Patterns of referral to palliative care in clinical practice in patients with stage IV non-small cell lung cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 39-39
Author(s):  
Safiya Karim ◽  
Shahid Ahmed
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Cox Regression ◽  
Smoking Status ◽  
Performance Status ◽  
Stage Iv ◽  
Cancer Center ◽  
Ecog Performance Status ◽  
Logistic Regression Models ◽  
Symptomatic Disease

39 Background: Recent evidence has shown that patients with stage IV NSCLC benefit from early referral to palliative care (PC). In August 2010, a landmark randomized control trial revealed that patients with advanced NSCLC, who received early PC, had better quality of life, mood and survival (NEJM 2010; 363:733-42). Our study aimed to determine pattern of PC referral in clinical practice, in patients with stage IV NSCLC before and after the publication of the trial, and to assess factors correlated with PC referral. Methods: The study population was comprised of a cohort of patients with stage IV NSCLC, diagnosed between 2009 and 2011, and referred to the Saskatoon Cancer Center. Logistic regression models were used to assess factors correlated with PC referral. Kaplan Meier method was used to estimate survival. Cox regression analyses were used to determine factors correlated with survival. Results: 215 patients with median age of 68 yrs (range: 40-92) and M:F of 108:107 were identified. 101 (47%) patients had comorbid illness, 100 (47%) had ECOG performance status <2, 136 (63%) were married/common law and 161 (75%) had symptomatic disease. 126/251 (58%) were referred to PC. 70/118 (59%) diagnosed before Sep 2010 were referred to PC compared with 56/97 (58%) diagnosed after Sep 2010 (p=NS). The median time to PC referral from date of diagnosis was 51 days (inter-quartile range: 19-155). 33% patients were referred within 4 wks of diagnosis. Symptomatic disease (odd ratio [OR]=3.7, 95% CI =1.8-7.5), bone metastasis (OR = 3.0, 95% CI = 1.6-5.6), and brain metastasis (OR=2.2, 95% CI =1.1-4.5) were correlated with referral to PC. Median survival of whole cohort was 4 months (95% CI: 3.1-4.8). 2nd or 3rd line therapy (Hazard ratio [HR]= 0.54, 95% CI:0.34-0.87), non-smoking status (HR= 0.58, 95% CI:0.38-0.87), chemotherapy (HR 0.64, 95% CI:0.46-0.89), and lack of symptoms (HR=0.68, 95%CI:0.48-0.96) were correlated with better survival. Conclusions: Our study shows that publication of the landmark trial did not influence the pattern of referral to PC at our center. Symptomatic patients and those with metastasis to brain or bone were more often referred to PC. No survival benefit was seen in patients who were referred to PC.

Development of an aid to decision-making form (ADF) integrated into a major institutional program in oncology: A tool to support care goal identification.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18646-e18646
Author(s):  
Laurence Vigouret-Viant ◽  
Clemence Legoupil ◽  
Aurelie Bardet ◽  
Celine Laurent ◽  
Michel Ducreux ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
Performance Status ◽  
Medical Decision ◽  
Cancer Center ◽  
P Value ◽  
Ecog Performance Status ◽  
Advance Care ◽  
Aggressive Care

e18646 Background: For cancer patients, life-threatening complications may be difficult to anticipate, leading to complex medical decision-making processes. Since 2015, the Gustave Roussy Cancer Center has implemented a major institutional program including a Decision-Aid Form (ADF), outlining the anticipation of appropriate care for patient in case of worsening evolution. Methods: Between January and May 2017, all patients transferred from Site 1 to Site 2 of the hospital were prospectively included. In this study, we assessed the acceptability of the ADF, its using and its impact on the patient’s becoming. Results: Out of 206 patients included, 89.3% had an ADF. The planned stratification of care was notified in practically all cases. Conversely, the involvement of the palliative care team was notified in only 29% of the ADF. The value of the WHO/ECOG Performance Status was limited, varying between physicians. Finally, the field “information for patients and relatives” was insufficiently completed. Although a possible transfer to Intensive Care Unit was initially proposed in two-thirds of the patients, the majority (76%) of the 35 patients experiencing an acute event received exclusive medical or palliative care. The level of therapeutic commitment suggested by the ADF was never upgraded, and often revised towards less aggressive care, and especially without excess mortality for the patients who were initially designated to be eligible for intensive care. Moreover, the patient's survival at 6 months seems to be correlated with the anticipated level of care recorded on the FAD (Log-rank P value < 0,0001). Conclusions: The results of our study suggest that setting up a care stratification file in advance is possible in a French cultural setting and it could be helpful for clarifying prognosis assessment. To achieve complete acculturation, our extensive institutional program remains a cornerstone for the development of advance care planning. Since 2017, this program has widely spreaded ADF which is now integrated into the electronic medical record. Each physician can complete and modify the patient's ADF at any stage of the patient's disease course.

