Background

Assessing patient-reported outcomes (PROs) is an important element of treatment and care of cancer patients with brain metastases (BMs). BMs are associated with substantial morbidity and mortality. Few prospective studies on PROs in patients with BMs exist. Further, poor accrual, differential dropout, missing data, timing of assessments, and response shift complicate interpretation of PROs in previous studies. We conducted a prospective, population-based study with clinical data and PROs to gain insight into the health-related quality of life (HRQOL) of patients with BMs.

Methods

Norwegian patients with newly verified BMs from solid cancers, who were adults (≥18 years) and provided written consent were included. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative (EORTC QLQ-C15-PAL) was used monthly to measure HRQOL. Student’s t-tests were used to examine differences in EORTC scores at baseline and 3 months.

Results

725 patients have been included so far; mean age 66, 53% females, 45% with lung cancer, 79% with extracranial metastases, 59% with ECOG 0-1. 35% died within 3 months after BM diagnosis. The table shows HRQOL scores at baseline for the entire sample and baseline and 3 month scores for the 235 patients who completed both. Patients reported significantly lower physical functioning and more fatigue, pain, nausea/vomiting and dyspnea, and poorer appetite, but less sleep disturbances at 3 months compared to baseline. Table: 1441O

EORTC QLQ-C15-PAL scores of the patients (n=725)

Conclusions

Deterioration in most HRQOL scores was detected three months after inclusion in the study. Preliminary analyses indicate a healthy bias, in that those with poor HRQOL at baseline have died or are too frail to complete PRO measures.

Clinical trial identification

NCT03346655.

Legal entity responsible for the study

Oslo University Hospital.

Funding

The South-Eastern Norway Regional Health Authority.

Disclosure

All authors have declared no conflicts of interest.

Background

Integrated palliative care (PC) is recommended for all cancer patients. It improves patient experience and communication, reduces symptom burden and futile medical interventions, and shortens length of hospital stay. Despite the mortality of 27-43% for cancer patients admitted to intensive care (ICU), early PC involvement has not been widely adopted. Previous studies have shown the potential for using specific “trigger” criteria to identify ICU patients for early PC referral. We show the benefits of using a novel trigger tool in practice at the time of admission to ICU in a specialist cancer hospital.

Methods

We developed a novel electronic tool, combining criteria outlined by Hua et al. (2016) with a locally-developed triggers checklist already used in the outpatient setting. This tool was integrated into the ICU clerking proforma. Patients meeting any of the tool’s criteria were referred to the PC team who provided early advice for symptom control and advanced care planning. Quality improvement methodology was used between February 2020 and January 2021 as we embedded this tool into clinical practice.

Results

In a timeline disrupted by two waves of COVID-19, there were 151 admissions of which 74 (49%) had a triggers form completed. Sixty-six cases (89%) were positive (≥1 criterion), leading to 16 (24%) referrals to palliative care. This represented 46% of all PC referrals made from ICU during this period. We show that many patients admitted to ICU have a poor functional baseline (47% had metastatic cancer progressing despite 1st line chemotherapy, 49% had an ECOG score ≥2). Many patients also had severe or uncontrolled symptoms (52%). Early palliative care provided vital input for those patients.

Conclusions

Our tool proactively identifies patients for early PC referral, streamlines the referral process, and empowers staff to consider treatment goals in a timely manner for the benefit of patients. Technical, practical, and cultural barriers to implementation were identified and changes made to address these, for example, having PC present at the weekly ICU meeting. We demonstrate a model for collaborative working which can be adapted for use in other ICUs and facilitate early PC for a broader cohort of cancer patients.

Legal entity responsible for the study

The authors (all staff at The Royal Marsden NHS Foundation Trust).

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

A large knowledge gap exists about the risk of cancer in individuals with intellectual disability (ID).

