MP19-07 PALLIATIVE CARE EXPERIENCES AND ATTITUDES AMONG PATIENT AND CAREGIVER PARTICIPANTS IN THE BLADDER CANCER ADVOCACY NETWORK PATIENT SURVEY NETWORK

176 Background: BC is the 6th leading cause of cancer in the US and it is estimated that 81,190 Americans will be diagnosed this year. Promoting patient knowledge and involvement in BC care have led to successful management strategies. We offered 1 hour of online education to patients and their caregivers to provide clinical and supportive information that lends a sense of control, supports effective self-management, and promotes patient-physician communication. Methods: PlatformQ Health Education, in partnership with the Bladder Cancer Advocacy Network, developed and executed an interactive education program for patients with BC and their caregivers, which was broadcast live online on cancercoachlive.com on September 29, 2017 and on-demand through March 29, 2018. The program was viewed on cancercoachlive.com by 587 learners and attracted 533 additional learners through social media channels (e.g. Facebook). Education focused on treatment options and the accessibility of resources and support. Self-reported surveys, distributed to patients and caregivers 8 weeks after the program, were analyzed for improvements in perceived engagement in their cancer care. Results: After participating in the education, a majority of the learners reported they felt knowledgeable on treatment options to discuss with their HCPs (92%, n = 60) and resources and information they can use for self-care strategies (88%, n = 58). Follow-up survey results (n = 60) also indicated that the education helped 50% of learners enhance their communication with their HCP. Moreover, 54% of learners (n = 48) felt more in control of health care decisions, and 36% of learners (n = 59) reported improvements in their health-related behaviors. Write-in examples focused on staying informed of treatments and side effects, seeking support, and proactively asking questions to their HCPs. Conclusions: As ASCO guidelines note, providing patients with preoperative information and encouraging them to take an active part in the decision-making process are essential elements to achieving positive outcomes in BC. Results from the patient survey indicate that participating in an interactive, online education program enhanced knowledge and promoted patient engagement in BC care.

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Palliative care use among bladder cancer patients treated with radical cystectomy

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2021.04.029 ◽

2021 ◽

Author(s):

Nourhan Ismaeel ◽

Dattatraya Patil ◽

Mehrdad Alemozaffar ◽

Christopher P. Filson ◽

Viraj A. Master ◽

...

Keyword(s):

Palliative Care ◽

Bladder Cancer ◽

Cancer Patients ◽

Radical Cystectomy

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Palliative care use amongst patients with bladder cancer

BJU International ◽

10.1111/bju.14708 ◽

2019 ◽

Vol 123 (6) ◽

pp. 968-975 ◽

Cited By ~ 6

Author(s):

Lee A. Hugar ◽

Samia H. Lopa ◽

Jonathan G. Yabes ◽

Justin A. Yu ◽

Robert M. Turner ◽

...

Keyword(s):

Palliative Care ◽

Bladder Cancer

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Trends and Utilization of Inpatient Palliative Care Among Patients With Metastatic Bladder Cancer

Journal of Palliative Care ◽

10.1177/0825859720924936 ◽

2020 ◽

pp. 082585972092493 ◽

Cited By ~ 1

Author(s):

Hedong Han ◽

Feifei Yu ◽

Cheng Wu ◽

Lihe Dai ◽

Yiming Ruan ◽

...

Keyword(s):

Palliative Care ◽

Bladder Cancer ◽

Mortality Risk ◽

International Classification Of Diseases ◽

The United States ◽

Related Factors ◽

Cross Sectional ◽

Metastatic Bladder Cancer ◽

Using Data ◽

Hospital Characteristics

Objective: To explore the trends and utilization of palliative care (PC) service among inpatients with metastatic bladder cancer (MBC). Methods: A retrospective, cross-sectional analysis was performed using data from the 2003 to 2014 National Inpatient Sample. Palliative care was identified through International Classification of Diseases, Ninth Revision code V66.7. Demographics, comorbidities, hospital characteristics, tumor-related, and treatment-related factors were compared between patients with and without PC. Multivariable logistic regression was used to explore predictors of PC use. Results: Among 131 852 patients with MBC, 13 224 (10.03%) received PC. Rate of PC increased from 2.49% in 2003 to 28.39% in 2014 ( P < .0001). Similarly, rate of PC in decedents increased from 7.02% in 2003 to 54.86% in 2014 ( P < .0001). Patients receiving PC were older, tendered to be white, had more comorbidities, and higher all-patient refined diagnosis-related group mortality risk. Predictors of PC included age (odds ratio [OR]: 1.02; 95% CI: 1.01-1.02; P < .0001), Medicaid (OR: 1.87; 95%.CI: 1.54-2.26; P < .0001), and private (OR: 1.61; 95% CI: 1.40-1.84; P < .0001) insurance, hospitals in the West (OR: 1.33; 95% CI: 1.10-1.61; P = .0032), and Mid-west (OR: 1.46; 95% CI: 1.22-1.75; P = .0032), major (OR: 1.32; 95% CI: 1.11-1.49; P < .0001), and extreme (OR: 2.37; 95% CI: 2.04-2.76; P < .0001) mortality risk. Chemotherapy and mechanical ventilation were related with lower odds of PC use. Palliative care predictors in the decedents were similar to those in overall patients with bladder cancer. Conclusions: Palliative care encounter in MBC shows an increasing trend. However, it still remains very low. Disparities in PC use covered age, insurance, and hospital characteristics among metastatic bladder cancer in the United States.

