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Nicole Andrea Arrato
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MA10 - Assessing and Managing Supportive Care Needs (ID 215)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 1/31/2021, 11:45 - 12:45, Scientific Program Auditorium
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MA10.03 - The FITNESS Study: An Innovative Approach to Assessing Disability in Older Adults with Lung Cancer (ID 3577)
11:45 - 12:45 | Presenting Author(s): Nicole Andrea Arrato
- Abstract
Introduction
Although survival is commonly utilized as a study outcome, the majority of older adults with cancer prioritize remaining functionally independent over prolonged survival. This study examines the feasibility of a new approach to assessing disability in older adults with lung cancer.
Methods
Adults age >60 receiving treatment for newly diagnosed non-small cell lung cancer (NSCLC) enrolled in this ongoing prospective cohort study. At baseline, demographic and disease-related variables were collected (e.g., age, sex, race/ethnicity, disease histology and grade, treatment regimen and toxicity). The multifactorial assessment included the Cancer and Aging Research Group cancer-specific Comprehensive Geriatric Assessment (CARG-CGA), the Short Physical Performance Battery (SPPB), which includes the Timed Up and Go test, a 13-item functional assessment measure focusing on patient-reported ability to complete activities of daily living (ADLs; e.g., dress, toilet) and instrumental ADLs (IADLs; e.g., shopping, finances), and the Patient Reported Outcomes Measurement Information System 10-item scale (PROMIS-10), which measures quality of life. Descriptive statistics were conducted to describe the sample on these outcomes at baseline.
Results
Seventy-two patients were approached; 15 declined and 57 (79.2%) consented. After consent, 10 patients dropped out and 1 has yet to start treatment, providing 46 patients for the present study. The mean age of the sample was 71.7 years (SD=6.52, range=60-88 years). The majority were male (n=26, 57.8%) and identified as Caucasian (n=41, 91.1%). The majority of the sample was diagnosed with adenocarcinoma (n=33, 73.3%) or squamous cell carcinoma (n=10, 22.2%) and had stage III/IV disease (n=40, 88.9%). As first-line treatment, patients received chemotherapy (n=19, 42.2%), immunotherapy (n=9, 20.0%), or a combination (n=15, 33.3%); two patients (4.4%) received an oral targeted agent. The average CARG-CGA score was 7.66 (SD=2.61, range=2-12), indicating a moderate risk of chemotherapy toxicity. The average SPPB score was 8.51 (SD=3.29, range=0-12), indicating one or more mobility limitations. According to the Timed Up and Go test, 21 (46.7%) demonstrated no fall risk (<10 seconds to perform test) and 18 (40%) demonstrated mild fall risk (10-20 seconds to perform test). The full sample reported independence with their ADLs (100% able to dress, toilet, walk, eat, self-groom). The average baseline disability score was 2.73 (SD=2.93, range=1-13), indicating mild disability in usual activities, self-care, and/or mobility. The average PROMIS-10 score was 34.5 (SD=7.08, range=19-49), approximately 1.5 standard deviations below the quality of life of the general population.
Conclusion
The FITNESS study is a feasible, multifactorial approach to describe baseline disability in older adults with advanced lung cancer. Future research will use these data to determine predictors of functional decline over the course of lung cancer treatment.
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OA08 - Putting the Patient at the Center: Holistic Patient Care (ID 156)
- Event: WCLC 2020
- Type: Oral
- Track: Nursing and Allied Health Professionals
- Presentations: 2
- Moderators:
- Coordinates: 1/30/2021, 11:45 - 12:45, Scientific Program Auditorium
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OA08.03 - Joint Modeling of Stress and Survival in Patients with Advanced Non-Small Cell Lung Cancer (ID 3757)
11:45 - 12:45 | Presenting Author(s): Nicole Andrea Arrato
- Abstract
- Presentation
Introduction
Patients with lung cancer are the most psychologically disabled of all cancer groups. Although it is understood that baseline stress predicts continued distress and shortened survival, the possibility that psychological stress thereafter adds to mortality risk has not been studied. Individuals newly diagnosed with stage IV non-small cell lung cancer (NSCLC) were accrued to an observational cohort study. Joint models test the hypothesis that patients’ trajectories of stress will adversely impact their psychological well-being and survival, above any contribution of demographic characteristics, stress at diagnosis, prognostic variables, and treatment received.
