Illness understanding of oncology patients in a community-based cancer institute.

e21605 Background: Several studies have demonstrated patients have a poor understanding of prognosis, survival and effectiveness of chemotherapy, particularly in the setting of advanced cancer. This study examines oncology patients’ understanding of their illness based on accurate reporting of stage at diagnosis as well as knowledge of remission status. Methods: 208 cancer patients previously treated at our large community based cancer institute participated in The Consumer-Based Cancer Care Value Index (CCCVI) Field Survey. Electronic medical record (EMR) documentation of stage at diagnosis and remission status were compared to patients’ self-reported responses. Concordance of responses and variables influencing discordance were evaluated. Results: 51.0% of patients’ self-reported cancer stage matched the abstracted stage with the highest concordance in the advanced cancer patients (72%) versus stage I-III patients (36.4%-61.5%). Unexpectedly, discordance was lower among advanced cancer patients as compared to stage I-III patients (p = 0.0528) Those who were concordant for cancer stage at diagnosis were significantly more likely to be female (p = 0.001), under the age of 65 (p = 0.01), have an income greater than $60,000 (p = 0.03), and have more education (p = 0.02). 64.4% of patients’ self-reported remission status matched the abstracted status. Nearly 30% of patients were not sure about their status even when they were in remission. Conclusions: Our findings confirm that more than one quarter of patients with advanced cancer have poor illness understanding, as well as highlights that an even greater number of patients with early stage I-III cancers have poor illness understanding. These observations highlight the need to improve illness understanding for patients across the entire cancer continuum.

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Illness Understanding of Oncology Patients in a Community-Based Cancer Institute

Journal of Oncology Practice ◽

10.1200/jop.2017.020982 ◽

2017 ◽

Vol 13 (9) ◽

pp. e800-e808 ◽

Cited By ~ 4

Author(s):

Shanthi Sivendran ◽

Sarah Jenkins ◽

Sarah Svetec ◽

Michael Horst ◽

Kristina Newport ◽

...

Keyword(s):

Advanced Cancer ◽

Early Stage ◽

Stage I ◽

Cancer Stage ◽

Stage At Diagnosis ◽

Community Based ◽

Oncology Patients ◽

Number Of Patients ◽

Knowledge Of Cancer ◽

Active Disease

Purpose: Several studies have demonstrated that patients have a poor understanding of prognosis, survival, and effectiveness of chemotherapy, particularly in the setting of advanced cancer. This study examines oncology patients’ understanding of their illness based on accurate reporting of stage at diagnosis and knowledge of cancer status (ie, free of cancer or in remission v active disease). Materials and Methods: Two hundred eight patients with cancer previously treated at our large community-based cancer institute participated in the Consumer-Based Cancer Care Value Index field survey. Electronic medical record documentation of stage at diagnosis and cancer status was compared with patients’ self-reported responses. Concordance of responses and variables influencing discordance were evaluated. Results: In 51.0% of patients, self-reported cancer stage matched the abstracted stage, with the highest concordance in patients with advanced cancer (72%) versus patients with stage I to III disease (36.4% to 61.5%). Unexpectedly, discordance was lower among patients with advanced cancer compared with patients with stage I to III cancer ( P = .0528). Patients who were concordant for cancer stage at diagnosis were significantly more likely to be female ( P = .001), be younger than age 65 years ( P = .01), have an income > $60,000 ( P = .03), and have more education ( P = .02). In 64.4% of patients, self-reported cancer status (ie, free of cancer or in remission v active disease) matched the abstracted status. Nearly 30% of patients were not sure about their status, even when they were free of cancer or in remission. Conclusion: Our findings confirm that more than one quarter of patients with advanced cancer have poor illness understanding and highlight that an even greater number of patients with early stage I to III cancer have poor illness understanding. These observations highlight the need to improve illness understanding for patients across the entire cancer continuum.

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Frequency, predictors, and outcomes of urine drug test among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.94 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 94-94

Author(s):

Joseph Anthony Arthur ◽

Tonya Edwards ◽

David Hui ◽

Jessica Marie Waletich-Flemming ◽

Suresh K. Reddy ◽

...

Keyword(s):

