- Email: [email protected]
Homcology: Home chemotherapy delivery in a simultaneous care project for frail advanced cancer patients
abstracts
Annals of Oncology
Table: 1784P Gender effect on the main PK parameters of ANAM after single administration in healthy volunteers and at steady state in NSCLC patients with cachexia
Funding: Nutricia, Research grant / Funding: Recipient, Honoraria: Fresenius Kabi, Honoraria: Nutricia. J.M. Garcia: Research grant / Funding: Helsinn Healthcare SA. A. Bernareggi: Full / Parttime employment: Helsinn Healthcare SA.
1785P
The patient voice: An Irish survey of nutrition attitudes & access to dietetic care throughout the cancer journey
E.S. Sullivan1, N. Rice2, E. Kingston1, A. Kelly1, L.E. Daly1, J.V. Reynolds3, D.G. Power4, A.M. Ryan1 1 School of Nutritional Sciences, University College Cork, Cork, Ireland, 2(IrSPEN), Irish Society of Clinical Nutrition & Metabolism, Dublin, Ireland, 3Department of Surgery, St. James’ Hospital, Dublin, Ireland, 4Departments of Medical Oncology, Cork & Mercy University Hospitals, Cork, Ireland Background: The attitudes of cancer patients towards nutrition and nutrition care has never been captured in Ireland. An awareness of the nutritional needs and attitudes of
v728 | Supportive Care
Methods: In September 2018, a national survey was conducted to examine patient attitudes towards nutrition and access to dietetic services during their cancer journey. Patients diagnosed or treated in Ireland since 2015 were asked to complete a 25-item survey (available online and at 20 hospitals across Ireland). Results: In total, 1085 valid responses were received (63% female, mean age 58 years). All major cancer groups were represented & 33% had metastatic disease. Overall, 45% reported suffering from a diet-related problem and 44% reported weight loss since diagnosis. Muscle loss was noted by 52%. Amongst weight losers, 42% were ‘unhappy/ worried’ while 27% reported being ‘delighted/happy’. Although 80% are ‘always/usually’ weighed in clinic, just 43% reported that they are ‘always/usually’ asked about diet. Nutrition was rated ‘very/extremely’ important by 89% of respondents. Only 39% had received dietary advice from a dietitian and 74% rated this advice as ‘very/extremely’ helpful. Overall, 57% of those who did not see an RD said they would have liked more support with diet. While 58% reported trying general healthy eating as a result of their diagnosis, 38% and 32% admitted trying at least one alternative dietary strategy or avoiding a specific food due to their diagnosis, respectively. Conclusions: While nutrition is highly important to Irish cancer patients, fewer than half surveyed had accessed a dietitian. Weight and muscle loss are common, but their significance is not always understood by patients. Almost half used alternative dietary strategies, highlighting the need to screen oncology patients for potentially restrictive diet or supplement use to guide appropriate referrals and education. Legal entity responsible for the study: The authors. Funding: IrSPEN. Disclosure: All authors have declared no conflicts of interest.
1786P
Homcology: Home chemotherapy delivery in a simultaneous care project for frail advanced cancer patients
C. Chini1, O. Nigro1, A. Giaquinto1, E. Magni1, G. Tinelli2, L. Bascialla1, S. Gobba1, G. Pinotti1 1 Medical Oncology, ASST-Settelaghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy, 2Clinical Psychology, ASST-Settelaghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy Background: Limited researches evaluate effectiveness of cancer patients-centered home care management. In this context, patients’ needs rather than prognosis should be considered. Our project represents an opportunity for patients who may benefit from chemotherapy, but with physical and social problems that prevent day-hospital access, and a model of no profit contribution to the Public Health System. Methods: Our Medical Oncology Department, supported by a no-profit organization and according to the GP, conducted the project from May 2014 to March 2019. We
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz265.032/5577489 by guest on 26 October 2019
