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Reasons for Radiation Therapy Nonadherence From the Patient’s Perspective
Poster Viewing E533
Volume 96 Number 2S Supplement 2016 Author Disclosure: K. Havard: None. J.K. Elson: None. J.R. Kharofa: None. V. Takiar: None.
NY, 3Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY
3306
Purpose/Objective(s): Treatment non-adherence can be a significant contributor to treatment prolongation, which can lead to inferior tumor control and worse overall survival in certain malignancies. Although studies have attempted to elucidate predictors of non-compliance to radiation therapy, few studies have attempted to identify the reasons causing patients to miss the planned course of treatment. To our knowledge, there have been no studies that have assessed reasons for non-adherence from the perspective of the patient. The purpose of this study is to identify the most common reasons for missed appointments in an urban radiation oncology department. Materials/Methods: We queried our department’s electronic medical record (EMR) to identify all incomplete scheduled consults and radiotherapy appointments at our institution. We cross-referenced medical record numbers with demographic data using Clinical looking Glass (CLG), an interactive software application developed at our institution to evaluate healthcare efficiency. Patients who missed any appointment were asked for reasons during their weekly physician visit. Results: 1561 incomplete appointments with available reasons for nonadherence were identified from a total of 728 patients who underwent curative and palliative radiation therapy between January 2014 and April 2015. 45.7 percent (%) of reasons were unavoidable, ranging from treatment-related side effects/ medical morbidities (23.7% of overall), machine breakdown (17.7%), and hospitalization (4.3%). 54.3% of reasons for nonadherence were avoidable, with bad weather (11.6%), conflicting healthcare appointments (7.6%), transportation barriers (5.9%), care coordination delays intra-departmentally [12.8%, i.e. treatment planning and machine delays, departmental closure] and interdepartmentally [6.2%, i.e. delays coordinating chemotherapy and medical clearance for radiation] cited as common reasons. Other avoidable reasons included personal and/ or social obligations (3.6%), holiday/travel (2.2%), patients unaware of appointment (1.3%), undecided about continuing treatment (0.6%) and choice to delay/terminate treatment (0.8%). Conclusion: Non-adherence to treatment represents a significant challenge in achieving optimal treatment for cancer patients undergoing radiation therapy. It is not only detrimental to overall cancer outcome but also adds to financial burden on the health care system. A treatment support learning system that encourages rapid communication and problem-solving procedures in an effort to quickly alert clinicians and patients of care coordination issues and toxicity burden may improve patients’ adherence to curative radiation treatment in real time. Author Disclosure: J. Purswani: None. S. Baliga: None. H. Haynes: None. R. Kabarriti: None. N. Ohri: None. B. Rapkin: None. M.K. Garg: None. S. Kalnicki: Chairman of Radiation Oncology; Montefiore Medical Center.
Sexual Function, Quality of Life (QOL), and Mood After Radiation Therapy in Patients With Anal Cancer R. Nipp,1 L.C. Drapek,2 S. Moran,1 S. D’Arpino,1 D. Mitra,3 T.I. Hong,4 D.S. Dizon,2 D.P. Ryan,5 J. Temel,2 and J.Y. Wo4; 1MGH Cancer Center, Boston, MA, 2Massachusetts General Hospital, Boston, MA, 3Harvard Radiation Oncology Program, Boston, MA, 4Massachusetts General Hospital, Harvard Medical School, Boston, MA, 5Masschusetts General Hospital, Boston, MA, United States Purpose/Objective(s): Patients with anal cancer who receive radiation therapy (RT) may experience RT-related toxicities, but the sexual function, QOL, and mood of this population are unknown. We hypothesized that a large proportion of patients with anal cancer experience issues with sexual function, QOL, and mood following