Longitudinal Perceptions of Prognosis and Goals of Therapy in Patients With Metastatic Non–Small-Cell Lung Cancer: Results of a Randomized Study of Early Palliative Care

2011 ◽  
Vol 29 (17) ◽  
pp. 2319-2326 ◽  
Author(s):  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Sonal Admane ◽  
Emily R. Gallagher ◽  
Vicki A. Jackson ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Early Palliative Care ◽  
Metastatic Nsclc ◽  
Oncology Care ◽  
To Receive ◽  
Over Time

Purpose Understanding of prognosis among terminally ill patients impacts medical decision making. The aims of this study were to explore perceptions of prognosis and goals of therapy in patients with metastatic non–small-cell lung cancer (NSCLC) and to examine the effect of early palliative care on these views over time. Patients and Methods Patients with newly diagnosed metastatic NSCLC were randomly assigned to receive either early palliative care integrated with standard oncology care or standard oncology care alone. Participants completed baseline and longitudinal assessments of their perceptions of prognosis and the goals of cancer therapy over a 6-month period. Results We enrolled 151 participants on the study. Despite having terminal cancer, one third of patients (46 of 145 patients) reported that their cancer was curable at baseline, and a majority (86 of 124 patients) endorsed getting rid of all of the cancer as a goal of therapy. Baseline perceptions of prognosis (ie, curability) and goals of therapy did not differ significantly between study arms. A greater percentage of patients assigned to early palliative care retained or developed an accurate assessment of their prognosis over time (82.5% v 59.6%; P = .02) compared with those receiving standard care. Patients receiving early palliative care who reported an accurate perception of their prognosis were less likely to receive intravenous chemotherapy near the end of life (9.4% v 50%; P = .02). Conclusion Many patients with newly diagnosed metastatic NSCLC hold inaccurate perceptions of their prognoses. Early palliative care significantly improves patient understanding of prognosis over time, which may impact decision making about care near the end of life.

scholarly journals Depression and Survival in Metastatic Non–Small-Cell Lung Cancer: Effects of Early Palliative Care

2012 ◽  
Vol 30 (12) ◽  
pp. 1310-1315 ◽  
Author(s):  
William F. Pirl ◽  
Joseph A. Greer ◽  
Lara Traeger ◽  
Vicki Jackson ◽  
Inga T. Lennes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell Lung Cancer ◽  
Survival Benefit ◽  
Small Cell ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Early Palliative Care ◽  
Metastatic Nsclc ◽  
Oncology Care

Purpose In a randomized trial, early palliative care (EPC) in patients with metastatic non–small-cell lung cancer (NSCLC) was observed to improve survival. In a secondary analysis, we explored the hypothesis that the survival benefit resulted from improving depression. Patients and Methods In total, 151 patients with newly diagnosed metastatic NSCLC participated in a randomized trial of EPC integrated with standard oncology care versus standard oncology care alone. Depression was assessed at baseline and at 12 weeks with the Patient Health Questionnaire-9 (PHQ-9) and was scored diagnostically by using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for major depression syndrome (MDS). Depression response was considered ≥ 50% reduction in PHQ-9 scores at 12 weeks. Survival differences were tested with log-rank and Cox proportional hazards models. Results At baseline, 21 patients (14%) met MDS criteria. MDS significantly predicted worse survival (hazard ratio, 1.82; P = .02). Patients assigned to EPC had greater improvements in PHQ-9 scores at 12 weeks (P < .001); among patients with MDS, those receiving EPC had greater rates of depression response at 12 weeks (P = .04). However, improvement in PHQ-9 scores was not associated with improved survival, except in a sensitivity analysis in which patients who died before 12 weeks were modeled to have worse depression. The group randomly assigned to EPC remained independently associated with survival after adding improvement in PHQ-9 scores to the survival model. Conclusion Depression predicted worse survival in patients with newly diagnosed metastatic NSCLC. Although EPC was associated with greater improvement in depression at 12 weeks, the data do not support the hypothesis that treatment of depression mediated the observed survival benefit from EPC.

Interdisciplinary palliative care in metastatic non-small-cell lung cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9068-9068
Author(s):  
Marianna Koczywas ◽  
Mihaela C. Cristea ◽  
Karen L. Reckamp ◽  
Jay Thomas ◽  
Virginia Sun ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Psychological Distress ◽  
Symptom Burden ◽  
Well Being ◽  
Small Cell ◽  
Small Cell Lung ◽  
Metastatic Nsclc ◽  
Care Intervention ◽  
Over Time