therapeutic use was assessed. Methods: In a phase 1 clinical trial, healthy volunteers received a single ANAM dose and the PK profile was evaluated by non-compartmental methods. Cachectic NSCLC patients from the phase 3 trial ROMANA 1 (NCT01387269) received ANAM once daily up to 12 weeks. Sparse blood samples were collected at steady state from 70 patients consenting to population PK modeling, along with ANAM PK data from phase 1 and 2 studies in healthy subjects and patients. Correlations between gender and predicted individual ANAM PK parameters in patients at steady state were assessed by analysis of variance models. In a separate phase II trial, serum insulin-like growth factor 1 (IGF-1) and insulin-like growth factor-binding protein 3 (IGFBP-3) levels were assessed in NSCLC male and female outpatients receiving ANAM up to 14 weeks. Results: In healthy volunteers, after dose normalization per body weight, the PK parameters of males and females were similar (Table). In patients with cachexia, no significant correlations were found between gender and predicted ANAM PK parameters at steady state (Table). No gender differences were observed in IGF-1 and IGFBP-3 serum levels. Conclusions: No significant gender effect on ANAM PK/PD was observed in healthy volunteers and NSCLC patients with cachexia at 100 mg ANAM, intended for therapeutic use. Clinical trial identification: ROMANA 3: NCT01387269. Editorial acknowledgement: Oana Draghiciu, PhD, CMPP, from Aptitude Health, The Hague, The Netherlands; funded by Helsinn Healthcare SA. Legal entity responsible for the study: Helsinn Healthcare SA. Funding: Helsinn Healthcare SA. Disclosure: S. Kaasa: Shareholder / Stockholder /Stock options: Eir Solution, Research grant /
abstracts
Annals of Oncology
1787P
Treatment-related adverse events and tolerability in patients with advanced non-squamous non-small cell lung cancer treated with first-line checkpoint inhibitors in combination with chemotherapy
R. d’Cunha1, P. D’Cunha2, S. Swarup3, A. Sultan3, F. Mogollon-Duffo3, N. Jahan3, T. Win Htut4, S. Wongsaengsak1, N. Adhikari3, A.M. Mon5, P.P. Hlaing1, A.M. Tun6, N. D’Cunha3, K.Z. Thein3 1 Internal Medicine, Texas Tech University, Lubbock, TX, USA, 2Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA, 3Hematology Oncology, Texas Tech University, Lubbock, TX, USA, 4Acute Medicine, Colchester General Hospital, Colchester, UK, 5Internal Medicine, Lincoln Medical Center, Brooklyn, NY, USA, 6Hematology Oncology, Brooklyn Hospital Center, Brooklyn, NY, USA Background: Non-squamous non-small cell lung cancer (NSCLC) accounts for majority of lung cancer, the second most common cancer in US. Combination of checkpoint inhibitors and chemotherapy has become a fundamental paradigm shift in the first-line treatment of advanced lung cancer. We conducted a combined analysis of randomized controlled trials (RCT) to determine the risk of treatment-related adverse events (TRAE) and treatment discontinuation due to TRAE. Methods: PUBMED, MEDLINE, EMBASE databases and meeting abstracts from inception through March 2019 were queried. RCTs of first-line chemotherapy þ/immunotherapy in patients with advanced non-squamous NSCLC were incorporated. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) and risk difference (RD) with 95% confidence interval (CI). Random effects model was applied. Results: A total of 2785 patients with advanced non-squamous NSCLC from 5 RCTs were included. The study arm used standard chemotherapy regimens in combination with pembrolizumab or atezolizumab while control arm used only standard chemotherapy regimens. The randomization ratio was 2:1 in IMpower-130 and Keynote-189 studies and 1:1 in other studies. The pooled RR of any-grade TRAE was 1.02 (95% CI: 0.99 –1.04, P ¼ 0.20) and RR of high-grade TRAE was significant at 1.20 (95% CI: 1.07 –1.34, P ¼ 0.002). Treatment-related deaths were 58 (3.57%) in study arm vs 31 (2.66%) in control arm. The pooled RR was not statistically significant at 1.26 (95% CI: 0.81 –1.95, P ¼ 0.31) and RD was 0.01 (95% CI: - 0.00 – 0.02, P ¼ 0.08). Treatment discontinuation due to TRAE was noted in 440 (27.14%) vs 235 (20.19%) in control group with RR of 1.35 (95% CI: 1.15 –1.59, P ¼ 0.0003) and RD of 0.07 (95% CI: 0.03 – 0.11, P ¼ 0.001). Conclusions: Patients on upfront combined chemoimmunotherapy experienced highgrade TRAE, ultimately leading to treatment discontinuation. Yet, there were no significant increase in the risk of treatment related deaths due to TRAE, compared to standard chemotherapy. Pre-emptive measures with proper supportive care may enhance patients’ quality of life and compliance. Legal entity responsible for the study: Kyaw Zin Thein. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Volume 30 | Supplement 5 | October 2019
1788P
Clinical utility of a systematic toxicity assessment form (STAF) in patients with breast cancer receiving adjuvant or neoadjuvant therapy
J.H. Kim1, S. Seo2, H-S. Im1, J.H. Lim1, W.R. Jo1, B.B. Im1, S.R. Park1 Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, 2Oncology, Asan Medical Center, Seoul, Republic of Korea
1
