Dan Pringle

The role of second-hand smoke exposure on smoking cessation in non-tobacco-related cancers.

Second‐hand smoke (SHS) is a significant barrier to smoking cessation after a diagnosis of cancer in patients with lung as well as head and neck cancers. In the current study, the authors evaluated the effect of SHS on smoking cessation among patients with those cancers not traditionally perceived to be strongly associated with smoking.

Lifestyle Behaviors in Elderly Cancer Survivors: A Comparison With Middle-Age Cancer Survivors

PURPOSE Improved cancer screening and treatment have led to a greater focus on cancer survivorship care. Older cancer survivors may be a unique population. We evaluated whether older cancer survivors (age ≥ 65 years) had lifestyle behaviors, attitudes, and knowledge distinct from younger survivors. PATIENTS AND METHODS Adult cancer survivors with diverse cancer subtypes were recruited from Princess Margaret Cancer Centre (Toronto, Ontario, Canada). Multivariable models evaluated the effect of age on smoking, alcohol, and physical activity habits, attitudes toward and knowledge of these habits on cancer outcomes, and lifestyle information and recommendations received from health care providers, adjusted for sociodemographic and clinicopathologic covariates. RESULTS Among the 616 survivors recruited, 23% (n = 139) were older. Median follow-up since diagnosis was 24 months. Older survivors were more likely ex-smokers and less likely current smokers than younger survivors, but they were less likely to know that smoking could affect cancer treatment (adjusted odds ratio [OR], 0.53; P = .007) or prognosis (adjusted OR, 0.53; P = .008). Older survivors were more likely to perceive alcohol as improving overall survival (adjusted OR, 2.39; P = .02). Rates of meeting moderate-to-vigorous physical activity guidelines 1 year before diagnosis (adjusted OR, 0.55; P = .02) and maintaining and improving their exercise levels to meet these guidelines after diagnosis (adjusted OR, 0.48; P = .02) were lower in older survivors. Older and younger cancer survivors reported similar rates of receiving lifestyle behavior information from health care providers (P = .36 to .98). CONCLUSION Older cancer survivors reported being less aware of the impact of smoking on their overall health, more likely perceived alcohol as beneficial to survival, and were less likely to meet exercise goals compared with younger survivors. Survivorship programs need to consider age when counseling on lifestyle behaviors.

Canadian cancer site-specific health utility values: Creating the basis for measuring value and costs of therapy.

7 Background: Health utility values (HUVs) play an integral role when conducting health economic analyses, but a paucity of reference HUVs exists for cancer patients. Using EQ-5D, we generated reference HUVs for multiple malignancies. We further assessed patient willingness to compete the instrument on a regular basis by adding the EQ-5D to an Ontario-wide patient-reported symptom tool mandated by Cancer Care Ontario, the provincial cancer government agency. METHODS 1,831 cancer patients across all non-CNS solid and hematologic cancer sites at the Princess Margaret Cancer Centre completed the EQ-5D instrument; a subset (n=618) were asked about the acceptability of regularly completing the EQ-5D. HUVs were calculated using Canadian valuations. RESULTS The mean±SD HUV for all patients was 0.81±0.15, but were significantly different across different disease sites (p<0.0001): Testicular cancer, 0.87±0.13; prostate, 0.87±0.15; colorectal, 0.83±0.12; head/neck, 0.82±0.15; lymphoma, 0.82±0.15; breast, 0.81±0.17; esophageal, 0.81±0.16; ovarian, 0.79±0.15; leukemia, 0.78±0.15; lung, 0.78±0.13 and myeloma, 0.77±0.14. Confirming the validity of these HUVs, patients with PRO-ECOG scores of 0, 1, 2 and 3 had HUVs of 0.90±0.14, 0.77±0.11, 0.65±0.14 and 0.59±0.19, respectively (p<0.0001). In patients with solid tumors, those with local disease had HUVs of 0.82±0.15; metastatic disease, 0.80±0.15; p=0.015. 88% of patients reported that the EQ-5D was easy to complete, 92% took less than 5 minutes, 89% were satisfied with its length and 86% were satisfied with the types of questions asked. Importantly, 92% reported that they would complete the EQ-5D, even if it was used solely for research purposes and 73% agreed with the notion of completing it regularly at their clinic visits. CONCLUSIONS We present the first Canadian reference dataset of HUVs for common cancers; stage-and site-specific reference values will be presented at the meeting. Mean HUVs varied by disease site, performance status, and disease severity. Furthermore, a majority of patients surveyed were willing to complete the EQ-5D on a regular basis, suggesting that routine administration is feasible across Ontario.

