- Email: [email protected]
MINI01.15: Prophylactic Cranial Irradiation (PCI) for Limited Small Cell Lung Cancer (LSCLC): An IASLC Physician Survey
November 2016
normal lung. Among the 30 cytokines measured, pretreatment levels of 17 changed this dose-RILT association. In 13 of these, higher levels decreased the dose-RILT association. The largest decrease corresponded to granulocyte-colony stimulated factor (GCSF), for which a one standard deviation increase in pretreatment level above the average decreased the doseRILT association from 0.119 per Gy to 0.104 per Gy. In the remaining 4 cytokines, higher levels increased the dose-RILT association. The largest increase corresponded to interleukin 1 alpha (IL1A), for which a one standard deviation increase in pre-treatment level above the average increased the dose-RILT association from 0.119 per Gy to 0.131 per Gy. Conclusion: Incorporating cytokine data modestly improved accuracy in predicting RILT. Further refinement of a comprehensive predictive model incorporating clinical, dosimetric and biologic factors could lead to more individualized treatment planning and potentially allow dose-escalation.
MINI01.14 Self-Efficacy and Decisions in Lung Cancer: Early Stage Lung Cancer Comparative Effectiveness Research Consortium Results Topic: Radiation Oncology Charles R. Thomas Jr.,1 Shannon M. Nugent,2 Sara E. Golden,2 Christopher G. Slatore2 1Oregon Health & Science University, Portland, OR/United States of America, 2VA Portland Health Care System, Portland, OR/ United States of America Background: Presently, surgical resection is the recommended first-line treatment for patients with early stage nonesmall cell lung cancer (NSCLC) but many cannot tolerate surgery and receive stereotactic body radiation therapy (SBRT). However, there is limited research comparing patient-centered outcomes between those who undergo surgery or SBRT. We herein present baseline data from a prospective, multi-center, longitudinal study regarding communication and decisionmaking processes for patients with early stage NSCLC. Methods: Eligible patients with confirmed or suspected Stage I NSCLC completed a baseline survey, temporally administered after a treatment discussion and prior to the treatment itself. The survey assessed sociodemographic characteristics, treatment decision variables, and patientcentered outcomes using validated instruments: Health Related quality of life (HRQOL) (European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-
Abstracts
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LC13), Decisional Conflict, Patient-Centered Communication, and Communication and Attitudinal Self-Efficacy. Results: Fifty percent of 129 individuals who completed the baseline survey received SBRT. Average age was 69 (SD ¼ 10), 74% were former smokers, and 21% were current smokers. Two-thirds (67%) indicated they felt very well informed about treatment options, over 90% reported being very satisfied with their provider’s explanation of the treatment options and indicated that they had high quality overall communication with their providers. Participants reported high global HRQOL (M ¼ 73.4, SD ¼ 21.3), high patient-centered communication (M ¼ 2.4, SD ¼ 0.9), high self-efficacy (M ¼ 1.5, SD ¼0.5), and no decisional conflict (M ¼ 16.2, SD ¼ 13.4). A linear multiple regression analysis adjusting for age, race, sex, smoking status, education, income, satisfaction with clinician, HRQOL, and patient centered communication found that SBRT was associated with decreased self-efficacy, b ¼ -0.24, t(119) ¼ -2.62, p <.05. The overall model also explained a significant proportion of the variance in self-efficacy scores, R2 ¼.30, F(12,119) ¼ 5.24, p<.01. Treatment type was not found to be significantly associated with decisional conflict when adjusting for the same variables. Conclusion: Among patients with Stage I NSCLC who were treated in multiple institutions, communication satisfaction was high and decisional conflict was low. SBRT selection was associated with decreased self-efficacy but not with decisional conflict. Self-efficacy influences many subsequent health outcomes and our findings suggest patients who receive SBRT may need improved communication strategies to increase their self-efficacy, despite high satisfaction with the communication with their clinicians. It is important to assess how this difference influences subsequent decisions and satisfaction with treatment.
