Original Report

Background No clinical standard currently exists for the optimal management of nausea induced by emetogenic chemotherapy, particularly delayed nausea.
 

Objective To compare the efficacy and safety of palonosetron with older 5-HT3 receptor antagonists (RAs) in preventing chemotherapy-induced nausea.
 

Methods Data were pooled from 4 similarly designed multicenter, randomized, double-blind, clinical trials that compared single intravenous doses of palonosetron 0.25 mg or 0.75 mg with ondansetron 32 mg, dolasetron 100 mg, or granisetron 40 μg/kg, administered 30 minutes before moderately emetogenic chemotherapy (MEC ) or highly emetogenic chemotherapy (HEC). Pooled data within each chemotherapy category (MEC: n = 1,132; HEC: n = 1,781) were analyzed by a logistic regression model. Nausea endpoints were complete control rates (ie, no more than mild nausea, no vomiting, and no rescue medication), nausea-free rates, nausea severity, and requirement for rescue antiemetic/antinausea medication over 5 days following chemotherapy. Pooled safety data were summarized descriptively.
 

Results Numerically more palonosetron-treated patients were nausea-free on each day, and fewer had moderate-severe nausea. Similarly, usage of rescue medication was less frequent among palonosetron-treated patients. Complete control rates for palonosetron and older 5-HT3 RAs in the acute phase were 66% vs 63%, 52% vs 42% in the delayed phase (24-120 hours), and 46% vs 37% in the overall phase. The incidence of adverse events was similar for palonosetron and older 5-HT3 RAs.
 

Limitations This post hoc analysis summarized data for palonosetron and several other 5-HT3 RAs but was not powered for statistical comparisons between individual agents. Because nausea is inherently subjective, the reliability of assessments of some aspects (eg, severity) may be influenced by interindividual variability.
 

Conclusion Palonosetron may be more effective than older 5-HT3 RAs in preventing nausea, with comparable tolerability.
 

Disclosures and funding Dr Schwartzberg is a consultant to and Dr Cox an employee at Esai. Mr Ballinari is a member of staff at and Dr Thorn consults for Helsinn Healthcare SA. Funding to support this study and the preparation of this manuscript was provided by Eisai Inc.
 

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Background No clinical standard currently exists for the optimal management of nausea induced by emetogenic chemotherapy, particularly delayed nausea.
 

Objective To compare the efficacy and safety of palonosetron with older 5-HT3 receptor antagonists (RAs) in preventing chemotherapy-induced nausea.
 

Methods Data were pooled from 4 similarly designed multicenter, randomized, double-blind, clinical trials that compared single intravenous doses of palonosetron 0.25 mg or 0.75 mg with ondansetron 32 mg, dolasetron 100 mg, or granisetron 40 μg/kg, administered 30 minutes before moderately emetogenic chemotherapy (MEC ) or highly emetogenic chemotherapy (HEC). Pooled data within each chemotherapy category (MEC: n = 1,132; HEC: n = 1,781) were analyzed by a logistic regression model. Nausea endpoints were complete control rates (ie, no more than mild nausea, no vomiting, and no rescue medication), nausea-free rates, nausea severity, and requirement for rescue antiemetic/antinausea medication over 5 days following chemotherapy. Pooled safety data were summarized descriptively.
 

Results Numerically more palonosetron-treated patients were nausea-free on each day, and fewer had moderate-severe nausea. Similarly, usage of rescue medication was less frequent among palonosetron-treated patients. Complete control rates for palonosetron and older 5-HT3 RAs in the acute phase were 66% vs 63%, 52% vs 42% in the delayed phase (24-120 hours), and 46% vs 37% in the overall phase. The incidence of adverse events was similar for palonosetron and older 5-HT3 RAs.
 

Limitations This post hoc analysis summarized data for palonosetron and several other 5-HT3 RAs but was not powered for statistical comparisons between individual agents. Because nausea is inherently subjective, the reliability of assessments of some aspects (eg, severity) may be influenced by interindividual variability.
 

Conclusion Palonosetron may be more effective than older 5-HT3 RAs in preventing nausea, with comparable tolerability.
 

Disclosures and funding Dr Schwartzberg is a consultant to and Dr Cox an employee at Esai. Mr Ballinari is a member of staff at and Dr Thorn consults for Helsinn Healthcare SA. Funding to support this study and the preparation of this manuscript was provided by Eisai Inc.
 

Click on the PDF icon at the top of this introduction to read the full article.

Background No clinical standard currently exists for the optimal management of nausea induced by emetogenic chemotherapy, particularly delayed nausea.
 

Objective To compare the efficacy and safety of palonosetron with older 5-HT3 receptor antagonists (RAs) in preventing chemotherapy-induced nausea.
 

Methods Data were pooled from 4 similarly designed multicenter, randomized, double-blind, clinical trials that compared single intravenous doses of palonosetron 0.25 mg or 0.75 mg with ondansetron 32 mg, dolasetron 100 mg, or granisetron 40 μg/kg, administered 30 minutes before moderately emetogenic chemotherapy (MEC ) or highly emetogenic chemotherapy (HEC). Pooled data within each chemotherapy category (MEC: n = 1,132; HEC: n = 1,781) were analyzed by a logistic regression model. Nausea endpoints were complete control rates (ie, no more than mild nausea, no vomiting, and no rescue medication), nausea-free rates, nausea severity, and requirement for rescue antiemetic/antinausea medication over 5 days following chemotherapy. Pooled safety data were summarized descriptively.
 

Results Numerically more palonosetron-treated patients were nausea-free on each day, and fewer had moderate-severe nausea. Similarly, usage of rescue medication was less frequent among palonosetron-treated patients. Complete control rates for palonosetron and older 5-HT3 RAs in the acute phase were 66% vs 63%, 52% vs 42% in the delayed phase (24-120 hours), and 46% vs 37% in the overall phase. The incidence of adverse events was similar for palonosetron and older 5-HT3 RAs.
 

Limitations This post hoc analysis summarized data for palonosetron and several other 5-HT3 RAs but was not powered for statistical comparisons between individual agents. Because nausea is inherently subjective, the reliability of assessments of some aspects (eg, severity) may be influenced by interindividual variability.
 

