- Email: [email protected]
29 Complex care strategies in patients undergoing combined chemo and targeted therapy
S8
Abstracts and Learning Outcomes / European Journal of Oncology Nursing 18S1 (2014) S1–S22
charge). Our HCU includes 7 nurses and two physicians covering the schedule between 8 am to 10 pm. We have a room in the ward, support Unit, available 24 h for the at home-SCT program. Eligibility for at home-SCT included ECOG ≤2; travel time from home to the hospital less than 1 hour; a caregiver available 24 hours a day; and patient acceptance. All patients received the conditioning regimen and stem cell infusion at the hospital and were discharged on day +1. Results and Discussion: A total of 213 patients receiving an autologous-SCT (ASCT) were managed at home so far in our Centre. The overall readmission rate was 11.7%. After reviewing ASCT performed at home in the first 10 years of the program we identify two main critical points: only 35% of the candidates were included, and high incidence of fever (85%) and need of readmission (21%) in patients who received BEAM as conditioning regimen. Thanks to advance first contact with HCU and to provide a flat close to hospital, ceded by Jose´ Carreras Leukaemia Foundation, we have increased the inclusion of patients up to 80% of candidates (p = 0.01). Finally, the use of piperacillin-tazobactam as primary prophylaxis after BEAM helped reduce the incidence of fever and readmission up to 46% (p = 0.0001) and 2.4% (p = 0.009), respectively. Conclusion: A critical revision of the results of these programs is advisable in order to improve their results. Nurse experienced teams in home care increase the excellence of care in high complexity patients and promote the patient/family empowerment. Finally, it is recommended to create a specific working group with the aim of develop multi-centre studies and clinical guidelines. No conflict of interest.
Boehringer Ingelheim, Eusa Pharma, GlaxoSmithKline, Merck Serono, Merck Sharp and Dohme, Nordic Pharma, Takeda, Novartis, Pfizer, and Roche. Board of directors: ISOO, LOOV, IMPAQTT Foundation. 30 The impact of ambulatory chemotherapy in elderly patients ao, Portugal D. Pires1 . 1 Portuguese Oncology Institute, Algueir˜ The Oncology disease is one of the biggest challenges in the current landscape of society. The incidence of cancer is exponential with increasing age. With an increasingly aging population and the increase in average life expectancy, the number of cancer patients tends to increase as well. Realize that age is a risk factor for incidence of cancer, is elemental to define strategies. Currently is known that elderly patients need a more specific and comprehensive approach, this can’t only focuses on oncologic pathology, and have to understand all the specificities of the elderly, taking in account their individuality. The approach to the elderly patient in oncology should focus on screening to enable early diagnosis, and therapy adjusted in order to maintain the quality of life. We speak of one approach that addresses a biopsychosocial evaluation of the elderly patients. In elderly patient undergoing chemotherapy is essential provided an overall assessment of the patient to enable the knowledge of the pathophysiological disease processes, the existence of comorbidities and psychosocial needs. No conflict of interest information specified.
29 Complex care strategies in patients undergoing combined chemo and targeted therapy
Parallel Session: Complexity of Care in Rare Cancers
C.B. Boers-Doets1,2 . 1 IMPAQTT Research & Consultancy, Clinical Oncology, Wormer, Netherlands; 2 Leiden University Medical Center, Department of Clinical Oncology, Leiden, Netherlands
31 What makes a rare cancer rare / soft tissue
Introduction: Modern cancer therapy include chemo- and targeted therapy as a part of a combined modality therapy in a number of cancers. Side effects of these treatments may sometimes appear similar – but they are distinct adverse events which require different management approaches. Material and Method: To support clinicians in implementing appropriate treatment options, the TARGET-system is developed. The TARGET-system provides a roadmap in six practical steps from diagnosis to management of side effects. The steps include: Terminology, Assessment, Reporting, Grading, Education, and Treatment. This system enables the provider to limit side effects of these treatments and promotes patient compliance with the targeted therapy without discontinuation or dose adjustments. When treatment is initiated early, at the onset of an adverse event, the symptoms may be more readily controlled. In this lecture side effects, like hand-foot syndrome and oral mucositis from cytotoxic chemotherapy, will be addressed. This