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Julia Trosman



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    MA19 - Looking at PROs in Greater Detail - What Patients Actually Want and Expect (ID 147)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      MA19.01 - Empirical Identification of Distress Clusters in Lung Cancer Patients (Now Available) (ID 2085)

      11:30 - 13:00  |  Author(s): Julia Trosman

      • Abstract
      • Presentation
      • Slides

      Background

      Screening for distress from the time of diagnosis is emerging as standard cancer care. Although there is heterogeneity in patients’ experience of distress, identification of subgroups of patients with unique distress profiles may inform interventions for distressed patients. Accordingly, we aimed to identify unique subgroups of patients based on their distress screening responses from a large sample of newly diagnosed lung cancer patients across two urban academic medical centers in Chicago, IL.

      Method

      Lung cancer patients (N=596) were screened for distress at their diagnostic visit between (2/22/16 – 8/14/18) with the Coleman Foundation “Patient Screening Questions for Supportive Care” tool; a 34-item screener that identifies patient needs across psychological, physical, family/caregiver, and treatment and care concerns. A Two-Step cluster analysis was conducted to identify natural clusters of patients based on similar responses to distress screening items.

      Result

      Cluster analysis results revealed a two-cluster outcome: “High Distress” (N=332) and “Low Distress” (N=264). The items that best distinguished High Distress patients from Low Distress patients were concerns about cancer stage/diagnosis, concerns about prognosis/long-term outcome, concerns about treatment options, and having higher average number of total concerns. Cancer stage at screening was not predictive of cluster membership. Demographic characteristics, descriptive statistics, and group difference tests for survey items by cluster and for the total sample are presented in Table 1.

      Conclusion

      More than half of lung cancer patients were grouped as experiencing high distress on screening. While cancer stage was not predictive of high distress grouping, concerns about stage, treatment, and prognosis were most predictive of high distress cluster membership. An intervention to improve communication between providers and patients about these concerns may reduce distress.

      Table 1

      High Distress (N=332/55.7%)

      Low Distress (N=264/ 44.3%)

      Total Sample (N=596)

      Significance

      Tests

      Demographics

      Age

      M=65.75 (SD=9.95)

      M=66.25 (SD=9.71)

      M=65.97 (SD=9.84)

      F=.39 (p>.05)

      Female

      N=171 (51.5%)

      N=144 (54.5%)

      N=315 (52.9%)

      χ2=.55 (p>.05)

      Race/Ethnicity

      χ2=30.83 (p<.01)

      White

      N=124 (37.3%)

      N=154 (58.3%)

      N=278 (46.6%)

      p<.01

      African American

      N=161 (48.5%)

      N=72 (27.3%)

      N=233 (39.1%)

      p<.01

      Other

      N=47 (14.2%)

      N=38 (14.4%)

      N=85 (14.3%)

      p>.05

      Stage IV

      N=160 (48.2%)

      N=118 (44.7%)

      N=278 (46.6%)

      χ2=.72 (p>.05)

      Physical & Psychological Health

      Psychological Distress (PhQ-4)

      M=3.55 (SD=3.63)

      M=1.56 (SD=2.14)

      M=2.67 (SD=3.29)

      F=58.86 (p<.01)

      Pain

      M=5.13 (SD=4.76)

      M=4.76 (SD=3.45)

      M=4.99 (SD=3.66)

      F=1.04 (p>.05)

      Fatigue

      M=8.56 (SD=5.31)

      M=7.63 (SD=4.74)

      M=8.15 (SD=5.01)

      F=4.34 (p<.05)

      Physical Activity

      M=12.63 (SD=7.74)

      M=16.70 (SD=8.52)

      M=14.42 (SD=8.33)

      F=35.55 (p<.01)

      Concerns

      Practical Concerns

      Childcare

      N=8 (2.5%)

      N=2 (.8%)

      N=10 (1.7%)

      χ2=2.43 (p>.05)

      Food & Housing

      N=58 (17.8%)

      N=13 (5.0%)

      N=71 (12.2%)

      χ2=22.06 (p<.01)

      Transportation

      N=72 (22.0%)

      N=14 (5.4%)

      N=86 (14.7%)

      χ2=31.29 (p<.01)

      Work/School

      N=19 (5.9%)

      N=8 (3.1%)

      N=27 (4.7%)

      χ2=2.49 (p>.05)

      Paying for Medication

      N=79 (24.1%)