Supportive Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Opioid Therapy ◽

Cancer Stage ◽

Chronic Opioid Therapy ◽

Advanced Cancer Patients ◽

Care Clinic ◽

Urine Drug ◽

Outpatient Supportive Care

94 Background: Data on the utilization and outcomes of urine drug tests (UDT) among advanced cancer patients is limited. The main objective of this study was to determine the factors associated with UDT ordering and results in advanced cancer outpatients. Methods: A retrospective chart review of 1058 patients seen from March 2014 to November 2015 at an outpatient supportive care clinic was conducted. Sixty-one patients on chronic opioid therapy who underwent UDT were identified. A control group of 120 patients who did not undergo UDT was selected for comparison of information on demographic and clinical characteristics. Results: 61/1058 patients (6%) underwent UDT. 33/61 patients (54%) had abnormal results. Multivariate analysis found that the odds ratio for UDT ordering was 3.9 in CAGE positive patients (p = 0.002), 4.41 in patients less than 45years (p < 0.001), 5.58 in patients with moderate to severe pain (ESAS pain score ≥ 4) (p < 0.001), 0.27 in patients with advanced cancer stage, (p = 0.008), and 0.25 in patients with moderate to severe fatigue (p = 0.001). Among 52 abnormal UDT results in 33 patients, the most common opioid findings were: prescribed opioids absent in urine (14/52, 27%) and un-prescribed opioids in urine (13/52, 25%). Conclusions: UDT was used infrequently among advanced cancer patients receiving outpatient chronic opioid therapy. Younger age, CAGE positivity, early cancer stage or NED status, higher pain intensity, and lower fatigue were significant predictors of UDT ordering. More than 50% of UDTs were abnormal. More research is necessary to better characterize aberrant opioid use in advanced cancer patients.

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553Stage at diagnosis for six major cancers in China with comparison to the United States

International Journal of Epidemiology ◽

10.1093/ije/dyab168.558 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Xianhui Ran ◽

Hongmei Zeng ◽

Siwei Zhang ◽

Lan An ◽

Rongshou Zheng ◽

...

Keyword(s):

Cancer Patients ◽

The United States ◽

Stage I ◽

Cancer Site ◽

Cancer Stage ◽

Stage At Diagnosis ◽

Stage Distribution ◽

The Us ◽

Center Hospital ◽

Clinical Records

Abstract Background To explore the distribution and factors associated with cancer stage at diagnosis, we conducted a multi-center hospital-based study in China. Methods 38 hospitals were selected to set up the Chinese cancer clinical database. Detailed stage information was collected from clinical records and focus on cancers of the lung, stomach, colon-rectum, liver, female breast, and esophagus diagnosed during 2016-2017. We compared the stage distribution with the US by data from Surveillance, Epidemiology, and End Results database during the same period. Results Overall 69632 first diagnosed cancer cases were analyzed. The proportion of cancer patients in stage I varies by cancer site, with highest in breast (28%) and lowest in liver (13%). The proportion of cancer cases at stage I was generally higher in women (OR:1.7,95%CI:1.6-1.8), in young (<65 years) (OR:1.2,1.1-1.2) and in subjects having Chinese Urban Insurances (OR:1.9,1. 8-2.0). Except for esophageal cancer, the other five major cancers in China had more advanced stage than in the US. Conclusions Socio-demographic inequalities exist in stage at diagnosis for major cancer cases in China. Early detection interventions are especially needed to be targeted on patients with higher risk of advance disease diagnosis. Key messages Multi-center hospital-based study on cancer stage distribution in China shows that women, young, and those with Chinese Urban Insurance were more likely to be diagnosed with early stage. Stage distribution in China was generally more advanced compared with cancer patients in the US.

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“I want to live, but…” The desire to live and its physical, psychological, and social factors among advanced cancer patients: Evidence from the APPROACH study in India

10.21203/rs.3.rs-958916/v1 ◽

2021 ◽

Author(s):

Anjum S Khan Joad ◽

Arati Hota ◽

Pratima Agarwal ◽

Krimal Patel ◽

Kinjal Patel ◽

...

Keyword(s):

Psychological Distress ◽

Middle Class ◽

Cancer Patients ◽

Advanced Cancer ◽

Pain Severity ◽

Lower Probability ◽

Cancer Stage ◽

Advanced Cancer Patients ◽

Negatively Associated ◽

Linear Probability

Abstract Background The limited access to palliative care resources along with the social stigma around cancer largely explains the poor quality of life (QoL) of Indian advanced cancer patients. As advanced cancer patients with poor QoL often harbour a desire for hastened death (DHD), it is imperative to understand factors affecting DHD, or the desire to live (DTL) among advanced cancer patients in India. We aim to examine the relationship between DTL and physical, psychological, social and spiritual factors measuring patients’ QoL alongside their awareness of their late cancer stage. Methods We surveyed 200 patients from a tertiary cancer hospital in India to collect their DTL, awareness of cancer stage, demographic characteristics, and standardized measures for patients’ QoL. We used a linear probability regression model to quantify the association between these factors and patients’ DTL among the final sample of 192 patients with no missing information for the variables of interest. Results Among the various domains affecting cancer patients’ QoL, we found that the pain severity score (ranging from 0 to 10) and psychological distress score (ranging from 0 to 42) are negatively associated with the DTL. One point increase in each score reduced the DTL by 2.2% (p <0.05) and 0.7% (p <0.05), respectively. Our results also showed that patients whose perceived socio-economic status (SES) is poor have a 16% (p <0.05) lower probability of DTL, compared to those with higher SES (lower middle class, upper middle class, and wealthy). Controlling for caste, religion, gender, age, marital status and years of education, we found psychological distress is statistically higher among patients belonging to this bottom SES. Conclusions We found that pain severity, psychological distress and perceived low SES are negatively associated with the desire to live in advanced cancer patients. Future research should focus on developing interventions to improve physical pain and psychological distress, particularly for patients who are socially and economically disadvantaged.

