- Email: [email protected]
Phone triage & acute review clinics: The emerging role of the oncology specialist nurse
Annals of Oncology 30 (Supplement 5): v836–v845, 2019 doi:10.1093/annonc/mdz276
CANCER NURSING: SYMPTOM MANAGEMENT CN68
Genetics, biomarkers and symptoms during breast cancer: A scoping review of literature
Background: Current evidence suggests that sensitive and specific biomarkers will be available to be used for the assessment and management of symptoms. The aims of the study; to explore the existing research evidence pertaining to biomarkers’/genes’ investigation within breast cancer symptom science, and to identify biomarkers to be targeted in future symptom research intervention among breast cancer patients. Methods: Search terms for this systematic review, included “biomarker*, biological marker*, genetics, genomics, genes, genotype, phenotype, AND oncology, cancer, neoplasm, AND sign*, symptom*, quality of life, cognitive functions/performance or cognitive impairment, sleep disturbances, impaired sleep/insomnia, fatique, pain, GI distress, nausea, vomiting, appetite changes, weight loss, neuropathy, xerostomia and mouth ulcers, neuropathy, skin and nail changes, dyspnea, depression, anxiety”. A comprehensive multistep search of CINAHL (160), Cochrane (41), OVID (18), PsycInfo (59), Pubmed (773), Web of Science (527) for identified articles to include in February 2019. Total 1573 articles found and after discarding the duplicates, 1301 articles were checked by title then abstract. A sample of 114 primary research articles were remained for full text review. Total 55 articles met the inclusion criteria in the review. Results: Twenty-three articles in different cancer types including breast cancer and 32 articles including only breast cancer patients were reviewed in details. The reference lists of these articles will be checked to find additional studies for scoping reviews. These studies were summarized using the following pre-specified evaluation criteria: the aim of study, major findings; genes and associated polymorphisms investigated, sample characteristics (i.e., size, setting, age); symptom’s assessment (i.e., timing). Symptoms investigated are sleep disturbances, anxiety, cognitive function (attentional function, memory complaints), peripheral neuropathy- neurotoxicity, depressive symptoms, fatigue- energy level, nausea-vomiting, pain (cancer pain, breast pain), quality of life, secondary lymphedema. Conclusions: In future, candidate genes may be targeted to describe mechanisms of symptoms or symptoms clusters for potential precision treatments and effective symptom management strategies. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
CN69
Nurse-led consultations for patients with gynaecological cancer receiving concurrent cisplatin: A pilot study
CN70
Pharmacist and Nurse (PN) led melanoma immunotherapy clinic: Patient experience survey
D. Chauhan, J.M.G. Larkin, S. Turajlic, P. Hughes Skin and Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK Background: In 2017 a new PN led clinic was established for immunotherapy patients. At the 1-year mark to ensure patients were satisfied with the service provision, a patient experience survey was conducted. The survey explored if patients felt comfortable in discussing side effects with the PN and if they felt part of their treatment related decisions. Importantly patients were asked if they had confidence and trust in the PN. Methods: The survey was provided to all patients whom attended the PN led clinic from May 2017 to May 2018. The survey consisted of 10 closed questions using the Likert scale, with spaces provided for personal comments. Data collection period was 1.06.18 to 29.06.18. Estimated number of patients was 10. Results: Questionnaires were provided to a total of 10 patients. Three questionnaires could not be provided to 3 patients whom attended the PN led clinic as they had died. Two patients did not respond back. 6/8 patients strongly agreed (SAg) to feeling comfortable in discussing treatment related side effects and 2/8 patients agreed (Ag). This same result was found when patients were asked if they felt involved in the decisions related to their care e.g. stopping immunotherapy treatment at 2 yrs. With respect to having confidence and trust with the advice and care provided by the PN, 7 patients SAg and 1 Ag. All patients felt that they were