Patient-Defined Treatment Success and Preferences in Advanced Stage - - PowerPoint PPT Presentation

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Patient-Defined Treatment Success and Preferences in Advanced Stage - - PowerPoint PPT Presentation

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ANNUAL OCT. 31-NOV. 2, 2017 MEETING ARLINGTON, VA Patient-Defined Treatment Success and Preferences in Advanced Stage Lung Cancer KM Monirul Islam, MBBS/MD, PhD Associate Professor of Epidemiology June Ryan, BS, MPA Patient Advocate

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ANNUAL MEETING

  • OCT. 31-NOV. 2, 2017

ARLINGTON, VA

#PCORI2017

KM Monirul Islam, MBBS/MD, PhD Associate Professor of Epidemiology June Ryan, BS, MPA Patient Advocate University of Nebraska Medical Center

November 2, 2017

Patient-Defined Treatment Success and Preferences in Advanced Stage Lung Cancer

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  • Dr. Islam has nothing to disclose.
  • Mrs. Ryan has nothing to disclose.

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Speakers Name

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Objectives

  • Objective 1: Determine if patients’ characteristics and

treatment experiences affect their definition (meaning)

  • f treatment success.
  • Objective 2: Determine patient’s treatment choices

based on their ranking of unwanted drug side effects.

  • Objective 3: Determine whether oncologists are likely

to change their chemotherapy treatment strategy when provided with information related to patient preferences.

November 2, 2017

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Background--Lung Cancer

  • Lung cancer is the leading cause of cancer deaths.
  • Most newly diagnosed patients are elderly.
  • 50% of patients die within one year of diagnosis.

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Background- Lung Cancer

  • Patients’ preferences regarding treatment adverse

events are not systematically considered when choosing a treatment for advanced stage NSCLC.

  • There is no clinical guide for patients or physicians on

how to integrate patient’s preferences of adverse events in treatment decisions.

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Scope of issues faced by patients

  • Patients often are not prepared for the effect that

advanced lung cancer will have on family dynamics as well as relationships with friends and co-workers.

  • Our project addresses these and other issues by asking

patients questions about preferred side effects of chemotherapy treatment.

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Long-term Goal

  • The long term goal of our study was to facilitate

patients’ treatment choices for advanced stage lung cancer.

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Study Design and Participants

  • We conducted a multi-center prospective longitudinal patient-

centered outcomes study-

  • Prospective cohort, and
  • randomized intervention study
  • We recruited 235 patients diagnosed with primary, advanced

stage, non-small cell lung cancer (NSCLC) for the prospective cohort study

  • Twenty two oncologists for the randomizes intervention part of

the study

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Specific Aim 1: Patients’ Definition of Treatment Success

  • We utilized a prospective cohort study to evaluate

patient-centered definition of treatment “success”, its relationship to patient characteristics, and changes after treatment.

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Patient Characteristics

  • We recruited 235 patients; average age was 68 years.
  • Participants were predominantly White (95.3%) and

more rural (34%) than the US in general.

  • A higher proportion of males (55.3%) than females.
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Patients’ Definition of Treatment Success

Variable Category n=235 % Treatment success definition at patient’s FIRST interview Living longer (LL)/survival alone 28 11.9 LL with other answers 142 60.4 Quality of life (QoL) without LL 54 23.0 Undecided/Unclear/Not Reported (NR) 11 4.7

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Patients’ Definition of Treatment Success

  • At the first interview, a majority of patients defined treatment

success as more than survival alone (60.4%).

  • Treatment success was defined by 23% as simply a good QoL.
  • Less than 12% considered survival alone as their definition of

treatment success.

  • Patients wished to live longer with a good quality of life (QoL)

and/or have time with family and friends and/or reach personal goals.

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Changes in Definition of Treatment Success

Variable Category n=235 % Changes in treatment success definition – between FIRST & LAST interviews Changed 79 47.0 No change 89 53.0

Table 1. Patient’s definition of treatment success changed between first and last interview

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Changes in Definition of Treatment Success

  • Of those patients who at first interview defined treatment

success as survival alone, 80% changed their definition to either more than just survival or switched to improved QoL

  • nly at their last interview.
  • Among patients who first gave ‘survival alone’ as their

treatment success definition, 52.4% changed into living longer plus other goals, and 23.8% changed into improved QoL only.

  • These findings highlight the importance of QoL for patients

and do not diminish their desire to live longer.

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Specific aim 2: Tolerance to Side Effects

Worst ranked side effect FIRST Interview% LAST Interview% shortness of breath 28.7 20.8 bleeding 20.9 14.3 fatigue 11.9 25.6 dizziness 10.8 10.7 a lot more expensive 8.4 9.5 jaundice 8.4 7.7 more trips to clinic for treatment 7.2 7.1 numbness/tingling 1.8 1.2 brittle nails 1.8 2.9 Table 2. Proportion of patients who ranked the listed side effect as the one they would most like to avoid at their FIRST* and LAST interviews (n=168)*

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Specific aim 2: Tolerance to Side Effects

  • The three side effects that patients would most like to

avoid were stable between first and last interviews, i.e., shortness of breath, bleeding, and fatigue.

  • In the last interview the order changed to fatigue,

shortness of breath, and bleeding.

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Specific aim 3: Oncologists are likely to change their treatment plan

  • We recruited 22 oncologists and administered a

questionnaire about chemotherapy treatment using control and intervention groups.

  • All oncologists in the intervention group adjusted their

recommended treatment after receiving actionable patient preferences, while 62.5% of those in the control group changed their recommended treatment.

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Study Results: Significance

  • Patients can successfully play active, engaged roles in

their own treatment which may lead to improved

  • utcomes and a higher degree of satisfaction.
  • Patients and clinicians may not share the same view of

treatment success.

  • Patients have clear preferences for side effects they will

tolerate; these preferences may change with the treatment experience.

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Learn More

  • www.pcori.org
  • info@pcori.org
  • #PCORI2017
  • www.YourURL.url Monirul—add

November 2, 2017

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Questions?

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Thank You!

KM Monirul Islam, MBBS/MD, PhD Associate Professor of Epidemiology University of Nebraska Medical Center kmislam@unmc.edu Twitter handle June Ryan, BS, MPA Patient Advocate University of Nebraska Medical Center juneryan71@gmail.com