will be done according to the steps of the TARGET-system. This system will also be used while discussing the hand-foot skin reaction and stomatitis as side effects of targeted therapy. In addition, another often incorrectly diagnosed complication will be addressed to: gastrointestinal complaints. When for instance loose stool is not defined correctly, treatment of this adverse event cannot be effective either, with far reaching consequences for treatment continuation. Results and Discussion: When the steps of the TARGET-system are followed, it becomes clear which adverse event is present and appropriate management options, based on this distinction, can be selected. Conclusion: The professional is able to make a distinction between adverse events of chemo and targeted therapy. This dissimilarity is necessary to be able to select effective management options. Conflict of interest: Ownership: IMPAQTT Research & Consultancy. Advisory board: Amgen, Astra Zeneca, Bayer Pharmaceuticals,
G. Gatta1 , A. Trama1 . 1 National Cancer Institute, Epidemiology Unit, Milan, Italy Introduction: Due to their low frequency, rare cancers are characterized by late or incorrect diagnosis, lack of access to appropriate therapies and clinical expertise, limited information about them and a dearth of clinical trials. The project Surveillance of Rare Cancers in Europe (RARECARE) estimated the burden of rare cancers in Europe providing the first indication of the size of the public health problem due to these diseases. According to RARECARE definition (incidence <6/100,000/year), around 4 million people in the EU are affected by rare cancers. Material and Method: We analyzed population-based cancer registry (CR) data on European patients 1988–2007 diagnosed, with vital status information available up to 31st December 2008. Cancer incidence and survival rates for 1995–2007 and prevalence at 1st January 2008 will be estimated. A subset of participating CRs, selected for wide national coverage and for European representativeness of different social, cultural and political context, will send individual data including information on the hospital of treatment for all incident cases. For all rare cancers, hospitals in which patients are most frequently treated will be detected. Results and Discussion: The results on the updated indicators on frequency and outcome, and the hospital volume analysis for rare cancers will be ready before the congress. However, according to RARECARE, all rare cancers together were about 22% of all cancer cases diagnosed in the EU27 each year. 5-year survival is significantly worse for rare cancers (47%) than for common cancers (65%). Updated incidence and prevalence data will support better healthcare planning and resource allocation for rare cancers. The availability of prevalence data updated to 2007 for rare cancers will also facilitate application of the EU orphan drug directive. Information on health care pathways and
Abstracts and Learning Outcomes / European Journal of Oncology Nursing 18S1 (2014) S1–S22
charge). Our HCU includes 7 nurses and two physicians covering the schedule between 8 am to 10 pm. We have a room in the ward, support Unit, available 24 h for the at home-SCT program. Eligibility for at home-SCT included ECOG ≤2; travel time from home to the hospital less than 1 hour; a caregiver available 24 hours a day; and patient acceptance. All patients received the conditioning regimen and stem cell infusion at the hospital and were discharged on day +1. Results and Discussion: A total of 213 patients receiving an autologous-SCT (ASCT) were managed at home so far in our Centre. The overall readmission rate was 11.7%. After reviewing ASCT performed at home in the first 10 years of the program we identify two main critical points: only 35% of the candidates were included, and high incidence of fever (85%) and need of readmission (21%) in patients who received BEAM as conditioning regimen. Thanks to advance first contact with HCU and to provide a flat close to hospital, ceded by Jose´ Carreras Leukaemia Foundation, we have increased the inclusion of patients up to 80% of candidates (p = 0.01). Finally, the use of piperacillin-tazobactam as primary prophylaxis after BEAM helped reduce the incidence of fever and readmission up to 46% (p = 0.0001) and 2.4% (p = 0.009), respectively. Conclusion: A critical revision of the results of these programs is advisable in order to improve their results. Nurse experienced teams in home care increase the excellence of care in high complexity patients and promote the patient/family empowerment. Finally, it is recommended to create a specific working group with the aim of develop multi-centre studies and clinical guidelines. No conflict of interest.
