population-based colorectal cancer patient sample in Italy
• Paolo Baili, Fondazione IRCCS Istituto Nazionale Tumori, Italy
• Massimo Vicentini, Reggio Emilia Cancer Registry, Italy
• Marina Vercelli, Genova Cancer Registry, Italy
• Ornelia Sechi, Sassari Cancer Registry, Italy
• Andrea Micheli, Fondazione IRCCS Istituto Nazionale Tumori, Italy
Purpose: To differentiate colorectal cancer prevalence in Italy ac-cording to cancer patients’ health status.
Methods: Data on all treatments, metastases, relapses and cause of death were collected by four Italian Cancer Registries follow-ing two approaches: a) cohort approach: 601 cases diagnosed in 2002 and followed up to December 31st 2007; b) period approach: 298 cases (diagnosed in 1997-2001) alive at January 1st 2007, followed for one year up to December 31st 2007 A 10-year-fictitious cohort of patients was created by applying the period approach results to the 2002 cohort. For every interval j after diagnosis, it was possible to estimate the health status (of patients alive at the beginning of the year j) 10 years after diag-nosis. In this way we defined the health status of prevalent cases over 10 years, irrespectively to the year of diagnosis.
Results: The 10-year colorectal cancer prevalence cases can be subdivided in four groups:
- 74.7% free from any treatment/metastasis/relapse at the end of 10th year from diagnosis
- 8.1% dead due to colorectal cancer in one year
- 11.4% dead due to colorectal cancer in more than one year (but before the 10th year from diagnosis) or under treatment/
with disease at the end of their 10th year from diagnosis - 5.8% dead due to other causes before the 10th year from di-agnosis
Conclusions: We introduced a new method useful for estimating different health demands for people who experienced cancer.
Cancer registry data are useful to quantify the amount of can-cer patients after diagnosis according to their health status and needs.
Poster number: 102
CAREMORE (CAncer REgistry MOdel on REha-bilitation): Results of a pilot study on rehabilitation services in a Italian cancer patients cohort
• Francesca Di Salvo, Fondazione IRCCS Istituto Nazionale Tumori, Italy
• Rosario Tumino, Ragusa Cancer Registry, Italy
• Paolo Contiero, Varese Cancer Registry, Italy
• Francesco De Lorenzo, FAVO - Federation of Italian Voluntary Associations in Oncology, Italy
• Paolo Baili, Fondazione IRCCS Istituto Nazionale Tumori, Italy
Abstracts
cord injury (9 patients), and asthenia (8 patients.) Twenty-three out of the 32 patients had full time care giver support available.
Patients who underwent inpatient rehabilitation: Eleven out of the 32 patients were accepted for transfer and subsequently underwent inpatient rehabilitation. Nine patients out of 11 were male. Two were female. Their average age was 57.2 years.
These patients had a wide variety of cancer diagnosis. A com-mon rehabilitation diagnoses was gait abnormality (6 patients).
Nine out of the 11 patients had full time caregiver support. For these 11 patients, mean ESAS scores at the time of initial evalua-tion were the following: Pain 2.8, Fatigue 3.1, Nausea 0.4, Depres-sion 2.8, Anxiety 2.5, Drowsiness 2.6, Appetite 2.9, Well-being 4.2, Dyspnea 1.5, Sleep 2.6. Average length of stay on the inpatient rehabilitation unit was 12 days. Eight out of the 11 patients were discharged home without hospice; two patients were discharge home with hospice. One patient was transferred back to the pal-liative care unit. Patients who did not undergo inpatient rehabili-tation. Twenty-one of the thirty-two patients were not accepted for transfer for inpatient rehabilitation. Nine were male, and twelve were female. Their average age was 49.8 years. Non-small cell lung cancer was the most common cancer diagnosis (6 patients). Common rehabilitation diagnosis were gait abnor-mality (8 patients) and spinal cord compression (7 patients). 14 patients had full time care giver support available. For these 21 patients not transferred to the acute inpatient rehabilitation unit, mean ESAS scores at the time of evaluation were the follow-ing: Pain 3.2, Fatigue 4.1, Nausea 1, Depression 1.6, Anxiety 2.3, Drowsiness 2.7, Appetite 2.7, Well-being 3.1, Dyspnea 1.4, Sleep 2.6. Nine patients were discharged by the palliative care unit to home hospice, five patients to inpatient hospice, three patients expired in the hospital, two patients were discharged to a SNF, and two patients were discharged home without hospice.