being listened to and had the opportunity to ask questions during their consultations (7 patients SAg and 1 Ag). Reassuringly all 8 patients said that they would recommend this service to their friends and family (7 patients SAg and 1 Ag). Conclusions: This survey was to ensure patients were satisfied with being reviewed by a PN and as the service was new to the melanoma unit in 2017; it was vital that the patients had the opportunity to evaluate the service provision. With this positive feedback the clinic was expanded from September 2018 and to date 36 patients have now been seen within the PN led immunotherapy clinic and another patient experience survey is due. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
M.G. Christiansen, H. Roed, C. Phanareth, K. Piil Oncology, Rigshospitalet, Copenhagen, Denmark CN71 Background: Optimal management of symptoms is essential for the patients adherence to the treatment schedule and quality of life. Nurses can play a crucial role in identifying the patient’s symptoms, side effects, needs and to provide support and guidance during treatment. At the Department of Oncology we replaced physician-led consultations with systematic nurse-led consultations. This study seeks to evaluate the feasibility of systematic nurse-led consultations among patients with cervical, vulvar or vaginal cancer during radiotherapy prior to the weekly treatment with cisplatin. Methods: This pilot study aimed to evaluate the feasibility, acceptability and safety from systematic nurse-led consultations among patients receiving curative concurrent chemotherapy. Patients who participated in minimum 4-6 nurse-led consultations responded to a self-developed questionnaire evaluating the consultations. The questionnaire consisted of 21 items on a 5-point Likert scale and ranged from very satisfied to very dissatisfied. Further, a focus group interview with nurse specialists (n ¼ 4) was conducted. Results: Patients (n ¼ 50) who participated in nurse-led consultation from March 2018 to April 2019 fulfilled the questionnaire. The nurse-led consultations were evaluated as being feasible with no adverse events reported. The majority (94 %) were very satisfied or satisfied (6%) with nurse-led consultations. They received sufficient information about self-management strategies and side-effects. They were very satisfied (87,5%) or satisfied (12,5%) with the information and guidance provided by the nurse specialists. The focus group interview revealed that the nurse specialists (n ¼ 4) appreciated the use of their competencies and e.g. valued the autonomy and holistic approach provided to their patients.
Phone triage & acute review clinics: The emerging role of the oncology specialist nurse
F.E. Barrett, F. Keane, D. O’Doherty, W. Connolly, C. Matassa, B. Ryan, T. Doyle, K. Dempsey, L. Grogan, P.G. Morris, B.T. Hennessy, O.S. Breathnach, C. O’Shea, A. Christie Medical Oncology, Beaumont Hospital Cancer Centre, Dublin, Ireland Background: Much of the work of a busy oncology day unit is undocumented, especially the work involved in phone triage during the working hours of 8am to 6pm. Phone calls from patients, their family doctors, palliative care teams, or from within the Hospital itself seeking advice form the majority of this aspect of the Specialist Oncology Nurse and Staff Nurses’ time. This project was performed to assess the nature of these calls and the broad advice given to the callers so that a dedicated Acute Review Specialist Oncology Nurse Clinic could be developed. Methods: In conjunction with key oncology nurses and their medical oncologist colleagues a log to capture each answered call was developed. This centred on the date and time of the call, the source, the issue raised, the advice given, if advised to go to the Emergency Room the reason why, and other actions that were necessary. A form was completed per answered call, and collected at the end of the day. Data was recorded on a spreadsheet. All forms were annonymised with regard to patient identifiers. The forms were focused on whether the issue was successfully addressed within the day unit, the Hospital’s emergency room, the community services, or whether solely by the advice given over the telephone.
C European Society for Medical Oncology 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. V
All rights reserved. For permissions, please email: [email protected].