Conclusion Palonosetron may be more effective than older 5-HT3 RAs in preventing nausea, with comparable tolerability.
 

Disclosures and funding Dr Schwartzberg is a consultant to and Dr Cox an employee at Esai. Mr Ballinari is a member of staff at and Dr Thorn consults for Helsinn Healthcare SA. Funding to support this study and the preparation of this manuscript was provided by Eisai Inc.
 

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Background Barriers to assessing a patient’s risk for breast cancer include the inadequate documentation of family history, the complexity of risk calculation and model selection, and a lack of awareness of risk on the part of the patient and/or provider. We have established computer-based, real-time assessment of a patient’s risk for breast cancer at the time of having a mammogram.
 

Objective To facilitate identification of high-risk patients who need genetic counseling and testing and magnetic resonance imaging screening based on the results of the risk assessment.
 

Methods Since November 23, 2010, all mammogram patients have completed questionnaires using a wireless tablet. On the basis of a real-time calculation for a patient’s risk of BRCA1/BRCA2 mutation (Myriad, Tyrer-Cuzick, BRCAPRO) and lifetime risk of breast cancer (Gail, Claus, Tyrer-Cuzick, BRCAPRO) using Hughes riskApps, patients were categorized as high risk (≥ 10% BRCA mutation or ≥ 20% lifetime breast cancer risk) or average risk and received a risk assessment letter. The risk data was integrated into our mammography information system (PenRad) at the same time. High-risk patients were contacted to facilitate evaluation.
 

Results As of June 30, 2012, a total of 24,213 unaffected patients completed the risk assessment. There were 2,196 patients (9.1%) identified as high risk: 1,051 (4.3%) had a BRCA mutation risk, 1,570 (6.5%) had lifetime breast cancer risk, and 425 (1.8%) had risk for both. Of the high-risk patients, 416 (18.7%) were evaluated by our APN and/or genetic counselor. Of the 231 who were evaluated by a genetic counselor, 97 had genetic testing and 9 (8.3%) were BRCA positive. Annual MRI screening was recommended to 254 patients.

Conclusions We have successfully implemented breast cancer risk assessment through our screening mammography service. Results suggest that 9.1% of our patients can benefit from risk assessment, 4.3% should consider genetic testing, and 6.5% may benefit from screening MRI. We strive to improve compliance through patient education.

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Background Barriers to assessing a patient’s risk for breast cancer include the inadequate documentation of family history, the complexity of risk calculation and model selection, and a lack of awareness of risk on the part of the patient and/or provider. We have established computer-based, real-time assessment of a patient’s risk for breast cancer at the time of having a mammogram.
 

Objective To facilitate identification of high-risk patients who need genetic counseling and testing and magnetic resonance imaging screening based on the results of the risk assessment.
 

Methods Since November 23, 2010, all mammogram patients have completed questionnaires using a wireless tablet. On the basis of a real-time calculation for a patient’s risk of BRCA1/BRCA2 mutation (Myriad, Tyrer-Cuzick, BRCAPRO) and lifetime risk of breast cancer (Gail, Claus, Tyrer-Cuzick, BRCAPRO) using Hughes riskApps, patients were categorized as high risk (≥ 10% BRCA mutation or ≥ 20% lifetime breast cancer risk) or average risk and received a risk assessment letter. The risk data was integrated into our mammography information system (PenRad) at the same time. High-risk patients were contacted to facilitate evaluation.
 

Results As of June 30, 2012, a total of 24,213 unaffected patients completed the risk assessment. There were 2,196 patients (9.1%) identified as high risk: 1,051 (4.3%) had a BRCA mutation risk, 1,570 (6.5%) had lifetime breast cancer risk, and 425 (1.8%) had risk for both. Of the high-risk patients, 416 (18.7%) were evaluated by our APN and/or genetic counselor. Of the 231 who were evaluated by a genetic counselor, 97 had genetic testing and 9 (8.3%) were BRCA positive. Annual MRI screening was recommended to 254 patients.

Conclusions We have successfully implemented breast cancer risk assessment through our screening mammography service. Results suggest that 9.1% of our patients can benefit from risk assessment, 4.3% should consider genetic testing, and 6.5% may benefit from screening MRI. We strive to improve compliance through patient education.

Click on the PDF icon at the top of this introduction to read the full article.

Background Barriers to assessing a patient’s risk for breast cancer include the inadequate documentation of family history, the complexity of risk calculation and model selection, and a lack of awareness of risk on the part of the patient and/or provider. We have established computer-based, real-time assessment of a patient’s risk for breast cancer at the time of having a mammogram.
 

Objective To facilitate identification of high-risk patients who need genetic counseling and testing and magnetic resonance imaging screening based on the results of the risk assessment.
 

Methods Since November 23, 2010, all mammogram patients have completed questionnaires using a wireless tablet. On the basis of a real-time calculation for a patient’s risk of BRCA1/BRCA2 mutation (Myriad, Tyrer-Cuzick, BRCAPRO) and lifetime risk of breast cancer (Gail, Claus, Tyrer-Cuzick, BRCAPRO) using Hughes riskApps, patients were categorized as high risk (≥ 10% BRCA mutation or ≥ 20% lifetime breast cancer risk) or average risk and received a risk assessment letter. The risk data was integrated into our mammography information system (PenRad) at the same time. High-risk patients were contacted to facilitate evaluation.
 

Results As of June 30, 2012, a total of 24,213 unaffected patients completed the risk assessment. There were 2,196 patients (9.1%) identified as high risk: 1,051 (4.3%) had a BRCA mutation risk, 1,570 (6.5%) had lifetime breast cancer risk, and 425 (1.8%) had risk for both. Of the high-risk patients, 416 (18.7%) were evaluated by our APN and/or genetic counselor. Of the 231 who were evaluated by a genetic counselor, 97 had genetic testing and 9 (8.3%) were BRCA positive. Annual MRI screening was recommended to 254 patients.

Conclusions We have successfully implemented breast cancer risk assessment through our screening mammography service. Results suggest that 9.1% of our patients can benefit from risk assessment, 4.3% should consider genetic testing, and 6.5% may benefit from screening MRI. We strive to improve compliance through patient education.

Click on the PDF icon at the top of this introduction to read the full article.

