- Email: [email protected]
Cancer patients’ expectations and understanding about their disease
abstracts
Annals of Oncology with a longer FU reported better QoL, but more financial issues. These study results may help to develop interventions to the individual healthcare needs of AMS and contribute to the development of appropriate survivorship care. Legal entity responsible for the study: Netherlands Cancer Institute. Funding: Bristol-Myers Squibb. Disclosure: All authors have declared no conflicts of interest.
1622P
G. Anugu, S. Dattatreya Palanki, S.S. Atilli Medical Oncology, Omega Hospitals, Hyderabad, India Background: The prognosis of patients with inoperable lower esophageal cancers remains poor with only option being concurrent chemo-radiation. Among the various agents available, there is no study done focusing on TWISTT score and QOL in southern Indian population. Methods: This is a single-centre, two arm, retrospective analysis evaluating 75 patients with histologically confirmed inoperable adenocarcinoma esophagus lower 1/3rd who are on definitive chemoradiation. The patients were administered IV cisplatin 40 mg/ m2 weekly IV (n ¼ 38) as per institutional protocol vs Capecitabine 800 mg/m2 PO (n ¼ 37) twice a day along with radiotherapy of 6600-7000 cGy over 35 fractions. Patients were evaluated over response evaluation criteria in solid tumors (RECIST) criteria 12 weeks after the last cycle of chemotherapy as well as for TWISTT score and QOL. Results: The median duration of follow up was 20 months. Objective Response Rate (ORR) was observed in 84.2% of the patients with patients in the Cisplatin arm vs 86.4% in Capecitabine arm. There are no differences in the complete response (CR) and partial response (PR) rates in the two arms. The median overall survival was 20.7 months (95% CI: 18.8-, 28.7) in cisplatin arm vs 22.7 months (95% CI: 20.2-, 30.2). The median TWISTT score in Cisplatin was 246 days vs 228 days for capecitabine. The median QOL was similar in both arms. Conclusions: Capecitabine vs Cisplatin along with concurrent radiotherapy had similar overall response rates and progression free survival with similar TWISTT score and QOL and either can be used for concurrent therapy based on physician/ patient preferences. Legal entity responsible for the study: A. Goutham. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
1623P
Cancer, mental health and end life simulation (CAMhELS): A novel effectiveness evaluation
Fernando1, T. Benepal2, K. Thillai3, O. Minton4, J. kelly5, L. Breeze6, C. Broom7, N. Gosling8 1 Cancer Services, St George’s University Hospitals NHS Foundation Trust & GAPS Simulation Centre, St George’s University of London, London, UK,2Oncology, St George’s Hospital NHS Trust, London, UK, 3Oncology, Guys and St Thomas’ NHS Trust, London, UK, 4Palliative Care, St George’s Hospital NHS Trust, London, UK, 5Anesthetics Department, St George’s Hospital NHS Trust, London, UK, 6Cancer Services, St George’s University of London, London, UK, 7Simulation, St George’s University of London, London, UK, 8Simulation, St George’s Hospital NHS Trust, London, UK Background: The case for investing in better integrated mental health provision and training in cancer care is compelling. Mental health co-morbidity in cancer and end of life care is very common, poorly recognized, and leads to distress and loss of functioning. The recent SMaRT oncology trials, (Walker et al., 2014) have demonstrated that up to 73% of cancer patients with depression receive no evidence-based treatment for their depression. Standardized mortality ratio (SMR) for completed suicide in the cancer patient is four to seven times that of the matched population, (Robinson et al., 2009; Robson et al ., 2010). The increased awareness of co-morbid mental health conditions have impacted upon and influenced the cancer world. Yet, despite the plethora of research and policy advocating for better mental health provision for cancer patients, there is still a lack of recognition of the importance of assessing and managing co-morbid mental health in cancer patients. Methods: The authors designed a one-day simulation based training programme using trained actors portraying cancer journeys, from diagnosis to end of life, with a number of different and relevant mental health co-morbidities. Inter-professional participants (n ¼ 75) filled questionnaires both before and after the intervention (the simulation programme). The questionnaires consisted of multiple choice questions assessing
Volume 30 | Supplement 5 | October 2019
1624P
Cancer patients’ expectations and understanding about their disease