Interest in cessation treatment and survival among smokers in a community-based multidisciplinary thoracic oncology program.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2028-2028
Author(s):  
Meghan Meadows ◽  
Kenneth Daniel Ward ◽  
Nicholas Ryan Faris ◽  
Matthew Smeltzer ◽  
Carrie Fehnel ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Social History ◽  
College Graduates ◽  
Cox Regression ◽  
Smoking Status ◽  
Cancer Center ◽  
Willingness To Participate ◽  
Community Based ◽  
Logistic Regression Models

2028 Background: Tobacco cessation is essential to high quality oncology care. Many patients smoke when diagnosed and continue to smoke during treatment, which adversely affects treatment response and survival. Although most patients are motivated to quit, few receive effective cessation therapy. The multidisciplinary clinic (MDC), where patients, their caregivers, and key specialists coordinate care, is an ideal setting to integrate a cessation program. To assess the need for cessation services within a MDC setting, we surveyed incoming patients about their smoking status, interest in quitting, and willingness to participate in a clinic-based cessation program. Methods: The study was conducted in the Multidisciplinary Thoracic Oncology Program at Baptist Cancer Center, Memphis TN. We evaluated sociodemographic/clinical characteristics, smoking status, and tobacco dependence of consecutive new patients diagnosed with lung cancer from 2014-2019, who completed a social history questionnaire. Current smokers reported their interest in quitting and their willingness to participate in a cessation program. Chi square tests and logistic regression models were used to compare characteristics of those who would participate vs. those who would not/were unsure. Kaplan-Meier curves and multivariable Cox regression were used to evaluate the association between willingness to participate in a cessation program and overall survival, adjusted for age, sex, race, and total pack-years of smoking. Results: Of 641 patients, the average age was 69 years (range: 32-95), 47% were men, 64% white/34% black, and 17% college graduates; 90% had ever smoked, 34% currently smoked, and 24% quit smoking within the past year. Among current smokers, 60% were very interested in quitting and 37% would participate in a clinic-based cessation program. Willingness to participate was associated with greater interest in quitting (p = 0.0010) and greater overall survival (log rank p = 0.01;HR: 0.48, 95% CI: 0.24-0.95) but was not associated with any sociodemographic, clinical, or smoking-related characteristics. Conclusions: Over half (58%) of patients in a community-based MDC program were current smokers/recent quitters. Willingness to participate in a cessation program was associated with improved survival, suggesting patients with favorable prognoses are especially interested in receiving cessation support. There is considerable need for cessation services and relapse-prevention support within a coordinated, MDC lung cancer care setting.

T-cell–inflamed gene expression profile (GEP) and PD-L1 expression in patients (pts) with esophageal cancer (EC).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 26-26
Author(s):  
Torben Steiniche ◽  
Sun Young Rha ◽  
Hyun Cheol Chung ◽  
Jeanette Bæhr Georgsen ◽  
Morten Ladekarl ◽  
...  
Keyword(s):  
T Cell ◽  
Tumor Cells ◽  
Proportional Hazards ◽  
Performance Status ◽  
Stage Iv ◽  
Cox Proportional Hazards ◽  
University Hospital ◽  
Cancer Center ◽  
Ecog Performance Status ◽  
Tissue Samples

