Medical Oncology Patients Research Articles

PCN506 MUTATION TESTING AND TREATMENT OF THE MOST COMMON ONCOLOGY DISEASES IN GERMANY: ANALYSIS OF AN ONCOLOGY EMR DATABASE

The role of real-world evidence (RWE) in healthcare decision-making is constantly growing, acknowledged by recent FDA and EMA communications. Especially in oncology, a better understanding of the real-world treatment of patients is needed, both to compare RWE with clinical trial results and to identify unmet needs in the real-world (RW) treatment of patients. However, there is a lack of reliable data in this respect. We aimed to describe the RW treatment of patients included in a new electronic medical record databank targeting German oncology patients (INGRESS-Indivumed Liquid Biopsy RWE oncology database). The databank is built based on German outpatient oncology cases, it currently includes 14,145 oncology patients. It provides data on patient and disease characteristics, treatments, diagnostics including mutation/immunohistochemistry testing, and clinical outcomes; furthermore, for each patient blood draws for an ex-post mutation testing are available. Most common cancer types in the database are breast cancer (BC), lung cancer (LC) and colon cancer (CC), with a proportion of 23.8%, 11.7% and 8.8%, respectively. The average age was 66.5 years in the overall sample (60.9/67.2/68.0 years in BC/LC/CC patients). Percentage of females was 56.3% (98.0%/40.6%/44.9%). A mutation/immunohistochemistry test was conducted in 98.9% of the patients with BC (54.6% of patients with HER2+). Proportion of tested patients was 66.0%/55.9% in LC/CC. Most common mutation types in LC were PD-L1 and EGFR+ (53.0%/12.1% of tested LC patients) and KRAS in CC (42.5%). The most frequently prescribed 1L treatment was paclitaxel in BC patients with/without HER2+, pembrolizumab in LC patients with PD-L1, carboplatin in non-PD-L1 LC patients, and irinotecan+folinic acid in KRAS+/non-KRAS CC patients. The Indivumed Liquid Biopsy RWE oncology database has the potential to provide valuable insights into RW data on the treatment and treatment-associated outcomes of German oncology patients.

Assessing the Financial Toxicity of Radiation Oncology Patients Using the Validated Comprehensive Score for Financial Toxicity as a Patient-Reported Outcome

PurposeThe financial burden of cancer care may significantly affect patient quality of life and clinical outcomes. However, the financial effect of radiation therapy on patients remains difficult to characterize, in part owing to the lack of standardized methods to measure patient distress related to treatment costs. Here, we assessed financial burden in the radiation oncology population by applying the Comprehensive Score for Financial Toxicity (COST), a patient-reported outcome measure, which has been validated in medical oncology patients. Methods and MaterialsConsecutive patients from a single academic radiation oncology clinic were recruited. Participants completed the 11-item COST-Functional Assessment of Chronic Illness Therapy questionnaire, with total possible scores ranging from 0 to 44. Scores were collected along with data regarding patient demographics, insurance, diagnosis, and treatment. Univariate and multivariate analyses were performed to identify factors associated with higher financial burden as measured by COST. ResultsA total of 167 patients completed the COST questionnaire. Lower COST scores indicated higher financial toxicity. The population’s mean COST score was 21.9 (95% confidence interval, 20.5-23.3). Fifteen percent of participants reported grade 2 to 3 COST toxicity, corresponding to a moderate or severe effect on quality of life. Use of concurrent or previous systemic therapy was significantly associated with lower COST scores on univariate analysis (P = .03), but not significant on multivariate analysis. A subset analysis of posttreatment follow-up patients identified rural residence and recent completion of radiation therapy as significant correlates of worse COST scores on univariate analysis, and rural residence remained independently associated on multivariate analysis (P = .017). Conclusions COST effectively identified a significant number of radiation oncology patients experiencing financial toxicity, indicating its prevalence in this population. A correlate of financial toxicity in this population is the use of systemic therapy. Of those who have completed radiation therapy, rural residence was independently associated with worse financial toxicity.

Cancer-oriented comprehensive nursing-caregiving service in Korea: 1 year report

Abstract Background Korean comprehensive nursing-caregiving service, which is covered by national insurance, has been officially initiated in 2016. Following interim analysis presented at JSMO 2018, we report our 1-year experience of cancer-oriented comprehensive nursing-caregiving unit´s outcomes and issues. Methods and Results Our institution is a general hospital (827 beds) with 246 doctors and 703 RNs. We are running cancer-oriented comprehensive nursing-caregiving service (46 beds with 25 RNs and 12 nurses aides) since December 2017. This special ward is caring only medical oncology patients. For 12 months, 11,946 inpatients (average 32.4 patients/day, bed turnover rate 85.7%) and 5,682 patients received chemotherapy in our unit. We evaluated our Results in three categories: structure, process, and outcome. First, structural (environmental) improvements were found in more interval between beds (1.5m), fully automatic beds with fall prevention sensors, comfortable patient lounge. Second, process improvements such as nursing time, quality of oncologic nursing is improved. For example, missed nursing care has been improved (nursing caregiving ward vs. general ward: 0.1 vs. 1.3 events/month). Finally, patient and nurse outcome are much improved when compared with general wards. Patient satisfaction (will to revisit: 91.7% vs. 78.4%, will to recommend to others: 95.0% vs. 76.8%) have been increased. Safety indicators such as pressure ulcer (0.3 vs. 0.8 events/month), falls (1.6 vs. 1.5 events/month) have dropped. Nurse outcomes such as resignation rate have been stabilized (resignation rate: 0 vs. 14.9%). Issues during unit operation were found in still heavy workloads for nursing staff and low compensation by the government compared with other countries. Conclusion Comprehensive nursing-caregiving service for medical oncology patients is a key to success in both improved quality of cancer care and nursing staff´s job satisfaction.