9068 Background: Palliative cancer care is the integration into cancer care of therapies that address multiple issues that cause suffering for patients and their families and impact their life quality. Challenges and barriers continue to hinder the integration of palliative care into comprehensive, ambulatory oncology care. This paper aims to describe how symptoms, distress, and quality of life (QOL) data from the usual care phase of a NCI-supported Program Project (P01) informed the development of an interdisciplinary palliative care intervention for patients with metastatic non-small-cell lung cancer (NSCLC). Methods: Patients receiving usual care for metastatic NSCLC were recruited into this prospective longitudinal study. A total of 130 patients with stage IV NSCLC were accrued, and 114 patients had evaluable data. Upon informed consent, patients completed outcome measures that assessed physical function/cognitive status, social activities and support, symptom characteristics, psychological distress, and overall QOL. Patient-reported outcomes were completed at baseline, 6, 12, and 24 weeks post-accrual. Results: Subjects were primarily female (64%), ranged in age from 40-84 years, and 39% were ethnic minorities. The majority were former smokers (66%). KPS, IADL, and Cognitive scores deteriorated significantly over time (p=.001, .009, and .042, respectively). Patients reported higher severity scores with symptoms such as dyspnea, fatigue, insomnia, lack of appetite, peripheral neuropathy, pain, dry skin, nail changes, and problems with sexual interest in all four time periods. Global Symptom Distress Index and Total Symptom score both significantly worsened at 24 weeks (p=.003 and .017, respectively). Physical Well-Being worsened significantly (p=.036), while overall QOL, spiritual well-being, and psychological distress scores remained statistically stable over time. Conclusions: Patients with metastatic NSCLC continue to experience high symptom burden and diminished physical well-being over time while receiving treatments. An interdisciplinary palliative care intervention is currently being tested to improve symptom burden and overall QOL.

Effect of Early Palliative Care on Chemotherapy Use and End-of-Life Care in Patients With Metastatic Non–Small-Cell Lung Cancer

2012 ◽  
Vol 30 (4) ◽  
pp. 394-400 ◽  
Author(s):  
Joseph A. Greer ◽  
William F. Pirl ◽  
Vicki A. Jackson ◽  
Alona Muzikansky ◽  
Inga T. Lennes ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life Care ◽  
Hospice Care ◽  
Small Cell ◽  
Life Care ◽  
Small Cell Lung ◽  
Early Palliative Care ◽  
Metastatic Nsclc ◽  
Chemotherapy Administration ◽  
Oncology Care

Purpose Prior research shows that introducing palliative care soon after diagnosis for patients with metastatic non–small-cell lung cancer (NSCLC) is associated with improvements in quality of life, mood, and survival. We sought to investigate whether early palliative care also affects the frequency and timing of chemotherapy use and hospice care for these patients. Patients and Methods This secondary analysis is based on a randomized controlled trial of 151 patients with newly diagnosed metastatic NSCLC presenting to an outpatient clinic at a tertiary cancer center from June 2006 to July 2009. Participants received either early palliative care integrated with standard oncology care or standard oncology care alone. By 18-month follow-up, 133 participants (88.1%) had died. Outcome measures included: first, number and types of chemotherapy regimens, and second, frequency and timing of chemotherapy administration and hospice referral. Results The overall number of chemotherapy regimens did not differ significantly by study group. However, compared with those in the standard care group, participants receiving early palliative care had half the odds of receiving chemotherapy within 60 days of death (odds ratio, 0.47; 95% CI, 0.23 to 0.99; P = .05), a longer interval between the last dose of intravenous chemotherapy and death (median, 64.00 days [range, 3 to 406 days] v 40.50 days [range, 6 to 287 days]; P = .02), and higher enrollment in hospice care for longer than 1 week (60.0% [36 of 60 patients] v 33.3% [21 of 63 patients]; P = .004). Conclusion Although patients with metastatic NSCLC received similar numbers of chemotherapy regimens in the sample, early palliative care optimized the timing of final chemotherapy administration and transition to hospice services, key measures of quality end-of-life care.

Improving time to molecular testing results in patients with newly diagnosed, metastatic non-small cell lung cancer (NSCLC).

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 244-244
Author(s):  
Stephanie Ossowski ◽  
Elad Neeman ◽  
Charles Borden ◽  
Amy Ying Ju Lin ◽  
Raymond Liu
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Turnaround Time ◽  
Small Cell ◽  
Pathological Diagnosis ◽  
Genomic Testing ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
First Line ◽  
Metastatic Nsclc