26 Background: GEP and PD-L1 expression have been associated with anti–PD-1/PD-L1 therapy. In this retrospective observational study we explored the prognostic value of GEP and PD-L1 expression in pts with EC receiving standard-of-care therapy (SOC). Methods: Tumor tissue samples collected from 2005 to 2017 were procured from Yonsei Cancer Center (South Korea), Memorial Sloan Kettering Cancer Center (USA) and Aarhus University Hospital (Denmark). GEP score was derived from an 18-gene signature using extracted tumor RNA analyzed by NanoString nCounter; GEP high/intermediate (GEP-H/I) and low were defined by a cutoff of –1.540, consistent with pembrolizumab clinical trials. PD-L1 expression was assessed by PD-L1 IHC 22C3 pharmDx assay (Agilent); positive was defined as combined positive score (CPS) ≥ 10, where CPS is the the number of PD-L1–positive cells (tumor cells, lymphocytes and macrophages) divided by the total number of viable tumor cells, multiplied by 100. Associations of GEP score and PD-L1 expression with clinicopathologic variables were analyzed by chi-square test and multiple logistic regression models. Overall survival (OS) from diagnosis date to death date/last follow-up was analyzed using Cox proportional hazards models adjusting for age, sex, stage, region and ECOG performance status (PS). Results: 294 samples with both PD-L1 and GEP data were analyzed. Median age was 65 y (range 33-88); 85% were from men, 58% were stage IV, 63% were esophageal adenocarcinoma (EAC) and 37% were esophageal squamous cell carcinoma (ESCC). Overall 36% of tumors were GEP-H/I: 46% in EAC vs 18% in ESCC. GEP was not associated with OS overall (adjusted hazard ratio [aHR] –0.90; 95% CI 0.68-1.18) or in pts with EAC (aHR 0.93; 95% CI 0.68-1.27) or ESCC (aHR 0.76; 95% CI 0.40-1.44). 21% of tumors were PD-L1-CPS ≥ 10: 18% in EAC and 26% in ESCC. PD-L1 expression was associated with ECOG PS (adjusted odds ratio 0.520; 95% CI 0.309-0.875; P = 0.014) but was not associated with OS overall (aHR 0.89; 95% CI 0.64-1.24) or in pts with EAC (aHR 0.97; 95% CI 0.63-1.49) or ESCC (aHR 1.31; 95% CI 0.73-2.34). Conclusions: Our results suggest that T-cell–inflamed GEP and PD-L1 expression may not be prognostic in pts with EC who received SOC.

Peritoneum metastasis (PM) as a prognostic factor in metastatic gastric cancer (MGC) treated with anti-PD-1/PD-L1 monotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3051-3051 ◽  
Author(s):  
Yukiya Narita ◽  
Keiji Sugiyama ◽  
Seiichiro Mitani ◽  
Kazunori Honda ◽  
Toshiki Masuishi ◽  
...  
Keyword(s):  
Cox Regression ◽  
Negative Impact ◽  
Performance Status ◽  
Univariate Analysis ◽  
Objective Response ◽  
Metastatic Gastric Cancer ◽  
Cancer Center ◽  
Ecog Performance Status ◽  
Cox Regression Analysis ◽  
Line Therapy

3051 Background: Anti-PD-1 monotherapy has proven effective for the patients (pts) with MGC. However, the identification of biomarkers for predicting clinical outcomes remain as critical needs. We aimed to identify baseline characteristics associated with time to treatment failure (TTF) or overall survival (OS) for anti-PD-1/PD-L1 monotherapy as second- or later-line therapy in MGC. Methods: Routine blood count parameters and clinical characteristics at baseline were retrospectively investigated in 31 pts with MGC in Aichi Cancer Center Hospital. Endpoints were TTF and OS following anti-PD-1/PD-L1 monotherapy. Kaplan-Meiyer and Cox regression analysis were applied for survival analyses. Results: Patient characteristics were as follows: median age (range), 68 (47–83); ECOG performance status (PS) 0/1, 21/10; PM +ve/-ve, 12/19; No. of metastatic sites 1–2/≥3, 18/13; No. of prior chemotherapy regimens 1–2/≥3, 11/20; and absolute eosinophil count (AEC) <150/≥150 /μl, 14/17. Objective response rate and disease control rate (RECIST ver. 1.1) were 26% vs. 0% (odds ratio [OR], 3.76; P = 0.12) and 79% vs. 50% (OR, 3.58; P = 0.12) in the PM -ve group (Cohort A) and the PM +ve group (Cohort B), respectively. On univariate analysis, the pts with poor PS, PM +ve, and high AEC were significantly poor TTF; and poor PS and PM +ve were significantly identified as prognostic factors of poor OS. On multivariate analysis, only PM +ve was independent negative impact not only for TTF but also for OS. Median TTF and OS were 5.4 vs. 1.3 months (M) (adjusted hazard ratio [HR], 4.29; 95%CI, 1.60–11.5; P < 0.01) and 28.2 vs. 7.5 M (adjusted HR, 3.68; 95%CI, 1.25–10.8; P = 0.02) in Cohort A and Cohort B. Six-months TTF probabilities of 42% vs. 0% ( P = 0.03) and one-year OS probabilities of 58% vs. 8% ( P< 0.01) were observed in Cohort A compared to in Cohort B. Conclusions: PM -ve in the pts treated with anti-PD-1/PD-L1 monotherapy was associated with better efficacy. In the pts with PM -ve, anti-PD-1/PD-L1 monotherapy could be adapted in first-line therapy. [Table: see text]