Methods
Patients with stage IV NSCLC (N=157) were enrolled (ClinicalTrials.gov identifier: NCT03199651) and completed the American Society of Clinical Oncology-recommended measure for cancer stress (Impact of Events Scale-Revised; IES-R) at diagnosis. Patients were reassessed every 1-4 months through 24 months and survival was monitored. Joint statistical models accounted for potentially informative censoring and provided simultaneous modeling of longitudinal (psychological) and time-to-event (survival) processes. Control variables were age, sex, smoking status, cancer type, treatment received, marital status, and education.
Results
Stress significantly decreased with time since diagnosis. IES-R scores, which decreased from 16.9 to 11.1, exhibited non-linearity as shown by increases in stress at 6 months, followed by decreases at approximately 12 months (see Figure 1). Interactions between time and cancer treatment were found non-significant, such that the observed trends in stress did not vary due to cancer treatment. For covariates, only education was significantly associated. Patients with a high school education or above had roughly 7-8 points lower mean IES-R scores (less stress) compared to patients with less than high school education. IES-R scores were not significantly associated with survival.
Conclusion
This is the first study to describe the course of stress for patients with advanced NSCLC as they received new cancer therapies. It is possible that more frequent assessments of the IES-R would have revealed significant associations with survival. Future research is needed in order to fully understand psychological risk factors for premature mortality from NSCLC.
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OA08.05 - Illness Perception Profiles at Lung Cancer Diagnosis and Physical and Psychological Symptom Trajectories During Treatment (ID 3670)
11:45 - 12:45 | Author(s): Nicole Andrea Arrato
- Abstract
- Presentation
Introduction
Advanced non-small cell lung cancer (NSCLC) takes an immense toll on patients’ lives, including disabling physical symptoms and high levels of psychological distress. According to Howard Leventhal’s Self-Regulatory Model of Illness Behavior, patients’ perceptions of their illness (e.g., views about the extent to which the illness affects one’s life, the expected duration of one’s illness, and the ability to control one’s illness with treatment) impact important physical and psychological outcomes. This study aimed to determine whether patterns (i.e., “profiles”) of illness perceptions among patients newly diagnosed with advanced NSCLC explain variability in lung cancer symptom severity (e.g., cough, dyspnea, pain) and psychological distress (i.e., anxiety, depression) during treatment.
Methods
Patients newly diagnosed with stage-IV NSCLC (N = 186) were enrolled in an observational study. The patients completed a self-report measure of illness perception dimensions—consequences, timeline, personal control, treatment control, identity (symptoms), coherence (understanding), concern, and emotional responses—at baseline, as well as measures of overall physical symptom severity, cough severity, dyspnea severity, pain severity, self-rated health status, anxiety symptoms, and depressive symptoms at baseline and monthly over an eight-month follow-up period during which patients received oncological treatment. Latent profile analysis categorized patients into groups sharing similar illness perceptions at baseline. Linear mixed models tested the baseline illness perception profiles as predictors of outcome trajectories during the follow-up period. Analyses controlled for sociodemographic and disease characteristics.
Results
Three illness perception profiles emerged: patients with relatively positive perceptions of their illness (n = 41), patients with high levels of concern about their illness despite relatively positive ratings of other illness perception dimensions (n = 62), and patients with relatively negative perceptions of their illness (n = 83). Over the course of the eight-month follow-up period, patients reported improvements in overall physical symptom severity, cough severity, anxiety symptoms, and depressive symptoms, whereas dyspnea severity, pain severity, and self-rated health status did not change. During this period, patients with more negative illness perceptions at baseline reported the most severe lung cancer symptoms, including overall physical symptoms, dyspnea, and pain, the poorest self-rated health status, and the highest levels of anxiety and depression. There were no interactions between illness perception profile and time.
Conclusion
Illness perception profiles at lung cancer diagnosis explain significant variability in subsequent disease outcomes. Patients with relatively negative perceptions of their lung cancer experience the highest burden of lung cancer symptoms, including dyspnea and pain, the poorest health-related quality of life, and the greatest psychological distress. Patients with more positive perceptions of their lung cancer at diagnosis are at significantly lower risk for adverse outcomes during treatment. The high frequency of a “negative” illness perception profile suggests that a significant proportion of individuals newly diagnosed with advanced NSCLC are in need of prompt referral for psychosocial intervention if the benefits of life-extending targeted and immunotherapies are to be maximized and if patients are to enjoy an optimal quality of life.
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