M.S. Pinho, J. Godinho Medical Oncology, CHEDV - Centro Hospitalar de Entre o Douro e Vouga E.P.E., Santa Maria Da Feira, Portugal Background: Cancer holds a huge psychosocial impact. Understanding the diagnosis and treatment gives cancer patients a feeling of autonomy and self-control. The patients’ perspective and expectations on the qualities of a medical oncologist are still poorly known. Methods: Observational cross-sectional study of cancer patients observed in a Portuguese peripheral hospital in October 2018. When patients knew the primary tumour site, stage of disease and intent of treatment they were considered to have “Full knowledge”. Descriptive statistics and univariate analysis were performed, considering a CI of 95%. Results: Seventy-two patients were included. Most were men (56.9%), with a median age of 60 years and 65.3% had an ECOG PS of 1. Patients reported feelings of shock (43.0%), sadness (38.9%), fear (34.7%) and courage (33.3%) when they became aware of their oncological diagnosis. About 12.5% of patients needed evaluation by Psychology/Psychiatry on the first 3 months after diagnosis, of which 2/3 had a history of depressive or anxiety disorders. The majority of patients (78%) received the diagnosis in a consultation, 12.5% in the emergency department with 4.2% being informed by their relatives (4.2%). About 90% of patients stated they knew their diagnosis while 5.6% were not sure. Correct identification of the primary tumour site occurred in 87% of patients and 81.9% knew the disease stage. Of those under treatment (n ¼ 58), almost 20% did not understand its intention. About 54% of patients had "full knowledge" of the disease and treatments. There was no significant correlation between socio-demographic and clinical variables and "full knowledge" of the disease, and only age approached the significance level (p ¼ 0.083). Patients mostly valued kindness (62.5%), honesty (55.6%) and knowledge (47.2%) in a medical oncologist. Conclusions: Despite the majority of patients claiming to be aware of their disease, almost half did not understand the disease stage or treatment intention. Clear communication can contribute to a greater sense of knowledge, autonomy and adaptation to the disease, potentially influencing quality of life. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
1625P
Impact of patients’ death on oncologists and coping strategies: An online survey
S. Labidi, H. El Benna, S. Sghaier, N. Nsiri, M. Nesrine, Y. Berrazega, N. Daoud, H. Boussen Medical Oncology, Abderrahmen Mami Hospital, Tunis, Tunisia Background: The practice of oncology is challenging, especially when dealing with terminally ill patients and end of life. This is not without an emotional impact on oncologists, with potential negative effect on patient care and personal lives. We aimed to outline the main factors that makes of patients’ death an emotionally difficult experience, and to identify practical coping strategies. Methods: An online survey was completed by 128 oncologists from three North African countries and France, on March-April 2019. All surveys were anonymous and confidential. The questionnaire included socio-demographic information, and sections about patients’ death and coping strategies. Results: Most respondents were female (83.5%) and young oncologists (20-40 yearsold), with less than 10 years professional experience (85.3%), but seeing more than 50 patients per week, and experiencing 0-2 deaths per month. They were mostly from
doi:10.1093/annonc/mdz262 | v669
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz262.008/5576636 by guest on 25 October 2019
Capecitabine vs cisplatin along with concurrent radiotherapy in the treatment of inoperable lower esophageal cancers focusing on TWISTT score and QOL
knowledge of mental health co-morbidity in the cancer patient, and confidence (self- rated 1-5 Likert scales). Results: Statistical t test analysis of pre v post intervention scores (n ¼ 75) revealed highly statistically significant imrpovements to participants’ clinical knowledge (p < 0.0001) and confidence (p < 0.0001) as a result of the simulation intervention. Conclusions: This study demonstrates that an innovative simulation programme has been evaluated as highly effective in improving knowledge and confidence of inter-professional learners at managing mental health co-morbidity in cancer patients. More research in this educational modality is welcomed in training clinicians. Legal entity responsible for the study: A. Fernando. Funding: Health Education England. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology with a longer FU reported better QoL, but more financial issues. These study results may help to develop interventions to the individual healthcare needs of AMS and contribute to the development of appropriate survivorship care. Legal entity responsible for the study: Netherlands Cancer Institute. Funding: Bristol-Myers Squibb. Disclosure: All authors have declared no conflicts of interest.