Treatment delay and outcomes in stage IV lung cancer: The reality of a public hospital in a developing country.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20709-e20709
Author(s):  
Nicolas Peruzzo ◽  
Juliano Ce Coelho ◽  
Gustavo Gössling ◽  
Pedro Grachinski Buiar ◽  
Gabriel de Souza Macedo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Median Time ◽  
Public Hospital ◽  
Cox Regression ◽  
De Novo ◽  
Performance Status ◽  
Stage Iv ◽  
Best Supportive Care ◽  
Egfr Mutations ◽  
Ecog Performance Status

e20709 Background: Lung cancer is the leading cause of cancer deaths globally. Despite the development of a number of new therapeutic options for stage IV non-small cell lung cancer (NSCLC), many patients (pts) still face difficulties in accessing proper treatment in adequate time, especially in developing countries. We analyzed clinical outcomes in a population with stage IV NSCLC treated at a public hospital in Southern Brazil. Methods: In this retrospective cohort study, we enrolled 57 pts with stage IV NSCLC treated at Hospital de Clinicas de Porto Alegre (HCPA) between 2016 and 2018. Results: Median follow-up was 20.3 months, 53% were men, mean age was 65 years, 86% had smoked, 84% had de novo metastatic disease, 96% had non-squamous histology, and 16% had EGFR mutations. At the point of therapeutic decision-making, 72% had ECOG performance status (PS) 0-2 (deemed as good), whereas 28% had PS 3-4 (poor). Among pts diagnosed at HCPA (91%), median time from symptoms to diagnosis was 23 days, and median time from diagnosis to palliative systemic therapy (PST) was 65 days. PST was delivered to 60% of pts, and the most used first-line protocol was Taxol-Carboplatin (79%). Two or more lines of PST were delivered to 23% of pts. In the subgroup of pts with sensitizing EGFR mutations, 75% received anti-EGFR therapy (Gefitinib). The main reason for upfront best supportive care (BSC) was poor PS. In the poor PS subgroup, 44% initially presented at HCPA with good PS; however, PS deterioration precluded them from starting PST. No pts with poor PS received PST. In the whole cohort, median overall survival (OS) was 7.7 months. In the Cox regression multivariate analysis, poor PS (HR 3.80, P < 0.0001, 95% CI 1.90–7.61) and second-line PST (HR 0.23, P = 0.002, 95% CI 0.09–0.58) were independent predictors of OS. Median OS was 10.3 months vs. 2.4 months in PST and BSC subgroups, respectively. Conclusions: In our cohort, which reflects the reality of a publicly insured population and thus most of Brazilian lung cancer pts, poor PS deprives nearly one-third of pts from PST and is associated with a worse prognosis. Postponement of PST may lead to a loss of opportunity for pts to being treated; therefore, it is crucial to develop strategies to improve time to PST.