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz276.003/5576311 by guest on 24 October 2019
S.I. Pasalak, M. Seven, G. Bagcivan School of Nursing, Koc¸ University, Istanbul, Turkey
Conclusions: Systematic nurse-led consultations during concurrent chemoradiation trajectory of cervical, vulvar or vaginal cancer is feasible, acceptable and safe for both patients and the nurse specialists. Legal entity responsible for the study: Rigshospitalet, Onkologisk Klinik. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
abstracts
Annals of Oncology
CN72
Patient reported outcomes during immunotherapy: Symptom burden in daily clinical practice
J.J. Koldenhof1, E.G. Verberne2, R.J. Verheijden1, E. Tonk1, F.H. van der Baan3, A. van Lindert4, J. van der Stap4, S.C. Teunissen3, P.O. Witteveen1, K.P.M. Suijkerbuijk1 1 Medical Oncology, UMC-University Medical Center Utrecht, Utrecht, Netherlands, 2 Zuidzorg, Eindhoven, Netherlands, 3Julius Center, UMC-University Medical Center Utrecht, Utrecht, Netherlands, 4Pulmonology, UMC Utrecht Cancer Center, Utrecht, Netherlands Background: PD(L)1-inhibitors can cause immune-related adverse events (irAEs.). IrAEs may be under-recognized and their influence on health-related quality of life (HRQL) underestimated. At this point, insight into patient-reported symptom prevalence and intensity is limited. Methods: In this cohort study, patients with melanoma or lung carcinoma treated with PD(L)1-inhibitors - as per standard of care - between February 2016 and December 2018, were included. Patient characteristics, patient-reported symptoms and wellbeing, influence of (ir)AEs on HRQL were prospectively obtained, just as irAEs from professional perspectives and treatment decisions. Used instruments were the patientscored Utrecht Symptom Diary (USD) and the professional-scored Common Terminology Criteria for AEs v4.03. Patients completed the USD as part of routine care. Results: 162 patients with melanoma (55%) or lung carcinoma (45%) were included. 59% were men, median age was 66 years. Most patients (89%) were treated with nivolumab or pembrolizumab. Preliminary analysis shows that at baseline patients reported a median of 4 symptoms with an USD-score 3 (11-point numeric rating scale). Symptom burden caused by anorexia (p¼.035), cough (p¼.000), dyspnea (p¼.002) and fatigue (p¼.012) differed significantly between tumor types. CTCAE grade 3 toxicity occurred in 20 patients (12%) and significantly more often in patients with melanoma (p¼.004) and in patients previously treated with immunotherapy (p¼.000). At time of grade 3 toxicity occurrence, patients experienced a median of six clinically relevant symptoms (USD 3), which was not significantly different from baseline. The median USD-score of influence of AEs on HRQL was 3 (NRS 0-7). Conclusions: This study shows that the use of patient-reported outcomes (PROs) as standard of care provides insight into symptom burden from patient perspectives in patients with melanoma or lung carcinoma during immunotherapy. As a result, PROs can add additional information to the objectified severity of symptoms as scored by professionals, just as to effect evaluation of interventions performed. Final results will be presented at the conference. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: J.J. Koldenhof: Honoraria (institution), Advisory / Consultancy: Novartis. K.P.M. Suijkerbuijk: Honoraria (institution), Advisory / Consultancy: Bristol-Myers Squibb; Honoraria (institution), Advisory / Consultancy: Novartis; Honoraria (institution), Advisory / Consultancy: MSD; Honoraria (institution), Advisory / Consultancy: Roche; Honoraria (institution), Advisory / Consultancy: Pierre Fabre. All other authors have declared no conflicts of interest.
CN73
Factors related to hospital length of stay, re-admissions and unplanned care for patients with cancer, an on-going study
H. Ullgren1,2 1 Department of Nursing, Umea˚ University, Umea˚, Sweden, 2Regional Cancer Center Stockholm-Gotland, Stockholm, Sweden
hospitalizations reveal that more than half of symptoms were related to disease and 30% to side-effects from treatment. Some research reveals that symptom burden in hospitalized patients may be associated with hospital length of stay (LOS) and readmissions. This study aims to analyze the relationship between Health-Related Quality of Life (HRQoL) and different aspects of health care utilization, such as; LOS, re-admissions within 30 days and unplanned care. Methods: Survey data using the European Organization for Research and Treatment of Cancer (EORTC QLQ C30) tool on HRQoL were linked data from the Swedish Cancer Quality registries and the database for health care utilization. Patients with a complex care trajectory (in this study Gynecology, Head & Neck, Hematology and Upper GI cancer) were included. Functional scales and symptom scales from EORTC QLQ C30 were analyzed for correlations with LOS, re- admissions within 30 days and unplanned care. Independent variables are patient demographics and clinical variables such as; treatment and/or type of treatment, performance status, co-morbidities and referral to palliative care. Results: In total, 1872 patients responded to the survey (response rate 64 %), 41 % men and 59 % women (mean age 67 years). The number of patients in each group are; Gynecological (n 598), Hematological (n 461), Head & Neck (n 395) and Upper GI cancers (n 418). Analysis are currently ongoing with multivariate regression models and will be presented in the poster/oral presentation. Conclusions: On possible correlations between different factors related to aspects of care utilization will be presented. Legal entity responsible for the study: The author. Funding: This investigation and study was supported by grants from the Cancer Research Foundation in Northern Sweden. Disclosure: The author has declared no conflicts of interest.
