- Email: [email protected]
25 Involvement of family physicians in the care of patients receiving palliative radiotherapy
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September 13-16
time effects. The Symptom Management Model (Dodd et al., 2001) was used as a conceptual framework for the study. Results: Participants in the intervention group showed significant decrease in symptom distress scores at the end of the intervention compared to women who received usual care (p=0.039). These effects were not sustained at three months after the completion of radiation. Expectedly, both groups experienced worsening of symptoms over the course of radiation therapy. However, women in the ISEP group had less worsening in symptom distress, pain, fatigue, nausea, pelvic symptoms and mood disturbance at the end of radiation treatment. Findings suggest that nurses can use individualized interventions to reduce symptom distress in women during radiation therapy. 25 I n v o l v e m e n t of Family Physicians in the Care of Patients Receiving Palliative Radiotherapy E. Barnes 1, L. Librach 2, E. Chow 1, K. Harris 1, G. Fan 1, M. Tsao ~, L. Barbera ~, C. Danjoux ~ Toronto Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Ontario ~ Mount Sinai Hospital, University of Toronto, Toronto, Ontario 2 toni. barnes@sunn ybrook, ca
Background: Cancer patients with locally advanced or metastatic disease often receive palliative radiotherapy. While at the cancer centre, it is important for patients to maintain continuity of care with their family physician (FP). The primary objective of this study was to determine the perception of patients seen in the Rapid Response Radiotherapy Program (RRRP) on FP involvement in their cancer care. Methods: Consecutive patients were recruited at the time of RRRP consultation and asked to complete a brief survey. Results: To date 244 patients have been accrued. Median age was 68 years (range 30-94), and median Karnofsky performance score was 70 (range 20-100). The most common primary cancer sites were lung (40%), prostate (18%), and breast (18%). Nearly all (98%) patients reported having a FP, and 71% of patients had been under the care of this FP for at least five years. 80% were satisfied with the overall care provided by their FP. Fifty-seven percent of patients felt their FP was involved in their cancer care, and only 23% wanted their FP to be more involved. The most common reason patients gave for perceiving limited FP involvement was that the medical oncologist was looking after all their cancer needs. Forty-three percent of patients had not seen their FP in over a month, and 73% reported they had no definite return appointment. Only 29% of patients had a palliative care physician involved in their care. Conclusions: Despite long-standing relationships and high levels of satisfaction with overall care, less than half (43%) of the patients surveyed perceived their FP as involved in their cancer care. Encouraging continuity of care between patients and FP during therapeutic treatment may allow easier transition of care back to the FP once palliative treatment at the cancer centre has finished, and allow pain and symptom management to be optimized. 26 A Quality of Life Module for Enteral Feeding: Reliability and Validity Assessment J. Ringash, B. Lemon, G. Lockwood, A. Bezjak, J. Waldron Princess Margaret Hospital, Toronto, Ontario j o l ie. rinqash @rmp. uhn. on. ca
Objectives: To determine the reliability and validity of a newly-developed quality of life (QOL) questionnaire, "QOL-EF", designed to measure the QOL impact of enteral feeding. Methods: A 20-item questionnaire with five-point Likert-type response options has been developed following literature review, focus groups with multi-disciplinary experts (nurses, nutritionists, a surgeon, radiation oncologist and interventional radiologist), and both pilot and item reduction studies in head and neck cancer (H&N) patients with current or past enteral feeding tubes. Reliability (test-retest and internal consistency)
CARe 2006
and concurrent validity compared to the FACT-H&N, UW QOL, clinical factors and performance status measures (KPS, ECOG PS) were assessed in a cross-sectional sample of 72 HNC patients receiving enteral feeding during or after radiotherapy. Results: Participants had median age 56; 56 males, 16 females; 88% stage IV cancer (no distant metastases); 67% oropharyngeal cancer. Median body mass index was 22.7 and median time with feeding tube was 1.4 months. Mean KPS was 73 and mean ECOG PS was 1.4. Mean QOL scores normalized to 100% were: FACT-H&N 59%, UW QOL 53%, and QOL-EF 61%. Test-retest reliability was determined in 31 patients; Pearson correlation coefficient was 0.83 (95% CI 0.66-0.91). Crohnbach's alpha (internal consistency) was 0.73 in 70 patients. We hypothesized Pearson correlation of 0.4-0.6 with FACT-H&N and UW QOL and found: FACT-H&N 0.61 (95% CI 0.43-0.74), UW QOL 0.47 (95% CI 0.25-0.63). QOL-EF score correlated positively with ECOG PS and inversely with weight loss. The most preferred of the three questionnaires was FACTH&N in 42%, QOL-EF in 34% and UW QOL in 24% of patients. Conclusions: This study confirms that QOL-EF has high reliability and validity, and that QOL concerns related to enteral feeding are of great importance to HNC patients. This novel QOL questionnaire is ready for use in prospective trials to determine its responsiveness to change. 