VTE among pancreatic cancer and its possible risk factors among metastatic pancreatic cancer (mPC): Experience at Fox Chase Cancer Center.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 232-232 ◽  
Author(s):  
Ramesh Kumar Pandey ◽  
Kristen Sorice ◽  
Jiangtao Gou ◽  
Shannon M. Lynch ◽  
Aryeh Blumenreich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Cancer ◽  
Overall Survival ◽  
Smoking Status ◽  
Performance Status ◽  
Stage Iv ◽  
Cancer Center ◽  
Academic Center ◽  
Impact On Survival ◽  
Potential Risk Factors

232 Background: The incidence of VTE is relatively high among mPC pts, upto 57%. It is associated with higher health care burden and mortality. We evaluated the mPC pts treated at a single academic center from 2010-16 for prevalence of VTE, its impact on survival and possible risk factors. Methods: Medical charts of mPC pts treated at a single academic center were analyzed retrospectively for VTE diagnosis, overall survival and potential risk factors for VTE development. The factors considered were: age, sex, stage, body mass index, smoking status, surgery, performance status (PS), Charlson comorbidity index (CCI) and treatment. Logistic regression was used to identify the factors correlating with VTE and Cox Proportional Hazard model was used to evaluate overall survival (OS) differences between those with VTE (Gp A) and those without VTE (Gp B). Results: Out of the 439 mPC pts (52% males, 86% with PS0-1, 63% with stage IV at diagnosis), 127 (29%) were in Gp A and 312 (71%) in Gp B. The groups were well balanced with respect to all factors except age (median age 67 Gp A; 65 in Gp B, p = 0.04). 2.3 % of pts in Gp A and 4.8 % pts in Gp B were on anticoagulation for reason other than VTE treatment. Within Gp A, 55% developed VTE after diagnosis of metastasis. A clear separation of the survival curves noted beyond the median OS (9 m, P = 0.02), favoring GpB. Statistically significant factors associated with risk of VTE included advanced stage at diagnosis (P = 0.004) and worse PS (P = 0.005). Treatment regimen used and CCI didn’t correlate with the risk of development of VTE. Conclusions: The incidence rate of VTE in our patients is lower than published literature, yet the diagnosis of VTE was associated with worse OS. Most cases occurred after the diagnosis of metastatic disease. The higher use of anticoagulants for other medical causes may be contributing to a lower incidence of VTE in mPC. These findings need prospective Validation.

Concordance Study Between IBM Watson for Oncology and real clinical practice for Cervical cancer patients in China：a Retrospective analysis. (Preprint)

2018 ◽  
Author(s):  
Fangwen Zou ◽  
Chao-Yuan Liu ◽  
Xu-Hong Liu ◽  
Yi-Fang Tang ◽  
Jin-An Ma ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Clinical Practice ◽  
Cancer Patients ◽  
Performance Status ◽  
Treatment Options ◽  
Clinical Decision Support Systems ◽  
Chinese Patients ◽  
Cancer Center ◽  
Ecog Performance Status ◽  
Real Clinical Practice

BACKGROUND Watson for Oncology (WFO) is a artificial intelligence clinical decision-support systems with evidence-based treatment options for oncologists. WFO has been gradually used in China, but limited reports on whether WFO is suitable for Chinese patients. OBJECTIVE This study aims to investigate the concordance of treatment options between WFO and real clinical practice at the Second Xiangya Hospital Cancer Center for Cervical cancer patients retrospectively. METHODS We retrospectively enrolled 300 cases of cervical cancer patients who were hospitalized at the Second Xiangya Hospital Cancer Center from May 2017 to August 2018. WFO provide treatment options for 246 supported cases. Real clinical practice were defined as concordant if treatment options were designated “recommended” or “for consideration” by WFO. Concordance of treatment option between WFO and real clinical practice was analysed statistically. RESULTS Treatment concordance between WFO and real clinical practice occurred in 72.8% (179/246) of cervical cancer cases.Logistic regression analysis showed that rural registration residence [0.64(0.427-0.946), P=0.025], advanced age [0.08(0.03-0.28), P=0.032], poor ECOG performance status [0.29(0.083-1.058), P=0.048], stages II-IV disease ([2.08 (1.002-4.325), P=0.046], [2.09(1.001-4.381), P=0.047], [0.19(0.038-0.91), P=0.025], respectively) have remarkable impact on consistency.Pathological type, differentiation degree, lymphatic and distant metastasis were not found to affect concordance.The main reasons attributed to the 27.2% (67/246) of the discordant cases were the substitution of nedaplatin for cisplatin,reimbursement plan of bevacizumab, surgical preference,and absence of neoadjuvant/adjuvant chemotherapy and PD-1/PD-L1 antibodies recommendations. CONCLUSIONS WFO recommendations were in 72.8% of concordant with real clinical practice for cervical cancer patients in China. However, several localization and individual factors limit its wider application. So,WFO could be an essential tool but it cannot currently replace oncologists.To be rapidly and fully apply to cervical cancer patients in China, accelerate localization and improvement were needed for WFO.