CN74
Providing a nurse-led telephone intervention for patients treated with oral anticancer medication: Symptom management and adherence monitoring
E. Minvielle1, M. Ferrua1, M. di Palma2, A. Fourcade1, M. Guillet3, D. Mathivon3, V. Puglisi3, O. Mir4 1 Research Department, Gustave Roussy, Villejuif, France, 2Medical Officer, American Hospital of Paris, Neuilly-sur-Seine, France, 3Outpatient Department, Gustave Roussy, Villejuif, France, 4Quality and Cancer Care Pathways, Department of Ambulatory Care, Gustave Roussy, Villejuif, France Background: Many interventions to improve a safe use of oral anti-cancer agents have been reported during the last decade. Frequently, these interventions involve nurse-led follow-up, but there is limited data to suggest the proportion of adherence and toxicity related to treatment that nurses can detect. Methods: CAPRI, a randomized phase III trial comparing: an intervention combining Nurse Navigators (NNs) and a mobile application vs. Standard of care in cancer patients treated with oral anticancer agents was initiated in 2016 at Gustave Roussy (Villejuif, France). Nurses conduct regular telephone follow-up (1/week for the 1st month, 2/month for the following 3 months, then 1/3 weeks). During follow-up, they assess adherence, symptoms and supportive care needs. PROMS (Patient Reported Outcome Measure) (e.g. pain, appetite) are also recorded by the patient via the mobile application. A coding grid was developed to extract from the nurses intervention reports the information identified during follow-up and to categorize the actions implemented by them. All regular follow-ups over a 24-month period were studied. Results: Nurses carried out 2279 regular follow-ups concerning 237 patients, of which 1880 could be carried out (patient available). They detected treatment-related symptoms/toxicities (or worsening) in 582 (31%) of the regular follow-ups involving 193 patients. Interventions performed in these situations are advice given to the patient (55%), advice or indications after the oncologist’s request (23%), referral to a primary care professional (14%) or to a health facility (8%). Twenty-six regular follow-ups concerning 18 patients identified adherence issues. Actions implemented by nurses encompassed: patient advice (n ¼ 14), request for advice from the referring oncologist (n ¼ 10), introduction of a homecare nurse (n ¼ 2). Conclusions: Close and proactive nurse-led follow-up might help not only detecting and managing toxicities, but also identifying adherence issues in cancer patients receiving oral anti-cancer agents. Clinical trial identification: 2016-A00254-47. Legal entity responsible for the study: Gustave Roussy. Funding: Fondation Philanthropia - Lombard Odier, Agence Nationale de la Recherche IHU-MMO, ARS Ile de France, Novartis, AstraZeneca. Disclosure: All authors have declared no conflicts of interest.
Background: Recent development in cancer care challenges the earlier and more linear care trajectory. This implies an increased need for symptom management and support. In research on intensity of care at end-of-life (EOL), there is a trend to increased utilization of health, such as re-admissions, emergency admissions and to intensive care (ICU). Previous research has investigated factors such as gender, socio-economic status, comorbidities and type of disease. Research on symptoms leading to
Volume 30 | Supplement 5 | October 2019
doi:10.1093/annonc/mdz276 | v837
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz276.003/5576311 by guest on 24 October 2019
Results: A sample size of 252 incoming answered calls by the Oncology Nursing Staff to the Nurses’ station was analysed. Just over half these calls (52%) were made by patients/ family members. Other calls related to internal questions such as from Interventional Radiology or other diagnostic areas of the Hospital (26%), pharmacies (7%), and family doctors (4%). The other 11% of calls were mainly from wards relating to advice on inpatients or seeking consults. Of the unwell patients calling for advice, near half (48%) were seeking advice on what action to take: stay at home or come to Hospital. 35% of patients were seeking either a new appointment or change in appointment date. The remaining 17% of patients were seeking non-emergency review by the medical oncology team. Conclusions: This analysis of answered calls highlights the need for involvement of experienced oncology nurses in the triage of phone calls to a busy oncology day unit, and the need to develop an Acute Review Clinic, managed by an experienced oncology nurse specialist. Legal entity responsible for the study: Beaumont Hospital Cancer Centre. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
