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Bryna Ewachiw
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P2.10 - Prevention and Tobacco Control (Not CME Accredited Session) (ID 959)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.10-01 - Success of a Pharmacy-Driven Smoking Cessation Program (ID 11315)
16:45 - 18:00 | Author(s): Bryna Ewachiw
- Abstract
Background
While national oncology organizations advocate smoking cessation integrated into cancer management, only 30-40% of oncologists provide assistance with quitting. Barriers to providing this service are well documented. Pharmacy learners are poised to provide this intervention with the incorporation of smoking cessation therapies in accredited PharmD curricula. Previous pharmacist-driven programs reported 30-day quit rates of 23%. A pharmacy-driven pilot was initiated in April 2017 in a Thoracic Oncology Center of Excellence. The purpose of this study was to establish a new standardized infrastructure for a cessation program, determine its feasibility, and determine 30-day smoking cessation success rates for patients in a thoracic multidisciplinary clinic (MDC).
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients seen in the thoracic MDC between April 2017 and March 2018 were included. Primary endpoints included patient capture rate in clinic, acceptance rate of tobacco assessment and smoking cessation counseling, and 30-day cessation rates. Tobacco use assessments and smoking cessation counseling were performed and documented by a pharmacy learner (pharmacy resident or student), under the supervision of a licensed pharmacist, prior to the history and physical by a health care provider. All patients who were active smokers or former smokers who quit within the last three months were offered cessation counseling and follow up. Nicotine replacement therapy was immediately available and provided to eligible patients based on tobacco use. Participants were followed up in clinic or by phone every two weeks for the first three months, at six months, nine months, and one year of program enrollment. At least two follow up phone call attempts were made until determined not successfully reached.
4c3880bb027f159e801041b1021e88e8 Result
One-hundred sixty-four of 189 patients seen in MDC were assessed by the pharmacy team. Forty-five (27%) of 164 assessed patients met eligibility criteria. Thirty-two (75%) of 45 eligible patients participated in same day counseling for smoking cessation and agreed to enroll in the follow up program. Quit rates at 30 days for enrolled patients were 44% (14/32). At one, three, and six months, 25%, 56%, and 81% of patients, respectively, were unavailable by phone.
8eea62084ca7e541d918e823422bd82e Conclusion
The majority of eligible patients enrolled in the smoking cessation program. More than 40% of enrolled patients were successful in smoking cessation at 30 days, which compares favorably to previous reports. Telephone follow up was challenging. Future efforts to expand smoking cessation in a comprehensive cancer center utilizing a pharmacy-driven intervention are warranted.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.15-05 - Prescribing Patterns of Physicians and Financial Implications for Lung Cancer Treatment at the End of Life (ID 12176)
16:45 - 18:00 | Author(s): Bryna Ewachiw
- Abstract
Background
Rates of systemic chemotherapy use at the end of life are estimated to be above 44%. Limited information exists on prescribing patterns of intravenous and oral treatments (immunotherapy, chemotherapy, and tyrosine kinase inhibitors) at the end of life. Use of systemic therapy in the last month of life may have a significant clinical and financial impact. This study aimed to evaluate prescribing patterns and costs associated with lung cancer treatments in the last month of life in two large academic institutions.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients (n=184) deceased between July 2016 and June 2017 who received lung cancer treatment were included in this analysis. The primary objective was characterization of prescribing patterns associated with end of life care. Patient, disease, and treatment related factors were recorded. Patient characteristics were compared between those who did and did not receive treatment in the final month of life using Wilcoxon and chi-square tests, respectively.
4c3880bb027f159e801041b1021e88e8 Result
Forty-three (23%) patients received treatment in the last 28 days of life. Patient-related factors were similar between patients who did and did not receive therapy at the end of life. Patients who did not receive therapy at the end of life were more likely to be enrolled in hospice (72% vs 40%; p =0.0035, chi-square test). Of therapies given within the last month of life, 47% were oral therapies, 35% were intravenous chemotherapy, and 16% were immunotherapy (p = <0.0001, chi-square test). Using average wholesale price, overall drug costs given in the last month of life were $422,454, of which oral agents accounted for $326,400. There were no statistical differences in patient factors, including age, creatinine, albumin, hemoglobin, Charlson Index, and ECOG performance status between patients who received therapy at the end of life and those that did not (all p-values >0.05).
8eea62084ca7e541d918e823422bd82e Conclusion
Oral therapies are the most commonly prescribed modality of treatment at the end of life compared to intravenous chemotherapy or intravenous immunotherapy. Oral therapies pose a significant financial burden to patients at the end of life. Using patient factors to determine candidates for therapy at the end of life continues to be an area of exploration. Further studies are warranted to identify when therapies should be discontinued or to identify patients who may not benefit from systemic therapy.
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