Sessions are scheduled in Singapore Time (SGT)
- Paolo Bossi (Brescia, Italy)
- Florian Scotté (Villejuif, France)
- Siew C. Chia (Singapore, Singapore)
273MO - A supportive and expanding nurse led model of care, symptom urgent review clinic (SURC)
- Lisa J. Taylor (Frankston, Australia)
Abstract
Background
Cancer patients undergoing systemic anti-cancer therapies (SACT) invariably experience toxicities precipitating presentations to Emergency Departments (ED). With the ongoing COVID-19 pandemic, it is imperative to continue to keep vulnerable immunocompromised patients out of hospital and encourage patients to contact SURC when symptoms develop. Peninsula Health (PH), SURC service was initiated post completion of a 12-month funded grant through the Victorian Government and has grown rapidly since its commencement. This nurse-led SURC model of care has been reported to achieve an investment return of $1.73 for every dollar invested.
Methods
ED presentations of Peninsula Health Oncology/Haematology patients pre- and post-SURC commencement were examined if potentially avoidable presentations have reduced. Ongoing SURC Episodes of care (Educations, phone, and physical attendances) between January 2022 to September 2022 captured in the SURC Access Database. Patient experience surveys were conducted post SURC phone contact and physical attendance if unwell. Patients and clinicians' surveys are ongoing.
Results
Intermediate statistical data (COSA2021) collated June 2021 to December 2022 post-grant, we observed 43.30% reduction in ED presentations within SURC operation hours by patients considered SURC eligible when compared to pre-SURC figures. The SURC from January 2022 to September 2022 has recorded, 2567 episodes of care, provided to 601 individuals; educations (12.43%), incoming phone triage (45.77%), outgoing phone triage (31.40%), and attendances (10.40%). Most frequent SURC contacts were for care-coordination (28.43%), gastrointestinal symptoms (17.97%), diagnostics (8.81%), pain management (7.56%),)and medication advice (6.23%). Notably, more than one-third indicated they would have done nothing (36.93%) with 7.13% indicating they would have presented to ED without SURC. Closely aligning with the local cancer prevalence rates, the commonest tumour streams are breast (22.63%), lung (17.14%), and colorectal (15.64%).
Conclusions
The SURC model of care continues to be an invaluable resource at PH to support cancer patients undergoing SACT which allows prompt access to specialist care while avoiding emergency presentations in the ambulatory setting. The model continues to expand post an additional government grant “SURC-additional support during COVID-19 and recovery” to increase additional support to vulnerable populations.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
274MO - Mobile application for breast cancer survivors to improve their post treatment quality of life: A randomized controlled trial
- Maninder D. Kaur (Chandigarh, India)
Abstract
Background
Breast cancer is affecting the among women worldwide.They suffered froms physical, psychosocial and sexual impairment after their treatment completion. It reduces their post treatment QOL. Smart devices and wearable technologies are becoming progressively more popular throughout society. m-health technology is the use of smartphones devies to deliver health care and preventive health services.
Methods
Study has conducted under 3 phases in hospital of Northern India. In I phase, mixed method approach was used to identify the problems faced by the patients, in II phase mobile app was developed and in III phase, PROBE design to assess the efficacy of mobile app. This includes 170 survivors with stage I-IIIA, who completed adjuvant therapy for 3 months ago. Participants were randomly allocated to mobile app and control group. Participants assesed at baseline, 3 months post intervention and 6 months follow up. The QOL assessed with EORTC QLQ-C30. For fatigue, CTCAE fatigue grades were used. For vaginal dryness, national cancer Institute common toxicity criteria version 5 was also used. For lymphedema, arm circumference was measured by using tmeasuring tape and LENT-SOMA criteria for arm edema was used. Data analysis was done using SPSS version 25.0.
Results
At baseline all health-related outcome parameters were comparable in both the groups. At 3 months follow up, quality of life score was better in app group compared to control group. No significant difference was seen in fatigue and vaginal dryness in any of the groups at 3 months (P>0.05). At 6 months, quality of life, fatigue and lymphedema was improved significantly improved in app group. In multivariate analysis, significantly improvement for fatigue and quality of life was seen in app group compared to control group at 6 months. However, as per intention to treat analysis significant improvement was seen in quality of life, fatigue, vaginal dryness and lymphedema.
Conclusions
Mobile application for breast cancer survivors was effective in improving the quality of life, fatigue, lymphedema and vaginal dryness among the survivors. However, further multicentric-RCTs are required for validation of the results in a larger population.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.