Background: Proper evaluation and management of chemotherapy-related toxicity (CRT) is critical to cancer patients. We aimed to assess the clinical utility of STAF in patients with breast cancer receiving chemotherapy. Methods: The STAF is a systematic form including common CRT lists and grades to help clinicians to assess CRT comprehensively as opposed to assessing CRT individually by cases. Using data from clinical data warehouse, the CRT profile was analyzed in patients with breast cancer receiving adjuvant or neoadjuvant therapy during two time periods; before (n ¼ 1874) and after (n ¼ 981) using STAF in the clinic at Asan Medical Center. The two cohorts were matched by age and chemotherapy, leaving conventional practice (A; n ¼ 333) and STAF (B; n ¼ 333) groups. The rates of unscheduled hospital utilization (outpatient department [OPD], emergency room [ER] and hospitalization) were compared between group A and B. Results: No significant differences were noted in baseline characteristics between the two groups, except for a higher proportion of patients living near the hospital in group A compared to group B (67.0 vs 56.2%; P ¼ 0.004). The completion rate of planned chemotherapy was 96.7% and 97.6% (P ¼ 0.704), and the rate of dose reduction was 12.3% and 10.8% (P ¼ 0.473), respectively, in group A and B. The median dose intensity was lower in group A than group B (0.92 vs. 0.95; P < 0.001). Higher reporting of CRT was observed in group B (P < 0.001). Despite a similar rate of unscheduled hospital utilization during cycle 1, since cycle 2, group B had a lower frequency of unexpected OPD (3.3 vs 6.6%, P ¼ 0.050) and ER visits (9.6 vs 16.8%, P ¼ 0.006), and hospitalization (8.4 vs 12.6%; P ¼ 0.077) than group A.
Table: 1788P Unscheduled utilization since cycle 2 of chemotherapy
Group A (n ¼ 333, %)
Group B (n ¼ 333, %)
P
OPD ER Hospitalization
22 (6.6) 56 (16.8) 42 (12.6)
11 (3.3) 32 (9.6) 28 (8.4)
0.050 0.006 0.077
Conclusions: Using the STAF may facilitate to capture CRT in clinical practice and reduce the rates of unscheduled hospital utilization in patients with breast cancer receiving adjuvant or neoadjuvant therapy. Legal entity responsible for the study: The authors. Funding: Korean Foundation for Cancer Research. Disclosure: All authors have declared no conflicts of interest.
1789P
Physicians’ satisfaction with health-related quality of life (HRQoL) assessment in daily clinical practice using electronic patient-reported outcome (ePRO) for cancer patients
G. Mouillet1, J. Fritzsch2, A. Thiery-Vuillemin1, N. Meneveau1, H. Almotlak1, L. Mansi1, E. Curtit1, S. Kim1, M. Jary1, T. Maurina1, G. Eberst3, P. Barthelemy4, J-C. Eymard5, L. Geoffrois6, O. Djoumakh2, A. Anota8, O. Adotevi7, V. Westeel3, S. Paget-Bailly2 1 Medical Oncology, University Hospital of Besanc¸on, Besanc¸on, France, 2 Methodological and Quality of Life Unit, University Hospital of Besanc¸on, Besanc¸on, France, 3Respiratory Medicine Department, University Hospital of Besanc¸on, Besanc¸on, France, 4Medical Oncology Department, C.H.U. Strasbourg-Nouvel Hopital Civil, Strasbourg, France, 5Medical Oncology Department, Institut Jean Godinot, Reims, France, 6Medical Oncology, Institut de Cance´rologie de Lorraine, Vandoeuvre Le`s Nancy, France, 7INSERM, EFS BFC, UMR1098, Interactions Hoˆte-Greffon-Tumeur/ Inge´nierie Cellulaire et Ge´nique, University Bourgogne Franche-Comte´, Besanc¸on, France8 Background: Routine Electronic Monitoring of HRQoL (REMOQOL) in daily clinical care with real-time feedback to physicians could help to manage treatment-related toxicities, to personalize supportive care, and to assess the treatment benefit from the patients’ point of view. Physicians’ satisfaction with REMOQOL was evaluated in two French clinical trials (CT) assessing its feasibility. Methods: Physicians’ satisfaction was evaluated in two CT: QOLIBRY a monocentric CT for breast, lung and colorectal cancers, and QUANARIE a multicentric CT involving 8 centres of France for renal cancer. Patients were invited to complete before each visit the EORTC QLQ-C30 questionnaire, cancer site-specific modules and selected items related to treatments, using the CHES software on tablets and/or computers at the hospital or at home. During the visit, the physicians had real-time access to visual summaries of HRQoL scores evolution. Physicians’ satisfaction was evaluated with a questionnaire specifically designed for these CT. The questionnaire addressed 43 items
doi:10.1093/annonc/mdz265 | v729
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz265.032/5577489 by guest on 26 October 2019