MINI01.15 Prophylactic Cranial Irradiation (PCI) for Limited Small Cell Lung Cancer (LSCLC): An IASLC Physician Survey Topic: Radiation Oncology Laurie E. Gaspar,1 Françoise Mornex,2 Feng-Ming (Spring) Kong,3 Fred Hirsch4 1University of Colorado, Aurora, CO/United States of America, 2 University Claude Bernard, Lyon/France, 3Indiana University School of Medicine, Indianapolis, AL/United States of America, 4University of Colorado Denver, Aurora, CO/United States of America Background: Patients with LSCLC who have had some response to initial treatment are standardly presented
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with the option of having PCI. This can be a difficult discussion given the need to present the possible benefits of improved overall survival but also the risk of diminished neurocognitive function following PCI. A patient decision aid (PDA) was developed to potentially facilitate this physician-patient discussion. Methods: A survey request was sent by email in July 2016 to members of the IASLC. Physicians who are involved with PCI in LSCLC were asked to respond to the survey which queried demographic information, their experience with presenting PCI to patients, what percentage of their patients decided to have PCI, and whether the PDA would facilitate the discussion. Physicians were also asked whether they were likely to have PCI if hypothetically faced with this decision. Results: As of July 31 there have been 180 respondents; 85 (47%) radiation oncologists, 58 (32.5%) medical oncology, 9 (5%) thoracic surgical oncology, and 28 (15.5%) other such as pulmonary medicine. Respondents were evenly distributed in terms of years of experience. 69% of respondents reporting having discussion regarding PCI 5 patients/yr, with 21% having the discussion with >15 patients/yr. PCI was strongly recommended to a 50 yr old and 70 yr old by 54% and 9% of respondents, respectively. 76% of respondents estimated that >75% of their patients 60 yrs old decided to have PCI. However, only 48% of respondents indicated that >75% of patients >60 yrs decided to have PCI. Most respondents (77%) answered that they would likely decide to have PCI if they were faced with such a decision, although comments indicated that it would depend on their age. 83% of respondents indicated that the PDA was easy for them to understand, and 64% felt that using the PCI would be better than their usual approach to presenting the information to patients. Many offered constructive comments to improve the PDA. Conclusion: PCI for LSCLC is recommended by the majority of respondents, although less strongly for patients >60 yrs of age. A patient decision aid might help the physician-patient discussion. Most respondents would have PCI themselves if faced with the decision.
MINI01.16 Not So Easy: Readability Assessment of Patient Education Material on NoneSmall Cell Lung Cancer Immunotherapy Topic: Medical Oncology Supreet Kaur,1 Abhishek Kumar,2 Dhruv Mehta,3 Rashika Bansal,4 Anubha Arora,5 Michael Maroules2
Journal of Thoracic Oncology
Vol. 11 No. 11S
1
St Joseph Regional Medical Center, Paterson/United States of America, 2St joseph regional medical center, Paterson, NJ/United States of America, 3Westchester Medical Center, Valahalla, AL/United States of America, 4 St joseph regional medical center, Paterson/United States of America, 5Mount Sinai School of Medicine, New York/ United States of America Background: Increased availability of internet has conveniently perusal the medical information to the patients. The National Institute of Health (NIH), American Medical Association, Department of Health & Human Services recommend online patient information (OPI) be written no greater than sixth grade level. Our aim is to assess the readability of the nonesmall cell lung cancer (NSCLC) immunotherapy related patient education materials (PEMs) and to determine whether the available PEMs are at par with the recommendations. We used a panel of readability analyses to assess OPI from NCI-Designated Cancer Center (NCIDCC), cancer associations and pharmacology websites. Methods: PEMs from patient only section of NCIDCC, cancer associations and pharmacology websites were collected. This text was analyzed by 7 commonly used readability tests - Flesch Reading Ease score(FRE), Gunning Fog(GF), Flesch-Kincaid Grade Level(FKGL), The Coleman-Liau Index(CLI), The Simple Measure of Gobbledygook (SMOG) Index, Automated Readability Index(ARI) and Linsear Write Formula(LWF). Text from each article was pasted into Microsoft Word and analyzed using the online software Readability formulas. Results: The mean FRE score is 51.94 (range 34.7- 62.7) which corresponded to difficult level grade. The mean GF score is 12.12 (range 10-16.5) that comes between difficult and hard. The FKGL score is 10.5 (range 9-13.7) that corresponds to above the level of ninth grader.The mean CLI score is 11.6 (range 10-13) which represented text of twelfth grade. The mean SMOG index is 9.02 (range 7.4-212.1) which corresponded to greater than seventh grade level. While the mean ARI score was 10.88 (range 9.6-13.8) which represents readability suitable for people more than tenth grade. The mean LWF was 11.28 (range 7.3-14.9) that corresponds to tenth grade level of text. Conclusion: The PEMs available to the patients on the NCIDCC and the pharmacology websites are above the national recommendation level. Testing the available text across seven different indexes failed to meet the requisite national recommendations on all the indexes. There is a dire need to revise the currently available material for easy comprehension by the general patient population.