Invited Discussant 273MO and 274MO
- Paolo Bossi (Brescia, Italy)
Q&A and discussion
- Paolo Bossi (Brescia, Italy)
275MO - Phase III double blind placebo-controlled study of olanzapine for chemotherapy related anorexia in patients with advanced gastric, hepatopancreaticobiliary and lung cancer
- Prasanth Ganesan (Puducherry, India)
Abstract
Background
Anorexia occurs in 30-80% of patients with advanced malignancies which worsens with chemotherapy. This may worsen weight loss with resultant increase in toxicity and poor oncological outcomes. There is no current standard therapy for anorexia. This trial was designed to assess the efficacy of olanzapine as an orexigenic agent in patients receiving cytotoxic chemotherapy.
Methods
Adults (≥18years) with untreated, advanced gastric, hepatopancreaticobiliary (HPB) and lung cancers were randomly assigned in a double-blind manner to receive olanzapine (2.5mg once a day for 12 weeks) or placebo along with planned chemotherapy. Both groups received standard dietary assessment and advice. Improvement in anorexia measured by “The Functional Assessment of Chronic Illness Therapy Anorexia Cachexia subscale (FAACT ACS)” and proportion of patients achieving weight gain of >5% at 12 weeks were the primary outcome measures. The study was powered to detect a 20% improvement in the proportion of patients achieving >5% weight gain in the olanzapine group.
Results
A total of 124 pts [median age: 55 yrs (18-78yrs), 64% males, mean wt: 53kgs, mean BMI: 20.9 kg/m2; Gastric (N=68,55%), lung (N=43,35%), and HPB (N=13 (10%)] were randomized, of which 58 (olanzapine) and 54 (placebo) were evaluable at 12 weeks. Proportion of patients with improvement in FAACT ACS score was superior with olanzapine [54/58 (93%) vs. 33/54(61%), p<0.0001]. Proportion achieving weight gain (≥5%) was more with olanzapine [35/58 (56%) vs. 5/54 (8%), p<0.0001] when compared to placebo. Patients on olanzapine had improvement in quality-of-life (p=0.003), SGA grade (p=0.004), and lesser grade 3 toxicity (14%vs 36%, p=0.02). No major side effects were due to olanzapine or placebo. Among patients with metastatic disease(N=99), median overall survival was better in the olanzapine arm[16 vs 10 mos (p=0.03)].
Conclusions
Low-dose olanzapine improves appetite and leads to weight gain when given along with chemotherapy with a potential to improve oncological outcomes. Olanzapine can be considered as a safe, and inexpensive addition to supportive treatment for patients receiving chemotherapy.
Clinical trial identification
CTRI/2020/08/027133.
Legal entity responsible for the study
Dr. Prasanth Ganesan.
Funding
JIPMER Intramural Research Grant.
Disclosure
All authors have declared no conflicts of interest.
276MO - Superior single agent effectiveness with plinabulin (Plin) versus (vs) placebo (Plac) for docetaxel (Doc)-induced neutropenia (DIN) prevention in non-small cell lung cancer (NSCLC) patients (pts)
- Douglas Blayney (Stanford, United States of America)
Abstract
Background
Hematologic complications (HC) in NSCLC pts increase pt toxicity, inconvenience, financial toxicity, and risk for COVID-19 infection. Plin, a novel progenitor cell-protective molecule is non-inferior to Pegfilgrastim (Peg) for the prevention of DIN (Blayney, JAMA Open 2021). Plin, as a single dose per cycle, reduces healthcare touches as it is given on the same day as Chemo, has minimal bone pain and thrombopenia (TP), and has anti-cancer efficacy (Blayney, JAMA Onc 2020). Doc 75 mg/m2 is typically used without G-CSF. Plin’s DIN effectiveness vs Plac (‘no G-CSF’) was evaluated in NSCLC.
