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Enza Esposito Nguyen
ES26 - The Impact of Specialist Nursing and Allied Health Professionals in the Care of Thoracic Oncology Patients (ID 28)
- Event: WCLC 2019
- Type: Educational Session
- Track: Nursing and Allied Professionals
- Presentations: 4
- Now Available
- Moderators:Pippa Labuc, Enza Esposito Nguyen
- Coordinates: 9/10/2019, 14:30 - 15:45, San Francisco (2009)
ES26.01 - The Impact of Specialist Nursing Intervention in Lung Cancer (Now Available) (ID 3292)
14:30 - 15:45 | Presenting Author(s): Alison Leary
The Impact of Specialist Nursing Intervention in Lung Cancer
Alison Leary on behalf of
Iain Stewarta, , Aamir Khakwania , Richard B. Hubbarda , Paul Beckettb , Diana Borthwickc , Angela Toddd , Alison Learye , Laila J. Tataa
A Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK
B Derby Teaching Hospitals NHS Foundation Trust, DE22 3NE, UK
c Edinburgh Cancer Centre, Western General Hospital, EH4 2JT, UK
d School of Nursing and Midwifery, University of Sheffield, S10 2LA, UK
e School of Primary & Social Care, London South Bank University, SE1 0AA, UK
In the UK the role of the Clinical Nurse Specialist is well established. Lung Cancer Clinical Nurse Specialists (LCNS) often start a therapeutic relationship with patients and families before formal diagnosis has been made. LCNS often manage the care of people with lung cancer but in an environment of austerity their worth to employers is still questioned.
This series of studies examined the impact of the LCNS on outcomes for lung cancer patients.
The focus of this abstract is one of the studies which looks at receipt of treatment for lung cancer.
Treatment choices for people with lung cancer may be influenced by contact and engagement with lung cancer nurse specialists (LCNSs). We investigated how service factors, LCNS workload, and LCNS working practices may influence the receipt of anticancer treatment.
Materials and methods
English National Lung Cancer Audit data and inpatient Hospital Episode Statistics for 109,079 people with lung cancer surviving 30 days from diagnosis were linked along with LCNS workforce census data and a bespoke nationwide LCNS survey. Multinomial logistic regression was used to determine adjusted relative risk ratios (RRRs) for receipt of anticancer therapies associated with LCNS assessment, LCNS workforce composition, caseload, LCNS reported working practices, treatment facilities at the patients’ attending hospitals, and the size of the lung cancer service.
Assessment by an LCNS was the strongest independent predictor for receipt of anticancer therapy, with early LCNS assessments being particularly associated with greater receipt of surgery (RRR 1.85, 95%CI 1.63–2.11). For people we considered clinically suitable for surgery, receipt was 55%. Large LCNS caseloads were associated with decreased receipt of surgery among suitable patients (RRR 0.71, 95%CI 0.51–0.97) for caseloads >250 compared to ≤150. Reported LCNS working practices were associated with receipt of surgery, particularly provision of psychological support (RRR 1.60, 95%CI 1.02–2.51) and social support (RRR 1.56, 95%CI 1.07–2.28).
LCNS assessment, workload, and working practices are associated with the likelihood of patients receiving anticancer therapy. Enabling and supporting LCNSs to undertake key case management interventions offers an opportunity to improve treatment uptake and reduce the apparent gap in receipt of surgery for those suitable
Early nurse specialist contact is associated with greater receipt of therapy.
•Receipt of surgery is less likely where nurse specialists have large caseloads.
•Therapy receipt is more likely if key nursing interventions are routinely provided.
•Managing nurse specialists’ workload could address disparities in therapy uptake.
Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anticancer therapy? (2018) Stewart, Iain et al. Lung Cancer, Volume 123, 160 – 165
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ES26.02 - Rehabilitation After Treatment of Thoracic Malignancies (Now Available) (ID 3293)
14:30 - 15:45 | Presenting Author(s): Chris L Wells
In this presentation the speaker will focus the talk on the collaborative model between the Departments of Nursing and Rehabilitation Services in the promotion of functional recovery of hospitalized adults. The speaker will incorporate the current literature regarding early mobilization and rehabilitation and the program's effects on outcomes. The talk will also examine the physical impairments and functional limitations associated with cancer associated frailty. Finally, the speaker will share some priminary data from the efforts at the University of Maryland Medical Center on the implementation of a collaborative mobilization and rehabilitation program to address barriers to recovery and hospital discharge.