normal lung. Among the 30 cytokines measured, pretreatment levels of 17 changed this dose-RILT association. In 13 of these, higher levels decreased the dose-RILT association. The largest decrease corresponded to granulocyte-colony stimulated factor (GCSF), for which a one standard deviation increase in pretreatment level above the average decreased the doseRILT association from 0.119 per Gy to 0.104 per Gy. In the remaining 4 cytokines, higher levels increased the dose-RILT association. The largest increase corresponded to interleukin 1 alpha (IL1A), for which a one standard deviation increase in pre-treatment level above the average increased the dose-RILT association from 0.119 per Gy to 0.131 per Gy. Conclusion: Incorporating cytokine data modestly improved accuracy in predicting RILT. Further refinement of a comprehensive predictive model incorporating clinical, dosimetric and biologic factors could lead to more individualized treatment planning and potentially allow dose-escalation.
MINI01.14 Self-Efficacy and Decisions in Lung Cancer: Early Stage Lung Cancer Comparative Effectiveness Research Consortium Results Topic: Radiation Oncology Charles R. Thomas Jr.,1 Shannon M. Nugent,2 Sara E. Golden,2 Christopher G. Slatore2 1Oregon Health & Science University, Portland, OR/United States of America, 2VA Portland Health Care System, Portland, OR/ United States of America Background: Presently, surgical resection is the recommended first-line treatment for patients with early stage nonesmall cell lung cancer (NSCLC) but many cannot tolerate surgery and receive stereotactic body radiation therapy (SBRT). However, there is limited research comparing patient-centered outcomes between those who undergo surgery or SBRT. We herein present baseline data from a prospective, multi-center, longitudinal study regarding communication and decisionmaking processes for patients with early stage NSCLC. Methods: Eligible patients with confirmed or suspected Stage I NSCLC completed a baseline survey, temporally administered after a treatment discussion and prior to the treatment itself. The survey assessed sociodemographic characteristics, treatment decision variables, and patientcentered outcomes using validated instruments: Health Related quality of life (HRQOL) (European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-
Abstracts
S265
LC13), Decisional Conflict, Patient-Centered Communication, and Communication and Attitudinal Self-Efficacy. Results: Fifty percent of 129 individuals who completed the baseline survey received SBRT. Average age was 69 (SD ¼ 10), 74% were former smokers, and 21% were current smokers. Two-thirds (67%) indicated they felt very well informed about treatment options, over 90% reported being very satisfied with their provider’s explanation of the treatment options and indicated that they had high quality overall communication with their providers. Participants reported high global HRQOL (M ¼ 73.4, SD ¼ 21.3), high patient-centered communication (M ¼ 2.4, SD ¼ 0.9), high self-efficacy (M ¼ 1.5, SD ¼0.5), and no decisional conflict (M ¼ 16.2, SD ¼ 13.4). A linear multiple regression analysis adjusting for age, race, sex, smoking status, education, income, satisfaction with clinician, HRQOL, and patient centered communication found that SBRT was associated with decreased self-efficacy, b ¼ -0.24, t(119) ¼ -2.62, p <.05. The overall model also explained a significant proportion of the variance in self-efficacy scores, R2 ¼.30, F(12,119) ¼ 5.24, p<.01. Treatment type was not found to be significantly associated with decisional conflict when adjusting for the same variables. Conclusion: Among patients with Stage I NSCLC who were treated in multiple institutions, communication satisfaction was high and decisional conflict was low. SBRT selection was associated with decreased self-efficacy but not with decisional conflict. Self-efficacy influences many subsequent health outcomes and our findings suggest patients who receive SBRT may need improved communication strategies to increase their self-efficacy, despite high satisfaction with the communication with their clinicians. It is important to assess how this difference influences subsequent decisions and satisfaction with treatment.