Heterogeneity of intermediate prognosis patients (pts) with metastatic renal cell cancer (mRCC) treated with sunitinib.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 446-446
Author(s):  
Avishay Sella ◽  
M. Dror Michaelson ◽  
Ewa M. Matczak ◽  
Ronit Simantov ◽  
Mariajose Lechuga ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kinase Inhibitors ◽  
Risk Model ◽  
Cox Regression ◽  
Performance Status ◽  
Cell Cancer ◽  
Objective Response ◽  
Progression Free Survival ◽  
Cancer Center ◽  
Ecog Performance Status

446 Background: The Memorial Sloan Kettering Cancer Center risk model (MSKCC) stratifies pts with mRCC into 3 prognostic groups based on 5 risk factors. The Intermediate Prognosis (INTMP) risk group is characterized by the presence of 1 or 2 factors, equivalent to 15 possible distinct entities. This heterogeneity suggests that the efficacy of tyrosine kinase inhibitors may be less predictable in the INTMP than in the other groups. Methods: We identified 548 patients with INTMP mRCC from a pooled analysis of patients treated with sunitinib in 6 prospective phase II and III clinical trials. Statistical analysis was performed using Cox regression and Kaplan-Meier methods and Pearson chi-square tests. Results: Most INTMP pts were male (69%), with clear cell carcinoma (93%), good ECOG performance status (PS) (60.5% PS 0; 38% PS 1; 1.5% PS 2) and median age 60. There were 325 pts (56%) with 1risk factor, and the most common were <1 year from diagnosis (38%); low hemoglobin (Hg) (29%), or both (16%). Objective response rate (RR) was 35.4%, progression free survival (PFS) was 8.4 months (m) and overall survival (OS) was 20.5 m. The 325 (59.3%) pts with one risk factor fared better than the 223 (40.7%) patients with two: PFS 10.7 vs 6.5 m, HR 0.684(95% CI 0.563-0.832, p<0.001); OS 26.3 vs 14.1 m, HR 0.522 (95% CI 0.420-0.648, p<0.001). RR was similar (38.5% vs 30.9%, p=0.071). Sunitinib was more effective in pts with PS 0: PFS 9.7 vs 7.8 m, HR 0.797 (95% CI 0.654-0.972, p=0.0242); OS 24.7 vs 14.0 m, HR 0.529 (95% CI 0.426-0.657, p<0.001), RR 38.9% vs 30.1%, (p=0.036). The most common grade 3/4 adverse events (AE) were fatigue (17%), hypertension (10%), hand foot skin reaction (9%), and nausea (4%). Overall, 17% of patients discontinued due to AE, and the overall pattern of AEs did not vary among the subgroups. Conclusions: MSKCC INTMP is a heterogeneous group comprised mostly of pts with low Hg and/or < 1 year from diagnosis. PFS and OS are superior in pts with 1 vs. 2 risk factors, and PS is also an important factor in the INTMP group. Sunitinib is active and well-tolerated in INTMP pts. Clinical trial information: NCT00077974, NCT00083889, NCT00137423, NCT00267748, NCT00338884, NCT00054886.

Time to first-line chemotherapy and travel distance to the cancer center and their relationship to subsequent-line therapies in stage IV CRC.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 724-724
Author(s):  
Mahjabeen Fatima Iqbal ◽  
Aleksi Emil Suo ◽  
Neha Papneja ◽  
Nayyer Iqbal ◽  
Tahir Abbas ◽  
...  
Keyword(s):  
Performance Status ◽  
Stage Iv ◽  
Travel Distance ◽  
Cancer Center ◽  
First Line ◽  
Ecog Performance Status ◽  
Third Line ◽  
Ecog Ps ◽  
Improvement In Survival ◽  
Line Chemotherapy