Conclusion: After inpatient cancer rehabilitation more acute pal-liative care patients were discharged home without hospice (73%
vs. 10%). At the time of evaluation for inpatient rehabilitation, no significant differences were found in mean ESAS scores between patients accepted and not accepted for acute inpatient rehabilita-tion. Inpatient cancer rehabilitation in a palliative care population with decreased symptom burden may be able to affect discharge disposition.
Poster number: 105
Operable lung cancer patients experiences of reha-bilitation and supportive needs at diagnosis. A quali-tative study
• Malene Missel, Department of Thoracic Surgery 3151, Rigshospitalet, Denmark
• Carsten Hendriksen, Department of Public Health, University of Copenhagen, Denmark
• Jesper Holst Pedersen, Department of Thoracic Surgery 2152, Rigshospitalet, Denmark
• Marianne Tewes, The Heart Centre, Rigshospitalet, Denmark
• Lis Adamsen, Department of Public Health, Copenhagen University and Uni-versity Hospitals Centre for Nursing and Care Research (UCSF), Denmark
related to the treatment. We lack evidence based knowledge about how disease-and treatment-related symptoms and com-plications are experienced by and affects the patients and their relatives during and after treatment. Few rehabilitative interven-tion studies have been conducted in this patient group. The lit-erature confirms that there is a need for a systematic evaluation of patients and relative’s needs in order to recommend national/
international and disease-specific rehabilitative interventions for patients with gliomas and their relatives.
Aim: The Ph.D. project aims to elucidate patients and relatives life situation, needs, wishes and preferences for rehabilitative inter-ventions during and after surgical and medical treatment for high grade glioma. Furthermore, the aim is to develop and test a re-habilitative intervention based on patient and family perspectives and research literature.
Design: The study will be conducted in 2 parts. Part 1 is a longi-tudinal, qualitative, explorative, and descriptive interview study of patients and their relatives’ life situation and rehabilitation needs and a quantitative evaluation of the patients health related quality of life. Part 2 is a pilot study with a pre experimental one-group design testing a rehabilitative intervention program. The interven-tion program will be developed from existing interveninterven-tion litera-ture and the findings from part 1 of the study. The study takes place from 2012 - 2015. The theoretical framework is phenom-enological and hermeneutic.
Poster number: 104
Inpatient cancer rehabilitation following acute pallia-tive care; initial outcomes from a national compre-hensive cancer center.
• Ki Shin, University of Texas MD Anderson Cancer Cente, USA
Inpatient cancer rehabilitation can address complex medical is-sues and functional deficits in a challenging patient population.
Acute inpatient palliative care can addresses complex medical issues and symptom burden for similar patients at the end of life. We will describe a unique population of inpatient cancer rehabilitation patients at the MD Anderson Cancer Center in Houston, Texas. Thirty two patients from September 2005-Au-gust 2008 were referred from the acute palliative care unit for possible transfer to the acute inpatient rehabilitation unit at MD Anderson Cancer Center. After internal review board approval, the medical records of these patients were retrospectively re-viewed for diagnosis, demographic data, Edmonton Symptom Assessment Score, degree of social support, length of stay, and discharge destination.
Results: General Demographic Data : Out of the total of 32 pa-tients who were referred for evaluation 18 were male, 14 were female. Average age was 52.3 years. Ten of the 32 patients had non-small cell lung cancer. Sarcoma, GI, and GU cancers were the next most common with four patients each. Common re-habilitation diagnoses were gait abnormality (14 patients), spinal
Poster Presentations
(drop-out 14%), 56 men and 58 women, age range 45-92 years (mean=69) with operable non-small cell lung cancer admit-ted for surgery at Department of Thoracic Surgery, University Hospital of Copenhagen. Comparison group were recruited from January to May 2011, and intervention group from June to November 2011. 75% were scheduled for video-assisted thora-coscopic surgery. Outcome variables were patients’ assessment of information, rehabilitation and practical support measured by a validated self-rating questionnaire. Statistics was calculated with SPSS version 19.