MINI01.15 Prophylactic Cranial Irradiation (PCI) for Limited Small Cell Lung Cancer (LSCLC): An IASLC Physician Survey Topic: Radiation Oncology Laurie E. Gaspar,1 Françoise Mornex,2 Feng-Ming (Spring) Kong,3 Fred Hirsch4 1University of Colorado, Aurora, CO/United States of America, 2 University Claude Bernard, Lyon/France, 3Indiana University School of Medicine, Indianapolis, AL/United States of America, 4University of Colorado Denver, Aurora, CO/United States of America Background: Patients with LSCLC who have had some response to initial treatment are standardly presented
S266
with the option of having PCI. This can be a difficult discussion given the need to present the possible benefits of improved overall survival but also the risk of diminished neurocognitive function following PCI. A patient decision aid (PDA) was developed to potentially facilitate this physician-patient discussion. Methods: A survey request was sent by email in July 2016 to members of the IASLC. Physicians who are involved with PCI in LSCLC were asked to respond to the survey which queried demographic information, their experience with presenting PCI to patients, what percentage of their patients decided to have PCI, and whether the PDA would facilitate the discussion. Physicians were also asked whether they were likely to have PCI if hypothetically faced with this decision. Results: As of July 31 there have been 180 respondents; 85 (47%) radiation oncologists, 58 (32.5%) medical oncology, 9 (5%) thoracic surgical oncology, and 28 (15.5%) other such as pulmonary medicine. Respondents were evenly distributed in terms of years of experience. 69% of respondents reporting having discussion regarding PCI 5 patients/yr, with 21% having the discussion with >15 patients/yr. PCI was strongly recommended to a 50 yr old and 70 yr old by 54% and 9% of respondents, respectively. 76% of respondents estimated that >75% of their patients 60 yrs old decided to have PCI. However, only 48% of respondents indicated that >75% of patients >60 yrs decided to have PCI. Most respondents (77%) answered that they would likely decide to have PCI if they were faced with such a decision, although comments indicated that it would depend on their age. 83% of respondents indicated that the PDA was easy for them to understand, and 64% felt that using the PCI would be better than their usual approach to presenting the information to patients. Many offered constructive comments to improve the PDA. Conclusion: PCI for LSCLC is recommended by the majority of respondents, although less strongly for patients >60 yrs of age. A patient decision aid might help the physician-patient discussion. Most respondents would have PCI themselves if faced with the decision.
MINI01.16 Not So Easy: Readability Assessment of Patient Education Material on NoneSmall Cell Lung Cancer Immunotherapy Topic: Medical Oncology Supreet Kaur,1 Abhishek Kumar,2 Dhruv Mehta,3 Rashika Bansal,4 Anubha Arora,5 Michael Maroules2
Journal of Thoracic Oncology
Vol. 11 No. 11S
1
St Joseph Regional Medical Center, Paterson/United States of America, 2St joseph regional medical center, Paterson, NJ/United States of America, 3Westchester Medical Center, Valahalla, AL/United States of America, 4 St joseph regional medical center, Paterson/United States of America, 5Mount Sinai School of Medicine, New York/ United States of America Background: Increased availability of internet has conveniently perusal the medical information to the patients. The National Institute of Health (NIH), American Medical Association, Department of Health & Human Services recommend online patient information (OPI) be written no greater than sixth grade level. Our aim is to assess the readability of the nonesmall cell lung cancer (NSCLC) immunotherapy related patient education materials (PEMs) and to determine whether the available PEMs are at par with the recommendations. We used a panel of readability analyses to assess OPI from NCI-Designated Cancer Center (NCIDCC), cancer associations and pharmacology websites. Methods: PEMs from patient only section of NCIDCC, cancer associations and pharmacology websites were collected. This text was analyzed by 7 commonly used readability tests - Flesch Reading Ease score(FRE), Gunning Fog(GF), Flesch-Kincaid Grade Level(FKGL), The Coleman-Liau Index(CLI), The Simple Measure of Gobbledygook (SMOG) Index, Automated Readability Index(ARI) and Linsear Write Formula(LWF). Text from each article was pasted into Microsoft Word and analyzed using the online software Readability formulas. Results: The mean FRE score is 51.94 (range 34.7- 62.7) which corresponded to difficult level grade. The mean GF score is 12.12 (range 10-16.5) that comes between difficult and hard. The FKGL score is 10.5 (range 9-13.7) that corresponds to above the level of ninth grader.The mean CLI score is 11.6 (range 10-13) which represented text of twelfth grade. The mean SMOG index is 9.02 (range 7.4-212.1) which corresponded to greater than seventh grade level. While the mean ARI score was 10.88 (range 9.6-13.8) which represents readability suitable for people more than tenth grade. The mean LWF was 11.28 (range 7.3-14.9) that corresponds to tenth grade level of text. Conclusion: The PEMs available to the patients on the NCIDCC and the pharmacology websites are above the national recommendation level. Testing the available text across seven different indexes failed to meet the requisite national recommendations on all the indexes. There is a dire need to revise the currently available material for easy comprehension by the general patient population.