included frail patients selected with G8 score (<14), with advanced disease, treated with oral, subcutaneously or parenteral biological agents, with limitations to day-hospital access, comorbidities and at least six months life expectancy. A multidisciplinary team, coordinated by three oncologists, included also four nurses, a pain therapist, a psychologist and a physiotherapist. Satisfaction was evaluated with the FAMCARE scale. Results: A total of 161 patients (median age of 71 years, range 38-93), were enrolled. Ninety percent of patients had metastatic disease and median G8 score of 8.8 (2.513.5). All of them received home cancer treatments and concomitant supportive cares, if necessary; 24 patients received two or more lines of cancer treatment. Considering 148 concluded taking care, median time was 175 days (7-1200). A median number of 254 (195-325) nursing home visits and 164 (139-190) medical home visits were performed each year, with an average of 1.6 and 1.1 visits per month per patient, respectively. Median number of in-line patients was 20 (17-25). Hospitalization occurred in 19.3%. Home blood transfusions were delivered in 6 patients, paracentesis in 8. One third of them died at home. FAMECARE assessed high satisfaction. Conclusions: Our experience demonstrates that the integration of home cancer treatment and supportive care is feasible and effective. Hospitalization rate is lower than data reported in literature. If confirmed in perspective pharmaco-economics studies, our data suggest that home cancer treatments provide high quality assistance to frail patients. Integration with no-profit organization was successful. Our model could be applied in other settings. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology
Table: 1784P Gender effect on the main PK parameters of ANAM after single administration in healthy volunteers and at steady state in NSCLC patients with cachexia
Funding: Nutricia, Research grant / Funding: Recipient, Honoraria: Fresenius Kabi, Honoraria: Nutricia. J.M. Garcia: Research grant / Funding: Helsinn Healthcare SA. A. Bernareggi: Full / Parttime employment: Helsinn Healthcare SA.
1785P
The patient voice: An Irish survey of nutrition attitudes & access to dietetic care throughout the cancer journey
E.S. Sullivan1, N. Rice2, E. Kingston1, A. Kelly1, L.E. Daly1, J.V. Reynolds3, D.G. Power4, A.M. Ryan1 1 School of Nutritional Sciences, University College Cork, Cork, Ireland, 2(IrSPEN), Irish Society of Clinical Nutrition & Metabolism, Dublin, Ireland, 3Department of Surgery, St. James’ Hospital, Dublin, Ireland, 4Departments of Medical Oncology, Cork & Mercy University Hospitals, Cork, Ireland Background: The attitudes of cancer patients towards nutrition and nutrition care has never been captured in Ireland. An awareness of the nutritional needs and attitudes of
v728 | Supportive Care
Methods: In September 2018, a national survey was conducted to examine patient attitudes towards nutrition and access to dietetic services during their cancer journey. Patients diagnosed or treated in Ireland since 2015 were asked to complete a 25-item survey (available online and at 20 hospitals across Ireland). Results: In total, 1085 valid responses were received (63% female, mean age 58 years). All major cancer groups were represented & 33% had metastatic disease. Overall, 45% reported suffering from a diet-related problem and 44% reported weight loss since diagnosis. Muscle loss was noted by 52%. Amongst weight losers, 42% were ‘unhappy/ worried’ while 27% reported being ‘delighted/happy’. Although 80% are ‘always/usually’ weighed in clinic, just 43% reported that they are ‘always/usually’ asked about diet. Nutrition was rated ‘very/extremely’ important by 89% of respondents. Only 39% had received dietary advice from a dietitian and 74% rated this advice as ‘very/extremely’ helpful. Overall, 57% of those who did not see an RD said they would have liked more support with diet. While 58% reported trying general healthy eating as a result of their diagnosis, 38% and 32% admitted trying at least one alternative dietary strategy or avoiding a specific food due to their diagnosis, respectively. Conclusions: While nutrition is highly important to Irish cancer patients, fewer than half surveyed had accessed a dietitian. Weight and muscle loss are common, but their significance is not always understood by patients. Almost half used alternative dietary strategies, highlighting the need to screen oncology patients for potentially restrictive diet or supplement use to guide appropriate referrals and education. Legal entity responsible for the study: The authors. Funding: IrSPEN. Disclosure: All authors have declared no conflicts of interest.