Methods
NSCLC pts with at least one febrile N (FN) risk factor received Doc 75 mg/m2 with Plin (20 mg/m2 (or its equivalent of 40 mg fixed dose); n=30) in the Ph2/3 study PROTECTIVE-1 (NCT03102606), or without Plin (Plac; n=224) in Ph3 study DUBLIN-3(NCT02504489). Plin is a single 30-min IV infusion per cycle (C), 30 min after Doc. C1 blood sampling was pre-dose, day (D)1, 2, 6, 7, 8, 9, 10, 15, 21 with Plin, and at predose, D1, D8 with Plac; and after C1, at predose, D8. HC endpoints (N (All Grade (Gr), Gr4, Gr3/4), anemia (AN), and TP, were calculated from Covance Central Laboratory over 4 Cs. Duration of severe (Gr4) N (DSN) was calculated in C1 from actual ANC profile over time for Plin, and through modeling with Plac, using observed D8 ANC (= ANC nadir for Doc). FN, Infections, adverse events, and Quality of Life (QoL with EORTC QLQ-C30) over 4 Cs were evaluated.
Results
Baseline demographics were comparable. Plin was well tolerated. Gr4N % with Plin in C1,2,3 and 4 was 17%, 3%, 0% and 0%. QoL with Plin remained stable. *p-value is significant in favor of Plin
All GrN Gr3/4N Gr4N DSN (days) Mean [95%CI] ANC Nadir Median Gr3/4 FN Infection Gr3/4 AN Gr3/4 TP Plin 60% 40% 17% 0.43 [0.06;0.8] 1.4 3.3% 13% 3.3% 0% Plac 71% 54% 40% 1.32 [0.9;1.3] 0.8 5.4% 23% 5.8% 0% p-value 0.24 0.15 0.02* 0.002* 0.02* >0.999 0.34 >0.999 >0.999
Conclusions
In prospective trials with NSCLC pts, Plin was superior for the prevention of DIN and HC vs Plac and had a favorable QoL and safety profile. The same-day-dosing and low AE burden with Plin minimizes healthcare touches, financial toxicity, and patient inconvenience.
Clinical trial identification
Ph3 DUBLIN-3(NCT02504489); Ph2/3 study PROTECTIVE-1 (NCT03102606).
Legal entity responsible for the study
BeyondSpring Pharmaceuticals, Inc.
Funding
BeyondSpring Pharmaceuticals, Inc.
Disclosure
D. Blayney, L. Huang, G. Legaspi, S. Duprez, R. Mohanlal: Financial Interests, Personal, Principal Investigator: BeyondSpring Pharmaceuticals, Inc. S. Ogenstad: Financial Interests, Personal, Advisory Role: BeyondSpring Pharmaceuticals, Inc.
277MO - Filgrastim versus pegfilgrastim as primary prevention for reduction of chemotherapy induced febrile neutropenia in Nepal
- Rajeev Sharma (Kathmandu, Nepal)
Abstract
Background
Chemotherapy-induced neutropenia is a frequent complication of cytotoxic chemotherapy treatment. It increases the risk of infection and often leads to febrile neutropenia (FN). Development of FN may compromise the treatment response with substantial economic burden. Granulocyte colony-stimulating factor (GCSF) administration could prevent episodes of FN and its related complications. Filgrastim and pegfilgrastim are GCSFs approved for the reduction of neutropenia-related outcomes. This study compares filgrastim and pegfilgrastim as primary prevention for reduction of chemotherapy induced FN and its direct cost to the patients.
Methods
Histologically confirmed solid cancer patients (n=112) receiving either high-risk or intermediate-risk chemotherapy regimens for FN were randomized into two groups. Group one received filgrastim 300 μg subcutaneously for five days and group two received pegfilgrastim 6 mg subcutaneously single dose, starting after 24 hours after completion of chemotherapy during each chemotherapy cycle. The primary end point was the occurrence of FN. The secondary end points were number of hospital visits, duration of hospital stay and total direct costs of filgrastim and pegfilgrastim.
Results
Fifty six patients were analyzed in each group. The incidence of FN was significantly lower in the pegfilgrastim group (42.90%) than in the filgrastim group (69.6%), p<0.004. The mean number of hospital visits were 1.84+1.93 in the filgrastim group and 0.84+1.19 in the pegfilgrastim group with 58.90% and 33.90% hospital admission, respectivelys. The mean duration of stay was 4.1429+3.69 days in the filgrastim group and 2.36+3.35 days in the pegfilgrastim group. The total mean cost (Nepali rupees) of filgrastim and pegfilgrastim was 20162.50+6645.37 and 32210.71+10429.43, respectively.
