdf/distress.pdf . QOPI The Quality Oncology Practice Initiative; Available at: http://qopi.asco.org/program .

Development of novel emoji scale to measure patient-reported outcomes in cancer patients.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 174-174 ◽  
Author(s):  
Carrie A. Thompson ◽  
Paul J Novotny ◽  
Alicia Bartz ◽  
Kathleen J. Yost ◽  
Jeff A. Sloan
Keyword(s):  
Physical Function ◽  
Cancer Patients ◽  
Patient Reported Outcomes ◽  
Well Being ◽  
Ordinal Scale ◽  
Card Sorting ◽  
The Past ◽  
Smart Watch ◽  
Patient Reported ◽  
Self Assessments

174 Background: Patient-reported outcomes (PROs), including physical function and quality of life (QOL), are important outcomes in cancer patients. Emoji are a near-universal, popular form of communication, understandable by diverse populations, including those with low health literacy. We aimed to explore whether emoji could be a valid, reliable scale for assessing PROs in cancer patients. Methods: To develop the emoji scale, 5 emoji faces were selected from the Apple emoji dictionary by study authors. 20 cancer patients participated in a card-sorting exercise to rank the emoji from negative to positive; 19 out of 20 selected the same order, which exceeded Coomb’s criteria for being a valid ordinal scale. Patients were recruited from Mayo Clinic practices. Eligibility included: adult patients with a diagnosis of lymphoma, multiple myeloma, brain, pancreatic, breast, and ovarian cancer within the past 5 years; life expectancy of > 6 months; and own an iPhone version ≥ 5.0. All patients were provided with an Apple Watch and downloaded the study app. Baseline PRO data was collected on the iPhone, including single-item linear analog self-assessments (LASA) and emoji scales for fatigue, physical function, emotional well-being, and overall QOL. Results: From 2/2017-8/2017, 294 eligible patients were recruited. 25% were male, and median age was 53 years (range 20-79). The median time since diagnosis was 8.4 months (range 0-60); 63% were on active therapy, 27% were in observation post-treatment, and 10% had not been treated. All patients were “extremely” confident filling out forms, 99% had used a computer in the past 12 months, and 27% had ever used a smart watch. Emoji responses were significantly associated with validated measures of PROs; the Spearman correlations between the ordinal emoji scales and LASAs were -0.83 for fatigue, 0.72 for physical well-being, 0.72 for emotional well-being, and 0.77 for overall QOL (all p < 0.0001). Of the 75 patients who have completed the study thus far, 92% reported they would use emoji scales again and 89% would recommend that others use emoji scales. Conclusions: A novel ordinal emoji scale is strongly associated with accepted measures of PROs in cancer patients and should be studied further.

Distress and its correlates in Korean cancer patients: pilot use of the distress thermometer and the problem list

2008 ◽  
Vol 17 (6) ◽  
pp. 548-555 ◽  
Author(s):  
Eun-Jung Shim ◽  
Yong-Wook Shin ◽  
Hong Jin Jeon ◽  
Bong-Jin Hahm
Keyword(s):  
Cancer Patients ◽  
Distress Thermometer ◽  
Problem List

Cancer patients’ perception of usefulness with wearable exercise tracker.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 51-51
Author(s):  
Amy Ng ◽  
Ekta Gupta ◽  
Swati Bansal ◽  
Rhodora C. Fontillas ◽  
Janet L. Williams ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cancer Patients ◽  
College Education ◽  
Well Being ◽  
Outpatient Rehabilitation ◽  
P Value ◽  
Resting Heart Rate ◽  
Or Education ◽  
Patient Reported ◽  
Steps Per Day

51 Background: Wearable trackers (WT) are known for its popular use in healthy, active persons but limited studies have been conducted in cancer survivors. Methods: Participants were asked to wear the WT and synchronize data. Patients were asked to fill out questionnaire regarding their patient reported perceptions of the WT and their perception of usefulness of the WT. Results: 110 cancer patients were enrolled with 100 evaluable surveys. Median age of patients was 62 years old, females (60, 55%), white (79,73%), married/with significant other (77, 71%), with college education and above (51, 47%). There was no statistically significant association between demographic factors of age, gender, ethnicity, marital status, or education and the perception of usefulness of the WT. Eighty-four percent of outpatient (OP) and 67% of inpatient (IP) cancer patients perceived WT as useful, 96% OP and 94% IP reported wearing WT daily, 64% OP and 55% IP perceived WT as helping to increase physical activity and 76% OP and 59% IP would continue to wear WT after this study. For inpatients, ESAS score of pain (p value <0.001), shortness of breath (p value <0.0002) and feeling of well-being (p value <0.001) improved over the course of rehabilitation. Improvement in FIM scores for transfers to wheelchair, walk assistance, walk distance, walking, stairs assistance, and stairs is significantly improved in rehabilitation (p value<0.05). The average resting heart rate was 77 beats per minute and average number of steps per day was 1,863. For outpatients, the average resting heart rate was 77 beats per minute and average number of steps per day was 3,423. Patients who reported the WT as useful had significantly lower fatigue severity (3.3 vs. 6, p value<0.05). Conclusions: Cancer patients perceived the WT as useful in both the inpatient and outpatient rehabilitation setting. No specific sub-group(s) of patients who expressed a higher level of agreement for usefulness of a wearable exercise tracker. There was an association between lower ESAS fatigue score and patient agreement of usefulness of the WT. These findings justify more research in WT and cancer rehabilitation. Clinical trial information: NCT03042884.