Boehringer Ingelheim, Eusa Pharma, GlaxoSmithKline, Merck Serono, Merck Sharp and Dohme, Nordic Pharma, Takeda, Novartis, Pfizer, and Roche. Board of directors: ISOO, LOOV, IMPAQTT Foundation. 30 The impact of ambulatory chemotherapy in elderly patients ao, Portugal D. Pires1 . 1 Portuguese Oncology Institute, Algueir˜ The Oncology disease is one of the biggest challenges in the current landscape of society. The incidence of cancer is exponential with increasing age. With an increasingly aging population and the increase in average life expectancy, the number of cancer patients tends to increase as well. Realize that age is a risk factor for incidence of cancer, is elemental to define strategies. Currently is known that elderly patients need a more specific and comprehensive approach, this can’t only focuses on oncologic pathology, and have to understand all the specificities of the elderly, taking in account their individuality. The approach to the elderly patient in oncology should focus on screening to enable early diagnosis, and therapy adjusted in order to maintain the quality of life. We speak of one approach that addresses a biopsychosocial evaluation of the elderly patients. In elderly patient undergoing chemotherapy is essential provided an overall assessment of the patient to enable the knowledge of the pathophysiological disease processes, the existence of comorbidities and psychosocial needs. No conflict of interest information specified.
29 Complex care strategies in patients undergoing combined chemo and targeted therapy
Parallel Session: Complexity of Care in Rare Cancers
C.B. Boers-Doets1,2 . 1 IMPAQTT Research & Consultancy, Clinical Oncology, Wormer, Netherlands; 2 Leiden University Medical Center, Department of Clinical Oncology, Leiden, Netherlands
31 What makes a rare cancer rare / soft tissue
Introduction: Modern cancer therapy include chemo- and targeted therapy as a part of a combined modality therapy in a number of cancers. Side effects of these treatments may sometimes appear similar – but they are distinct adverse events which require different management approaches. Material and Method: To support clinicians in implementing appropriate treatment options, the TARGET-system is developed. The TARGET-system provides a roadmap in six practical steps from diagnosis to management of side effects. The steps include: Terminology, Assessment, Reporting, Grading, Education, and Treatment. This system enables the provider to limit side effects of these treatments and promotes patient compliance with the targeted therapy without discontinuation or dose adjustments. When treatment is initiated early, at the onset of an adverse event, the symptoms may be more readily controlled. In this lecture side effects, like hand-foot syndrome and oral mucositis from cytotoxic chemotherapy, will be addressed. This will be done according to the steps of the TARGET-system. This system will also be used while discussing the hand-foot skin reaction and stomatitis as side effects of targeted therapy. In addition, another often incorrectly diagnosed complication will be addressed to: gastrointestinal complaints. When for instance loose stool is not defined correctly, treatment of this adverse event cannot be effective either, with far reaching consequences for treatment continuation. Results and Discussion: When the steps of the TARGET-system are followed, it becomes clear which adverse event is present and appropriate management options, based on this distinction, can be selected. Conclusion: The professional is able to make a distinction between adverse events of chemo and targeted therapy. This dissimilarity is necessary to be able to select effective management options. Conflict of interest: Ownership: IMPAQTT Research & Consultancy. Advisory board: Amgen, Astra Zeneca, Bayer Pharmaceuticals,
G. Gatta1 , A. Trama1 . 1 National Cancer Institute, Epidemiology Unit, Milan, Italy Introduction: Due to their low frequency, rare cancers are characterized by late or incorrect diagnosis, lack of access to appropriate therapies and clinical expertise, limited information about them and a dearth of clinical trials. The project Surveillance of Rare Cancers in Europe (RARECARE) estimated the burden of rare cancers in Europe providing the first indication of the size of the public health problem due to these diseases. According to RARECARE definition (incidence <6/100,000/year), around 4 million people in the EU are affected by rare cancers. Material and Method: We analyzed population-based cancer registry (CR) data on European patients 1988–2007 diagnosed, with vital status information available up to 31st December 2008. Cancer incidence and survival rates for 1995–2007 and prevalence at 1st January 2008 will be estimated. A subset of participating CRs, selected for wide national coverage and for European representativeness of different social, cultural and political context, will send individual data including information on the hospital of treatment for all incident cases. For all rare cancers, hospitals in which patients are most frequently treated will be detected. Results and Discussion: The results on the updated indicators on frequency and outcome, and the hospital volume analysis for rare cancers will be ready before the congress. However, according to RARECARE, all rare cancers together were about 22% of all cancer cases diagnosed in the EU27 each year. 5-year survival is significantly worse for rare cancers (47%) than for common cancers (65%). Updated incidence and prevalence data will support better healthcare planning and resource allocation for rare cancers. The availability of prevalence data updated to 2007 for rare cancers will also facilitate application of the EU orphan drug directive. Information on health care pathways and