Background Approval of new agents provides alternative treatment options for medical oncologists and their patients with renal cell carcinoma (RCC). Treatment decisions remain challenging in the absence of clear evidence supporting optimal selection and sequencing of treatment for different patient or tumor characteristics.
 

Objective To assess the clinical practice gaps of medical oncologists treating patients with RCC.
 

Methods Medical oncologists practicing in the United States with a case load of 1 or more RCC patient(s) a year were recruited to participate in either an online case-based survey followed by a 45-minute interview (phase 1) or a 15-minute online survey with case vignettes (phase 2). Respondents’ answers were compared with treatment guidelines and faculty experts’ recommendations.
 

Results Qualitative interviews (n = 27) and quantitative surveys (n = 142) were compiled. Clinical performance gaps demonstrating oncologists’ difficulties to optimally adjust their treatment plan were identified. When presented with an RCC patient with treatment-related hypertension, 34% of respondents did not select an expert-recommended option. In a scenario focused on recognizing clinical signs and symptoms as an important component of treatment decision-making, 40% of respondents agreed with the expert-recommended approach. For a progressive patient with chronic obstructive pulmonary disease, 78% of respondents were misaligned with evidence-based treatment options.
 

Limitations Self-selection and respondent bias may have occurred. Sample size may have limited the statistical power.
 

Conclusions This study identified clinically relevant performance gaps among US oncologists treating RCC patients. Education to assure familiarity with the most recent changes is needed.
 

Funding/sponsorship Pfizer Medical Education Group provided financial support through an educational research grant.
 

Click on the PDF icon at the top of this introduction to read the full article.

Background Approval of new agents provides alternative treatment options for medical oncologists and their patients with renal cell carcinoma (RCC). Treatment decisions remain challenging in the absence of clear evidence supporting optimal selection and sequencing of treatment for different patient or tumor characteristics.
 

Objective To assess the clinical practice gaps of medical oncologists treating patients with RCC.
 

Methods Medical oncologists practicing in the United States with a case load of 1 or more RCC patient(s) a year were recruited to participate in either an online case-based survey followed by a 45-minute interview (phase 1) or a 15-minute online survey with case vignettes (phase 2). Respondents’ answers were compared with treatment guidelines and faculty experts’ recommendations.
 

Results Qualitative interviews (n = 27) and quantitative surveys (n = 142) were compiled. Clinical performance gaps demonstrating oncologists’ difficulties to optimally adjust their treatment plan were identified. When presented with an RCC patient with treatment-related hypertension, 34% of respondents did not select an expert-recommended option. In a scenario focused on recognizing clinical signs and symptoms as an important component of treatment decision-making, 40% of respondents agreed with the expert-recommended approach. For a progressive patient with chronic obstructive pulmonary disease, 78% of respondents were misaligned with evidence-based treatment options.
 

Limitations Self-selection and respondent bias may have occurred. Sample size may have limited the statistical power.
 

Conclusions This study identified clinically relevant performance gaps among US oncologists treating RCC patients. Education to assure familiarity with the most recent changes is needed.
 

Funding/sponsorship Pfizer Medical Education Group provided financial support through an educational research grant.
 

Click on the PDF icon at the top of this introduction to read the full article.

Background Approval of new agents provides alternative treatment options for medical oncologists and their patients with renal cell carcinoma (RCC). Treatment decisions remain challenging in the absence of clear evidence supporting optimal selection and sequencing of treatment for different patient or tumor characteristics.
 

Objective To assess the clinical practice gaps of medical oncologists treating patients with RCC.
 

Methods Medical oncologists practicing in the United States with a case load of 1 or more RCC patient(s) a year were recruited to participate in either an online case-based survey followed by a 45-minute interview (phase 1) or a 15-minute online survey with case vignettes (phase 2). Respondents’ answers were compared with treatment guidelines and faculty experts’ recommendations.
 

Results Qualitative interviews (n = 27) and quantitative surveys (n = 142) were compiled. Clinical performance gaps demonstrating oncologists’ difficulties to optimally adjust their treatment plan were identified. When presented with an RCC patient with treatment-related hypertension, 34% of respondents did not select an expert-recommended option. In a scenario focused on recognizing clinical signs and symptoms as an important component of treatment decision-making, 40% of respondents agreed with the expert-recommended approach. For a progressive patient with chronic obstructive pulmonary disease, 78% of respondents were misaligned with evidence-based treatment options.
 

Limitations Self-selection and respondent bias may have occurred. Sample size may have limited the statistical power.
 

Conclusions This study identified clinically relevant performance gaps among US oncologists treating RCC patients. Education to assure familiarity with the most recent changes is needed.
 

Funding/sponsorship Pfizer Medical Education Group provided financial support through an educational research grant.
 

Click on the PDF icon at the top of this introduction to read the full article.

Background Most cancer patients have symptoms from their disease or treatment. Symptoms are not ideally managed in the context of busy clinics, resulting in potentially avoidable emergency department (ED) visits and hospitalizations. Adjunct supportive care clinics (SCCs) may more effectively address patient needs, but they contribute to fractionation of care if different personnel are involved.

Objective We describe an SCC embedded within a physician practice in which an employed nurse practitioner delivered most of the care. We measured the disposition of patients from the SCC to the ED, and the effect on ED visits and admissions for symptom management.

Methods We conducted a retrospective review of the patients attending the SCC over a period of 11 months. Demographics and disposition outcomes were tracked and compared with pre-intervention controls.

Results In all, 340 visits were recorded from 330 unique patients. Same-day and next-day appointments with a nurse practitioner were arranged for 62% and 25% of patients, respectively. The most common complaints related to pain and gastrointestinal issues. Most of the patients were discharged home. A few needed hospitalization or ED-level care. Admissions for symptom-related care fell by 31%. An estimated 66 ED visits were avoided by patients accessing the SCC.

Limitations The study was retrospective. It did not include detailed financial data. Results may not be generalizable because of the high level of central planning and use of a shared electronic medical record system, which may be lacking in some practices.

Conclusions An embedded supportive care clinic allowed rapid access to experienced oncology care under supervision by the patient’s own oncologists. The clinic was associated with less use of the ED and need for hospitalization. New methods of reimbursing medical care will increasingly require oncology practices to improve patient access to symptom-related care to avoid unnecessary admissions. An embedded SCC can accomplish these goals while avoiding further fractionation of care.