CANCER NURSING: SYMPTOM MANAGEMENT CN68
Genetics, biomarkers and symptoms during breast cancer: A scoping review of literature
Background: Current evidence suggests that sensitive and specific biomarkers will be available to be used for the assessment and management of symptoms. The aims of the study; to explore the existing research evidence pertaining to biomarkers’/genes’ investigation within breast cancer symptom science, and to identify biomarkers to be targeted in future symptom research intervention among breast cancer patients. Methods: Search terms for this systematic review, included “biomarker*, biological marker*, genetics, genomics, genes, genotype, phenotype, AND oncology, cancer, neoplasm, AND sign*, symptom*, quality of life, cognitive functions/performance or cognitive impairment, sleep disturbances, impaired sleep/insomnia, fatique, pain, GI distress, nausea, vomiting, appetite changes, weight loss, neuropathy, xerostomia and mouth ulcers, neuropathy, skin and nail changes, dyspnea, depression, anxiety”. A comprehensive multistep search of CINAHL (160), Cochrane (41), OVID (18), PsycInfo (59), Pubmed (773), Web of Science (527) for identified articles to include in February 2019. Total 1573 articles found and after discarding the duplicates, 1301 articles were checked by title then abstract. A sample of 114 primary research articles were remained for full text review. Total 55 articles met the inclusion criteria in the review. Results: Twenty-three articles in different cancer types including breast cancer and 32 articles including only breast cancer patients were reviewed in details. The reference lists of these articles will be checked to find additional studies for scoping reviews. These studies were summarized using the following pre-specified evaluation criteria: the aim of study, major findings; genes and associated polymorphisms investigated, sample characteristics (i.e., size, setting, age); symptom’s assessment (i.e., timing). Symptoms investigated are sleep disturbances, anxiety, cognitive function (attentional function, memory complaints), peripheral neuropathy- neurotoxicity, depressive symptoms, fatigue- energy level, nausea-vomiting, pain (cancer pain, breast pain), quality of life, secondary lymphedema. Conclusions: In future, candidate genes may be targeted to describe mechanisms of symptoms or symptoms clusters for potential precision treatments and effective symptom management strategies. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
CN69
Nurse-led consultations for patients with gynaecological cancer receiving concurrent cisplatin: A pilot study
CN70
Pharmacist and Nurse (PN) led melanoma immunotherapy clinic: Patient experience survey
D. Chauhan, J.M.G. Larkin, S. Turajlic, P. Hughes Skin and Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK Background: In 2017 a new PN led clinic was established for immunotherapy patients. At the 1-year mark to ensure patients were satisfied with the service provision, a patient experience survey was conducted. The survey explored if patients felt comfortable in discussing side effects with the PN and if they felt part of their treatment related decisions. Importantly patients were asked if they had confidence and trust in the PN. Methods: The survey was provided to all patients whom attended the PN led clinic from May 2017 to May 2018. The survey consisted of 10 closed questions using the Likert scale, with spaces provided for personal comments. Data collection period was 1.06.18 to 29.06.18. Estimated number of patients was 10. Results: Questionnaires were provided to a total of 10 patients. Three questionnaires could not be provided to 3 patients whom attended the PN led clinic as they had died. Two patients did not respond back. 6/8 patients strongly agreed (SAg) to feeling comfortable in discussing treatment related side effects and 2/8 patients agreed (Ag). This same result was found when patients were asked if they felt involved in the decisions related to their care e.g. stopping immunotherapy treatment at 2 yrs. With respect to having confidence and trust with the advice and care provided by the PN, 7 patients