Results: Intervention resulted in significantly more patients were offered physical rehabilitation (p=0.001), were aware of where to seek help after discharge (p=0.000), had knowledge about the impact of lifestyle on health (p=0.027) and experienced support to get back to everyday life (p=0.013). In addition the interven-tion significantly increased numbers of patients who received rehabilitation with regard to financial problems (p=0.020), work-related problems (p=0.010) and psychological assistance (p=0.022) related to their disease.
Although there were significant improvements in the interven-tion group, the results also showed that 59% of patients in the intervention group were not offered physical rehabilitation and 72% were not offered psychological rehabilitation.
Conclusion: A systematic rehabilitation interview produces sig-nificant improvements in management of rehabilitation needs in the transition between hospital and everyday life in lung cancer patients after surgery.
Poster number: 107
Information needs of cancer outpatients and their significant others
• Nanna Friðriksdóttir, Landspítali University Hospital, University of Iceland, Ice-land
• Þórunn Sævarsdóttir, Landspítali University Hospital, Iceland
• Þóra Þórsdóttir, Landspítali University Hospital, Iceland
• Sigríður Gunnarsdóttir, Landspítali University Hospital, University of Iceland, Iceland
Patient education is an important part of cancer rehabilitation and multiple information needs are well known. Since 2000 can-cer outpatients starting chemotherapy/radiation at Landspítali receive individualized information supported in the form of a notebook containing information leaflets on treatment and side-effects, self-care, services in- and outside the hospital, and when and how to contact health care providers(HCP). Earlier surveys conducted in 2000 and 2005 have shown that 80-90% of pa-tients are satisfied with the notebook but little is known about the degree to which information needs are perceived to have been met.
Purpose: To examine whether outpatients receiving chemo-therapy/radiation and their relatives receive too little, adequate or too much information; satisfaction with the cancer notebook;
satisfaction with opportunities, time and setting for discussions Purpose: Lung cancer is one of the most frequently occuring
cancers, and the cancer site with the highest rate of mortality.
Lung cancer patients have complex problems through the dis-ease trajectory and they are considered as disadvantaged when compared with other cancer patients. There are limited interven-tion studies. These studies have demonstrated promising results, but lung cancer patients’ needs during treatment trajectory still remains to be identified systematically. Present study is part of a ph.d. study ’Four critical moments in everyday life during disease and treatment trajectory in operable lung cancer patients and relatives, and the significance of participation in an intervention consisting of physical exercise’. The ph.d. study is part of The Center for Integrated Rehabilitation of Cancer Patients – CIRE.
Purpose of present study is to explore lung cancer patients’ chal-lenges, needs, problems and the management of symptoms at diagnosis in order to expose diagnosis interference in everyday life.
Methods: A sample of 20 patients are planned to be included.
Inclusion criteria are diagnosis of non small cell lung cancer re-ferred for surgery at department of thoracic surgery, Rigshospi-talet and age above 18. Individual in-depths interviews combined with validated questionaires with a phenomenological approach are conducted five days following diagnosis. Focus is the present and deals with themes of patients’ experiences with the diagnosis and everyday life, motivation in relation to behavior and life style.
There will be follow-up interviews and questionaires 14 weeks post surgery focusing on the patients return to everyday life.
Results: The study is an ongoing study started up in february 2012, and 11 patients have subsequently been included. Results are expected to be published at the end of 2012.
Conclusion: Findings are expected to contribute to the develop-ment and initiation of further interventions for lung cancer pa-tients early in the disease and treatment trajectory.
Poster number: 106
Transition between hospital and everyday life – im-pact of a nurse-led intervention to improve rehabili-tation in lung cancer patients after surgery
• Malene Missel, The University Hospital of Copenhagen, Dept. of Thoracic Sur-gery, Denmark
• Mai Schønau, The University Hospital of Copenhagen, Dept. of Thoracic Sur-gery, Denmark
• Jesper Holst Pedersen, The University Hospital of Copenhagen, Dept. of Tho-racic Surgery, Denmark
• Preben Ulrich Pedersen, Intitute of Public Health, Aarhus University, Denmark
Objective: To investigate the outcome of a nurse-led systematic rehabilitation interview based on individual rehabilitation needs performed before discharge. This was to prevent concerns in hospital-to-home-gap in rehabilitation of lung cancer patients after surgery.