ES26.03 - The Impact of Early Nursing Intervention on Outcomes for Thoracic Oncology Patients (Now Available) (ID 3295)
14:30 - 15:45 | Presenting Author(s): Iveta Nohavova
Introduction: The roles of nurses vary from cancer screening, detection, and prevention, to active clinical assessment, treatment administration or symptom management. These various aspects play part when raising public awareness of important role of prevention. One of the very effective examples of an early health intervention is prevention of no tobacco use uptake or quitting using tobacco products in order to enhance health outcomes. The latest WHO/Europe report1 “European tobacco use – trends report 2019” shows tobacco use continues to be a paramount public health issue. At the same time, it is estimated 90% of lung cancers (incl. tracheal or bronchal) could be avoided if tobacco use is eliminated. Sadly, the WHO European Region has the highest proportion of tobacco use in the world, with an estimated 29% of population using tobacco. Nurses can help.
Methods: A review of guidelines and recommendations for nurses to use in daily practice will be presented.
Results: Not applicable
Conclusions: With prevention must be the key priority action, such focused early nurses interventions can contribute to timely diagnosis of the cancer positively impacting outcomes of thoracic oncology patients, including quality of life and care experience. Nurses are ideally positioned to assume this role. This presentation will explore current evidence related to the role of cancer nurse in early interventions to thoracic cancer patients‘ outcomes. The session will include discussion and recommendations to increase role of nurses in prevention of tobacco use.
1. WHO (2019). European Tobacco Use: Trends Report 2019. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0009/402777/Tobacco-Trends-Report-ENG-WEB.pdf
ES26.04 - Early Intervention and Rehabilitation for Patients Newly Diagnosed with Thoracic Malignancies (Now Available) (ID 3296)
14:30 - 15:45 | Presenting Author(s): Morten Quist
This presentation will outline the rationale, role and evidence supporting early Intervention and rehabilitation for patients newly diagnosed with thoracic malignancies. Thoracic malignancies are associated with high disease burden and increased inactivity. Newly diagnosed Individuals with thoracic malignancies experience complex symptoms, which can include dyspnoea, fatigue and pain. These frequently lead to a cycle of inactivity and functional decline. Individuals with thoracic malignancies are less physically active than similar aged healthy peers at time of diagnosis, with less than 40% meeting the physical activity guidelines (1). Following diagnosis, physical activity levels are lowest whilst patients undergo treatment and do not recover back to pretreatment levels within six months. Progressive functional decline occurs over time, with reduction in exercise capacity and muscle strength (1). In thoracic malignancies, reduced exercise performance is associated with poorer functional independence, worse cancer treatment tolerability and higher all-cause mortality (2). People with thoracic malignancies, who are less physically active, have worse symptoms, and poorer exercise capacity and health-related quality of life (HRQoL) compared to those who are more active (1). This is supported and linked with the research by Gralla et al in 2014 (3) who identified key issues that patients with thoracic malignancies mainly fear. Gralla el al described the five rated issues which were: maintaining independence, ability to perform normal daily activities, ability to sleep, not being a burden for caregivers and not being fatigued, in a survey among 660 patients with lung cancer. Moreover, up to 44% of patients with thoracic malignancies experience depression and anxiety symptoms, which is consistently higher than other cancers types, and psychological distress has also been proven to affect anti-cancer treatment and mortality (4).
Supervised high-intensity exercise training is associated with improved exercise capacity and QOL in most cancer patients (5). Systematic reviews have reported that both pre- and postoperative exercise interventions are safe and feasible for patients with operable thoracic malignancies, and suggest benefits on exercise capacity, symptoms as fatigue and some domains of QOL (6). However, this evidence does not include patients with advanced inoperable thoracic malignancies. Although research groups have previously shown that exercise in these patients is safe, feasible, and beneficial (7), conclusive randomized controlled trials (RCT) still remain to be carried out to determine the effect of exercise for patients with advanced inoperable thoracic malignancies. But larger RCT within this group of patients is currently finished and ongoing and within the next few years the evidence will increase. Next step though is to implement evidence into daily practice.
1. Granger CL, McDonald CF, Irving L, Clark RA, Gough K, Murnane A, et al. Low physical activity levels and functional decline in individuals with lung cancer. Lung Cancer. 2014;83(2):292-9.
2. Jones LW, Hornsby WE, Goetzinger A, Forbes LM, Sherrard EL, Quist M, et al. Prognostic significance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer. Lung Cancer. 2012;76(2):248-52.
3. Gralla RJ, Hollen PJ, Msaouel P, Davis BV, Petersen J. An evidence-based determination of issues affecting quality of life and patient-reported outcomes in lung cancer: results of a survey of 660 patients. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 2014;9(9):1243-8.
4. Sullivan DR, Ganzini L, Duckart JP, Lopez-Chavez A, Deffebach ME, Thielke SM, et al. Treatment receipt and outcomes among lung cancer patients with depression. Clinical oncology (Royal College of Radiologists (Great Britain)). 2014;26(1):25-31.
5. Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs. Cancer treatment reviews. 2017;52:91-104.
6. Ni HJ, Pudasaini B, Yuan XT, Li HF, Shi L, Yuan P. Exercise Training for Patients Pre- and Postsurgically Treated for Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis. Integr Cancer Ther. 2016.
