Elyse Slater

The correlation between patient characteristics and expectations of benefit from phase I clinical trials

Patients in Phase I clinical trials sometimes report high expectations regarding the benefit of treatment. The authors examined a range of patient characteristics to determine which factors were associated with greater expectations of benefit from Phase I trials.

An Exploration of Relative Health Stock in Advanced Cancer Patients

Objective. The authors sought to empirically test whether relative health stock, a measure of patients’ sense of loss in their health due to illness, influences the treatment decisions of patients facing life-threatening conditions. Specifically, they estimated the effect of relative health stock on advanced cancer patients’ decisions to participate in phase I clinical trials. Method. A multicenter study was conducted to survey 328 advanced cancer patients who were offered the opportunity to participate in phase I trials. The authors asked patients to estimate the probabilities of therapeutic benefits and toxicity, their relative health stock, risk preference, and the importance of quality of life. Results. Controlling for health-related quality of life, an increase in relative health stock by 10 percentage points reduced the odds of choosing to participate in a phase I trial by 16% (odds ratio = 0.84, 95% confidence interval = 0.72, 0.97). Conclusion. Relative health stock affects advanced cancer patients’ treatment decisions.

A Web-based communication aid for patients with cancer: The CONNECT Study

Cancer patients and their oncologists often report differing perceptions of consultation discussions and discordant expectations regarding treatment outcomes. CONNECT, a computer‐based communication aid, was developed to improve communication between patients and oncologists.

Assessing Compliance with National Comprehensive Cancer Network Guidelines for Elderly Patients with Stage III Colon Cancer: The Fox Chase Cancer Center Partners' Initiative

BACKGROUND Fox Chase Cancer Center Partners (FCCCP) performs an annual quality review of affiliate practices based on National Comprehensive Cancer Network (NCCN) guidelines. Given recent treatment advances, we initiated this medical record review in elderly patients with stage III colon cancer to measure compliance with these guidelines. METHODS Medical records of 124 patients age ≥ 65 diagnosed with stage III colon cancer between 2003 and 2006 were reviewed. Metrics were developed and based on NCCN guidelines for workup and staging, treatment, and gerontology. Documentation was reviewed via paper (13 sites) and electronic record (2 sites). RESULTS High compliance with staging and workup guidelines was noted with chest imaging (100%), stage (98%), computed tomography (CT) of the abdomen/pelvis (93%), pathology (91%), and carcinoembryonic antigen (CEA; 91%). Activities of daily living were documented commonly (83%) but colonoscopy less (75%). Age and life expectancy were discussed with the patient in only 49%. Nearly all patients (123 of 124 patients) received adjuvant chemotherapy, with 76 patients (61%) receiving oxaliplatin. Common regimens were FOLFOX (oxaliplatin plus infusional/bolus 5-fluorouracil and folinic acid) 54%, 5-fluorouracil/leucovorin (5-FU/LV; 19%), and capecitabine (12%). Reasons for excluding oxaliplatin were comorbidity (68%), age (19%), and not specified (13%). Three-quarters of the patients had ≥ 12 lymph nodes sampled and 56% identified the radial margin. Nearly all patients (115 = 93%) received surveillance with history and physical and CEA. Surveillance CT was performed in 78% of the patients. CONCLUSIONS A quality review of community oncology practices can assess implementation of treatment advances. Guideline compliance for elderly patients with stage III colon cancer is generally high. Forty percent did not receive oxaliplatin and documentation of life expectancy was infrequent. Further study of oncologist decision making for elderly colon cancer patients is warranted.

Implementation of a comprehensive cancer control program at the worksite: year one summary report.

The worksite is an ideal forum for cancer risk assessment. We describe here the baseline characteristics of a large cohort. Participants completed surveys that assessed a variety of risk factors and behavioral mediators. Personalized feedback letters identified cancer risks. A total of 4395 surveys were received. Cancer prevalence was 6.5% (range, 4.3% to 11.2%). The most common risk factors were lack of exercise (41%; 32% to 68%), obesity (28%; 24% to 39%), and smoking (14%; 13% to 32%). Cardiovascular risk was also common (25%; 15% to 48%). Screening was fair to good for all cancers except colon cancer. The perceived risk for cancer was less than that for cardiovascular disease (P < 0.0001). Most smokers were in the pre-contemplation phase, whereas action/maintenance phases predominated for breast and colon cancer screening. Modifiable cancer risk factors can be identified in the majority of workers. Inaccurate risk perception is an important target for future interventions.

Change in worksite smoking behavior following cancer risk feedback: a pilot study.