Method: Quasi-experimental design. 114 patients participated
Abstracts
Method: A self-report questionnaire designed for this survey was completed by 363 outpatients and 65 relatives. It measures the degree to which 22 information needs are met and the degree of satisfaction with the notebook, opportunities, time, and set-ting/privacy for discussion.
Results: The majority was satisfied with the cancer notebook (91%) and with time, opportunities and setting (89%) for discus-sion. Adequate information was received by ≥70% about cancer, treatment, side-effects, body image, fertility, exercise, services of psychology and social work, support outside the hospital and where to go when something occurs at home. None had re-ceived too much information, but 30-50% had rere-ceived too little information about nutrition and use of vitamins/supplements, home services, symptoms to watch for at home, social resources, effects on family and relationships/marriage, support for relatives, relaxation, psychological wellbeing and sexual functioning. Signifi-cantly more relatives than patients received too little information about treatment, psychological well-being and resources, and the services of psychology.
Conclusion: The results provide guiding information about where information for patients, relatives, and collaboration can be im-proved.
Poster number: 108
Sexuality and Cancer: A project integrating oncosex-ology into cancer care
• Nanna Friðriksdóttir, Landspítali University Hospital, University of Iceland, Ice-land
• Jóna Ingibjörg Jónsdóttir, Landspítali University Hospital, Iceland
• Þóra Þórsdóttir, Landspítali University Hospital, Iceland
• Ásgerður Sverrisdóttir, Landspítali University Hospital, Iceland
• Sigríður Gunnarsdóttir, Landspítali University Hospital, University of Iceland, Iceland
Cancer and it´s treatment can affect sexual health. In an Icelandic study >50% of patients had problems in relation to body image, sexual interest and performance during chemotherapy (Saevars-dottir etal, 2010) but little is known about practices and attitudes of Icelandic health care providers toward sexuality cancer-relat-ed issues. With the support of two pharmaceutical companies a 2-year project was started at the end of 2010 with the purpose of integrating oncosexology into cancer care at Landspítali.
Purpose: To evaluate the effectiveness of the integration by as-sessing the attitudes and practices of nurses and physicians to-wards cancer- related sexual health issues.
Method: A pre-post one group evaluation was conducted to assess the effectiveness of the intervention. A sexuality counselor was hired for weekly consultations and a team from medical, surgical and gynecological oncology was formed. Key staff mem-bers identified to act as change agents attended a workshop at baseline and a year later. Educational meetings were held on wards, staff pocket-guides and patient information leaflets were developed. A web-site was launched for the project. A
trans-lated (Hatamäki etal, 2007) and adapted questionnaire assessing practices and attitudes was mailed electronically to health profes-sionals at baseline (T1,N=206), 11 months (T2,N=216) and 17 months (T3, N=210).
Results: At all time points the majority of participants agreed that it is a part of the job to discuss sexual health issues with cancer patients. The intervention seems to be effective since scores on assessing and discussing sexual health issues increased significantly from T1-T3 and from T2-T3, as well as scores on the provision of patient education material and referrals to sexual-health professionals. Scores also increased significantly from T1-T3 and T2-T1-T3 on having enough knowledge and from T1-T2 and T1-T3 on having enough training to discuss sexual health.
Conclusion: The project has been successful in changing practice and is still ongoing. Further assessment will be based on a fourth staff survey, chart documentation and the practices of the sexual-ity counselor.
Poster number: 109
Pain prevalence, severity, and interference in hospi-talized cancer and palliative patients
• Sigridur Zoega, Landspítali - The National University Hospital of Iceland, Iceland
• Nanna Fridriksdottir, Landspítali - The National University Hospital of Iceland, Iceland
• Svandis Iris Halfdanardottir, Landspítali - The National University Hospital of Iceland, Iceland
• Sigridur Gunnarsdottir, Landspítali - The National University Hospital of Iceland, Iceland
Purpose: Pain is a common symptom in both cancer and pallia-tive patients. The purpose of the study was to assess pain preva-lence, severity, and interference with physical function, sleep, and emotions in hospitalized cancer- and palliative patients.