Click on the PDF icon below for the full article.
 

Background Most cancer patients have symptoms from their disease or treatment. Symptoms are not ideally managed in the context of busy clinics, resulting in potentially avoidable emergency department (ED) visits and hospitalizations. Adjunct supportive care clinics (SCCs) may more effectively address patient needs, but they contribute to fractionation of care if different personnel are involved.

Objective We describe an SCC embedded within a physician practice in which an employed nurse practitioner delivered most of the care. We measured the disposition of patients from the SCC to the ED, and the effect on ED visits and admissions for symptom management.

Methods We conducted a retrospective review of the patients attending the SCC over a period of 11 months. Demographics and disposition outcomes were tracked and compared with pre-intervention controls.

Results In all, 340 visits were recorded from 330 unique patients. Same-day and next-day appointments with a nurse practitioner were arranged for 62% and 25% of patients, respectively. The most common complaints related to pain and gastrointestinal issues. Most of the patients were discharged home. A few needed hospitalization or ED-level care. Admissions for symptom-related care fell by 31%. An estimated 66 ED visits were avoided by patients accessing the SCC.

Limitations The study was retrospective. It did not include detailed financial data. Results may not be generalizable because of the high level of central planning and use of a shared electronic medical record system, which may be lacking in some practices.

Conclusions An embedded supportive care clinic allowed rapid access to experienced oncology care under supervision by the patient’s own oncologists. The clinic was associated with less use of the ED and need for hospitalization. New methods of reimbursing medical care will increasingly require oncology practices to improve patient access to symptom-related care to avoid unnecessary admissions. An embedded SCC can accomplish these goals while avoiding further fractionation of care.

Click on the PDF icon below for the full article.
 

Background Most cancer patients have symptoms from their disease or treatment. Symptoms are not ideally managed in the context of busy clinics, resulting in potentially avoidable emergency department (ED) visits and hospitalizations. Adjunct supportive care clinics (SCCs) may more effectively address patient needs, but they contribute to fractionation of care if different personnel are involved.

Objective We describe an SCC embedded within a physician practice in which an employed nurse practitioner delivered most of the care. We measured the disposition of patients from the SCC to the ED, and the effect on ED visits and admissions for symptom management.

Methods We conducted a retrospective review of the patients attending the SCC over a period of 11 months. Demographics and disposition outcomes were tracked and compared with pre-intervention controls.

Results In all, 340 visits were recorded from 330 unique patients. Same-day and next-day appointments with a nurse practitioner were arranged for 62% and 25% of patients, respectively. The most common complaints related to pain and gastrointestinal issues. Most of the patients were discharged home. A few needed hospitalization or ED-level care. Admissions for symptom-related care fell by 31%. An estimated 66 ED visits were avoided by patients accessing the SCC.

Limitations The study was retrospective. It did not include detailed financial data. Results may not be generalizable because of the high level of central planning and use of a shared electronic medical record system, which may be lacking in some practices.

Conclusions An embedded supportive care clinic allowed rapid access to experienced oncology care under supervision by the patient’s own oncologists. The clinic was associated with less use of the ED and need for hospitalization. New methods of reimbursing medical care will increasingly require oncology practices to improve patient access to symptom-related care to avoid unnecessary admissions. An embedded SCC can accomplish these goals while avoiding further fractionation of care.

Click on the PDF icon below for the full article.
 

Background Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores are used to quantify overall disease status and are widely used to stratify participants at clinical trial entry. Longitudinal ECOG-PS measurement between 2 tumor types may provide important data for patient management in community settings.
 

Objective To describe oncology patients’ performance status before and after their first course of chemotherapy.
 

Methods ECOG-PS scores from electronic medical records (EMRs) of 47 oncology clinics across the United States were retrieved. The included patients had breast, lymphoma, prostate, colorectal, or lung cancers and ECOG-PS scores within ± 14 days of initiation and completion of the first chemotherapy course. Descriptive statistics of ECOG-PS were analyzed and compared within tumor types (via the Wilcoxon signed-rank test) and between tumor types (via the Kruskal-Wallis test).
 

Results In all, 7,912 cancer patients were identified as having breast cancer, lymphoma, prostate cancer, colorectal cancer, or lung cancer. At baseline, patients’ mean (SD) ECOG-PS scores were breast cancer, 0.51 (0.01); lymphoma, 0.82 (0.02); prostate cancer, 1.04 (0.05); colorectal cancer, 0.72 (0.02); and lung cancer, 0.97 (0.02). The percentages of patients with ECOG-PS < 2 at chemotherapy start were 94%, 86%, 78%, 89%, and 81% for each tumor, respectively; percentages at the end of the first course were 88%, 80%, 68%, 84%, and 66%, respectively. All pre- and postchemotherapy comparisons of scores between tumor types were statistically significantly different (P < .001), with the exceptions of lung and prostate cancer before chemotherapy, and lung, prostate, lymphoma, and colorectal cancers after chemotherapy. Changes of ECOG-PS scores from baseline to postchemotherapy assessments were statistically significant in all tumor types (P < .01).
 

Limitations The lack of a standardized method for collecting ECOG-PS scores in routine oncology practice led to the unavailability of scores for many patients.
 

Conclusions This study describes a national sample of community oncology patients’ performance status. Even though there was a significant drop in ECOG-PS scores from pre- to postchemotherapy, good ECOG-PS scores were maintained in a majority of patients. These findings demonstrate that ECOG-PS scores can be routinely assessed and can aid in decisions throughout chemo- therapy and in the planning for future treatments.
 

Funding Amgen Inc funded the study.
 

Click on the PDF icon at the top of this introduction to read the full article.

Background Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores are used to quantify overall disease status and are widely used to stratify participants at clinical trial entry. Longitudinal ECOG-PS measurement between 2 tumor types may provide important data for patient management in community settings.
 

Objective To describe oncology patients’ performance status before and after their first course of chemotherapy.
 

