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B. Ferrell



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    MINI 28 - Psychological Impact of Lung Cancer and its Treatment (ID 150)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Palliative and Supportive Care
    • Presentations: 2
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      MINI28.03 - Causes of Death and Hospitalization in Long-Term Lung Cancer Survivors: A Population-Based Appraisal (ID 740)

      16:45 - 18:15  |  Author(s): B. Ferrell

      • Abstract
      • Presentation
      • Slides

      Background:
      Survivorship care has emerged as an important topic in lung cancer due to advances in screening and treatment that have led to prolonged survival. These survivors may have pre-existing comorbidities or health impairments from their treatments that impact quality of life. A better understanding of the healthcare needs of lung cancer survivors will assist in the development of patient-centered, comprehensive survivorship care. We used a population dataset to assess the most common reasons for hospital admission and causes of death among long term (5-year) survivors of lung cancer.

      Methods:
      Using linked data from the California Cancer Registry and Office of Statewide Health Planning and Development database, we identified all in-state lung cancer patients diagnosed from 2000-2009. Patients of all stages were included. We used ICD-9 codes to identify causes of death and primary admission diagnoses in survivors after 5 years of lung cancer diagnosis. Annual proportional distribution of reasons for admission and causes of death for survivors were calculated over time.

      Results:
      Among 157,236 lung cancer patients, 80.6% (n=126,775) died within 5 years of diagnosis. Although lung cancer accounted for the majority of hospital admissions in the initial years post-diagnosis, nonmalignant pulmonary disease, (n=7,102, 23.3%) replaced lung cancer progression (n=2,047, 6.7%) as the most common principal diagnosis in 30,461 admissions among 9,166 survivors who were admitted after 5 years from initial lung cancer diagnosis (Figure 1A). Cardiovascular (n=5,712, 18.8%), gastrointestinal (n=2,901, 9.5%), and infectious diseases (n=2,819, 9.3%) also surpassed lung cancer progression as reasons for admission after 5 years of survival. However, lung cancer progression remained the leading cause of death in long-term lung cancer survivors (Figure 1B). Among 5-year survivors, 46.2% (n= 2,855) eventually died from lung cancer progression. The next most common causes of death were cardiovascular disease (n=947, 15.3%), nonmalignant pulmonary disease (n=776, 12.6%), and secondary malignancy (n=605, 9.8%). Figure 1



      Conclusion:
      Most lung cancer patients died within 5 years of diagnosis. Among remaining survivors, cardiovascular, pulmonary, and gastrointestinal diseases rather than lung cancer were the primary reasons for hospital admission 5 years after diagnosis. However, lung cancer progression remained the dominant cause of patient death even beyond 5 years of survival. Cardiopulmonary disease and other malignancies were secondary competitors for mortality. Active control of chronic cardiopulmonary disease in addition to lung cancer surveillance should be priorities in long-term lung cancer survivors.

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      MINI28.07 - Interdisciplinary Palliative Care for Lung Cancer Patients and Family Caregivers (ID 379)

      16:45 - 18:15  |  Author(s): B. Ferrell

      • Abstract
      • Presentation
      • Slides

      Background:
      Palliative care is focused on supporting the best possible quality of life (QOL) for patients and family caregivers (FCGs) coping with serious and complex illnesses such as lung cancer. Although the accepted definition of palliative care encompasses the entire trajectory of the cancer continuum from diagnosis to the end of life, the majority of published palliative care trials focused primarily on patients with metastatic disease. The purpose of this National Cancer Institute-supported Program Project (P01) was to test the effect of a concurrent, interdisciplinary palliative care intervention in patients with Stage I-IV non-small cell lung cancer (NSCLC) and FCGs in an ambulatory care setting, comparing the usual care and intervention groups.

      Methods:
      Patients undergoing treatments for NSCLC and their FCGs were enrolled in a prospective, sequential design whereby the usual care group was accrued first followed by the intervention group. Patients and FCGs in the intervention group completed a comprehensive QOL assessment at baseline, and were presented by nurses at weekly interdisciplinary care meetings. They also received four educational sessions that addressed physical, psychological, social, and spiritual well-being needs. Patients and FCGs in the usual care group received disease-focused therapies and procedures and were referred by their treating oncologist to palliative care services as needed per standard of care. Patients’ QOL, symptoms, and psychological distress were assessed at baseline and 12 weeks using validated measures which included the FACT-L, FACIT-Sp-12, LCS, and the Distress Thermometer. FCG outcomes included QOL, psychological distress, perceived burden, and caregiving preparedness, with validated measures that included the COH-QOL-FCG, Distress Thermometer, Caregiver Burden Scale, and Caregiver Skills Preparedness Tool. Outcomes were tested using factorial ANOVAs controlling for baseline scores, with disease stage as a blocking variable and group (usual care versus intervention) as the factor.