27 W h a t Factors Should be Used for Considering Brain Metastases Patients for Stereotactic Radiosurgery?: A Population Based Study of all Brain Metastases Patients Referred for Radiation at the Tom Baker Cancer Centre Between 1999 and 2 0 0 4 P. Craighead I, A. Chan 1, Z. Kiss 2, C. Newcomb I University of Calgary, Calgary, Alberta1; Tom Baker Cancer Centre, Calgary, Alberta 2 peterch @cancerboard. ab. ca This retrospective review was set up to determine the prognostic factors for selecting patients for stereotactic radiosurgery (SRS). Patients with brain metastases secondary to epithelial primary cancer referred for radiotherapy were reviewed for this study. Information relating to patients, tumour, treatment, and outcomes were collected into an electronic database. Results: Five hundred and sixty-nine cases were included in this review. Median age of patients was 61 years, median number of ~esions was three, and the median size of the lesions was 2.7cm. Sixty-one percent (346 patients) had lung cancer, 13% (75 patients) breast cancer, 4.6% (26) melanoma, and the rest comprised other primary sites. Sixty-five percent of patients had persistent, recurrent primary disease, and 48% had extracranial metastases. Sixty-six percent of patients (389) had Karnofsky performance, status of 70 or greater. Seventy percent of patients received 20 Gy in 5 fractions to the whole head, and 47 patients (8.7%) underwent radiosurgery (SRS). The median survival of all patients was 3.05 months. Multivariate analysis using logistic regression showed that good performance status, age under 65 years, and fewer than five lesions were all independently predictive of overall survival. SRS was also an independent treatment factor predicting better survival. Discussion: Patients are considered candidates for SRS usually if they have KPS >70, fewer than four lesions, younger than 65 years, and with no active primary disease/ other extracranial metastases. Given the results of this study we have proposed to consult patients SRS with the above guidelines, plus those who have active primary or extracranial or extracranial metastatic disease that is under control. This implies that there was a 16% under-referral of patients for SRS. This data shows the most significant factor to be poor performance status, meaning this is more important to exclude than any other if SRS is being considered. In poor KPS patients the dismal prognosis questions the role of palliative whole brain radiotherapy. In this subgroup only patients who do not respond to Decadron should be considered for radiotherapy.
September 13-16
time effects. The Symptom Management Model (Dodd et al., 2001) was used as a conceptual framework for the study. Results: Participants in the intervention group showed significant decrease in symptom distress scores at the end of the intervention compared to women who received usual care (p=0.039). These effects were not sustained at three months after the completion of radiation. Expectedly, both groups experienced worsening of symptoms over the course of radiation therapy. However, women in the ISEP group had less worsening in symptom distress, pain, fatigue, nausea, pelvic symptoms and mood disturbance at the end of radiation treatment. Findings suggest that nurses can use individualized interventions to reduce symptom distress in women during radiation therapy. 25 I n v o l v e m e n t of Family Physicians in the Care of Patients Receiving Palliative Radiotherapy E. Barnes 1, L. Librach 2, E. Chow 1, K. Harris 1, G. Fan 1, M. Tsao ~, L. Barbera ~, C. Danjoux ~ Toronto Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Ontario ~ Mount Sinai Hospital, University of Toronto, Toronto, Ontario 2 toni. barnes@sunn ybrook, ca
Background: Cancer patients with locally advanced or metastatic disease often receive palliative radiotherapy. While at the cancer centre, it is important for patients to maintain continuity of care with their family physician (FP). The primary objective of this study was to determine the perception of patients seen in the Rapid Response Radiotherapy Program (RRRP) on FP involvement in their cancer care. Methods: Consecutive patients were recruited at the time of RRRP consultation and asked to complete a brief survey. Results: To date 244 patients have been accrued. Median age was 68 years (range 30-94), and median Karnofsky performance score was 70 (range 20-100). The most common primary cancer sites were lung (40%), prostate (18%), and breast (18%). Nearly all (98%) patients reported having a FP, and 71% of patients had been under the care of this FP for at least five years. 80% were satisfied with the overall care provided by their FP. Fifty-seven percent of patients felt their FP was involved in their cancer care, and only 23% wanted their FP to be more involved. The most common reason patients gave for perceiving limited FP involvement was that the medical oncologist was looking after all their cancer needs. Forty-three percent of patients had not seen their FP in over a month, and 73% reported they had no definite return appointment. Only 29% of patients had a palliative care physician involved in their care. Conclusions: Despite long-standing relationships and high levels of satisfaction with overall care, less than half (43%) of the patients surveyed perceived their FP as involved in their cancer care. Encouraging continuity of care between patients and FP during therapeutic treatment may allow easier transition of care back to the FP once palliative treatment at the cancer centre has finished, and allow pain and symptom management to be optimized. 26 A Quality of Life Module for Enteral Feeding: Reliability and Validity Assessment J. Ringash, B. Lemon, G. Lockwood, A. Bezjak, J. Waldron Princess Margaret Hospital, Toronto, Ontario j o l ie. rinqash @rmp. uhn. on. ca