1622P
G. Anugu, S. Dattatreya Palanki, S.S. Atilli Medical Oncology, Omega Hospitals, Hyderabad, India Background: The prognosis of patients with inoperable lower esophageal cancers remains poor with only option being concurrent chemo-radiation. Among the various agents available, there is no study done focusing on TWISTT score and QOL in southern Indian population. Methods: This is a single-centre, two arm, retrospective analysis evaluating 75 patients with histologically confirmed inoperable adenocarcinoma esophagus lower 1/3rd who are on definitive chemoradiation. The patients were administered IV cisplatin 40 mg/ m2 weekly IV (n ¼ 38) as per institutional protocol vs Capecitabine 800 mg/m2 PO (n ¼ 37) twice a day along with radiotherapy of 6600-7000 cGy over 35 fractions. Patients were evaluated over response evaluation criteria in solid tumors (RECIST) criteria 12 weeks after the last cycle of chemotherapy as well as for TWISTT score and QOL. Results: The median duration of follow up was 20 months. Objective Response Rate (ORR) was observed in 84.2% of the patients with patients in the Cisplatin arm vs 86.4% in Capecitabine arm. There are no differences in the complete response (CR) and partial response (PR) rates in the two arms. The median overall survival was 20.7 months (95% CI: 18.8-, 28.7) in cisplatin arm vs 22.7 months (95% CI: 20.2-, 30.2). The median TWISTT score in Cisplatin was 246 days vs 228 days for capecitabine. The median QOL was similar in both arms. Conclusions: Capecitabine vs Cisplatin along with concurrent radiotherapy had similar overall response rates and progression free survival with similar TWISTT score and QOL and either can be used for concurrent therapy based on physician/ patient preferences. Legal entity responsible for the study: A. Goutham. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
1623P
Cancer, mental health and end life simulation (CAMhELS): A novel effectiveness evaluation
Fernando1, T. Benepal2, K. Thillai3, O. Minton4, J. kelly5, L. Breeze6, C. Broom7, N. Gosling8 1 Cancer Services, St George’s University Hospitals NHS Foundation Trust & GAPS Simulation Centre, St George’s University of London, London, UK,2Oncology, St George’s Hospital NHS Trust, London, UK, 3Oncology, Guys and St Thomas’ NHS Trust, London, UK, 4Palliative Care, St George’s Hospital NHS Trust, London, UK, 5Anesthetics Department, St George’s Hospital NHS Trust, London, UK, 6Cancer Services, St George’s University of London, London, UK, 7Simulation, St George’s University of London, London, UK, 8Simulation, St George’s Hospital NHS Trust, London, UK Background: The case for investing in better integrated mental health provision and training in cancer care is compelling. Mental health co-morbidity in cancer and end of life care is very common, poorly recognized, and leads to distress and loss of functioning. The recent SMaRT oncology trials, (Walker et al., 2014) have demonstrated that up to 73% of cancer patients with depression receive no evidence-based treatment for their depression. Standardized mortality ratio (SMR) for completed suicide in the cancer patient is four to seven times that of the matched population, (Robinson et al., 2009; Robson et al ., 2010). The increased awareness of co-morbid mental health conditions have impacted upon and influenced the cancer world. Yet, despite the plethora of research and policy advocating for better mental health provision for cancer patients, there is still a lack of recognition of the importance of assessing and managing co-morbid mental health in cancer patients. Methods: The authors designed a one-day simulation based training programme using trained actors portraying cancer journeys, from diagnosis to end of life, with a number of different and relevant mental health co-morbidities. Inter-professional participants (n ¼ 75) filled questionnaires both before and after the intervention (the simulation programme). The questionnaires consisted of multiple choice questions assessing
Volume 30 | Supplement 5 | October 2019
1624P
Cancer patients’ expectations and understanding about their disease