Methods ECOG-PS scores from electronic medical records (EMRs) of 47 oncology clinics across the United States were retrieved. The included patients had breast, lymphoma, prostate, colorectal, or lung cancers and ECOG-PS scores within ± 14 days of initiation and completion of the first chemotherapy course. Descriptive statistics of ECOG-PS were analyzed and compared within tumor types (via the Wilcoxon signed-rank test) and between tumor types (via the Kruskal-Wallis test).
 

Results In all, 7,912 cancer patients were identified as having breast cancer, lymphoma, prostate cancer, colorectal cancer, or lung cancer. At baseline, patients’ mean (SD) ECOG-PS scores were breast cancer, 0.51 (0.01); lymphoma, 0.82 (0.02); prostate cancer, 1.04 (0.05); colorectal cancer, 0.72 (0.02); and lung cancer, 0.97 (0.02). The percentages of patients with ECOG-PS < 2 at chemotherapy start were 94%, 86%, 78%, 89%, and 81% for each tumor, respectively; percentages at the end of the first course were 88%, 80%, 68%, 84%, and 66%, respectively. All pre- and postchemotherapy comparisons of scores between tumor types were statistically significantly different (P < .001), with the exceptions of lung and prostate cancer before chemotherapy, and lung, prostate, lymphoma, and colorectal cancers after chemotherapy. Changes of ECOG-PS scores from baseline to postchemotherapy assessments were statistically significant in all tumor types (P < .01).
 

Limitations The lack of a standardized method for collecting ECOG-PS scores in routine oncology practice led to the unavailability of scores for many patients.
 

Conclusions This study describes a national sample of community oncology patients’ performance status. Even though there was a significant drop in ECOG-PS scores from pre- to postchemotherapy, good ECOG-PS scores were maintained in a majority of patients. These findings demonstrate that ECOG-PS scores can be routinely assessed and can aid in decisions throughout chemo- therapy and in the planning for future treatments.
 

Funding Amgen Inc funded the study.
 

Click on the PDF icon at the top of this introduction to read the full article.

Background Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores are used to quantify overall disease status and are widely used to stratify participants at clinical trial entry. Longitudinal ECOG-PS measurement between 2 tumor types may provide important data for patient management in community settings.
 

Objective To describe oncology patients’ performance status before and after their first course of chemotherapy.
 

Methods ECOG-PS scores from electronic medical records (EMRs) of 47 oncology clinics across the United States were retrieved. The included patients had breast, lymphoma, prostate, colorectal, or lung cancers and ECOG-PS scores within ± 14 days of initiation and completion of the first chemotherapy course. Descriptive statistics of ECOG-PS were analyzed and compared within tumor types (via the Wilcoxon signed-rank test) and between tumor types (via the Kruskal-Wallis test).
 

Results In all, 7,912 cancer patients were identified as having breast cancer, lymphoma, prostate cancer, colorectal cancer, or lung cancer. At baseline, patients’ mean (SD) ECOG-PS scores were breast cancer, 0.51 (0.01); lymphoma, 0.82 (0.02); prostate cancer, 1.04 (0.05); colorectal cancer, 0.72 (0.02); and lung cancer, 0.97 (0.02). The percentages of patients with ECOG-PS < 2 at chemotherapy start were 94%, 86%, 78%, 89%, and 81% for each tumor, respectively; percentages at the end of the first course were 88%, 80%, 68%, 84%, and 66%, respectively. All pre- and postchemotherapy comparisons of scores between tumor types were statistically significantly different (P < .001), with the exceptions of lung and prostate cancer before chemotherapy, and lung, prostate, lymphoma, and colorectal cancers after chemotherapy. Changes of ECOG-PS scores from baseline to postchemotherapy assessments were statistically significant in all tumor types (P < .01).
 

Limitations The lack of a standardized method for collecting ECOG-PS scores in routine oncology practice led to the unavailability of scores for many patients.
 

Conclusions This study describes a national sample of community oncology patients’ performance status. Even though there was a significant drop in ECOG-PS scores from pre- to postchemotherapy, good ECOG-PS scores were maintained in a majority of patients. These findings demonstrate that ECOG-PS scores can be routinely assessed and can aid in decisions throughout chemo- therapy and in the planning for future treatments.
 

Funding Amgen Inc funded the study.
 

Click on the PDF icon at the top of this introduction to read the full article.

Background Patients with advanced cancer often visit the emergency department (ED). Little is known about their willingness or ability to engage in palliative care research, although enrollment in clinical trials of other seriously ill ED patients -- those with stroke, for example -- has been shown to be feasible.

Objective To identify barriers to the enrollment of ED patients with advanced cancer in palliative care research.

Methods We prospectively tracked factors that affected patient accrual into a trial of palliative care for adults with metastatic solid tumors at an urban, academic ED. Research staff screened the electronic medical records for patients admitted to the hospital with metastatic solid tumors 8-12 hours a day, Monday through Friday. The ED attending of record and the patient’s medical oncologist had to agree before research staff invited the patient to participate. Informed consent was obtained at the bedside in the ED, and patients were offered a $20 incentive to participate.

Results Attempts were made to enroll 150 eligible patients in the study, and 73 were enrolled (49% enrollment rate). Barriers to enrollment for the 77 patients who did not participate were deduced from the field notes and placed into the following categories: patient refusal (n = 38, 49%), diagnostic uncertainty regarding cancer stage (n = 11, 14%), symptom burden (n = 9, 12%), family refusal (n = 7, 9%), physician refusal (n = 7, 9%), and/or patient unaware of illness or stage (n = 5, 7%).

Limitations The findings are descriptive and do not test predetermined hypotheses.

Conclusion Patient refusal, symptom burden, and diagnostic disparities are common barriers encountered when recruiting ED patients with advanced cancer. Despite the barriers, recruitment was feasible for such ED patients.

Funding/sponsor This study was funded by a Mentored Research Scholar Grant from the American Cancer Society (Dr Grudzen), a Medical Student Training in Aging Research Grant from the American Federation on Aging (Mr Kandarian), and by a Mid- Career Investigator Award in Patient Oriented Research (K24 AG022345) from the National Institute on Aging (Dr Morrison).

Click on the PDF icon at the top of this introduction to read the full article.

Background Patients with advanced cancer often visit the emergency department (ED). Little is known about their willingness or ability to engage in palliative care research, although enrollment in clinical trials of other seriously ill ED patients -- those with stroke, for example -- has been shown to be feasible.