SAg and 1 Ag. All patients felt that they were being listened to and had the opportunity to ask questions during their consultations (7 patients SAg and 1 Ag). Reassuringly all 8 patients said that they would recommend this service to their friends and family (7 patients SAg and 1 Ag). Conclusions: This survey was to ensure patients were satisfied with being reviewed by a PN and as the service was new to the melanoma unit in 2017; it was vital that the patients had the opportunity to evaluate the service provision. With this positive feedback the clinic was expanded from September 2018 and to date 36 patients have now been seen within the PN led immunotherapy clinic and another patient experience survey is due. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
M.G. Christiansen, H. Roed, C. Phanareth, K. Piil Oncology, Rigshospitalet, Copenhagen, Denmark CN71 Background: Optimal management of symptoms is essential for the patients adherence to the treatment schedule and quality of life. Nurses can play a crucial role in identifying the patient’s symptoms, side effects, needs and to provide support and guidance during treatment. At the Department of Oncology we replaced physician-led consultations with systematic nurse-led consultations. This study seeks to evaluate the feasibility of systematic nurse-led consultations among patients with cervical, vulvar or vaginal cancer during radiotherapy prior to the weekly treatment with cisplatin. Methods: This pilot study aimed to evaluate the feasibility, acceptability and safety from systematic nurse-led consultations among patients receiving curative concurrent chemotherapy. Patients who participated in minimum 4-6 nurse-led consultations responded to a self-developed questionnaire evaluating the consultations. The questionnaire consisted of 21 items on a 5-point Likert scale and ranged from very satisfied to very dissatisfied. Further, a focus group interview with nurse specialists (n ¼ 4) was conducted. Results: Patients (n ¼ 50) who participated in nurse-led consultation from March 2018 to April 2019 fulfilled the questionnaire. The nurse-led consultations were evaluated as being feasible with no adverse events reported. The majority (94 %) were very satisfied or satisfied (6%) with nurse-led consultations. They received sufficient information about self-management strategies and side-effects. They were very satisfied (87,5%) or satisfied (12,5%) with the information and guidance provided by the nurse specialists. The focus group interview revealed that the nurse specialists (n ¼ 4) appreciated the use of their competencies and e.g. valued the autonomy and holistic approach provided to their patients.
Phone triage & acute review clinics: The emerging role of the oncology specialist nurse
F.E. Barrett, F. Keane, D. O’Doherty, W. Connolly, C. Matassa, B. Ryan, T. Doyle, K. Dempsey, L. Grogan, P.G. Morris, B.T. Hennessy, O.S. Breathnach, C. O’Shea, A. Christie Medical Oncology, Beaumont Hospital Cancer Centre, Dublin, Ireland Background: Much of the work of a busy oncology day unit is undocumented, especially the work involved in phone triage during the working hours of 8am to 6pm. Phone calls from patients, their family doctors, palliative care teams, or from within the Hospital itself seeking advice form the majority of this aspect of the Specialist Oncology Nurse and Staff Nurses’ time. This project was performed to assess the nature of these calls and the broad advice given to the callers so that a dedicated Acute Review Specialist Oncology Nurse Clinic could be developed. Methods: In conjunction with key oncology nurses and their medical oncologist colleagues a log to capture each answered call was developed. This centred on the date and time of the call, the source, the issue raised, the advice given, if advised to go to the Emergency Room the reason why, and other actions that were necessary. A form was completed per answered call, and collected at the end of the day. Data was recorded on a spreadsheet. All forms were annonymised with regard to patient identifiers. The forms were focused on whether the issue was successfully addressed within the day unit, the Hospital’s emergency room, the community services, or whether solely by the advice given over the telephone.
C European Society for Medical Oncology 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. V
All rights reserved. For permissions, please email: [email protected].
