Psychosocial Support and Nutrition Counselling Among Patients with Cancer Receiving Chemotherapy: A Mixed-Methods Study

Purpose Cancer chemotherapy causes nutrition impact symptoms (NIS) that affect patient diet and nutrition. Such patients, therefore, require nutrition counselling. In this study, we aimed to 1) identify the psychosocial factors of patients who require nutrition counselling and 2) articulate the specific details of the issues for which patients desire advice. Methods We conducted anthropometric measurements, surveys using questionnaires, and interviews with patients receiving outpatient chemotherapy for head and neck, oesophageal, gastric, colorectal, and lung cancers. The questionnaire included items on NIS, patients’ experience of eating-related distress (ERD), and quality of life (QOL). Interviews were conducted with patients who required nutrition counselling regarding specific issues. We provided nutrition counselling in two sessions. Results Of the 151 patients, 42 required nutrition counselling. The psychosocial factors affecting the required nutrition counselling were the number of people in the household, employment status, QOL, and ERD. The contexts of the specific issues patients wanted to discuss included self-management, distress, understanding and sympathy, anxiety, and confusion. Conclusion Nutrition counselling for patients receiving cancer chemotherapy needs to involve multidisciplinary support that considers psychological (anxiety, confusion) and social (family structure, employment situation) aspects as additional means to address NIS.

Association between personality traits and self-care behaviors in patients with gastrointestinal cancer undergoing outpatient chemotherapy

Purpose Practicing self-care behaviors is important for patients with gastrointestinal cancer undergoing outpatient chemotherapy. Knowledge of personality traits may be useful in providing individualized support that can improve self-care behaviors. Therefore, we assessed the association between personality traits and self-care behaviors in these patients. Methods This cross-sectional study was conducted among patients who received intravenous chemotherapy at a designated regional cancer hospital between June 2020 and October 2020. A self-administered survey was conducted among these patients using the Japanese version of the Ten Item Personality Inventory and a 29-item questionnaire to assess self-care behaviors. Association between the scores of the personality traits and frequency of each self-care behavior was analyzed using the Spearman's rank correlation coefficient. Results In total, 53 responses were obtained from 57 participants, of which 52 valid responses were included in the analysis. Openness and conscientiousness were personality traits significantly associated with multiple self-care behaviors. High degree of openness, characterized by the ability to tackle new situations, had a moderately significant positive correlation with adjustment of exercise (ρ = 0.49, p<0.01) and activities for a change of mood (ρ = 0.40, p<0.01). High degree of conscientiousness, characterized by the ability to take a health action, had a significant positive correlation with acquisition of information on disease and treatment (ρ = 0.30, p=0.03) and confirmation of inspection results (ρ = 0.39, p<0.01). Conclusion Openness and conscientiousness are associated with self-care behaviors in patients with gastrointestinal cancer undergoing outpatient chemotherapy and may be useful in explaining and predicting individual self-care behaviors.

Risk factors for ED visits and admissions during outpatient chemotherapy in head and neck cancer.

223 Background: Despite the recent introduction of the CMS metric, OP-35, which tracks 30-day inpatient admissions and ED visits after outpatient chemotherapy administration, the risk factors driving acute care utilization (ACU) in the head and neck cancer treatment setting are not yet well understood. Further characterization of these risk factors could allow for improved care quality and reduce preventable inpatient and ED admissions. Methods: This was a retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked cancer registry-claims database. The study cohort consisted of patients aged 66 years or older diagnosed with head and neck cancer between 2004-2015 who received outpatient chemotherapy within the first two years after diagnosis. Multivariable logistic regression modeling was utilized to characterize the risk factors associated with an inpatient or ED admission within 30 days after receiving chemotherapy. Results: Of the 2,236 eligible patients, 735 (32.9%) had at least one inpatient or ED admission within 30 days of receiving outpatient chemotherapy. On multivariable analysis, cancer of the oral cavity [odds ratio (OR) 1.43; 95% confidence interval (CI) 1.04-1.96] and oropharynx/hypopharynx [OR 1.34; 95% CI 1.06-1.70] were associated with an increased odds of ACU. Other factors associated with ACU included NCI comorbidity index [OR 1.10; 95% CI 1.03-1.18], prior ACU [OR 1.06; 95% CI 1.02-1.09], second cycle of chemotherapy relative to the first cycle [OR 0.38, 95% CI 0.29-0.50], and third or greater cycle of chemotherapy [OR 0.17; 95% CI 0.13-0.21]. Certain chemotherapeutic agents also modified risk: use of an angiogenesis inhibitor [OR 0.18; 95% CI 0.06-0.45], alkylating agent [OR 1.24; 95% 1.01-1.53], plant alkaloid [OR 1.63; 95% CI 1.25-2.10], or antimetabolite [OR 2.69; 95% CI 1.78-4.09]. The most common admission diagnosis was pain (n = 243; 33.1%) followed by dehydration (n = 167; 22.7%). Conclusions: Multiple clinical variables modify risk of acute care utilization after outpatient chemotherapy in the head and neck cancer setting, providing several potential avenues of intervention for providers.

Evaluating the utility of rule OP-35 to define preventability of ED visits for oncology patients at an academic cancer center.