Objectives: To determine the reliability and validity of a newly-developed quality of life (QOL) questionnaire, "QOL-EF", designed to measure the QOL impact of enteral feeding. Methods: A 20-item questionnaire with five-point Likert-type response options has been developed following literature review, focus groups with multi-disciplinary experts (nurses, nutritionists, a surgeon, radiation oncologist and interventional radiologist), and both pilot and item reduction studies in head and neck cancer (H&N) patients with current or past enteral feeding tubes. Reliability (test-retest and internal consistency)
CARe 2006
and concurrent validity compared to the FACT-H&N, UW QOL, clinical factors and performance status measures (KPS, ECOG PS) were assessed in a cross-sectional sample of 72 HNC patients receiving enteral feeding during or after radiotherapy. Results: Participants had median age 56; 56 males, 16 females; 88% stage IV cancer (no distant metastases); 67% oropharyngeal cancer. Median body mass index was 22.7 and median time with feeding tube was 1.4 months. Mean KPS was 73 and mean ECOG PS was 1.4. Mean QOL scores normalized to 100% were: FACT-H&N 59%, UW QOL 53%, and QOL-EF 61%. Test-retest reliability was determined in 31 patients; Pearson correlation coefficient was 0.83 (95% CI 0.66-0.91). Crohnbach's alpha (internal consistency) was 0.73 in 70 patients. We hypothesized Pearson correlation of 0.4-0.6 with FACT-H&N and UW QOL and found: FACT-H&N 0.61 (95% CI 0.43-0.74), UW QOL 0.47 (95% CI 0.25-0.63). QOL-EF score correlated positively with ECOG PS and inversely with weight loss. The most preferred of the three questionnaires was FACTH&N in 42%, QOL-EF in 34% and UW QOL in 24% of patients. Conclusions: This study confirms that QOL-EF has high reliability and validity, and that QOL concerns related to enteral feeding are of great importance to HNC patients. This novel QOL questionnaire is ready for use in prospective trials to determine its responsiveness to change. 27 W h a t Factors Should be Used for Considering Brain Metastases Patients for Stereotactic Radiosurgery?: A Population Based Study of all Brain Metastases Patients Referred for Radiation at the Tom Baker Cancer Centre Between 1999 and 2 0 0 4 P. Craighead I, A. Chan 1, Z. Kiss 2, C. Newcomb I University of Calgary, Calgary, Alberta1; Tom Baker Cancer Centre, Calgary, Alberta 2 peterch @cancerboard. ab. ca This retrospective review was set up to determine the prognostic factors for selecting patients for stereotactic radiosurgery (SRS). Patients with brain metastases secondary to epithelial primary cancer referred for radiotherapy were reviewed for this study. Information relating to patients, tumour, treatment, and outcomes were collected into an electronic database. Results: Five hundred and sixty-nine cases were included in this review. Median age of patients was 61 years, median number of ~esions was three, and the median size of the lesions was 2.7cm. Sixty-one percent (346 patients) had lung cancer, 13% (75 patients) breast cancer, 4.6% (26) melanoma, and the rest comprised other primary sites. Sixty-five percent of patients had persistent, recurrent primary disease, and 48% had extracranial metastases. Sixty-six percent of patients (389) had Karnofsky performance, status of 70 or greater. Seventy percent of patients received 20 Gy in 5 fractions to the whole head, and 47 patients (8.7%) underwent radiosurgery (SRS). The median survival of all patients was 3.05 months. Multivariate analysis using logistic regression showed that good performance status, age under 65 years, and fewer than five lesions were all independently predictive of overall survival. SRS was also an independent treatment factor predicting better survival. Discussion: Patients are considered candidates for SRS usually if they have KPS >70, fewer than four lesions, younger than 65 years, and with no active primary disease/ other extracranial metastases. Given the results of this study we have proposed to consult patients SRS with the above guidelines, plus those who have active primary or extracranial or extracranial metastatic disease that is under control. This implies that there was a 16% under-referral of patients for SRS. This data shows the most significant factor to be poor performance status, meaning this is more important to exclude than any other if SRS is being considered. In poor KPS patients the dismal prognosis questions the role of palliative whole brain radiotherapy. In this subgroup only patients who do not respond to Decadron should be considered for radiotherapy.