M.S. Pinho, J. Godinho Medical Oncology, CHEDV - Centro Hospitalar de Entre o Douro e Vouga E.P.E., Santa Maria Da Feira, Portugal Background: Cancer holds a huge psychosocial impact. Understanding the diagnosis and treatment gives cancer patients a feeling of autonomy and self-control. The patients’ perspective and expectations on the qualities of a medical oncologist are still poorly known. Methods: Observational cross-sectional study of cancer patients observed in a Portuguese peripheral hospital in October 2018. When patients knew the primary tumour site, stage of disease and intent of treatment they were considered to have “Full knowledge”. Descriptive statistics and univariate analysis were performed, considering a CI of 95%. Results: Seventy-two patients were included. Most were men (56.9%), with a median age of 60 years and 65.3% had an ECOG PS of 1. Patients reported feelings of shock (43.0%), sadness (38.9%), fear (34.7%) and courage (33.3%) when they became aware of their oncological diagnosis. About 12.5% of patients needed evaluation by Psychology/Psychiatry on the first 3 months after diagnosis, of which 2/3 had a history of depressive or anxiety disorders. The majority of patients (78%) received the diagnosis in a consultation, 12.5% in the emergency department with 4.2% being informed by their relatives (4.2%). About 90% of patients stated they knew their diagnosis while 5.6% were not sure. Correct identification of the primary tumour site occurred in 87% of patients and 81.9% knew the disease stage. Of those under treatment (n ¼ 58), almost 20% did not understand its intention. About 54% of patients had "full knowledge" of the disease and treatments. There was no significant correlation between socio-demographic and clinical variables and "full knowledge" of the disease, and only age approached the significance level (p ¼ 0.083). Patients mostly valued kindness (62.5%), honesty (55.6%) and knowledge (47.2%) in a medical oncologist. Conclusions: Despite the majority of patients claiming to be aware of their disease, almost half did not understand the disease stage or treatment intention. Clear communication can contribute to a greater sense of knowledge, autonomy and adaptation to the disease, potentially influencing quality of life. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
1625P
Impact of patients’ death on oncologists and coping strategies: An online survey
S. Labidi, H. El Benna, S. Sghaier, N. Nsiri, M. Nesrine, Y. Berrazega, N. Daoud, H. Boussen Medical Oncology, Abderrahmen Mami Hospital, Tunis, Tunisia Background: The practice of oncology is challenging, especially when dealing with terminally ill patients and end of life. This is not without an emotional impact on oncologists, with potential negative effect on patient care and personal lives. We aimed to outline the main factors that makes of patients’ death an emotionally difficult experience, and to identify practical coping strategies. Methods: An online survey was completed by 128 oncologists from three North African countries and France, on March-April 2019. All surveys were anonymous and confidential. The questionnaire included socio-demographic information, and sections about patients’ death and coping strategies. Results: Most respondents were female (83.5%) and young oncologists (20-40 yearsold), with less than 10 years professional experience (85.3%), but seeing more than 50 patients per week, and experiencing 0-2 deaths per month. They were mostly from
doi:10.1093/annonc/mdz262 | v669
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz262.008/5576636 by guest on 25 October 2019
Capecitabine vs cisplatin along with concurrent radiotherapy in the treatment of inoperable lower esophageal cancers focusing on TWISTT score and QOL
knowledge of mental health co-morbidity in the cancer patient, and confidence (self- rated 1-5 Likert scales). Results: Statistical t test analysis of pre v post intervention scores (n ¼ 75) revealed highly statistically significant imrpovements to participants’ clinical knowledge (p < 0.0001) and confidence (p < 0.0001) as a result of the simulation intervention. Conclusions: This study demonstrates that an innovative simulation programme has been evaluated as highly effective in improving knowledge and confidence of inter-professional learners at managing mental health co-morbidity in cancer patients. More research in this educational modality is welcomed in training clinicians. Legal entity responsible for the study: A. Fernando. Funding: Health Education England. Disclosure: All authors have declared no conflicts of interest.