Methods

We conducted a population-based cohort study of more than 3.5 million Swedish children born to mothers from the Nordic countries, including 27,956 (0.8%) clinically ascertained cases of ID, born from 1974 to 2013, to investigate the association between ID and risk of cancer. Incident cancers were identified from the Swedish Cancer Register. We used Cox regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of cancer in relation to ID while performing detailed adjustment for potential confounding. We analyzed by ID severity and ID type (idiopathic or syndromic) separately. To evaluate potential familial confounding, we further performed a sibling-comparison.

Results

We found a statistically significantly increased risk for any cancer (HR 1.57; 95% CI 1.35-1.82), as well as for several cancer types, including cancers in esophagus (HR 28.4, 95% CI 6.2-130.6), stomach (HR 6.1, 95% CI 1.5-24.9), small intestine (HR 12.0, 95% CI 2.9-50.1), colon (HR 2.0, 95% CI 1.0-4.1), pancreas (HR 6.0, 95% CI 1.5-24.8), uterus (HR 11.7, 95% CI 1.5-90.7), kidney (HR 4.4, 95% CI 2.0-9.8), central nervous system (HR 2.7, 95% CI 2.0-3.7), and other or unspecified sites (HR 4.8, 95% CI 1.8-12.9), as well as acute lymphoid leukemia (HR 2.4, 95% CI 1.3-4.4) and acute myeloid leukemia (HR 3.0, 95% CI 1.4-6.4). The risk increase was not modified by ID severity or sex but was higher for syndromic ID. Results from sibling-comparison spoke against familial confounding.

Conclusions

Individuals with ID show an increased risk for developing cancer. The association could not be explained by shared genetics or familial confounders between ID and cancer.

Legal entity responsible for the study

F. Fang and S. Sandin.

Funding

This study was supported by the European Union’s Horizon 2020 research and innovation programme, the Swedish Cancer Society, the Swedish Research Council for Health, Working Life and Welfare, and the China Scholarship Council.

Disclosure

A. Kolevzon: Financial Interests, Institutional, Funding, Research Support: AMO Pharma; Non-Financial Interests, Personal and Institutional, Advisory Role, Consult: Ovid Therapeutics, Acadia Pharmaceuticals, Alkermes, Jaguar Health, Ritrova. All other authors have declared no conflicts of interest.

Background

Great efforts and impressive progresses are being made in tumor treatment. Research and care concerning long-term problems and late effects of cancer in disease survivors is, however, still insufficient.

Methods

The FiX study enrolled 2,508 patients across 15 different cancer entities around 2 years after diagnosis via an Epidemiological Cancer Registry in Germany, with the primary aim to assess pattern, severity, and impact of fatigue. A follow-up survey was conducted between 12/2020 and 04/2021. Using a list with 36 potential long-term problems or late effects, participants were asked how much these are/were a burden to them (no/ little / moderate / significant / extreme burden), and, in case of burden, how they rate the received support for this problem (good / moderate / poor).

Results

1,874 participants (76%) completed the follow-up survey at a median (Q1, Q3) of 4.2 (3.8, 4.8) years after cancer diagnosis. This population had a mean (SD) age of 65.8 (11.2) years, and 49% were female.

The most frequently reported problems rated with at least moderate burden were: loss of physical capacity (40.7%), fatigue (38.5%), sleep problems (36.6%), sexual problems (35.4%), arthralgia (33.4%), anxiety (33.2%), and neuropathy (28.9%). Cardiac disorders and osteoporosis burdened 15.6% and 11.9% of survivors, respectively. Extreme burden was most frequently rated for sexual problems (10.1%), mainly in men with prostate cancer. This was also the problem with the highest proportion of dissatisfaction with received support (44.7% of affected survivors rated support as poor). Support for fatigue was rated as poor by 37.7% and as good only by 29.5% of affected survivors. Support was also reported as poor for neuropathy (35.9%), cognitive problems (35.3%), weight gain (34.7%), or hot flashes/night sweats (33.7%). In contrast, support in case of pain was rated as good by a majority (51.3%). Determinants of the different burdens and of satisfaction with support have been identified.

Conclusions

A significant number of cancer survivor suffer from long-term effects. Our study identified several groups with open needs for improvements in supportive care.

Clinical trial identification

NCT03318224.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.