Marcia Grant

An Overview of the ACE Project—Advocating for Clinical Excellence: Transdisciplinary Palliative Care Education

Background. Excellence in palliative care demands attention to the multidimensional aspects of patient and family suffering, yet too few psycho-oncology professionals report adequate preparation in this vital area. Methods. A total of 148 competitively selected psychologists, social workers, and spiritual care professionals participated in intensive educational courses to enhance their palliative care delivery, leadership, and advocacy skills. Extensive process and outcome evaluations measured the effectiveness of this educational program. Results. To date, 2 national courses have been completed. The courses received strong overall evaluations, with participants rating increased confidence in defined palliative care skills. Conclusions. The initial results of this innovative National Cancer Institute-funded transdisciplinary training for psycho-oncology professionals affirm the need and feasibility of the program. See the Advocating for Clinical Excellence Project Web site (www.cityofhope.org/ACEproject) for additional course information.

Abstract 3431: What are the greatest challenges of rectal cancer survivors? Results of a population-based survey

Purpose: Rectal cancer (RC) survivors with and without permanent ostomy have similar health-related quality of life outcomes, though these may be driven by different factors. Identifying patient-centered concerns among survivors with different surgical reconstructions can guide treatment decision-making and optimize survivorship care. Methods: We mailed a survey to long-term (≥5 years post-diagnosis) RC survivors enrolled in Kaiser Permanente (Northern California and Oregon/Southwest Washington). Participants with anastomosis, temporary ostomy, and permanent ostomy were asked an open-ended question about the “greatest challenge” they experienced related to their cancer surgery. Using a grounded theory approach, we identified all topics in the responses of 440 participants who wrote an answer (76% of 577 respondents). These topics were collapsed into codes and organized into domains. Responses were assigned as many codes as were applicable and double-coded by pairs of researchers who met to resolve any discrepancies. We used Bonferroni-adjusted chi-squares to test differences in the proportion of respondents within each surgical group who mentioned challenges in each domain. Results: Greatest challenge responses were provided by 241 participants with anastomosis, 54 with temporary ostomy, and 145 with permanent ostomy. Respondents were more educated but otherwise they resembled non-respondents demographically and clinically. Respondents described seven challenge domains: 1) bowel dysfunction; 2) bowel self-care; 3) post-operative recovery; 4) complications and late-effects; 5) negative psychosocial impacts; 6) comorbidities and aging (unrelated to RC); and 7) negative health care experiences. The most commonly reported problems in each group were bowel dysfunction, negative psychosocial impacts, complications and late effects, and bowel self-care. Anastomosis and temporary ostomy groups provided similar response profiles, but there were some significant differences in the proportion of respondents in each group who mentioned challenges for each domain. Respondents with permanent ostomy were less likely to mention challenges with bowel management than either respondents with temporary ostomy (p = .0024) or anastomosis (p = .0003). Respondents with temporary ostomy reported more complications and late effects than those with permanent ostomy (p = .0009). Respondents with anastomosis were less likely to report negative psychosocial impacts than those with permanent ostomy (p = .0003). Conclusions: We identified enduring concerns for long-term RC survivors that should be prioritized in survivorship care. Patients choosing among surgical options should know that long-term bowel dysfunction, complications, and late effects are more common concerns for patients without permanent ostomy. In contrast, patients with permanent ostomy report the most negative psychosocial impacts. Citation Format: Robert S. Krouse, Joanna E. Bulkley, Andrea Altschuler, Christopher S. Wendel, Marcia Grant, Mark C. Hornbrook, Virginia Sun, Carmit K. McMullen. What are the greatest challenges of rectal cancer survivors? Results of a population-based survey. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3431. doi:10.1158/1538-7445.AM2015-3431

Abstract 3432: Dietary modifications of rectal cancer survivors to improve bowel function symptoms

Purpose: Rectal cancer (RC) survivors with and without permanent ostomy have similar bowel function challenges, and seek improvement of symptoms through dietary modifications. Identifying patient-reported dietary modifications among survivors with different surgical reconstructions can guide postoperative supportive care and improve health-related quality of life (HRQOL). Methods: We mailed a survey to long-term (≥5 years post-diagnosis) RC survivors enrolled in Kaiser Permanente (Northern California and Northwest). It included a question eliciting foods that were helpful with bowel function and the bowel symptoms that were impacted. Food types were recoded into broader categories based on food families developed around nutrition and common usage patterns and frequencies of food types and symptoms addressed were compared by sex and surgery type (ostomy vs. anastomosis). Results: Of the 577 RC survivors who responded to the survey, 201 (35%) responded to the question related to foods that helped bowel function. Food groups that most commonly were used were fruits other than prunes (16.3%) and vegetables (15.5%). Water was often used (9.2%). The only specific food that was commonly used was prunes (7.6%). Most foods cited were credited with helping prevent the constellation of symptoms and signs of constipation or bloating, followed by predictability. A few foods (e.g., bananas, bread, rice) were more likely to help with diarrhea. Helpful foods addressing constipation/bloating were more likely cited by women than men (55% vs. 44%, p = .007). Vegetables were more likely cited by anastomosis than ostomy subjects (18% vs. 11%, p = .03). Conclusions: Multiple dietary alterations are attempted by RC survivors. It appears very individualized, although multiple strategies can be suggested to improve bowel function. Through this exploratory analysis, strategies can be developed and tested for RC survivors. Citation Format: Robert S. Krouse, Christopher S. Wendel, Wendy Demark-Wahnefried, Joanna E. Bulkley, Carmit K. McMullen, Marcia Grant, Mark C. Hornbrook, Andrea Altschuler, Virginia Sun, Lisa J. Herrinton. Dietary modifications of rectal cancer survivors to improve bowel function symptoms. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3432. doi:10.1158/1538-7445.AM2015-3432