Kristina Newport

Reporting quality of abstracts in phase III clinical trials of systemic therapy in metastatic solid malignancies

BackgroundManuscript abstracts represent a critical source of information for oncology practitioners. Practitioners may utilize the information contained in abstracts as a basis for treatment decisions particularly when full-text articles are not accessible. In 2007, the Consolidated Standards of Reporting Trials (CONSORT) extension statement for abstracts provided a minimum list of elements that should be included in abstracts. In this study we evaluate the degree of adherence to these recommendations and accessibility of full text publications in oncology publications.MethodsA systematic review of abstracts of randomized, controlled, phase III trials in metastatic solid malignancies published between January 2009 and December 2011 in PubMed, Medline, and Embase was completed. Abstracts were assigned a completeness score of 0–18 based on the number of CONSORT-recommended elements. Accessibility through open access was recorded.Results174 abstracts with data for 95,956 patients were reviewed. The median completeness score was 9 (range, 3–17). Open access to full text articles was available for 80 % of abstracts. The remaining 20 % (35 out of 174) had a median cost of 38 USD (range:

Impact of a nurse practitioner-staffed, symptom-management clinic on emergency department utilization in a large community oncology cancer institute.

22–49.95). The least frequently reported elements were: trial design description (20 %), participant allocation method (13 %), blinding (24 %), trial enrollment status (22 %), registration and name of trial (26 %) and funding source (18 %). The most frequently reported elements were eligibility criteria (98 %), study interventions (100 %), and primary endpoint (87 %).ConclusionThere is poor adherence to the CONSORT recommendations for abstract reporting in publications of randomized cancer clinical trials which could negatively impact clinical decision-making. Full-text articles are frequently available through open access.

Impact of NCCN distress thermometer screening at new patient oncology visits in a large community cancer institute.

58 Background: Emergency department (ED) utilization among oncology patients is a source of patient distress as well as a financial burden to the health care system. Effective outpatient symptom management can potentially reduce ED utilization. In this analysis, we review ED utilization prior to and post the institution of a nurse practitioner staffed symptom management clinic in a large community oncology practice. METHODS In April 2014 a symptom management clinic staffed by a nurse practitioner five days a week was established at our outpatient cancer institute to increase patient access to acute symptom management. ED utilization 6 months prior to and post starting this clinic was measured. Only patients who received chemotherapy within 30 days of an ED visit were included in this analysis. RESULTS Between October 2013 and September 2014, a total of 420 visits to the ED were documented. A total of 196 visits occurred in the 6 months prior to establishing the clinic. There was an increase in visits to 224 after instituting the clinic. The median number of monthly visits was 34.5 (range 24-38) prior to the clinic and increased to 38 (range 30-43) after establishing the clinic. CONCLUSIONS In our practice, a nurse practitioner led symptom management clinic did not reduce ED utilization in patients receiving chemotherapy. Based on published studies, other factors may need to be incorporated into our cancer institute to effectively reduce ED utilization. These include standardizing symptom assessment and management, patient and caregiver education on how to effectively manage symptoms at home, and improved coordination with supportive services.

Illness understanding of oncology patients in a community-based cancer institute

226 Background: Psychosocial distress can impact a patients quality of life and potentially impact timely and effective cancer management. The National Comprehensive Cancer Network (NCCN) developed a distress thermometer that includes a ten point scale of distress and checklist of psychosocial issues. In this analysis we compare rates of referrals to our support services prior to and post implementation of this tool in our community oncology practice. METHODS Data one year prior to and post implementation of the NCCN distress thermometer was retrospectively reviewed. The tool was implemented in July 2013 and administered to the patients by our clinical staff at the patients first visit. Based on this tool, the clinical staff offered referrals to social work, chaplaincy, nutrition, or financial counseling. Re-education on administration of this tool occurred in January 2014. In this study we compare support service referrals pre and post NCCN distress screening implementation and staff education. RESULTS From July 2012 to June 2013, 829 referrals were made to support services. Specifically, 39% of these referrals were to social work, 19% to chaplaincy, and 38% to nutrition. From July 2013 to May 2014, 1434 referrals were made to support services. Specifically, 37% of these referrals were to social work, 10% to chaplaincy, 20% to nutrition, and 34% to financial counseling. Referrals to social work were most impacted by implementation of the NCCN distress screening with a median increase from 26.5 (range 14-45) to 45 (range 32-68). Referrals to other support services were not impacted. Referrals to financial counseling were most impacted by the re-education process with a median increase from 38 (range 28-42) to 53 (range 42-58). CONCLUSIONS Implementation of the NCCN distress thermometer allowed better identification of patients for social work and financial counseling interventions. This tool was less effective at increasing referrals to nutrition and chaplaincy. The need for these services may be better captured during the treatment period. Future investigation into this may include application of the distress tool during subsequent patient visits.