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Feasibility of advanced practice nurse in lung cancer consultations during early treatment: a phase II study
S160
Abstracts
tumour profile was adjusted if there was a solitary metastasis (solitary as favourable; not-solitary as moderate). Survival curves were estimated using the Kaplan–Meier method and accuracy was assessed with the C-statistic. Results: Median overall survival was 7.4 months (95% CI 6.8−8.1). Primary tumours were categorised into three clinical profiles: favourable (34%), moderate (27%), and unfavourable (39%). Visceral and/or brain metastases were present in 42%. KPS was 80–100 in 43% and 0−70 in 34%. The model distributed the patients as such: category A (12%), category B (30%), category C (36%), category D (22%). Median survival in category A was 30.4 months (95% CI 26.8–33.9), for B 12.9 months (95% CI 11.5–14.4), for C 5.1 months (95% CI 4.3−5.9), and for D 2.2 months (95% CI 1.8−2.5). Harrell’s C-statistic was 0.69. Conclusion: Clinical tumour profile, presence of visceral and/or brain metastases, and KPS, according to the previously proposed spinal metastasis prognostic model, provide significantly different prognostic categories for patients with cancer and metastases of the long bones. This indicates that the use of one simple survival for spinal and long bone metastases is possible, which facilitates and encourages its use in routine care of patient with bone metastases. The use of survival estimation tools aids doctors and patients in shared decision-making. No conflict of interest. 1737 ORAL Feasibility of advanced practice nurse in lung cancer consultations during early treatment: a phase II study A. Serena1,2,3 , A. Dwyer4 , S. Peters2 , M. Eicher4 . 1 Institute of Higher Education and Research in Healthcare- University of Lausanne, Doctoral School, Lausanne, Switzerland; 2 Lausanne University Hospital, Oncology, Lausanne, Switzerland; 3 University of Applied Sciences and Arts Western Switzerland- School of Health Sciences Fribourg, Research and development, Fribourg, Switzerland; 4 Institute of Higher Education and Research in Healthcare- University of Lausanne, Research and development, Lausanne, Switzerland Background: Lung cancer and its treatment impose significant physical and psychosocial burden on patients. New models of care are needed to deliver effective supportive care, decrease symptom burden and support symptom self-management. The Advanced Practice Nurse in Lung Cancer (APNLC) role specifically targets these patient needs through specific consultations, contribution to continuous quality development and interprofessional collaboration. To date this role is not well established in many European countries − including Switzerland. The primary aim of this pilot study was to assess the feasibility of APNLC consultations and the ability to collect patient-reported outcome measures (PROMs) during firstline treatment. The secondary aim was to describe changes in self-efficacy for managing lung cancer-related symptoms, symptom intensity/burden and unmet supportive care needs. Material and Methods: Using a phase II design, we targeted a consecutive sample of newly diagnosed patients with lung cancer (n = 71) receiving ambulatory systemic treatment at the thoracic cancer center of a Swiss university hospital. The APNLC intervention comprised four alternating face-to-face and telephone consultations during first line-treatment. The intervention was considered feasible if >55% of the scheduled APNLC consultations were completed and PROMs were collected at three timepoints (baseline, T1: day 4−50, T2: d71−95). Mixed effect modeling was employed to analyze PROMs. Results: In total, 35/46 (76%, 95% CI: 0.61–0.87) of participants received all the scheduled APNLC consultations and 26/46 (56%, 95% CI: 0.41– 0.71) completed the PROMs assessments at all timepoints. Patient selfefficacy for managing their symptoms tended to improve from baseline to T1 and remained elevated at subsequent follow-up. Both average symptom intensity and symptom burden index increased from baseline to T2 (b = 8.30, 95% CI: 3.63–12.98, p < 0001; b = 6.52 [95% CI:2.06– 10.98], P < 0001 respectively). Loss of appetite, fatigue and dyspnea were the most predominantly-reported symptoms. Unmet information needs decreased significantly following APNLC consultations and changes in sexual relationships was increased during the follow-up period. Recruitment was stopped prior to reaching the target enrollment due to financial and staffing issues. Conclusions: While target enrollment was not met, results were promising for the feasibility of the APNLC consultations and the ability to collect PROMs during the first-line treatment. Notably, the intervention did not sufficiently affect the disease trajectory as patient status worsened. However, APNLC consultations appear to help stabilize patient self-efficacy despite the functional decline and increased symptom intensity/burden. These findings of this pilot study provide the basis for designing a larger multicenter study to evaluate APNLC effectiveness. No conflict of interest.