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Advanced cancer patients' self-reported perception of timeliness of their referral to outpatient supportive/palliative care and their survival data.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.10121 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 10121-10121 ◽

Cited By ~ 3

Author(s):

Angelique Wong ◽

David Hui ◽

Margeaux Epner ◽

Vishidha Reddy Balankari ◽

Vera J De la Cruz ◽

...

Keyword(s):

Palliative Care ◽

Supportive Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Just In Time ◽

Advanced Cancer Patients ◽

Care Clinic ◽

Disease Trajectory ◽

Number Of Patients ◽

Significant Difference

10121 Background: Palliative Care referral is often thought to be delayed as judged by health professionals and caregivers. However, no studies have ever examined patients’ perception of timeliness of referral. The primary objective of this study was to determine patients’ perception of the timeliness of their own referral to an outpatient palliative care clinic. We also examined the association between perceived timeliness and actual timing of referral. Methods: In this prospective survey, patients with advanced cancer were asked to rate their perceived timeliness of referral using a 5-point Likert scale ranging from much too early to much too late within 7-35 days after their first consultation visit at Supportive Care Center. They were also asked when they felt referral to Supportive Care should occur along 4 points in their disease trajectory. Actual timing of referral was assessed based on survival from the timing of completion of the survey. Results: 200 advanced cancer patients were surveyed. Median age was 64, 111 (55%) were female, and 35 (18%), 32 (16%) and 26 (13%) had gastrointestinal, lung and breast cancer, respectively. The median overall survival was 8.5 months. 144 (72%) patients perceived their referral was “just in time,” 42 (21%) felt it was “late/much too late,” and 14 (7%) felt it was much “too early/early.” 76/193 (39%) felt the referral should occur at the time of diagnosis of cancer, 32 (17%) when they start first-line chemotherapy, 46 (24%) at diagnosis of recurrent disease, 14 (7%) when there are no further treatment options, and 4 (2%) reported never. We found no significant difference in survival among patients who reported their referral was early, just in time, and late (median 9.8 vs. 8.3 vs. 9.0 months, P=0.43). Conclusions: Patients with advanced cancer were referred to our outpatient Supportive Care clinic a median of 8.5 months before death. A vast majority of patients perceived the timing of referral was appropriate, and many agreed that referral should occur early in the disease trajectory. The lack of association between perceived timeliness of referral and survival may be related to the ceiling effect and the small number of patients who felt their referral was late.

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The frequency and predictors of end-of-life symptom in patients with advanced cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24061 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24061-e24061

Author(s):

Shuji Hiramoto ◽

Ayako Kikuchi ◽

Tomohiko Taniyama ◽

Hori Tetsuo ◽

Akira Yoshioka ◽

...

Keyword(s):

Cancer Pain ◽

End Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Peritoneal Metastasis ◽

Group Performance ◽

Nausea And Vomiting ◽

Advanced Cancer Patients ◽

Consciousness Level ◽

Number Of Patients

e24061 Background: Advanced cancer patients complain of highly distressing symptom at the end-of-life, and important reasons for palliative intervention to relive symptoms. Methods: We analyzed 1282 patients who died of advanced cancer from August 2011 to August 2019 retrospectively. We divided into patients who complain of symptom include fatigue, dyspnea, nausea and vomiting, and cancer pain, or didn’t for 3 days prior to death, and analyzed predictors by multiple logistics method. The primary endpoint of this study was to identify frequency and predictors of end-of-life symptoms in advanced cancer patients. Results: As a background, the median age is 73 years old, 690 males, 592 females, 227 gastroesophageal cancers, 250 biliary pancreatic cancers, 54 hepatocellular carcinomas, 189 colorectal cancer, 251 lung cancers, 71 breast cancers, 58 urological malignancies, 60 gynecological malignancies, 47 head and neck cancer, 31 hematological malignancies, and 22 sarcomas. Number of patients who complained of dyspnea, fatigue, nausea and vomiting, and cancer pain were 235 (18.3%), 318 (24.8%), 81 (6.3%), and 322 (25.1%) at the end-of-life. In a multivariate analysis, peritoneal metastasis (ORs 1.812), with mental (ORs 0.549), palliative referral (ORs 0.680), Eastern Cancer Organization Group Performance Status (ECOG-PS) (OR0.679) and consciousness level (ORs 0.610) was independent predictors in patients with fatigue at the end-of-life. Chest cancer (Odds Ratio 2.635), lung (ORs 2.159), brain (ORs 0.431) and peritoneal metastasis (ORs 0.602), with mental (ORs 0.429), respiratory (ORs 1.960) and metabolic disorder (ORs 0.520), palliative referral (ORs 0.645) and consciousness level (ORs 0.468) was independent predictors in patients with dyspnea. Lung metastasis (ORs 0.480, peritoneal metastasis (ORs 1.812), with anti-cancer therapy (OR 2.244) and consciousness level (ORs 0.610) was independent predictors in patients with nausea and vomiting. Brain metastasis (ORs 0.435, liver metastasis (ORs 1.374), and consciousness level (ORs 0.599) was independent predictors in patients with cancer pain. Conclusions: We reported frequency and independent predictors of end-of-life symptoms in advanced cancer patients. Information on these predictors be useful to explaining about their end-of-life in advance.

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