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz276.003/5576311 by guest on 24 October 2019
S.I. Pasalak, M. Seven, G. Bagcivan School of Nursing, Koc¸ University, Istanbul, Turkey
Conclusions: Systematic nurse-led consultations during concurrent chemoradiation trajectory of cervical, vulvar or vaginal cancer is feasible, acceptable and safe for both patients and the nurse specialists. Legal entity responsible for the study: Rigshospitalet, Onkologisk Klinik. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
abstracts
Annals of Oncology
CN72
Patient reported outcomes during immunotherapy: Symptom burden in daily clinical practice
J.J. Koldenhof1, E.G. Verberne2, R.J. Verheijden1, E. Tonk1, F.H. van der Baan3, A. van Lindert4, J. van der Stap4, S.C. Teunissen3, P.O. Witteveen1, K.P.M. Suijkerbuijk1 1 Medical Oncology, UMC-University Medical Center Utrecht, Utrecht, Netherlands, 2 Zuidzorg, Eindhoven, Netherlands, 3Julius Center, UMC-University Medical Center Utrecht, Utrecht, Netherlands, 4Pulmonology, UMC Utrecht Cancer Center, Utrecht, Netherlands Background: PD(L)1-inhibitors can cause immune-related adverse events (irAEs.). IrAEs may be under-recognized and their influence on health-related quality of life (HRQL) underestimated. At this point, insight into patient-reported symptom prevalence and intensity is limited. Methods: In this cohort study, patients with melanoma or lung carcinoma treated with PD(L)1-inhibitors - as per standard of care - between February 2016 and December 2018, were included. Patient characteristics, patient-reported symptoms and wellbeing, influence of (ir)AEs on HRQL were prospectively obtained, just as irAEs from professional perspectives and treatment decisions. Used instruments were the patientscored Utrecht Symptom Diary (USD) and the professional-scored Common Terminology Criteria for AEs v4.03. Patients completed the USD as part of routine care. Results: 162 patients with melanoma (55%) or lung carcinoma (45%) were included. 59% were men, median age was 66 years. Most patients (89%) were treated with nivolumab or pembrolizumab. Preliminary analysis shows that at baseline patients reported a median of 4 symptoms with an USD-score 3 (11-point numeric rating scale). Symptom burden caused by anorexia (p¼.035), cough (p¼.000), dyspnea (p¼.002) and fatigue (p¼.012) differed significantly between tumor types. CTCAE grade 3 toxicity occurred in 20 patients (12%) and significantly more often in patients with melanoma (p¼.004) and in patients previously treated with immunotherapy (p¼.000). At time of grade 3 toxicity occurrence, patients experienced a median of six clinically relevant symptoms (USD 3), which was not significantly different from baseline. The median USD-score of influence of AEs on HRQL was 3 (NRS 0-7). Conclusions: This study shows that the use of patient-reported outcomes (PROs) as standard of care provides insight into symptom burden from patient perspectives in patients with melanoma or lung carcinoma during immunotherapy. As a result, PROs can add additional information to the objectified severity of symptoms as scored by professionals, just as to effect evaluation of interventions performed. Final results will be presented at the conference. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: J.J. Koldenhof: Honoraria (institution), Advisory / Consultancy: Novartis. K.P.M. Suijkerbuijk: Honoraria (institution), Advisory / Consultancy: Bristol-Myers Squibb; Honoraria (institution), Advisory / Consultancy: Novartis; Honoraria (institution), Advisory / Consultancy: MSD; Honoraria (institution), Advisory / Consultancy: Roche; Honoraria (institution), Advisory / Consultancy: Pierre Fabre. All other authors have declared no conflicts of interest.
CN73
Factors related to hospital length of stay, re-admissions and unplanned care for patients with cancer, an on-going study
H. Ullgren1,2 1 Department of Nursing, Umea˚ University, Umea˚, Sweden, 2Regional Cancer Center Stockholm-Gotland, Stockholm, Sweden
hospitalizations reveal that more than half of symptoms were related to disease and 30% to side-effects from treatment. Some research reveals that symptom burden in hospitalized patients may be associated with hospital length of stay (LOS) and readmissions. This study aims to analyze the relationship between Health-Related Quality of Life (HRQoL) and different aspects of health care utilization, such as; LOS, re-admissions within 30 days and unplanned care. Methods: Survey data using the European Organization for Research and Treatment of Cancer (EORTC QLQ C30) tool on HRQoL were linked data from the Swedish Cancer Quality registries and the database for health care utilization. Patients with a complex care trajectory (in this study Gynecology, Head & Neck, Hematology and Upper GI cancer) were included. Functional scales and symptom scales from EORTC QLQ C30 were analyzed for correlations with LOS, re- admissions within 30 days and unplanned care. Independent variables are patient demographics and clinical variables such as; treatment and/or type of treatment, performance status, co-morbidities and referral to palliative care. Results: In total, 1872 patients responded to the survey (response rate 64 %), 41 % men and 59 % women (mean age 67 years). The number of patients in each group are; Gynecological (n 598), Hematological (n 461), Head & Neck (n 395) and Upper GI cancers (n 418). Analysis are currently ongoing with multivariate regression models and will be presented in the poster/oral presentation. Conclusions: On possible correlations between different factors related to aspects of care utilization will be presented. Legal entity responsible for the study: The author. Funding: This investigation and study was supported by grants from the Cancer Research Foundation in Northern Sweden. Disclosure: The author has declared no conflicts of interest.