Poster Session, Saturday 28 January 2017 1738 ORAL The impact of an automated, telephone-based coaching module on the adoption of an exercise program for cancer chemotherapy patients experiencing symptoms K. Mooney1 , S. Beck1 , C. Echeverria1 , G. Donaldson2 . 1 University of Utah, College of Nursing, Salt Lake City, USA; 2 University of Utah, School of Medicine, Salt Lake City, USA Background: Exercise has been shown to help reduce cancer treatmentrelated symptoms including fatigue, nausea, anxiety and weight gain. However, getting patients to adopt and maintain exercise during chemotherapy is difficult and can involve costly program development. The purpose of this study was to evaluate the effect of an automated symptom monitoring and coaching system that provided coaching about starting and maintaining a home exercise program for patients receiving chemotherapy at the time the patient reported fatigue, nausea, anxiety and/or weight gain. Material and Methods: 180 patients in the intervention arm of a symptom monitoring study daily called an automated telephone-based system, Symptom Care at Home, and reported symptom severity levels including for fatigue, nausea, anxiety, and weight gain. When any of the 4 symptoms were initially reported, participants received automated coaching on the benefit of exercise for their reported symptom and were asked if they would like to set an exercise goal for the week including the number of times/week and minutes each time. Seven days later the automated system ‘remembered’ the goal and asked the participant if the goal had been met, then provided further coaching tailored to the participant’s reported level of success and encouraged setting a new goal for the next week. The primary outcomes of evaluation were the percent of patients who adopted an exercise program by setting one or more goals, the percent achieving one or more goals and whether higher exercise goal attainment produced significant symptom reduction. Results: Participants had a mean age of 55 years. The majority were female with breast or lung cancer and had stage III-IV disease. Length of enrollment in the study averaged 77 days. 167 participants (93%) triggered the exercise coaching module with 103 (62%) setting 1 or more goals and 82 (80%) completing 1 or more goals. Thus about half of those prompted to begin an exercise program successfully met goals. Participants set multiple weeks of goals, on average 6.3 times with the average goal set involving exercise sessions 3 days/per week for 15−30 minutes. Those identifying as non-exercisers at study start (54%) were more likely to adopt goal setting. Participants who achieved a higher percentage of goal attainment reported significantly lower symptom severity (p < 0.001). Conclusions: Automated remote coaching of chemotherapy patients about the value of adopting an exercise program at the time they are experiencing symptoms is an efficient and effective approach to improving symptom outcomes for fatigue, nausea, anxiety and weight gain. Patients who describe themselves as non-exercisers are particularly willing to set goals. No conflict of interest.