RT. Materials/Methods: We prospectively enrolled anal cancer patients who were between 30 days and 10 years from completing definitive chemoRT and were seen by our multidisciplinary cancer team for routine surveillance from 1/12/2015 to 11/9/2015. All but 2 patients received dosepainted IMRT per RTOG 0529 and all but 1 received 5-FU plus Mitomycin C. We collected demographic and clinical characteristics from the medical record. We assessed sexual function using the Female Sexual Function Index (FSFI) for female patients and the International Index of Erectile Function (IIEF) for male patients. For both, lower scores indicate worse sexual function and we categorized subscale scores7 denote clinically significant depression or anxiety). We used descriptive statistics to evaluate sexual function, QOL, and mood. Results: We enrolled 42 of 50 (84%) eligible patients (mean ageZ65.9 years; 52% [nZ22] age <65; 81% [nZ34] female) with a median time since completing RT of 2.7 years (range, 0.1-8.3; 86% [nZ36] completed RT >1 year ago). Few had colostomies (10% [nZ4]). Most female patients had poor sexual function related to satisfaction (57% [12/21]), lubrication (57%, [17/30]), pain (56% [15/27]), arousal (55% [17/31]), orgasm (55% [17/31], and desire (53% [17/32]). Most male patients had poor satisfaction with intercourse (71% [5/7]) and erectile function (57% [4/7]). Mean global QOL (QLQ-C30: 86.8) and physical function (QLQC30: 91.0) scores were high with low CR29 scores for fecal incontinence (14.0), sore anal skin (19.4) and frequent stools (13.4). Only 5% (2/42) reported depression, yet 19% (8/42) had anxiety. Patients age <65 reported more problems with fecal incontinence (20.8 vs 6.7, PZ0.03) and sore anal skin (27.1 vs 11.1, PZ0.06), yet had better FSFI-orgasm scores (2.5 vs 0.8, PZ0.04) than older patients. Those who completed RT >1 year ago reported better FSFI-arousal (2.0 vs 0.0, P<0.01) and IIEF-overall satisfaction scores (7.3 vs 4.0, P<0.01) than those completing <1 year ago. Conclusion: Patients with anal cancer who receive RT experience high rates of sexual dysfunction. Despite high QOL scores, nearly one-fifth of patients reported anxiety. Additionally, we found that sexual function and symptoms differ across demographic and clinical factors. Our data support the need for ongoing efforts to understand and address issues with sexual function, QOL, and mood following RT for patients with anal cancer. Author Disclosure: R. Nipp: None. L.C. Drapek: None. S. Moran: None. S. D’Arpino: None. D. Mitra: None. T.I. Hong: None. D.S. Dizon: None. D.P. Ryan: None. J. Temel: None. J.Y. Wo: None.
3307 Reasons for Radiation Therapy Nonadherence From the Patient’s Perspective J. Purswani,1 S. Baliga,2 H. Haynes,3 R. Kabarriti,1 N. Ohri,1 B. Rapkin,1 M.K. Garg,1 and S. Kalnicki1; 1Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, 2Montefiore Medical Center, Bronx,
3308 Acute Quality of Life Changes After Stereotactic Ablative Radiation Therapy for Liver Metastasis: A Prospective Cohort Analysis J. Helou,1,2 I. Thibault,2,3 W. Chu,4,5 P. Munoz,2,3 D. Erler,2,3 G. Rodrigues,6,7 A. Warner,8 K. Chan,2,3 E. Chow,2,3 R. Korol,2 M.T. Davidson,2,3 and H.T. Chung2,5; 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada, 3 Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, ON, Canada, 4Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 5Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 6 Western University, London, ON, Canada, 7Department of Radiation Oncology, Western University, London, ON, Canada, 8London Health Sciences Centre, London, ON, Canada Purpose/Objective(s): The use of stereotactic ablative radiotherapy (SABR) to treat metastatic disease is increasing. There is a paucity of prospective quality of life (QOL) data published for liver SABR. Moreover reported series often include hepatocellular-carcinoma. Herein we report QOL after SABR in patients with liver metastases (LM)
Volume 96 Number 2S Supplement 2016 Author Disclosure: K. Havard: None. J.K. Elson: None. J.R. Kharofa: None. V. Takiar: None.