OBJECTIVE To pilot a worksite smoking intervention. METHODS Following baseline assessment, participants (N=6378) received cancer risk feedback; 2 annual evaluations were conducted. RESULTS Using all data, smoking dropped from 13.7% to 8.4% and 9.3%, and smokers readiness to quit increased. Using complete data, smoking initially increased from 5.7% to 6.7%, but subsequently decreased to 5.3%; the increase in smokers readiness to quit remained. Being male, younger, and with lower education and self-efficacy predicted smoking. Lower age and higher self-efficacy predicted readiness to quit smoking. CONCLUSIONS These findings support a formal evaluation of a worksite smoking intervention using cancer risk feedback.

Prospective quality review of breast care navigation and treatment: Fox Chase Cancer Center Partners’ (FCCCP) initiative.

85 Background: There is increasing emphasis on quality metrics and process improvement for breast cancer treatment. FCCC designed a study to measure compliance with NCCN breast cancer guidelines at 11 FCCCP institutions. METHODS A relational data base was created to track indicators for operational timing, access, treatment modalities, and variance data in a population of breast cancer patients diagnosed and receiving first course of treatment at participating FCCCP institutions for 2009 calendar year. Pilot was conducted to ensure integrity of data collection tool in the previous year. Activation workshop, quarterly on site quality monitoring plan, real time quarterly reports to cancer committee, and benchmarking data were embedded in study. The primary objective was to benchmark participating institutions against each other and national benchmarks. Secondary objectives were to assess causes for variance and explore the role nurse navigation plays in real time quality metrics. RESULTS See Table. CONCLUSIONS This novel prospective quality study demonstrated significant compliance with established breast cancer metrics across a large community hospital affiliate program. The impact of navigation appears greatest in reducing time between screening and diagnostic testing, demonstrating that navigations benefits extend beyond patient satisfaction to improvement of quality metrics. [Table: see text].

Abstract B7: Use of risk assessment services and predictive genetic testing (PGT) for hereditary gastrointestinal (GI) cancers: How do men and women differ?

Background: Uptake of risk assessment and PGT for hereditary GI cancer risk has lagged far behind that of the hereditary breast‐ovarian cancer syndrome and BRCA1/2, despite the parallel clinical availability of genetic services for hereditary GI cancers, the proportion of patients with incident colorectal cancers who demonstrate familial risk (∼ 1 in 3), and the prevalence of Lynch syndrome associated mismatch repair gene mutations among incident colorectal cancers (∼ 3–5%). The bulk of data on perceptions of PGT have focused on women considering BRCA1/2 testing for personal and/or familial risk estimation. Studies in men are less plentiful, and have often focused on men9s opinions about PGT for prostate cancer risk, although clinical PGT for hereditary prostate cancer is not currently available. Individuals enrolled in a high‐risk GI cancer registry represent a unique population in which important differences in perceptions of PGT between men and women may be directly examined to shed light on barriers to risk assessment and PGT, and cancer prevention services in general, that may differ by gender. Methods: The GI Tumor Risk Assessment Program (GI‐TRAP) registry at Fox Chase Cancer Center enrolls individuals at increased risk for GI cancers because of a suggestive personal or family history. At enrollment and prior to risk education and counseling, participants are asked to complete a detailed personal and family history and a questionnaire examining screening practices and psychosocial aspects of hereditary cancer risk. The GI‐TRAP registry currently contains information collected from members of 269 families. Results: Women (n=293) participants outnumbered men (n=105) almost 3 to 1, were younger (47.0 vs 50.8 yrs)(p=0.01), and were less likely to work full‐time (39.9% vs 59.0%)(p Conclusions: Compared to women, overall fewer men obtain available risk assessment services for hereditary GI cancers. Men seek risk assessment for similar reasons to women, but express lower concern for out‐of‐pocket costs or adverse personal and familial emotional reactions to testing results. Efforts to make cancer risk assessment services more visible and available to men and working individuals (e.g., expanded clinical hours, on‐site education/counseling at places of employment, health clubs, etc) may help to increase the identification of high‐risk individuals who would benefit from tailored GI prevention education, genetic counseling, and PGT. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B7.

Assessing the treatment quality of elderly patients with stage III colon cancer in a large community oncology network: A Fox Chase Cancer Center Partners (FCCCP) quality initiative

6576 Background: FCCCP performs an annual quality review of affiliated community practices based on NCCN guidelines. Given recent treatment advances in stage III colon cancer, we initiated a chart review in patients (pts) age ≥65 years to assess incorporation of these advances in elderly pts. Methods: Charts of 124 pts age ≥65 diagnosed with stage III colon cancer between 2003 and 2006 were reviewed and a relational database used for data capture and report generation. Based on NCCN guidelines, specific metrics were developed for colon cancer, gerontology, and activities of daily living (ADL) documentation, treatment, and surveillance. Documentation was reviewed via paper record in 13 sites and electronic medical record in 2. Results: Compliance with NCCN guidelines for documentation was: staging (98%), pathology report (91%), colonoscopy (75%; 58% reaching cecum), CEA (91%), CT abdomen/pelvis (93%), and chest imaging (100%). ADL were documented commonly (83%), but age and life expectancy in relation to a...