Conclusions
A single dose of pegfilgrastim is better than multiple doses of filgrastim in reducing FN incidence which minimizes hospital stay, visits and frequency of admission in cancer patients receiving chemotherapy. Taken together, the adequate evaluation of patients and the use of prophylactic GCSFs become relevant for optimizing clinical outcomes and reducing hospitalization related morbidities in the management of FN.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Invited Discussant 275MO, 276MO and 277MO
- Florian Scotté (Villejuif, France)
Q&A and discussion
- Paolo Bossi (Brescia, Italy)
278MO - Adherence optimisation, benefits, and limitations of oral anti-cancer therapy: A systematic review of patient preferences
- Amy G. Davies (Clayton, Australia)
Abstract
Background
Oral anti-cancer (OAC) therapies are now commonplace in cancer treatment. Variable adherence and irregular toxicity monitoring remain concerning, particularly for treatments with curative intent. This study reviews literature on patient preferences considering: 1) factors contributing to patient adherence; 2) benefits and limitations; 3) concordance between patient and clinician perspectives.
Methods
This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An a priori protocol was established with systematic searches of major databases (Pubmed, Ovid Emcare, CINAHL and Scopus) from January 2000 – March 2022. Quantitative and qualitative studies of adult populations were included. Methodological quality was assessed using the Johanna Briggs Institute Critical Appraisal Tools. A narrative synthesis of findings was conducted.
Results
1438 articles were screened, 272 completed full-text review with 58 included studies. One-third (17/58) were published in the past 2 years. Most studies (53/58, 91%) involved patients from USA and Europe; there were 5 studies from Asia (Japan 3, China 2). Factors contributing to lower adherence were less patient education, lack of habitual administration, avoidance of side effects and reduced understanding of oral regimens. More recent trials of patient-prompting interventions such as apps and reminders had mixed efficacy. Patient-reported benefits of OAC included convenience of home administration, patient empowerment, better psychological wellbeing, and less social and productivity interruption when compared with intravenous administration. Limitations included poorer understanding of safe-handling and reactive management of side-effect due to reduced contact with clinicians. Pharmaceutical interventions were shown to improve adherence in some studies. Studies comparing patient and clinician perspectives (n=5) identified a lack of relevant toxicity education.
Conclusions
Barriers and enablers of oral anticancer treatment have been identified. This information should be used by clinicians to optimise this mode of cancer treatment.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
279MO - What ‘new normal’ means to lung cancer survivors: A qualitative study
- Genehee Lee (Seoul, Korea, Republic of)
Abstract
Background
Cancer is a life-changing experience, and side effects from treatment hinder survivors from going back to their pre-cancer ‘normal life’. Moreover, it becomes an even greater burden for lung cancer survivors who have received pulmonary resection. We aimed to understand the ‘new normal’ and barriers to achieve it among lung cancer survivors who underwent surgery.
Methods
This is a qualitative study using semi-structured interviews among survivors of lung cancer after surgery. Thirty-two participants were recruited from their postoperative follow-up clinics. In-depth interviews were conducted in accordance with semi-structured interview guidelines that consisted of how survivors defined “new normal”, their expectation to reach this notion, type of support needed and the barriers that hindered them from achieving it. Audio-recorded interviews were transcribed and analyzed using thematic analysis. Systematic comparison of transcripts was made to identify recurrent or common themes, and arrange them into categories, which were relevant to the purpose of the study.
Results
The following 3 themes were found to describe lung cancer survivors’ perspectives about “new normal”: (1) improvement of burdensome symptoms, (2) no difficulty in carrying out desired activities, and (3) being financially responsible for their family. Survivors considered improvements in shortness of breath, fatigue, and pain to indicate recovery, hence when these symptoms improved over time, they felt like they have recovered well, although not exactly to their pre-surgery level. Majority of the survivors expected to recover 70∼90% of their baseline function. Defining one’s ‘new normal’ and setting realistic expectations were helpful for survivors. We also found that fear of cancer recurrence, persisting symptoms, and high family expectation were barriers to achieve ‘new normal’.
Conclusions
“Can I go back to the life I once had?” is a critical question survivors have. Understanding how lung cancer survivors perceive their status and figure out their ‘new normal’ would be important. It is needed for healthcare professionals to communicate with patients about their expectations on ‘normality’ from the beginning of treatment. This process should be included in comprehensive survivorship care.
Legal entity responsible for the study
The authors.
Funding
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (2019R1A2C2009751 and NRF-2020R1F1A1075388).
Disclosure
All authors have declared no conflicts of interest.
Invited Discussant 278MO and 279MO
- Siew C. Chia (Singapore, Singapore)