1786P
Homcology: Home chemotherapy delivery in a simultaneous care project for frail advanced cancer patients
C. Chini1, O. Nigro1, A. Giaquinto1, E. Magni1, G. Tinelli2, L. Bascialla1, S. Gobba1, G. Pinotti1 1 Medical Oncology, ASST-Settelaghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy, 2Clinical Psychology, ASST-Settelaghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy Background: Limited researches evaluate effectiveness of cancer patients-centered home care management. In this context, patients’ needs rather than prognosis should be considered. Our project represents an opportunity for patients who may benefit from chemotherapy, but with physical and social problems that prevent day-hospital access, and a model of no profit contribution to the Public Health System. Methods: Our Medical Oncology Department, supported by a no-profit organization and according to the GP, conducted the project from May 2014 to March 2019. We
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz265.032/5577489 by guest on 26 October 2019
therapeutic use was assessed. Methods: In a phase 1 clinical trial, healthy volunteers received a single ANAM dose and the PK profile was evaluated by non-compartmental methods. Cachectic NSCLC patients from the phase 3 trial ROMANA 1 (NCT01387269) received ANAM once daily up to 12 weeks. Sparse blood samples were collected at steady state from 70 patients consenting to population PK modeling, along with ANAM PK data from phase 1 and 2 studies in healthy subjects and patients. Correlations between gender and predicted individual ANAM PK parameters in patients at steady state were assessed by analysis of variance models. In a separate phase II trial, serum insulin-like growth factor 1 (IGF-1) and insulin-like growth factor-binding protein 3 (IGFBP-3) levels were assessed in NSCLC male and female outpatients receiving ANAM up to 14 weeks. Results: In healthy volunteers, after dose normalization per body weight, the PK parameters of males and females were similar (Table). In patients with cachexia, no significant correlations were found between gender and predicted ANAM PK parameters at steady state (Table). No gender differences were observed in IGF-1 and IGFBP-3 serum levels. Conclusions: No significant gender effect on ANAM PK/PD was observed in healthy volunteers and NSCLC patients with cachexia at 100 mg ANAM, intended for therapeutic use. Clinical trial identification: ROMANA 3: NCT01387269. Editorial acknowledgement: Oana Draghiciu, PhD, CMPP, from Aptitude Health, The Hague, The Netherlands; funded by Helsinn Healthcare SA. Legal entity responsible for the study: Helsinn Healthcare SA. Funding: Helsinn Healthcare SA. Disclosure: S. Kaasa: Shareholder / Stockholder /Stock options: Eir Solution, Research grant /
abstracts
Annals of Oncology
1787P
Treatment-related adverse events and tolerability in patients with advanced non-squamous non-small cell lung cancer treated with first-line checkpoint inhibitors in combination with chemotherapy
R. d’Cunha1, P. D’Cunha2, S. Swarup3, A. Sultan3, F. Mogollon-Duffo3, N. Jahan3, T. Win Htut4, S. Wongsaengsak1, N. Adhikari3, A.M. Mon5, P.P. Hlaing1, A.M. Tun6, N. D’Cunha3, K.Z. Thein3 1 Internal Medicine, Texas Tech University, Lubbock, TX, USA, 2Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA, 3Hematology Oncology, Texas Tech University, Lubbock, TX, USA, 4Acute Medicine, Colchester General Hospital, Colchester, UK, 5Internal Medicine, Lincoln Medical Center, Brooklyn, NY, USA, 6Hematology Oncology, Brooklyn Hospital Center, Brooklyn, NY, USA Background: Non-squamous non-small cell lung cancer (NSCLC) accounts for majority of lung cancer, the second most common cancer in US. Combination of checkpoint inhibitors and chemotherapy has become a fundamental paradigm shift in the first-line treatment of advanced lung cancer. We conducted a combined analysis of randomized controlled trials (RCT) to determine the risk of treatment-related adverse events (TRAE) and treatment discontinuation due to TRAE. Methods: PUBMED, MEDLINE, EMBASE databases and meeting abstracts from inception through March 2019 were queried. RCTs of first-line chemotherapy þ/immunotherapy in patients with advanced non-squamous NSCLC were incorporated. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) and risk difference (RD) with 95% confidence interval (CI). Random effects model was applied. Results: A total of 2785 patients with advanced non-squamous NSCLC from 5 RCTs were included. The study arm used standard chemotherapy regimens in combination with pembrolizumab or atezolizumab while control arm used only standard chemotherapy regimens. The randomization ratio was 2:1 in IMpower-130 and Keynote-189 studies and 1:1 in other studies. The pooled RR of any-grade TRAE was 1.02 (95% CI: 0.99 –1.04, P ¼ 0.20) and RR of high-grade TRAE was significant at 1.20 (95% CI: 1.07 –1.34, P ¼ 0.002). Treatment-related deaths were 58 (3.57%) in study arm vs 31 (2.66%) in control arm. The pooled RR was not statistically significant at 1.26 (95% CI: 0.81 –1.95, P ¼ 0.31) and RD was 0.01 (95% CI: - 0.00 – 0.02, P ¼ 0.08). Treatment discontinuation due to TRAE was noted in 440 (27.14%) vs 235 (20.19%) in control group with RR of 1.35 (95% CI: 1.15 –1.59, P ¼ 0.0003) and RD of 0.07 (95% CI: 0.03 – 0.11, P ¼ 0.001). Conclusions: Patients on upfront combined chemoimmunotherapy experienced highgrade TRAE, ultimately leading to treatment discontinuation. Yet, there were no significant increase in the risk of treatment related deaths due to TRAE, compared to standard chemotherapy. Pre-emptive measures with proper supportive care may enhance patients’ quality of life and compliance. Legal entity responsible for the study: Kyaw Zin Thein. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Volume 30 | Supplement 5 | October 2019
1788P
Clinical utility of a systematic toxicity assessment form (STAF) in patients with breast cancer receiving adjuvant or neoadjuvant therapy
J.H. Kim1, S. Seo2, H-S. Im1, J.H. Lim1, W.R. Jo1, B.B. Im1, S.R. Park1 Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, 2Oncology, Asan Medical Center, Seoul, Republic of Korea
1
Background: Proper evaluation and management of chemotherapy-related toxicity (CRT) is critical to cancer patients. We aimed to assess the clinical utility of STAF in patients with breast cancer receiving chemotherapy. Methods: The STAF is a systematic form including common CRT lists and grades to help clinicians to assess CRT comprehensively as opposed to assessing CRT individually by cases. Using data from clinical data warehouse, the CRT profile was analyzed in patients with breast cancer receiving adjuvant or neoadjuvant therapy during two time periods; before (n ¼ 1874) and after (n ¼ 981) using STAF in the clinic at Asan Medical Center. The two cohorts were matched by age and chemotherapy, leaving conventional practice (A; n ¼ 333) and STAF (B; n ¼ 333) groups. The rates of unscheduled hospital utilization (outpatient department [OPD], emergency room [ER] and hospitalization) were compared between group A and B. Results: No significant differences were noted in baseline characteristics between the two groups, except for a higher proportion of patients living near the hospital in group A compared to group B (67.0 vs 56.2%; P ¼ 0.004). The completion rate of planned chemotherapy was 96.7% and 97.6% (P ¼ 0.704), and the rate of dose reduction was 12.3% and 10.8% (P ¼ 0.473), respectively, in group A and B. The median dose intensity was lower in group A than group B (0.92 vs. 0.95; P < 0.001). Higher reporting of CRT was observed in group B (P < 0.001). Despite a similar rate of unscheduled hospital utilization during cycle 1, since cycle 2, group B had a lower frequency of unexpected OPD (3.3 vs 6.6%, P ¼ 0.050) and ER visits (9.6 vs 16.8%, P ¼ 0.006), and hospitalization (8.4 vs 12.6%; P ¼ 0.077) than group A.