272 Background: Rule OP-35, which characterizes treatment-related complications of patients receiving outpatient chemotherapy that result in a potentially avoidable emergency department (ED) visit or hospitalization, was developed to encourage practices to build treatment models that reduce such events. However, defining visits as potentially avoidable based on symptoms may not capture the complexity of caring for oncology patients. We aim to evaluate the effectiveness of OP-35 in identifying preventable ED visits by real world standards at an academic institution. Methods: A retrospective analysis was performed reviewing ED visits at the Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University for oncology patients from 10/1/2020 to 1/31/2021. Each patient received care at SKCC had received intravenous or oral chemotherapy in the preceding 30 days, and each encounter was classified as potentially avoidable by OP-35 criteria. Two investigators independently conducted chart reviews to determine whether these visits were potentially avoidable, recording whether the patient attempted to contact their care team prior to the ED encounter and assessing if the concern could have been managed in a timely manner in an outpatient setting. The two records were then compared, and the principal investigator served as an arbiter for determining if a visit was potentially avoidable in instances where the investigators disagreed. Results: We reviewed 144 total encounters and excluded events from patients with either acute leukemia or breast cancer on hormone therapy only, leaving 107 encounters for analysis. After evaluating the clinical circumstances, we determined that 29% of these ED encounters were potentially avoidable. Applying New York University Emergency Department Algorithm (NYU-EDA) criteria, 69% of encounters were considered potentially avoidable. Patients called for advice before seeking ED care in 53% of unavoidable encounters compared to 26% of potentially avoidable encounters. An additional 14% of visits deemed unavoidable were from patients sent directly from clinic. For potentially avoidable encounters, 60% of patients were discharged directly from the ED. In comparison, 8% of unavoidable encounters led to discharge from the ED. Pain was the most common reason for encounters and 53% of these visits were considered potentially avoidable. Conclusions: We found that approximately 30% of ED encounters deemed avoidable by OP-35 criteria were considered potentially avoidable following clinician review. In the majority of cases patients were referred to the ED following initial outpatient attempts at management. NYU-EDA criteria for preventability did not correlate with OP-35 nor clinician consensus regarding potentially avoidable encounters. More work remains in refining tools to identify potentially avoidable ED visits for oncology patients.

Feasibility and acceptability of hypnosis-derived communication administered by trained nurses to improve patient well-being during outpatient chemotherapy: a pilot-controlled trial

Purpose This pilot-controlled trial aimed to examine the feasibility and acceptability of hypnosis-derived communication (HC) administered by trained nurses during outpatient chemotherapy to optimize symptom management and emotional support — two important aspects of patient well-being in oncology. Methods The trial was conducted in two outpatient oncology units: (1) intervention site (usual care with HC), and (2) control site (usual care). Nurses at the intervention site were invited to take part in an 8-h training in HC. Participants’ self-ratings of symptoms and emotional support were gathered at predetermined time points during three consecutive outpatient visits using the Edmonton Symptom Assessment Scale and the Emotional Support Scale. Results Forty-nine patients (24 in the intervention group, 25 in the control group) with different cancer types/stages were recruited over a period of 3 weeks and completed the study. All nurses (N = 10) at the intervention site volunteered to complete the training and were able to include HC into their chemotherapy protocols (about ± 5 min/intervention). Compared to usual care, patients exposed to HC showed a significant reduction in physical symptoms during chemotherapy. In contrast, perception of emotional support did not show any significant effect of the intervention. Participants exposed to HC report that the intervention helped them relax and connect on a more personal level with the nurse during chemotherapy infusion. Conclusions Our results suggest that HC is feasible, acceptable, and beneficial for symptom management during outpatient chemotherapy. While future studies are needed, hypnosis techniques could facilitate meaningful contacts between cancer patients and clinicians in oncology. Trial registration Clinical Trial Identifier: NCT04173195, first posted on November 19, 2019

Anorexia, pain and peripheral neuropathy are associated with a decrease in quality of life in patients with advanced pancreatic cancer receiving outpatient chemotherapy — a retrospective observational study

Background Cancer chemotherapy usually improves clinical outcomes in patients with advanced pancreatic cancer (APC), but can also cause moderate-to-severe adverse events (AEs). We investigated the relationship between moderate-to-severe AEs and quality of life (QOL) in patients with APC who received outpatient chemotherapy. Methods We recruited APC patients who received outpatient chemotherapy in Gifu University Hospital between September 2017 and December 2018. Adverse events related to chemotherapy were assessed by a pharmacist collaborating with a physician using common terminology criteria for AEs (CTCAE) ver 4.0, and QOL of patients was self-assessed by patients using the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L Japanese edition 2). Associations between the EQ-5D-5L utility value and serious AEs were assessed using proportional odds logistic regression. Results A total of 59 patients who received 475 chemotherapy cycles were included. The proportional odds logistic regression indicated that grade ≥ 2 anorexia, pain and peripheral neuropathy were significantly correlated with a decreased EQ-5D-5L utility value. Pharmaceutical intervention for these AEs significantly improved the patients’ EQ-5D-5L utility value. Conclusions Anorexia, pain and peripheral neuropathy were significantly associated with a decrease in QOL. It is assumed that appropriate pharmaceutical intervention with particular emphasis on these AEs can improve the QOL of pancreatic cancer patients receiving outpatient chemotherapy.