      Results:
      A total of 491 patients (219 = usual care; 272 = intervention) and 354 FCGs (157 = usual care; 197 = intervention) who completed baseline assessments were included in the primary analysis. Patients who received the intervention had significantly better scores for QOL (109.1 vs. 101.4; p<.001), symptoms (25.8 vs. 23.9; p<.001) spiritual well-being (38.1 vs. 36.2; p=.001), lower psychological distress (2.2 vs. 3.3; p<.001), and more advance care planning (44% versus 9%; p<.001) at 12 weeks compared to patients in the usual care group. FCGs in the intervention group had significantly better scores for social well-being (5.84 vs. 6.86; p<.001) and lower psychological distress (4.61 vs. 4.20; p=.010) at 12 weeks compared to FCGs in the usual care group. Survival analysis for stage IV patients using the Kaplan-Meier approach did not achieve statistical significance but showed a 6 month difference in favor of the intervention group. t included the COH-QOL-FCG, Distress Thermometer, Caregiver Burden Scale, and Caregiver Skills Preparedness Tool. Outcomes were tested using factorial ANOVAs controlling for baseline scores, with disease stage as a blocking variable and group (usual care versus intervention) as the factor.

      Conclusion:
      Interdisciplinary palliative care in the ambulatory care setting resulted in significant improvements in QOL, symptoms, and psychological distress for NSCLC patients and FCGs.

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    P1.11 - Poster Session/ Palliative and Supportive Care (ID 229)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Palliative and Supportive Care
    • Presentations: 1
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      P1.11-004 - Impact of Lung Cancer Surgery on Quality of Life of Family Caregivers (ID 1431)

      09:30 - 17:00  |  Author(s): B. Ferrell

      • Abstract
      • Slides

      Background:
      Family caregivers (FCGs) of lung cancer patients experience decreased quality of life (QOL) and psychological distress related to their caregiving role. Although there is extensive data about the significant impact of lung cancer surgery on patient QOL, little is known about the impact on FCGs. We describe QOL, psychological distress, and perceived caregiver burden outcomes among FCGs of patients undergoing lung cancer surgery.

      Methods:
      As part of a National Cancer Institute-supported Program Project (P01) testing the effect of a palliative care intervention in patients with non-small cell lung cancer, patients and their FCGs were sequentially enrolled into a usual care group or an intervention group, which received interdisciplinary care planning as well as a comprehensive assessment and education by an advanced practice nurse. For this subset analysis, we included only those patients who underwent surgery and their FCGs. Outcomes were assessed at baseline (pre-operatively), at 6-7 weeks, and 12 weeks after surgery. FCGs were assessed using the following validated measures: distress thermometer for psychological distress, family version of QOL scale in four domains (physical, psychological, social, and spiritual well being), and Caregiver Burden Scale. Patients were assessed using distress thermometer and FACT-L for QOL domains.

      Results:
      QOL data were available for 41 pairs of patients and FCGs (10 usual care and 31 intervention). Psychological distress levels were highest for patients (3.8/10) and FCGs (5.1/10) before surgery, then decreased six weeks after surgery for both groups respectively (2.9/10 and 4.2/10). Patients’ distress continued to decrease at 12 weeks (2.2/10, p = .001), but FCGs did not (4.4/10, p = .0.157). Although patients had improvements in all domains between 6 and 12 weeks, FCGs did not experience similar improvements in most domains (Figure 1). Likewise, there was no significant decrease in caregiver objective burden over the 12 weeks (21.1 vs. 21.3, p = 0.942). Patients in the intervention group had improved total QOL at 12 weeks compared to usual care (Total FACT-L 116 vs. 94, p <.001). In contrast, there were no significant differences between the usual care and intervention groups in QOL of FCGs.

      Conclusion:
      FCGs of lung cancer patients experience significant psychological distress. FCGs continue to have decreased QOL 3 months after lung cancer surgery. The trajectory of QOL for FCGs does not mirror that of patients. FCGs play an important role in patient recovery and greater research is needed to understand how they are impacted by thoracic surgery. Figure 1



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