Table: 1788P Unscheduled utilization since cycle 2 of chemotherapy
Group A (n ¼ 333, %)
Group B (n ¼ 333, %)
P
OPD ER Hospitalization
22 (6.6) 56 (16.8) 42 (12.6)
11 (3.3) 32 (9.6) 28 (8.4)
0.050 0.006 0.077
Conclusions: Using the STAF may facilitate to capture CRT in clinical practice and reduce the rates of unscheduled hospital utilization in patients with breast cancer receiving adjuvant or neoadjuvant therapy. Legal entity responsible for the study: The authors. Funding: Korean Foundation for Cancer Research. Disclosure: All authors have declared no conflicts of interest.
1789P
Physicians’ satisfaction with health-related quality of life (HRQoL) assessment in daily clinical practice using electronic patient-reported outcome (ePRO) for cancer patients
G. Mouillet1, J. Fritzsch2, A. Thiery-Vuillemin1, N. Meneveau1, H. Almotlak1, L. Mansi1, E. Curtit1, S. Kim1, M. Jary1, T. Maurina1, G. Eberst3, P. Barthelemy4, J-C. Eymard5, L. Geoffrois6, O. Djoumakh2, A. Anota8, O. Adotevi7, V. Westeel3, S. Paget-Bailly2 1 Medical Oncology, University Hospital of Besanc¸on, Besanc¸on, France, 2 Methodological and Quality of Life Unit, University Hospital of Besanc¸on, Besanc¸on, France, 3Respiratory Medicine Department, University Hospital of Besanc¸on, Besanc¸on, France, 4Medical Oncology Department, C.H.U. Strasbourg-Nouvel Hopital Civil, Strasbourg, France, 5Medical Oncology Department, Institut Jean Godinot, Reims, France, 6Medical Oncology, Institut de Cance´rologie de Lorraine, Vandoeuvre Le`s Nancy, France, 7INSERM, EFS BFC, UMR1098, Interactions Hoˆte-Greffon-Tumeur/ Inge´nierie Cellulaire et Ge´nique, University Bourgogne Franche-Comte´, Besanc¸on, France8 Background: Routine Electronic Monitoring of HRQoL (REMOQOL) in daily clinical care with real-time feedback to physicians could help to manage treatment-related toxicities, to personalize supportive care, and to assess the treatment benefit from the patients’ point of view. Physicians’ satisfaction with REMOQOL was evaluated in two French clinical trials (CT) assessing its feasibility. Methods: Physicians’ satisfaction was evaluated in two CT: QOLIBRY a monocentric CT for breast, lung and colorectal cancers, and QUANARIE a multicentric CT involving 8 centres of France for renal cancer. Patients were invited to complete before each visit the EORTC QLQ-C30 questionnaire, cancer site-specific modules and selected items related to treatments, using the CHES software on tablets and/or computers at the hospital or at home. During the visit, the physicians had real-time access to visual summaries of HRQoL scores evolution. Physicians’ satisfaction was evaluated with a questionnaire specifically designed for these CT. The questionnaire addressed 43 items
doi:10.1093/annonc/mdz265 | v729
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz265.032/5577489 by guest on 26 October 2019
included frail patients selected with G8 score (<14), with advanced disease, treated with oral, subcutaneously or parenteral biological agents, with limitations to day-hospital access, comorbidities and at least six months life expectancy. A multidisciplinary team, coordinated by three oncologists, included also four nurses, a pain therapist, a psychologist and a physiotherapist. Satisfaction was evaluated with the FAMCARE scale. Results: A total of 161 patients (median age of 71 years, range 38-93), were enrolled. Ninety percent of patients had metastatic disease and median G8 score of 8.8 (2.513.5). All of them received home cancer treatments and concomitant supportive cares, if necessary; 24 patients received two or more lines of cancer treatment. Considering 148 concluded taking care, median time was 175 days (7-1200). A median number of 254 (195-325) nursing home visits and 164 (139-190) medical home visits were performed each year, with an average of 1.6 and 1.1 visits per month per patient, respectively. Median number of in-line patients was 20 (17-25). Hospitalization occurred in 19.3%. Home blood transfusions were delivered in 6 patients, paracentesis in 8. One third of them died at home. FAMECARE assessed high satisfaction. Conclusions: Our experience demonstrates that the integration of home cancer treatment and supportive care is feasible and effective. Hospitalization rate is lower than data reported in literature. If confirmed in perspective pharmaco-economics studies, our data suggest that home cancer treatments provide high quality assistance to frail patients. Integration with no-profit organization was successful. Our model could be applied in other settings. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.