Objective To identify barriers to the enrollment of ED patients with advanced cancer in palliative care research.

Methods We prospectively tracked factors that affected patient accrual into a trial of palliative care for adults with metastatic solid tumors at an urban, academic ED. Research staff screened the electronic medical records for patients admitted to the hospital with metastatic solid tumors 8-12 hours a day, Monday through Friday. The ED attending of record and the patient’s medical oncologist had to agree before research staff invited the patient to participate. Informed consent was obtained at the bedside in the ED, and patients were offered a $20 incentive to participate.

Results Attempts were made to enroll 150 eligible patients in the study, and 73 were enrolled (49% enrollment rate). Barriers to enrollment for the 77 patients who did not participate were deduced from the field notes and placed into the following categories: patient refusal (n = 38, 49%), diagnostic uncertainty regarding cancer stage (n = 11, 14%), symptom burden (n = 9, 12%), family refusal (n = 7, 9%), physician refusal (n = 7, 9%), and/or patient unaware of illness or stage (n = 5, 7%).

Limitations The findings are descriptive and do not test predetermined hypotheses.

Conclusion Patient refusal, symptom burden, and diagnostic disparities are common barriers encountered when recruiting ED patients with advanced cancer. Despite the barriers, recruitment was feasible for such ED patients.

Funding/sponsor This study was funded by a Mentored Research Scholar Grant from the American Cancer Society (Dr Grudzen), a Medical Student Training in Aging Research Grant from the American Federation on Aging (Mr Kandarian), and by a Mid- Career Investigator Award in Patient Oriented Research (K24 AG022345) from the National Institute on Aging (Dr Morrison).

Click on the PDF icon at the top of this introduction to read the full article.

Background Patients with advanced cancer often visit the emergency department (ED). Little is known about their willingness or ability to engage in palliative care research, although enrollment in clinical trials of other seriously ill ED patients -- those with stroke, for example -- has been shown to be feasible.

Objective To identify barriers to the enrollment of ED patients with advanced cancer in palliative care research.

Methods We prospectively tracked factors that affected patient accrual into a trial of palliative care for adults with metastatic solid tumors at an urban, academic ED. Research staff screened the electronic medical records for patients admitted to the hospital with metastatic solid tumors 8-12 hours a day, Monday through Friday. The ED attending of record and the patient’s medical oncologist had to agree before research staff invited the patient to participate. Informed consent was obtained at the bedside in the ED, and patients were offered a $20 incentive to participate.

Results Attempts were made to enroll 150 eligible patients in the study, and 73 were enrolled (49% enrollment rate). Barriers to enrollment for the 77 patients who did not participate were deduced from the field notes and placed into the following categories: patient refusal (n = 38, 49%), diagnostic uncertainty regarding cancer stage (n = 11, 14%), symptom burden (n = 9, 12%), family refusal (n = 7, 9%), physician refusal (n = 7, 9%), and/or patient unaware of illness or stage (n = 5, 7%).

Limitations The findings are descriptive and do not test predetermined hypotheses.

Conclusion Patient refusal, symptom burden, and diagnostic disparities are common barriers encountered when recruiting ED patients with advanced cancer. Despite the barriers, recruitment was feasible for such ED patients.

Funding/sponsor This study was funded by a Mentored Research Scholar Grant from the American Cancer Society (Dr Grudzen), a Medical Student Training in Aging Research Grant from the American Federation on Aging (Mr Kandarian), and by a Mid- Career Investigator Award in Patient Oriented Research (K24 AG022345) from the National Institute on Aging (Dr Morrison).

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Background Palliative care services in the United States are increasing in their prevalence but continue to vary in their implementation, with different referral policies and timing of patient access to services.

Objective To better define a late referral and to understand the association of late referrals to palliative care with patient health outcomes, including postreferral length of hospital stay and in-hospital mortality.

Methods We performed a retrospective study using multiple linear and logistic regressions on 1,225 patients with preexisting oncologic diagnoses who received a referral to Stanford Hospital’s palliative care service.

Results Those oncologic patients who were referred to palliative care in the first week following admission had significantly shorter lengths of stay after referral, as well as lower in-hospital mortality, compared with patients who were referred later than 1 week following admission. Regression analyses, adjusted for demographic variables, DNR status, and sickness, revealed that waiting 1 week or longer to refer a patient was associated with an overall increased length of stay of 2.70 days (P < .001). This increased to 3.40 days (P < .001) when patients who died in the hospital were removed from the data, suggesting that in-hospital mortality was not solely responsible for the trend. Waiting 1 week to refer was associated with increased odds of a patient’s dying in the hospital vs being discharged alive by a factor of 3.04 (P < .001).

Limitations This study was limited to analyzing inpatient palliative care consultation services with a emphasis on patients with metastatic solid tumors. We used a proxy for patient sickness burden but did not analyze outcomes specific to cancer stage or individual oncologic diagnosis separately.

Conclusions Our study suggests that late referrals may have a marked negative impact on health outcomes, which argues for the design and implementation of hospital policies that encourage early referral to palliative care for advanced cancer patients.

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Background Palliative care services in the United States are increasing in their prevalence but continue to vary in their implementation, with different referral policies and timing of patient access to services.

Objective To better define a late referral and to understand the association of late referrals to palliative care with patient health outcomes, including postreferral length of hospital stay and in-hospital mortality.

Methods We performed a retrospective study using multiple linear and logistic regressions on 1,225 patients with preexisting oncologic diagnoses who received a referral to Stanford Hospital’s palliative care service.

Results Those oncologic patients who were referred to palliative care in the first week following admission had significantly shorter lengths of stay after referral, as well as lower in-hospital mortality, compared with patients who were referred later than 1 week following admission. Regression analyses, adjusted for demographic variables, DNR status, and sickness, revealed that waiting 1 week or longer to refer a patient was associated with an overall increased length of stay of 2.70 days (P < .001). This increased to 3.40 days (P < .001) when patients who died in the hospital were removed from the data, suggesting that in-hospital mortality was not solely responsible for the trend. Waiting 1 week to refer was associated with increased odds of a patient’s dying in the hospital vs being discharged alive by a factor of 3.04 (P < .001).