Longitudinal investigation of Distress Thermometer scores in patients with cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24200-e24200
Author(s):  
Fauzia Ullah ◽  
Emily Brugioni ◽  
Matthew M Gannon ◽  
Hayden L Smith ◽  
Joshua Cole Lukenbill
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Patient Population ◽  
Large Scale ◽  
Well Being ◽  
Distress Thermometer ◽  
Average Score ◽  
Cancer Type ◽  
Initial Screening ◽  
Study Results

e24200 Background: The Distress Thermometer (DT) is a tool used to evaluate distress among cancer patients. The DT can provide information for intervention recommendations such as social work, psychological, and other ancillary services. The National Comprehensive Cancer Network (NCCN) recommends recurrent use of the tool. The DT is widely used as a standard of care for an initial screening of cancer patients, but data on subsequent use is lacking. The aim of this research was to evaluate repeat DT scores in a heterogeneous cancer patient population. Methods: Clinical investigators conducted a longitudinal study of DT ratings for cancer patients receiving outpatient care at a community-based oncology subspecialty practice in a mid-sized city from 2018 to 2019. Study objectives included reviewing referrals and evaluating the relationship between the initial screening and the screening at the 6-month checkup. The Distress Thermometer was used (i.e., 0-10; zero is “no distress” and ten “extreme distress”) with scores of four or greater regarded as a signal of greater risk for patient distress. Results: The study sample included 79 patients with an average score of 4.3 and 4.0 at baseline and the 6-month screening, respectively. Patient referrals included physical and emotional therapy (n=1) or social/psychosocial worker assessment (n=26). Patients with a documented referral had a crude 1.7 (95% CI: 0.6, 3.3) greater point decrease in scores compared to patients not offered a service referral. When adjusting for baseline scores and the time between scores, referral accounted for 1% (95% CI: 0%, 14%) of variability in score changes, while baseline scores accounted for 40% (95% CI: 22%, 52%) and time accounted for 3% (95% CI: 0%, 14%). Conclusions: Study results reveal a possible decrease in higher scores from the initial screening to the 6-month check-up. Patients with a referral did not have their service utilization confirmed and this study failed to show an additional decrease in scores based on referrals when controlling for baseline score and time. Most previous research has focused on one specific cancer type. This study revealed the possible importance in understanding DT scores in a heterogenous cancer patient population. Furthermore, large scale research is needed to confirm preliminary data and further expound on distress at initial and subsequent screenings after interventions. A better understanding of this content area may function to improve future care and patient well-being.

Factors associated with patient-reported subjective well-being among advanced lung or non-colonic gastrointestinal cancer patients

2017 ◽  
Vol 16 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Yu Jung Kim ◽  
Yi Zhang ◽  
Jichan Park ◽  
Joseph Arthur ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Gastrointestinal Cancer ◽  
Family Caregiver ◽  
Well Being ◽  
Advanced Lung Cancer ◽  
Caregiver Distress ◽  
Factors Associated ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale

ABSTRACTObjective:The aim of this study was to determine the factors associated with a feeling of well-being using the Edmonton Symptom Assessment Scale (ESAS)–Feeling of Well-Being item (ESAS–FWB; where 0 = best and 10 = worst) among advanced lung or non-colonic gastrointestinal cancer patients who were referred to an outpatient palliative care clinic (OPCC). We also examined the association of performance on the ESAS–FWB with overall survival (OS).Method:We reviewed the records of consecutive patients with incurable advanced lung cancer and non-colonic gastrointestinal cancer presenting to an OPCC from 1 January 2008 through to 31 December 2013. Descriptive statistics were employed to summarize patient characteristics. Multivariate regression analysis was used to determine the factors associated with ESAS–FWB severity. We also examined the association of ESAS–FWB scores and survival using Kaplan–Meier survival analysis.Results:A total of 826 evaluable patients were analyzed (median age = 62 years, 57% male). Median ESAS–FWB scores were five times the interquartile range (5 × IQR; 3–7). ESAS–FWB score was found to be significantly associated with ESAS fatigue (OR = 2.31, p < 0.001); anxiety (OR = 1.98, p < 0.001); anorexia (OR = 2.31, p < 0.001); cut down, annoyed, guilty, eye opener (CAGE) score (hazard ratio [HR] = 1.80, p = 0.008); and family caregiver distress (HR = 1.93, p = 0.002). A worse ESAS–FWB score was significantly associated with decreased OS (r = –0.18, p < 0.001). However, ESAS–FWB score was not independently associated with OS in the final multivariate model (p = 0.35), which included known major clinical prognostic factors.Conclusions:Worse ESAS–FWB scores were significantly associated with high scores on ESAS fatigue, anorexia, anxiety, CAGE, and family caregiver distress. More research is necessary to understand how palliative care interventions are capable of improving the contributory factors related to ESAS–FWB score.

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