Poster Session (Saturday 28 January 2017) Palliative and Supportive Care 1789 The role of volunteers in quality palliative care delivery
POSTER
A. Manna1 . 1 Chief Caregiver, Palliative Care, Padumbasan- TamlukPurba Medinipur, India Introduction: Here in India almost 75% of cancer patient die a sad death of neglect due to lack of awareness about palliative care and low economic level. Surveys in India show that two third of cancer patient do not get proper care during the terminal phase of their life. Palliative care through volunteers can make a significant difference in this respect. Objective: To identify and try to solve, to the extent possible, the main difficulties in giving palliative care to the terminal cancer patients of the area. And evaluate the impact of volunteer’s direct care of palliative patients and their families. Methods: Feedback from patients and their relatives regarding the palliative care they receive from nursing home and from volunteers and compare the two. Also feedback from volunteers regarding their positive and negative experience while delivering palliative care service. Then evaluate the data to compare and improve the quality of service. Results: We carried out two studies. One study was undertaken in nursing home palliative care and another was in home setting by volunteers. Both studies were in adult palliative care services. Since January 2015, 496 cases were studied to enquire about their experience in both home
Abstracts
tumour profile was adjusted if there was a solitary metastasis (solitary as favourable; not-solitary as moderate). Survival curves were estimated using the Kaplan–Meier method and accuracy was assessed with the C-statistic. Results: Median overall survival was 7.4 months (95% CI 6.8−8.1). Primary tumours were categorised into three clinical profiles: favourable (34%), moderate (27%), and unfavourable (39%). Visceral and/or brain metastases were present in 42%. KPS was 80–100 in 43% and 0−70 in 34%. The model distributed the patients as such: category A (12%), category B (30%), category C (36%), category D (22%). Median survival in category A was 30.4 months (95% CI 26.8–33.9), for B 12.9 months (95% CI 11.5–14.4), for C 5.1 months (95% CI 4.3−5.9), and for D 2.2 months (95% CI 1.8−2.5). Harrell’s C-statistic was 0.69. Conclusion: Clinical tumour profile, presence of visceral and/or brain metastases, and KPS, according to the previously proposed spinal metastasis prognostic model, provide significantly different prognostic categories for patients with cancer and metastases of the long bones. This indicates that the use of one simple survival for spinal and long bone metastases is possible, which facilitates and encourages its use in routine care of patient with bone metastases. The use of survival estimation tools aids doctors and patients in shared decision-making. No conflict of interest. 1737 ORAL Feasibility of advanced practice nurse in lung cancer consultations during early treatment: a phase II study A. Serena1,2,3 , A. Dwyer4 , S. Peters2 , M. Eicher4 . 1 Institute of Higher Education and Research in Healthcare- University of Lausanne, Doctoral School, Lausanne, Switzerland; 2 Lausanne University Hospital, Oncology, Lausanne, Switzerland; 3 University of Applied Sciences and Arts Western Switzerland- School of Health Sciences Fribourg, Research and development, Fribourg, Switzerland; 4 Institute of Higher Education and Research in Healthcare- University of Lausanne, Research and development, Lausanne, Switzerland Background: Lung cancer and its treatment impose significant physical and psychosocial burden on patients. New models of care are needed to deliver effective supportive care, decrease symptom burden and support symptom self-management. The Advanced Practice Nurse in Lung Cancer (APNLC) role specifically targets these patient needs through specific consultations, contribution to continuous quality development and interprofessional collaboration. To date this role is not well established in many European countries − including Switzerland. The primary aim of this pilot study was to assess the feasibility of APNLC consultations and the ability to collect patient-reported outcome measures (PROMs) during firstline treatment. The secondary aim was to describe changes in self-efficacy for managing lung cancer-related symptoms, symptom intensity/burden and unmet supportive care needs. Material and Methods: Using a phase II design, we targeted a consecutive sample of newly diagnosed patients with lung cancer (n = 71) receiving ambulatory systemic treatment at the thoracic cancer center of a Swiss university hospital. The APNLC intervention comprised four alternating face-to-face and telephone consultations during first line-treatment. The intervention was considered feasible if >55% of the scheduled APNLC consultations were completed and PROMs were collected at three timepoints (baseline, T1: day 4−50, T2: d71−95). Mixed effect modeling was employed to analyze PROMs. Results: In total, 35/46 (76%, 95% CI: 0.61–0.87) of participants received all the scheduled APNLC consultations and 26/46 (56%, 95% CI: 0.41– 0.71) completed the PROMs assessments at all timepoints. Patient selfefficacy for managing their symptoms tended to improve from baseline to T1 and remained elevated at subsequent follow-up. Both average symptom intensity and symptom burden index increased from baseline to T2 (b = 8.30, 95% CI: 3.63–12.98, p < 0001; b = 6.52 [95% CI:2.06– 10.98], P < 0001 respectively). Loss of appetite, fatigue and dyspnea were the most predominantly-reported symptoms. Unmet information needs decreased significantly following APNLC consultations and changes in sexual relationships was increased during the follow-up period. Recruitment was stopped prior to reaching the target enrollment due to financial and staffing issues. Conclusions: While target enrollment was not met, results were promising for the feasibility of the APNLC consultations and the ability to collect PROMs during the first-line treatment. Notably, the intervention did not sufficiently affect the disease trajectory as patient status worsened. However, APNLC consultations appear to help stabilize patient self-efficacy despite the functional decline and increased symptom intensity/burden. These findings of this pilot study provide the basis for designing a larger multicenter study to evaluate APNLC effectiveness. No conflict of interest.