Limitations This study was limited to analyzing inpatient palliative care consultation services with a emphasis on patients with metastatic solid tumors. We used a proxy for patient sickness burden but did not analyze outcomes specific to cancer stage or individual oncologic diagnosis separately.

Conclusions Our study suggests that late referrals may have a marked negative impact on health outcomes, which argues for the design and implementation of hospital policies that encourage early referral to palliative care for advanced cancer patients.

Click on the PDF icon at the top of this introduction to read the full article.

Background Palliative care services in the United States are increasing in their prevalence but continue to vary in their implementation, with different referral policies and timing of patient access to services.

Objective To better define a late referral and to understand the association of late referrals to palliative care with patient health outcomes, including postreferral length of hospital stay and in-hospital mortality.

Methods We performed a retrospective study using multiple linear and logistic regressions on 1,225 patients with preexisting oncologic diagnoses who received a referral to Stanford Hospital’s palliative care service.

Results Those oncologic patients who were referred to palliative care in the first week following admission had significantly shorter lengths of stay after referral, as well as lower in-hospital mortality, compared with patients who were referred later than 1 week following admission. Regression analyses, adjusted for demographic variables, DNR status, and sickness, revealed that waiting 1 week or longer to refer a patient was associated with an overall increased length of stay of 2.70 days (P < .001). This increased to 3.40 days (P < .001) when patients who died in the hospital were removed from the data, suggesting that in-hospital mortality was not solely responsible for the trend. Waiting 1 week to refer was associated with increased odds of a patient’s dying in the hospital vs being discharged alive by a factor of 3.04 (P < .001).

Limitations This study was limited to analyzing inpatient palliative care consultation services with a emphasis on patients with metastatic solid tumors. We used a proxy for patient sickness burden but did not analyze outcomes specific to cancer stage or individual oncologic diagnosis separately.

Conclusions Our study suggests that late referrals may have a marked negative impact on health outcomes, which argues for the design and implementation of hospital policies that encourage early referral to palliative care for advanced cancer patients.

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Bacground Colorectal cancer is one of the leading causes of morbidity and mortality in Canada. A report of community dwelling seniors showed that 25% received some sort of home care, and that the quantity of home care increased with age and disability. Few population-based studies have examined home care and the associated costs in elderly persons with cancer.

Objective To determine overall utilization and costs associated with home care services in Ontario, Canada by linking a home care database to a stage IV colorectal cancer cohort.

Methods The names of patients with stage IV colorectal cancer at time of diagnosis (diagnosed from 2005 through 2009) were extracted from the Ontario Cancer Registry. The study cohort comprised those who died before the end of the study. The terminal phase of care was the period of time between diagnosis and death, with a maximum value of 180 days (6 months). Patients were linked to home care services datasets. The type, frequency, and cost of home care services were determined. Regression analysis was used to examine factors associated with utilization and cost.

Results In all, 3,613 stage IV colorectal cancer patients (median age, 71 years) were diagnosed and died during the study’s time horizon. During the terminal phase, 79.3% received at least 1 home care visit, and 58.0% had at least 1 palliative visit. Terminal metastatic colorectal cancer patients received an average of 8 home care visits at Canadian $800 within a 30-day time horizon. Home care costs were highest in the month before death. Male sex, a history of moderate or high utilization of health care services, and hospitalization were associated with lower home care costs.

Limitations Administrative data do not reveal the purpose, efficiency, effectiveness/sufficiency, quality, or appropriateness of home care.

Conclusion Patients with advanced colorectal cancer who were approaching death required a moderate level of home care support, resulting in costs of about $5,000 over the 6-month time horizon.

Funding This study was conducted with the support of the Ontario Institute for Cancer Research and Cancer Care Ontario through funding provided by the government of Ontario. Data were provided by Cancer Care Ontario and the Institute for Clinical Evaluative Sciences. The ICES also provided funding for the study from an annual grant by the Ontario Ministry of Health and Long-term Care.

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Bacground Colorectal cancer is one of the leading causes of morbidity and mortality in Canada. A report of community dwelling seniors showed that 25% received some sort of home care, and that the quantity of home care increased with age and disability. Few population-based studies have examined home care and the associated costs in elderly persons with cancer.

Objective To determine overall utilization and costs associated with home care services in Ontario, Canada by linking a home care database to a stage IV colorectal cancer cohort.

Methods The names of patients with stage IV colorectal cancer at time of diagnosis (diagnosed from 2005 through 2009) were extracted from the Ontario Cancer Registry. The study cohort comprised those who died before the end of the study. The terminal phase of care was the period of time between diagnosis and death, with a maximum value of 180 days (6 months). Patients were linked to home care services datasets. The type, frequency, and cost of home care services were determined. Regression analysis was used to examine factors associated with utilization and cost.

Results In all, 3,613 stage IV colorectal cancer patients (median age, 71 years) were diagnosed and died during the study’s time horizon. During the terminal phase, 79.3% received at least 1 home care visit, and 58.0% had at least 1 palliative visit. Terminal metastatic colorectal cancer patients received an average of 8 home care visits at Canadian $800 within a 30-day time horizon. Home care costs were highest in the month before death. Male sex, a history of moderate or high utilization of health care services, and hospitalization were associated with lower home care costs.

Limitations Administrative data do not reveal the purpose, efficiency, effectiveness/sufficiency, quality, or appropriateness of home care.

Conclusion Patients with advanced colorectal cancer who were approaching death required a moderate level of home care support, resulting in costs of about $5,000 over the 6-month time horizon.

Funding This study was conducted with the support of the Ontario Institute for Cancer Research and Cancer Care Ontario through funding provided by the government of Ontario. Data were provided by Cancer Care Ontario and the Institute for Clinical Evaluative Sciences. The ICES also provided funding for the study from an annual grant by the Ontario Ministry of Health and Long-term Care.

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Bacground Colorectal cancer is one of the leading causes of morbidity and mortality in Canada. A report of community dwelling seniors showed that 25% received some sort of home care, and that the quantity of home care increased with age and disability. Few population-based studies have examined home care and the associated costs in elderly persons with cancer.

Objective To determine overall utilization and costs associated with home care services in Ontario, Canada by linking a home care database to a stage IV colorectal cancer cohort.