724 Background: Second and third line therapies in stage IV colorectal (CRC) have been associated with significant improvement in survival. However, not all patients receive all available therapies. Delay in starting treatment and travel burden can affect patient access and use of future therapy. Little is known about time to first line chemotherapy (TC) and travel distance to cancer center (TD) and their relationship to future therapies in stage IV CRC. The study aims to determine relationship between TC and TD with second and subsequent line of therapies. Methods: A patients cohort diagnosed with synchronous stage IV CRC during 2006-2010 in the province of Saskatchewan, Canada was studied. Patients with ECOG performance status of > 1 or who did not receive chemotherapy were excluded. The logistic regression analyses were performed to assess relationship between TC and TD and subsequent line therapies. Results: 569 patients were diagnosed with synchronous stage IV CRC. 326 patients received first line chemotherapy (mostly FOLFIRI ± bevacizumab). Of 326 patients 62 with ECOG performance status (PS) > 1 were excluded. The median age of 264 eligible patients was 62 yrs (IQR:53-72). 61% were male and 38% had ECOG PS of 0. Mean Charlson score was 9±1.3. 24% underwent metastasectomy. Median TC was 77 days (IQR: 53-107) and median TD was 64.4 km (IQR:4.8-166). 42.8% patients had to travel > 100 km for their treatment. Of 326 patients 144 (55%) received future therapies. On multivariate analysis absence of comorbid illness (as per Charlson comorbid index), odd ratio (OR) 1.45 (95% CI: 1.19-1.77), no metastasectomy, OR 1.89 (1.03-3.46) and TD < 100 km, OR 1.69 (1.003-2.84) were correlated with the utility of 2ndand subsequent line therapies. Conclusions: Our result revealed that although time to first line chemotherapy did not correlate with future systemic therapies, travel distance to Cancer Center > 100 km was associated with low rate of second or subsequent line therapies in statge IV CRC patients with good performance status.

Comparing physician and nurse ECOG performance status ratings as predictors of clinical outcomes in cancer patients.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 248-248
Author(s):  
Elad Neeman ◽  
Gillian Gresham ◽  
Andrew Eugene Hendifar ◽  
Richard Tuli ◽  
Robert A. Figlin ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Cancer Center ◽  
Ecog Performance Status ◽  
Logistic Regression Models ◽  
Score Difference ◽  
Grade 3 ◽  
Additional Clinical Benefit

248 Background: The Eastern Cooperative Oncology Group Performance Status (ECOG) scale is commonly used in the clinical and research setting, and has been shown to correlate with cancer morbidity, mortality, and tolerance to chemotherapy. ECOG is frequently rated by physicians (MDs) and nurses (RNs), and MD-RN ECOG score agreement varies widely in the literature. It remains unclear whether MD and RN ECOG scores differ in their ability to predict clinical outcomes. Methods: As part of a quality initiative at Cedars-Sinai Cancer Center, oncologists and chemotherapy RNs independently scored ECOGs for a random sample of 309 patients with various solid malignancies, on one or more visits, for a total of 506 pairs of ECOG scores. MD/RN interrater agreement was evaluated using the Cohen's kappa coefficient. Logistic regression models were fit to evaluate the ability of RN and MD ECOG scores, as well as the RN-MD score difference, to predict the occurrence of chemotoxicity (CTCAE v4, grade≳3) and hospitalizations within 1 month from ECOG ratings as well as 6-month mortality/hospice referrals. Results: The agreement among 506 ECOG MD/RN pairs was 71% (Kappa = 0.485, p < 0.0001). RN ECOGs had a stronger odds ratio (OR) for 6-month mortality/hospice (OR = 3.55, CI 2.2-5.7) compared to MD ECOGs (OR = 2.99, CI 1.67-5.3). RN ECOG scores also significantly correlated with one-month chemotoxicity (OR = 1.39, CI 1.02-1.90), but MD ECOGs did not. Both MD and RN ECOG scores did not significantly correlate with 1-month hospitalizations. The magnitude of RN to MD ECOG score difference was also positively associated with 6-month mortality/hospice (OR = 3.42, CI 1.87-6.3), but not with 1-month hospitalization or chemotoxicity. Conclusions: Our findings suggest that RN-rated ECOGs may be stronger predictors of chemotoxicity and 6-month mortality/hospice compared to MD ECOGs. Furthermore, the magnitude of difference between ECOG MD and RN ratings was associated with increased mortality/hospice rates, specifically when the MD rating was “healthier” than that of the RN. As ECOG scores are frequently used for prognostication and to inform treatment decisions, ECOG scoring by RNs may result in additional clinical benefit.

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