NY, 3Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY
3306
Purpose/Objective(s): Treatment non-adherence can be a significant contributor to treatment prolongation, which can lead to inferior tumor control and worse overall survival in certain malignancies. Although studies have attempted to elucidate predictors of non-compliance to radiation therapy, few studies have attempted to identify the reasons causing patients to miss the planned course of treatment. To our knowledge, there have been no studies that have assessed reasons for non-adherence from the perspective of the patient. The purpose of this study is to identify the most common reasons for missed appointments in an urban radiation oncology department. Materials/Methods: We queried our department’s electronic medical record (EMR) to identify all incomplete scheduled consults and radiotherapy appointments at our institution. We cross-referenced medical record numbers with demographic data using Clinical looking Glass (CLG), an interactive software application developed at our institution to evaluate healthcare efficiency. Patients who missed any appointment were asked for reasons during their weekly physician visit. Results: 1561 incomplete appointments with available reasons for nonadherence were identified from a total of 728 patients who underwent curative and palliative radiation therapy between January 2014 and April 2015. 45.7 percent (%) of reasons were unavoidable, ranging from treatment-related side effects/ medical morbidities (23.7% of overall), machine breakdown (17.7%), and hospitalization (4.3%). 54.3% of reasons for nonadherence were avoidable, with bad weather (11.6%), conflicting healthcare appointments (7.6%), transportation barriers (5.9%), care coordination delays intra-departmentally [12.8%, i.e. treatment planning and machine delays, departmental closure] and interdepartmentally [6.2%, i.e. delays coordinating chemotherapy and medical clearance for radiation] cited as common reasons. Other avoidable reasons included personal and/ or social obligations (3.6%), holiday/travel (2.2%), patients unaware of appointment (1.3%), undecided about continuing treatment (0.6%) and choice to delay/terminate treatment (0.8%). Conclusion: Non-adherence to treatment represents a significant challenge in achieving optimal treatment for cancer patients undergoing radiation therapy. It is not only detrimental to overall cancer outcome but also adds to financial burden on the health care system. A treatment support learning system that encourages rapid communication and problem-solving procedures in an effort to quickly alert clinicians and patients of care coordination issues and toxicity burden may improve patients’ adherence to curative radiation treatment in real time. Author Disclosure: J. Purswani: None. S. Baliga: None. H. Haynes: None. R. Kabarriti: None. N. Ohri: None. B. Rapkin: None. M.K. Garg: None. S. Kalnicki: Chairman of Radiation Oncology; Montefiore Medical Center.
Sexual Function, Quality of Life (QOL), and Mood After Radiation Therapy in Patients With Anal Cancer R. Nipp,1 L.C. Drapek,2 S. Moran,1 S. D’Arpino,1 D. Mitra,3 T.I. Hong,4 D.S. Dizon,2 D.P. Ryan,5 J. Temel,2 and J.Y. Wo4; 1MGH Cancer Center, Boston, MA, 2Massachusetts General Hospital, Boston, MA, 3Harvard Radiation Oncology Program, Boston, MA, 4Massachusetts General Hospital, Harvard Medical School, Boston, MA, 5Masschusetts General Hospital, Boston, MA, United States Purpose/Objective(s): Patients with anal cancer who receive radiation therapy (RT) may experience RT-related toxicities, but the sexual function, QOL, and mood of this population are unknown. We hypothesized that a large proportion of patients with anal cancer experience issues with sexual function, QOL, and mood following RT. Materials/Methods: We prospectively enrolled anal cancer patients who were between 30 days and 10 years from completing definitive chemoRT and were seen by our multidisciplinary cancer team for routine surveillance from 1/12/2015 to 11/9/2015. All but 2 patients received dosepainted IMRT per RTOG 0529 and all but 1 received 5-FU plus Mitomycin C. We collected demographic and clinical characteristics from the medical record. We assessed sexual function using the Female Sexual Function Index (FSFI) for female patients and the International Index of Erectile Function (IIEF) for male patients. For both, lower scores indicate worse sexual function and we categorized subscale scores
3307 Reasons for Radiation Therapy Nonadherence From the Patient’s Perspective J. Purswani,1 S. Baliga,2 H. Haynes,3 R. Kabarriti,1 N. Ohri,1 B. Rapkin,1 M.K. Garg,1 and S. Kalnicki1; 1Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, 2Montefiore Medical Center, Bronx,
3308 Acute Quality of Life Changes After Stereotactic Ablative Radiation Therapy for Liver Metastasis: A Prospective Cohort Analysis J. Helou,1,2 I. Thibault,2,3 W. Chu,4,5 P. Munoz,2,3 D. Erler,2,3 G. Rodrigues,6,7 A. Warner,8 K. Chan,2,3 E. Chow,2,3 R. Korol,2 M.T. Davidson,2,3 and H.T. Chung2,5; 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada, 3 Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, ON, Canada, 4Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 5Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 6 Western University, London, ON, Canada, 7Department of Radiation Oncology, Western University, London, ON, Canada, 8London Health Sciences Centre, London, ON, Canada Purpose/Objective(s): The use of stereotactic ablative radiotherapy (SABR) to treat metastatic disease is increasing. There is a paucity of prospective quality of life (QOL) data published for liver SABR. Moreover reported series often include hepatocellular-carcinoma. Herein we report QOL after SABR in patients with liver metastases (LM)