Poster Session, Saturday 28 January 2017 1738 ORAL The impact of an automated, telephone-based coaching module on the adoption of an exercise program for cancer chemotherapy patients experiencing symptoms K. Mooney1 , S. Beck1 , C. Echeverria1 , G. Donaldson2 . 1 University of Utah, College of Nursing, Salt Lake City, USA; 2 University of Utah, School of Medicine, Salt Lake City, USA Background: Exercise has been shown to help reduce cancer treatmentrelated symptoms including fatigue, nausea, anxiety and weight gain. However, getting patients to adopt and maintain exercise during chemotherapy is difficult and can involve costly program development. The purpose of this study was to evaluate the effect of an automated symptom monitoring and coaching system that provided coaching about starting and maintaining a home exercise program for patients receiving chemotherapy at the time the patient reported fatigue, nausea, anxiety and/or weight gain. Material and Methods: 180 patients in the intervention arm of a symptom monitoring study daily called an automated telephone-based system, Symptom Care at Home, and reported symptom severity levels including for fatigue, nausea, anxiety, and weight gain. When any of the 4 symptoms were initially reported, participants received automated coaching on the benefit of exercise for their reported symptom and were asked if they would like to set an exercise goal for the week including the number of times/week and minutes each time. Seven days later the automated system ‘remembered’ the goal and asked the participant if the goal had been met, then provided further coaching tailored to the participant’s reported level of success and encouraged setting a new goal for the next week. The primary outcomes of evaluation were the percent of patients who adopted an exercise program by setting one or more goals, the percent achieving one or more goals and whether higher exercise goal attainment produced significant symptom reduction. Results: Participants had a mean age of 55 years. The majority were female with breast or lung cancer and had stage III-IV disease. Length of enrollment in the study averaged 77 days. 167 participants (93%) triggered the exercise coaching module with 103 (62%) setting 1 or more goals and 82 (80%) completing 1 or more goals. Thus about half of those prompted to begin an exercise program successfully met goals. Participants set multiple weeks of goals, on average 6.3 times with the average goal set involving exercise sessions 3 days/per week for 15−30 minutes. Those identifying as non-exercisers at study start (54%) were more likely to adopt goal setting. Participants who achieved a higher percentage of goal attainment reported significantly lower symptom severity (p < 0.001). Conclusions: Automated remote coaching of chemotherapy patients about the value of adopting an exercise program at the time they are experiencing symptoms is an efficient and effective approach to improving symptom outcomes for fatigue, nausea, anxiety and weight gain. Patients who describe themselves as non-exercisers are particularly willing to set goals. No conflict of interest.
Poster Session (Saturday 28 January 2017) Palliative and Supportive Care 1789 The role of volunteers in quality palliative care delivery
POSTER
A. Manna1 . 1 Chief Caregiver, Palliative Care, Padumbasan- TamlukPurba Medinipur, India Introduction: Here in India almost 75% of cancer patient die a sad death of neglect due to lack of awareness about palliative care and low economic level. Surveys in India show that two third of cancer patient do not get proper care during the terminal phase of their life. Palliative care through volunteers can make a significant difference in this respect. Objective: To identify and try to solve, to the extent possible, the main difficulties in giving palliative care to the terminal cancer patients of the area. And evaluate the impact of volunteer’s direct care of palliative patients and their families. Methods: Feedback from patients and their relatives regarding the palliative care they receive from nursing home and from volunteers and compare the two. Also feedback from volunteers regarding their positive and negative experience while delivering palliative care service. Then evaluate the data to compare and improve the quality of service. Results: We carried out two studies. One study was undertaken in nursing home palliative care and another was in home setting by volunteers. Both studies were in adult palliative care services. Since January 2015, 496 cases were studied to enquire about their experience in both home