7. Quist M, Adamsen L, Rorth M, Laursen JH, Christensen KB, Langer SW. The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy. Integr Cancer Ther. 2015;14(4):341-9.
EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
EP1.16-02 - Proactively Improving the Management of Immune-Related Adverse Events (irAEs) in a Community Cancer Program (Now Available) (ID 1874)
08:00 - 18:00 | Author(s): Enza Esposito Nguyen
As more patients with lung cancer are being treated with immune checkpoint inhibitor (ICI) therapy in community settings, there is a pressing need to properly identify and manage immune-related adverse events (irAEs). Promptly and correctly identifying and managing irAEs can be challenging since clinicians may lack knowledge about irAEs. Furthermore, patients may not know when to report symptoms. For these reasons, an educational research project supported by a grant from Genentech was developed to assess how cancer clinicians may improve the identification and management of irAEs.Method
The cancer care team at St. Joseph Hospital Orange (SJO) reviewed 30 patient charts (9 lung cancer, 21 other types of cancers) in early 2018 and assessed the documentation of different types of irAEs, the grading of symptom severity, and how often irAEs led to a visit to an urgent care, ER, or inpatient hospital visit. 37% of patients developed a suspected irAE; the severity of symptoms was documented in 57% of charts; 27% of patients developed irAEs that required care in an ER or hospital. In July 2018, members of the cancer care team held a workshop to discuss their findings and identify opportunities to improve the identification and management of irAEs. Using Plan-Do-Study-Act (PDSA) cycles for improvement, the team at SJO developed and implemented the following process changes: 1) a patient education video explaining irAEs (made in English and Spanish) that is delivered by infusion nurses when patients start ICI therapy; 2) continued use of immunotherapy wallet cards for patients; 3) improving awareness among infusion nurses about irAEs; 4) updates to survivorship care plans to highlight how delayed irAEs may occur after active cancer treatment is completed.Result
The project remains ongoing at the time of abstract submission. The patient education video was approved by the oncology council and launched in Jan 2019. The infusion nurses report that patients who watch the video are highly engaged and asking questions about irAEs. Changes to the survivorship care plans were finalized at the end of 2018 and were focused on patients receiving ICI therapy for curative intent (eg, adjuvant melanoma and lung cancer).Conclusion
Since serious irAEs may occur at any time, a proactive approach is required to improve the identification and management of irAEs and ensure optimal patient outcomes. This project demonstrates how one community cancer center developed feasible interventions based on identified needs.
P1.07 - Nursing and Allied Professionals (ID 171)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Nursing and Allied Professionals
- Presentations: 1
- Now Available
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
P1.07-03 - Improving Non-Oncology Provider Knowledge of Unique Immunotherapy Adverse Events (Now Available) (ID 1846)
09:45 - 18:00 | Presenting Author(s): Enza Esposito Nguyen
Immunotherapy use is increasing in frequency among oncology patients as a single treatment or in combination with other modalities. Immunotherapy related adverse events (IrAE) have unique presentations that are often overlooked or misdiagnosed outside of oncology. This IRB approved study sought to evaluate the effectiveness of microteaching on non-oncology providers’ identification of IrAEs and timely initiation of definitive therapy. A second aim was to review result on patient outcomes through review of EHR.Method
Microteaching sessions of 10 minutes in length were scheduled. Sessions occurred before or after staff meetings, at change of shift huddles, and at the monthly ER physician meeting. The six item test pretest/posttest evaluated familiarity with immunotherapy, and identification of and appropriateness of treatment for patients with IrAEs. A paper version of the pretest was given prior to the education which was delivered to nursing in small groups consisting of 2 to10 participants. All physician participants received education at the same time. Immediately following the teaching participants completed the posttest. A retrospective review of electronic health records was conducted to determine timeliness of identification of IrAEs and appropriateness of treatment.Result
A Phi coefficient was calculated to measure the association between pretest and posttest scores on five questions. For all RNs, all items demonstrated an increase in knowledge (p <.0001). Similarly, ER nurses demonstrated an increase in knowledge in all items (p < .0001). Conversely, oncology nurses had better baseline knowledge compared to “all” nurses. This supports the premise that within the oncology specialty, information about irAEs is better known and understood. Although oncology nurses are more prepared to identify and manage these issues, these nurses are not involved in patient care during an ER visit or admission to an ICU. Physicians also had higher baseline scores compared to all nurses, however, to the question ‘are you familiar with the intervention (s) needed to start reversing most immunotherapy adverse events?’ had a significant increase in knowledge following the micro-teaching in-service (p < .0001).Conclusion
Immunotherapy is increasing in use in oncology, as a result, non-oncology providers will progressively encounter patients receiving these agents in non-oncology settings throughout the hospital such as emergency department or ICU. Brief educational sessions were found effective in increasing non-oncology providers knowledge of these immunotherapy agents and their AEs management .