Methods The names of patients with stage IV colorectal cancer at time of diagnosis (diagnosed from 2005 through 2009) were extracted from the Ontario Cancer Registry. The study cohort comprised those who died before the end of the study. The terminal phase of care was the period of time between diagnosis and death, with a maximum value of 180 days (6 months). Patients were linked to home care services datasets. The type, frequency, and cost of home care services were determined. Regression analysis was used to examine factors associated with utilization and cost.

Results In all, 3,613 stage IV colorectal cancer patients (median age, 71 years) were diagnosed and died during the study’s time horizon. During the terminal phase, 79.3% received at least 1 home care visit, and 58.0% had at least 1 palliative visit. Terminal metastatic colorectal cancer patients received an average of 8 home care visits at Canadian $800 within a 30-day time horizon. Home care costs were highest in the month before death. Male sex, a history of moderate or high utilization of health care services, and hospitalization were associated with lower home care costs.

Limitations Administrative data do not reveal the purpose, efficiency, effectiveness/sufficiency, quality, or appropriateness of home care.

Conclusion Patients with advanced colorectal cancer who were approaching death required a moderate level of home care support, resulting in costs of about $5,000 over the 6-month time horizon.

Funding This study was conducted with the support of the Ontario Institute for Cancer Research and Cancer Care Ontario through funding provided by the government of Ontario. Data were provided by Cancer Care Ontario and the Institute for Clinical Evaluative Sciences. The ICES also provided funding for the study from an annual grant by the Ontario Ministry of Health and Long-term Care.

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Background With modern treatment, more than 95% of American men who are diagnosed with testicular cancer will be cured. Although there is growing evidence that these individuals may face heightened risk of cardiovascular disease after chemotherapy, there is a paucity of research to objectively classify health-promoting behaviors in this population and to identify the barriers to improving their health behaviors.

Objectives To identify health behavior patterns in a group of testicular cancer survivors (TCSs) and the barriers to more positive health behaviors and to examine the relationship between barriers, health behaviors, and quality of life (QOL).

Methods TCSs from the Pennsylvania State Cancer Registry who had been diagnosed during 1990-2005 completed a comprehensive survey about QOL, health behaviors, and barriers to optimal healthy behaviors. QOL, health behaviors, and the barriers were assessed for 189 respondents.

Results Smoking (25%), risky drinking (35%), elevated body-mass index (83%), poor diet (95% did not meet the guidelines for fruit and vegetable intake), and inadequate exercise (50%) were common. Barriers to achieving optimal health behaviors were categorized as either cancer-related or competing demands. Cancer-related barriers contributed to worse physical QOL, whereas competing demands related to worse mental-health–related QOL.

Limitations Our sample size was moderate and self-selected. In addition, we used self-reports rather than the more standardized observation or interview-based data collection.

Conclusion TCSs demonstrate behaviors that put them at increased risk for future cardiovascular disease and complications. Interventions aimed at reducing tobacco and risky alcohol use and improving dietary and physical activity levels are needed.

Funding/sponsorship NCI grant number 1R03CA124217; the Livestrong Foundation. Disclosures The authors have no disclosures.

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Background With modern treatment, more than 95% of American men who are diagnosed with testicular cancer will be cured. Although there is growing evidence that these individuals may face heightened risk of cardiovascular disease after chemotherapy, there is a paucity of research to objectively classify health-promoting behaviors in this population and to identify the barriers to improving their health behaviors.

Objectives To identify health behavior patterns in a group of testicular cancer survivors (TCSs) and the barriers to more positive health behaviors and to examine the relationship between barriers, health behaviors, and quality of life (QOL).

Methods TCSs from the Pennsylvania State Cancer Registry who had been diagnosed during 1990-2005 completed a comprehensive survey about QOL, health behaviors, and barriers to optimal healthy behaviors. QOL, health behaviors, and the barriers were assessed for 189 respondents.

Results Smoking (25%), risky drinking (35%), elevated body-mass index (83%), poor diet (95% did not meet the guidelines for fruit and vegetable intake), and inadequate exercise (50%) were common. Barriers to achieving optimal health behaviors were categorized as either cancer-related or competing demands. Cancer-related barriers contributed to worse physical QOL, whereas competing demands related to worse mental-health–related QOL.

Limitations Our sample size was moderate and self-selected. In addition, we used self-reports rather than the more standardized observation or interview-based data collection.

Conclusion TCSs demonstrate behaviors that put them at increased risk for future cardiovascular disease and complications. Interventions aimed at reducing tobacco and risky alcohol use and improving dietary and physical activity levels are needed.

Funding/sponsorship NCI grant number 1R03CA124217; the Livestrong Foundation. Disclosures The authors have no disclosures.

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Background With modern treatment, more than 95% of American men who are diagnosed with testicular cancer will be cured. Although there is growing evidence that these individuals may face heightened risk of cardiovascular disease after chemotherapy, there is a paucity of research to objectively classify health-promoting behaviors in this population and to identify the barriers to improving their health behaviors.

Objectives To identify health behavior patterns in a group of testicular cancer survivors (TCSs) and the barriers to more positive health behaviors and to examine the relationship between barriers, health behaviors, and quality of life (QOL).

Methods TCSs from the Pennsylvania State Cancer Registry who had been diagnosed during 1990-2005 completed a comprehensive survey about QOL, health behaviors, and barriers to optimal healthy behaviors. QOL, health behaviors, and the barriers were assessed for 189 respondents.

Results Smoking (25%), risky drinking (35%), elevated body-mass index (83%), poor diet (95% did not meet the guidelines for fruit and vegetable intake), and inadequate exercise (50%) were common. Barriers to achieving optimal health behaviors were categorized as either cancer-related or competing demands. Cancer-related barriers contributed to worse physical QOL, whereas competing demands related to worse mental-health–related QOL.

Limitations Our sample size was moderate and self-selected. In addition, we used self-reports rather than the more standardized observation or interview-based data collection.

Conclusion TCSs demonstrate behaviors that put them at increased risk for future cardiovascular disease and complications. Interventions aimed at reducing tobacco and risky alcohol use and improving dietary and physical activity levels are needed.

Funding/sponsorship NCI grant number 1R03CA124217; the Livestrong Foundation. Disclosures The authors have no disclosures.

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