Methods: A point prevalence study was conducted in two pal-liative, one hematology, and one oncology department in a uni-versity hospital in January (T1) and November (T2) 2011. Data were collected with a questionnaire (APS-POQ-R) assessing pain severity, pain interference, and quality of pain management. Par-ticipants had to be 18 years or older, hospitalized for at least 24 hours, speak Icelandic, alert, and able to participate.
Results: Participants were 43 at T1 and 39 at T2, 82 in total. The response rate was 77%. Pain prevalence was 85.0% in the past 24 hours, 16.3% had moderate pain, but 32.5% experienced severe pain. The mean (SD) worst pain severity on a 0-10 scale was 4.5 (3.3) in the past 24 hours. The mean (SD) interference from pain with physical function on a 0-10 scale was 2.8 (2.7), but 2.3 (2.5) with emotional functioning. Moderate to severe in-terference from pain with physical function and sleep was experi-enced in 17.1% patients, but with emotional functioning in 11.0%.
The highest mean (SD) interference with physical functioning was with the ability to walk and sit 3.8 (3.5) but anxiety was the emotion most severely affected by pain 2.8 (2.8). No difference was found in any of the variables between the two time points.
Poster Presentations
Conclusion: Pain was prevalent and a high proportion of patients experienced moderate to severe pain. The interference of pain on physical function, sleep and emotions was however generally mild. There is need to improve pain management in order to reduce pain severity in hospitalized cancer and palliative patients.
Poster number: 110
Perioperative Rehabilitation in Operations for LUng CAncer – a randomised clinical trial with blinded ef-fect evaluation: rationale and design (PROLUCA).
• Karen Trier, Copenhagen Center for Cancer and Health, Denmark
• Malene Missel, Rigshospitalet, Denmark
• Klaus Richter Larsen, Bispebjerg Hospital, Denmark
• Jette Vibe-Petersen, Copenhagen Center for Cancer and Health, Denmark
• Jesper Holst Pedersen, Rigshospitalet, Denmark
Background: The purpose is, in a non-hospital setting, to inves-tigate the efficacy of preoperative and early postoperative re-habilitation in patients with operable lung cancer with focus on exercise training.
Methods: Using a 2x2 factorial design with continuous effect endpoint (VO2peak), 380 subjects (95 patients/study arm) with histological evidence of non-small cell lung cancer (NSCLC) at disease stage I-IIIa, referred for surgical resection at Department of Cardiothoracic surgery RT, Rigshospitalet, will be randomly assigned to one of four groups (three intervention groups and one control group): (1) Preoperative and postoperative reha-bilitation initiated two weeks after surgery; (2) Preoperative and postoperative rehabilitation initiated six weeks after surgery; (3) Postoperative rehabilitation initiated two weeks after surgery; (4) Today´s standard care, which is postoperative rehabilitation initi-ated six weeks after surgery. The preoperative rehabilitation pro-gram consists of an individually designed, 30 minutes daily, home exercise program. The postoperative rehabilitation program consists of a supervised group exercise program comprising resistance and cardiovascular training two hours weekly for 12 weeks (exercise intensity at 60-90% of VO2peak) combined with individual counseling. The primary study endpoint is VO2peak (direct measurement). Secondary endpoints include: Periopera-tive complications (registered prospecPeriopera-tively up to 30 days after surgery), 6 MWT, 1 RM, patient-reported outcomes (e.g., quality of life, fatigue, depression, lifestyle etc.), hospitalization time, sick leave and work status, and survival. All endpoints will be assessed at baseline, the day before surgery, and, postoperatively, at week 20 and 52.
Results: The results of PROLUCA will identify the optimal peri-operative rehabilitation for non-small cell lung cancer patients with focus on exercise training initiated immediately after diagno-sis and surgery.
Conclusion: This study will contribute to establishing rehabilitation guidelines for operable NSCLC patients.
Poster number: 111
Feasibility, safety and benefits of exercise and health counseling in patients with acute leukemia undergo-ing chemotherapy durundergo-ing outpatient management - A pilot study
• Mary Jarden, UCSF, Denmark
• Lis Adamsen, UCSF, Denmark
• Tom Møller, UCSF, Denmark
• Tom Møller, UCSF, Denmark