Assessment of accuracy of data obtained from patient-reported questionnaire (PRQ) compared to electronic patient records (EPR) in patients with lung cancer.

40 Background: Cigarette smoking, alcohol consumption and co-morbidities are important determinants of health in lung cancer patients. The gold standard for obtaining accurate data is PRQ. The purpose of this study is to ascertain the accuracy of abstracting health-related behaviour data from retrospective chart review compared to data directly obtained from PRQ in a lung cancer patient population. METHODS 731 lung cancer patients completed a PRQ related to lifetime tobacco use, alcohol consumption and co-morbidity. Relevant smoking, alcohol and co-morbidity data was collected independently from EPR. RESULTS Ever/never status for smoking showed almost perfect agreement (k=0.95) between PRQ and EPR and surpassed all other health behavioural measures and co-morbidity agreement values. Both the sensitivity and specificity were high (0.94 and 0.99 respectively). The calculation of pack-years from EPR and PRQ showed substantial agreement (k=0.77); However, categorizing the smoking status into current/ former / never, resulted in moderate agreement (k=0.46). Alcohol ever/ never status agreement was moderate (0.43) with high sensitivity (0.90) but low specificity (0.50). Agreement for co-morbidities varied by condition showing moderate to substantial agreement for hypertension (K=0.57), heart attack (K=0.80) and diabetes (K=0.76) while fair to slight agreement (K<0.4) was seen in the others. Specificity was 0.86 or higher for co-morbidity conditions and was consistently higher than the sensitivity. CONCLUSIONS EPR may be used as a reliable surrogate to PRQ in determining ever/never smoking status and lifetime smoking exposure. Evaluation of current/former/never smoking status and alcohol consumption is best determined by PRQ. Diabetes, hypertension and heart attack are more accurately reported in the PRQ than other co-morbidities. Patients tend to report absence of a medical condition more accurately than the presence of it. Missing EPR data related to smoking pack years, alcohol consumption and lung co-morbidities is concerning and suggests more synoptic reporting by physicians would improve opportunities for research.

Use of iPad technology to determine cancer patient-reported preferences for and understanding of pharmacogenetic testing (PGT).

319 Background: PGT in oncology can be used to predict the efficacy and toxicity of a particular treatment in an individual. Previous work by our group has demonstrated that among cancer patients willing to undergo chemotherapy, >98% wanted PGT testing if it could identify patients who would respond to chemo. However, in the original study using a paper questionnaire, 22% of patients did not understand the concept of PGT and its clinical implications. Therefore, we have devised a simpler, more visual questionnaire in electronic format using iPad technology and simple animations. We are assessing if patient understanding using this format is increased and also if patients prefer completing the survey with this novel technology. METHODS An interim analysis of a broad cross-section of cancer patients using an iPad was performed. PGT questions related to hypothetical efficacy, toxicity, time to test results, willingness to pay as well as understanding of PGT scenarios were assessed. RESULTS 135 cancer patients (87% adjuvant, 12% metastatic; 27% breast, 25% colon, 22% heme malignancy, 23% other) attending Princess Margaret Hosptial participated. 85% of patients accepted chemo that had a 5% absolute improvement in survival and <10% chance of side effects. 94% of patients chose to have PGT if it could identify subsets of patients who would benefit from chemo. The median that patients were willing to pay for PGT was

Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors

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Effect of physical activity (PA) perceptions in cancer survivors on PA behaviors: Helping health care providers improve patient communication.

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Complementary and alternative medicine and other health behaviors.

5,000), however the median that patients felt was a reasonable price was

Use of online resources by patients with cancer: The Canadian experience.

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Patient preference: a comparison of electronic patient‐completed questionnaires with paper among cancer patients

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