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Examining the management of muscle-invasive bladder cancer (MIBC) by medical oncologists (MO).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.298 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 298-298 ◽

Cited By ~ 2

Author(s):

Andrea Borghese Apolo ◽

Bernard Bochner ◽

Seth M. Steinberg ◽

Dean F. Bajorin ◽

William Kevin Kelly ◽

...

Keyword(s):

Bladder Cancer ◽

Residual Disease ◽

Performance Status ◽

Single Agent ◽

The United States ◽

Perioperative Chemotherapy ◽

Ecog Performance Status ◽

Upper Tract ◽

Advocacy Network ◽

American Society

298 Background: Neoadjuvant chemotherapy (NC) for the treatment of MIBC remains underutilized in the United States despite evidence supporting its use. The aim of this project is to examine the current management of MIBC by MO to move towards standardization of practice. Methods: An electronic 26 question survey was emailed to 92 MO belonging to the Bladder Cancer Advocacy Network or the American Society of Clinical Oncology, and posted on the US Oncology portal for 8 wks. The study was approved by the Office of Management and Budget (0925-0046). Percentages are based on the fraction that responded to a given question. Results: Of the 83 respondents: 48% were non-academic. 51% were general oncologists and 45% focused on GU malignancies. The majority of MIBC referrals came from urologists (79%). Initial CT staging with abd/pelvis was required by 88%, CT chest by only 72% and PET by 21%. NC is offered by 79% of MO to all MIBC pts and by 45% to all pts with high grade upper tract urothelial carcinoma. Adjuvant chemotherapy (AC) was offered by 46% to all MIBC pts and by 41% to pts with upper tract disease. NC was not offered if ECOG performance status (PS) was >3 (49%), in T2 disease without lymphovascular invasion (29%), or with GFR of <50 ml/min (35%). Chemotherapy regimens used for NC included gemcitabine/cisplatin (90%); methotrexate/vinblastine/adriamycin/cisplatin (MVAC) (30%), dose dense MVAC (20%); gemcitabine/carboplatin (36%); single-agent gemcitabine (10%), other regimens described include carboplatin/paclitaxel and ifosfamide/doxorubicin/gemcitabine. Response to NC was assessed by CT abd/pelvis (82%), CT chest (39%), cystoscopy (30%) and PET (12%). Pts with pathologic residual disease (>pT2 or positive LN) after NC were generally observed (74%). Conclusions: The majority of MO do offer perioperative chemotherapy for MIBC pts with a trend towards increased use of NC over AC, which follows best evidence. The main reason for not offering perioperative chemotherapy was poor PS. The majority offer cisplatin-based combination therapy by preference. Increasing the rate of referrals of MIBC pts to MO, will result in more pts receiving perioperative cisplatin-based chemotherapy and may lead to better outcomes in this disease.

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Embedding palliative care into care coordination.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.62 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 62-62

Author(s):

Finly Zachariah ◽

Mariela Gallo ◽

Matthew Loscalzo ◽

Laura E. Crocitto

Keyword(s):

Palliative Care ◽

Bladder Cancer ◽

Cancer Patients ◽

Care Coordination ◽

Multidisciplinary Team ◽

Average Length ◽

Family Satisfaction ◽

Cost Index ◽

Average Case ◽

Advanced Directives

62 Background: The Institute of Medicine (IOM) identified care coordination as a key strategy with potential to improve the safety and effectiveness of implemented care by deliberately organizing patient care activities and sharing information among all participants concerned. Palliative care maximizes quality of life for patient and family in serious illness and can be provided early and concurrently with curative therapies. At City of Hope National Medical Center (COH), we developed a pilot program for bladder cancer patients undergoing cystectomy to provide the benefits of care coordination and palliative care. Methods: 72 patients underwent cystectomy at COH from 2011-2013, the average case mix index was 3.51, the average length of stay (LOS) was 10.65 days, the LOS index was.92, Cost index 1.61, 30-day readmission rate 32.14%, and the most common causes for readmission were infection and dehydration. Based on comparative data, the urology service supported development of a novel pathway by a multidisciplinary team. The goals of the pathway are to facilitate navigation through the healthcare system, integrate tablet-based bio-psycho-social screening to proactively address patient and caregiver needs and goals, optimize medications to improve symptom management and recovery, empower patients with teach-back education, have anticipated interventions for likely readmission reasons, and develop effective collaboration amongst multidisciplinary providers across settings. The metrics include LOS, readmission rates, patient and family satisfaction, advanced directives on file, and cost index. Results: Hospital leadership and provider buy in was obtained, a daily rounding multidisciplinary team was created, change champions were identified, staff engagement increased, and COH and community agency staff were equipped with needed skills and support. Care model diagrams and clinical pathway orders were developed. Education materials were revised and updated. The pilot launched in April of 2014. Conclusions: We believe that a care coordination model with early integration of palliative care will improve the effectiveness of care delivered to our bladder cancer patients. A six-month retrospective review will be done to assess metric achievement.

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