CN74
Providing a nurse-led telephone intervention for patients treated with oral anticancer medication: Symptom management and adherence monitoring
E. Minvielle1, M. Ferrua1, M. di Palma2, A. Fourcade1, M. Guillet3, D. Mathivon3, V. Puglisi3, O. Mir4 1 Research Department, Gustave Roussy, Villejuif, France, 2Medical Officer, American Hospital of Paris, Neuilly-sur-Seine, France, 3Outpatient Department, Gustave Roussy, Villejuif, France, 4Quality and Cancer Care Pathways, Department of Ambulatory Care, Gustave Roussy, Villejuif, France Background: Many interventions to improve a safe use of oral anti-cancer agents have been reported during the last decade. Frequently, these interventions involve nurse-led follow-up, but there is limited data to suggest the proportion of adherence and toxicity related to treatment that nurses can detect. Methods: CAPRI, a randomized phase III trial comparing: an intervention combining Nurse Navigators (NNs) and a mobile application vs. Standard of care in cancer patients treated with oral anticancer agents was initiated in 2016 at Gustave Roussy (Villejuif, France). Nurses conduct regular telephone follow-up (1/week for the 1st month, 2/month for the following 3 months, then 1/3 weeks). During follow-up, they assess adherence, symptoms and supportive care needs. PROMS (Patient Reported Outcome Measure) (e.g. pain, appetite) are also recorded by the patient via the mobile application. A coding grid was developed to extract from the nurses intervention reports the information identified during follow-up and to categorize the actions implemented by them. All regular follow-ups over a 24-month period were studied. Results: Nurses carried out 2279 regular follow-ups concerning 237 patients, of which 1880 could be carried out (patient available). They detected treatment-related symptoms/toxicities (or worsening) in 582 (31%) of the regular follow-ups involving 193 patients. Interventions performed in these situations are advice given to the patient (55%), advice or indications after the oncologist’s request (23%), referral to a primary care professional (14%) or to a health facility (8%). Twenty-six regular follow-ups concerning 18 patients identified adherence issues. Actions implemented by nurses encompassed: patient advice (n ¼ 14), request for advice from the referring oncologist (n ¼ 10), introduction of a homecare nurse (n ¼ 2). Conclusions: Close and proactive nurse-led follow-up might help not only detecting and managing toxicities, but also identifying adherence issues in cancer patients receiving oral anti-cancer agents. Clinical trial identification: 2016-A00254-47. Legal entity responsible for the study: Gustave Roussy. Funding: Fondation Philanthropia - Lombard Odier, Agence Nationale de la Recherche IHU-MMO, ARS Ile de France, Novartis, AstraZeneca. Disclosure: All authors have declared no conflicts of interest.
Background: Recent development in cancer care challenges the earlier and more linear care trajectory. This implies an increased need for symptom management and support. In research on intensity of care at end-of-life (EOL), there is a trend to increased utilization of health, such as re-admissions, emergency admissions and to intensive care (ICU). Previous research has investigated factors such as gender, socio-economic status, comorbidities and type of disease. Research on symptoms leading to
Volume 30 | Supplement 5 | October 2019
doi:10.1093/annonc/mdz276 | v837
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Results: A sample size of 252 incoming answered calls by the Oncology Nursing Staff to the Nurses’ station was analysed. Just over half these calls (52%) were made by patients/ family members. Other calls related to internal questions such as from Interventional Radiology or other diagnostic areas of the Hospital (26%), pharmacies (7%), and family doctors (4%). The other 11% of calls were mainly from wards relating to advice on inpatients or seeking consults. Of the unwell patients calling for advice, near half (48%) were seeking advice on what action to take: stay at home or come to Hospital. 35% of patients were seeking either a new appointment or change in appointment date. The remaining 17% of patients were seeking non-emergency review by the medical oncology team. Conclusions: This analysis of answered calls highlights the need for involvement of experienced oncology nurses in the triage of phone calls to a busy oncology day unit, and the need to develop an Acute Review Clinic, managed by an experienced oncology nurse specialist. Legal entity responsible for the study: Beaumont Hospital Cancer Centre. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.