      N=35 (13.6%)

      N=114 (19.5%)

      χ2=10.19 (p<.01)

      Family/Caregiver Concerns

      Children

      N=46 (18.7%)

      N=18 (8.0%)

      N=64 (13.6%)

      χ2=11.58 (p<.01)

      Partner

      N=51 (20.9%)

      N=24 (10.6%)

      N=75 (15.9%)

      χ2=9.37 (p<.01)

      Caregiver

      N=23 (9.5%)

      N=8 (3.5%)

      N=31 (6.6%)

      χ2=6.91 (p<.01)

      Ability to have children

      N=8 (3.3%)

      N=2 (.9%)

      N=10 (2.1%)

      χ2=3.35 (p>.05)

      Family

      N=62 (25.6%)

      N=24 (10.5%)

      N=86 (N=18.3%)

      χ2=18.07 (p<.01)

      Treatment & Care Concerns

      Cancer Diagnosis & Stage

      N=303 (93.5%)

      N=8 (3.3%)

      N=311 (55.1%)

      χ2=453.34(p<.01)

      Prognosis & Long-term Outcome

      N=312 (95.7%)

      N=37 (15.4%)

      N=349 (61.6%)

      χ2=378.04 (p<.01)

      Treatment Options

      N=246 (75.7%)

      N=11 (4.6%)

      N=257 (45.4%)

      χ2=282.43 (p<.01)

      Communicating treatment wishes

      N=165 (52.1%)

      N=7 (2.9%)

      N=172 (30.8%)

      χ2=155.09 (p<.01)

      Physical Health Concerns

      Breathing

      N=160 (64.3%)

      N=78 (35.5%)

      N=238 (50.7%)

      χ2=38.77 (p<.01)

      Constipation

      N=86 (43.4%)

      N=41 (20.0%)

      N=127 (31.5%)

      χ2=25.63 (p<.01)

      Diarrhea

      N=47 (27.0%)

      N=17 (8.5%)

      N=64 (17.1%)

      χ2=22.68 (p<.01)

      Fevers

      N=22 (13.3%)

      N=4 (2.1%)

      N=26 (7.2%)

      χ2=16.72 (p<.01)

      Nausea/Vomiting

      N=66 (33.7%)

      N=16 (8.1%)

      N=82 (20.8%)

      χ2=39.15 (p<.01)

      Sleep

      N=137 (59.3%)

      N=58 (27.4%)

      N=195 (44.0%)

      χ2=45.79 (p<.01)

      Urination

      N=46 (26.1%)

      N=12 (6.0%)

      N=58 (15.5%)

      χ2=28.79 (p<.01)

      Chewing/Swallowing

      N=49 (27.1%)

      N=18 (9.1%)

      N=67 (17.7%)

      χ2=21.01 (p<.01)

      Mouth Sores

      N=24 (14.5%)

      N=13 (6.6%)

      N=37 (10.2%)

      χ2=6.18 (p<.05)

      Dry Mouth

      N=116 (53.2%)

      N=51 (24.5%)

      N=167 (39.2%)

      χ2=36.76 (p<.01)

      Swollen Arms or Legs

      N=76 (39.6%)

      N=21 (10.5%)

      N=97 (24.7%)

      χ2=44.49 (p<.01)

      Feeling full quickly or swollen abdomen

      N=57 (32.0%)

      N=18 (9.2%)

      N=75 (20.1%)

      χ2=30.35 (p<.01)

      Sexual Intimacy or Functioning

      N=54 (28.3%)

      N=17 (8.4%)

      N=71 (18.0%)

      χ2=23.37 (p<.01)

      Dry/Itchy or Blistered Skin

      N=94 (46.3%)

      N=43 (20.7%)

      N=137 (33.3%)

      χ2=30.37 (p<.01)

      Tingling in hands/feet

      N=84 (43.5%)

      N=33 (16.8%)

      N=117 (30.1%)

      χ2=32.93 (p<.01)

      Appearance

      N=31 (19.35)

      N=14 (7.2%)

      N=45 (12.7%)

      χ2=11.52 (p<.01)

      Use of Alcohol or Drugs

      N=3 (2.0%)

      N=1 (.5%)

      N=4 (1.2%)

      χ2=1.59 (p>.05)

      Total # of Concerns

      M=7.84 (SD=3.71)

      M=2.53 (SD=2.47)

      M=5.49(SD=4.16)

      F=400.82 (p<.01)

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