244 Background: Next generation sequencing (NGS) is a crucial component of evaluation of newly diagnosed patients with metastatic non-small cell lung cancer (NSCLC) to determine appropriate first line treatment. Delays in NGS can lead to psychologic distress for patients and can affect choices in first line therapy, especially for patients with underlying targetable mutations. While more data is needed to benchmark turnaround time for NGS results, guidelines and expert consensus suggest time from diagnosis to treatment should be 15 days and turnaround time for genomic testing 10-14 days. This study was aimed at reducing time to NGS results in a large integrated health care system. Methods: Through the ASCO Quality Training Program, we reviewed electronic medical records of 25 patients with newly diagnosed, untreated metastatic NSCLC from 12/2018 to 9/2020 and determined number of days from pathological diagnosis to NGS results. We reviewed process maps for oncology, pathology, the internal data management division, and a genomic testing company to determine factors leading to significant preventable delays. Since 11/2020, we created an automated weekly report using CoPath to identify new pathological diagnoses of potential metastatic NSCLC. The oncology department reviewed these cases weekly and NGS orders were placed for patients with metastatic NSCLC. Eleven additional patients with newly diagnosed metastatic NSCLC were included in the prospective cohort. Results: Demographic characteristics are noted in Table. Our intervention reduced median time from pathological diagnosis to NGS results from 24 to 19 days. Median time from biopsy results to NGS order was reduced from 7 to 1 day. Time from specimen being sent from pathology to NGS vendor was a median of 6 days in both cohorts. Total time from pathological diagnosis to appropriate treatment was reduced from a median of 33 to 25 days. Conclusions: Delays in time to NGS results can be reduced by improved communication between departments and simple, automated interventions to ensure results are efficiently released to an oncologist. Additional Plan-Do-Study-Act cycles are currently being developed to further reduce time from biopsy results to NGS results. [Table: see text]

Early Palliative Care for Patients with Metastatic Non-Small Cell Lung Cancer (DRAFT)

2018 ◽  
Author(s):  
Nathan A. Gray ◽  
Thomas W. LeBlanc
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Trial Design ◽  
Small Cell ◽  
Small Cell Lung ◽  
Early Palliative Care ◽  
Study Intervention

This chapter provides an overview and commentary on the 2010 study by Temel and colleagues regarding early palliative care for patients with non-small cell lung cancer. It describes the trial design and findings while also providing a concise critique of the study and a brief review of relevant subsequent studies. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Fundamental Concepts in the Application of Plasma Genotyping (Liquid Biopsy) to EGFR Mutation Detection in Non–Small-Cell Lung Cancer

2018 ◽  
pp. 1-12
Author(s):  
Adrian G. Sacher
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Kinase Inhibitors ◽  
Acquired Resistance ◽  
Small Cell ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Metastatic Nsclc ◽  
Egfr Kinase

Plasma genotyping has rapidly evolved from an investigational technology into a standard-of-care tool used to direct therapy in metastatic non–small-cell lung cancer (NSCLC). Multiple testing platforms exist for plasma genotyping, each with unique test characteristics and scientific validation. The optimal use and interpretation of plasma genotyping requires understanding of cell-free DNA biology, the assay characteristics of the available testing technologies, and the application of testing in each clinical scenario. Current recommendations for plasma genotyping in metastatic NSCLC are limited to patients with newly diagnosed disease and those with acquired resistance to targeted therapy, in particular, epidermal growth factor receptor (EGFR) kinase inhibitors. In newly diagnosed metastatic NSCLC, under certain circumstances, plasma genotyping is useful for the detection of targetable genomic alterations or nontargetable driver alterations (eg, KRAS) that are mutually exclusive with targetable alterations. In patients with acquired resistance to therapy, such as EGFR T790M-mediated acquired resistance to EGFR kinase inhibitors, plasma genotyping may detect resistance mutations missed by standard tissue genotyping because of tumor heterogeneity. In both scenarios, the high specificity and positive predictive value of validated plasma genotyping assays allow for the reliable selection of therapy on the basis of a positive plasma genotyping result. However, the modest sensitivity of these assays requires that negative results be confirmed by tissue genotyping with repeat biopsy, if necessary. There is considerable potential for plasma genotyping in the detection of early-stage disease, for patients at risk for disease recurrence, and as an integrated biomarker of therapeutic response in clinical trials of novel therapies.

Placebo-controlled trial of hydrazine sulfate in patients with newly diagnosed non-small-cell lung cancer.

1994 ◽  
Vol 12 (6) ◽  
pp. 1126-1129 ◽  
Author(s):  
C L Loprinzi ◽  
R M Goldberg ◽  
J Q Su ◽  
J A Mailliard ◽  
S A Kuross ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cancer Patients ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Hydrazine Sulfate ◽  
Double Blind ◽  
To Receive

PURPOSE Hydrazine sulfate, an agent that appears to inhibit gluconeogenesis, has been studied in cancer patients for approximately 20 years. There was a recent resurgence of interest in this drug when subset analysis of a small placebo-controlled, double-blind, clinical trial reported improved survival among non-small-cell lung cancer patients with a good performance status who were randomized to receive this drug along with standard chemotherapy. PATIENTS AND METHODS Patients on this trial had newly diagnosed, unresectable non-small-cell lung cancer and were treated with cisplatin and etoposide. In addition, they were randomized to receive hydrazine sulfate or placebo in a double-blind manner. RESULTS A total of 243 patients were randomized. Response rates were similar in the two treatment arms. There were trends for worse time to progression and survival in the hydrazine sulfate arm. No significant differences were noted in the two study arms with regard to toxicity or quality of life (QL). CONCLUSION This trial failed to demonstrate any benefit for patients who received hydrazine sulfate.

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