Implementation of standardized workflows to reduce inpatient length of stay for medical oncology patients.

80 Background: Reducing length of stay (LOS) is an important initiative for hospitals for both clinical and financial reasons. Patients who are hospitalized for extended lengths of time may be more susceptible to hospital-acquired infections and other complications. Reducing LOS can also decrease cost of care and allow for more streamlined patient throughput. Our institution sought to evaluate opportunities to reduce LOS for our medical oncology patient population. Methods: Several interventions were implemented to streamline discharge planning. The structure of rounding was evaluated and standardized on each inpatient oncology unit to ensure that it was multidisciplinary and occurred each day at an established time. A process was established for Advanced Practice Providers (APPs) to write prescriptions the day before discharge (delivered directly to the bedside), and for APPs to begin discharge of patients early the following morning with use of a new discharge checklist. Standardized workflow was also created for instances where prior authorizations were required for prescriptions. We partnered with our Home Care providers to streamline the process for patients anticipated to be discharged to that service. Partnership was also established with physical therapy (PT) to avoid ordering low-value consults and to provide enhanced education to nursing staff about early patient mobility. Another project is being piloted to move lab draws six hours earlier the night prior to discharge. This provides the medical team additional time to assess and treat based on lab results if the patient required blood product transfusions or electrolyte replacement prior to discharge. Results: Implementation of interventions began throughout the first several months of 2019. Each of the first four months of 2019 saw consecutive improvements in both observed average LOS and LOS observed-to-expected ratios. Overall, a 2% decrease was seen in both of these metrics when comparing January to April 2019 to the 2018 baseline. Conclusions: Implementing several interventions to streamline workflows and processes leading up to a patient’s discharge can be effective in reducing both overall LOS and LOS observed-to-expected ratios.

Long-term medical cannabis use and risk factors for diversion: Report on physician's guidance and patients’ behaviour

Various jurisdictions have legalized cannabis for medical purposes. As with all psychoactive medications, medical cannabis carries a risk of diversion and accidental ingestion. These risks may be particularly high among long-term medical cannabis patients as safety practices may become less salient to patients once the treatment becomes part of everyday life. The current study examines whether patients who have used medical cannabis for longer periods differ from those who have used for shorter periods in terms of sociodemographic background and other key aspects of medical cannabis use. Furthermore, the study examines the relationship between length of medical cannabis treatment and risk factors related to storage and diversion. Finally, the study examines the extent to which oncologists provide information to their patients about safe storage and disposal. One hundred twenty-one medical cannabis oncology patients were interviewed face-to-face and 55 oncologists participated in a survey about safe storage and disposal practices related to medical cannabis. Length of medical cannabis treatment was related to administration by smoking and using higher monthly dosages. In terms of risk for unsafe storage and diversion, length of medical cannabis was positively associated with using cannabis outside the home and having been asked to give away medical cannabis. Physicians did not report providing information to patients regarding safe storage and disposal practices in a regular manner. Results suggest that there is an ongoing risk of unsafe storage and diversion over the course of medical cannabis treatment. Oncologists may need to give more consistent and continued training in safe storage and disposal practices, especially among long-term medical cannabis patients.

The role of anticoagulants for the primary prophylaxis of venous thromboembolism in patients with malignancy: A systematic review and meta-analysis of randomized controlled trials.

e14691 Background: Venous thromboembolism (VTE) is a common cause of morbidity and mortality in cancer patients. Despite this, pharmacologic prophylaxis for the primary prevention of VTE is not offered for most medical oncology patients, likely due to the competing risk of bleeding. Recent trials may offer new insight into the role of anticoagulants for the prevention of cancer associated thrombosis (CAT). Accordingly, we conducted a meta-analysis of randomized controlled trials (RCTs) that evaluated anticoagulants for the primary prophylaxis of VTE in cancer patients. Methods: A literature search of Pubmed/MEDLINE, Embase, and Cochrane library was done by two investigators. All RCTs that used anticoagulant in cancer patients for primary prevention of VTE were included. The primary outcomes were VTE events and all-cause mortality; VTE related mortality and major bleeding were secondary outcomes. A random effects model was used to report the risk ratios (RR) with 95% confidence intervals (CIs), and odds ratios (ORs) with Bayesian 95% credible intervals for both direct and network meta-analysis, respectively. Results: Twenty-four RCTs were included with a total of 13,338 patients (7,197 received anticoagulants and 6,141 received placebo). Of these trials, 19 used low-molecular weight heparin (LMWH), 3 used direct oral anticoagulants (DOACs), 2 used warfarin, and 1 used heparin. Mean age ranged between 54.6 to 68.1 years, with 50.5% male. Compared with placebo, LMWH or DOACs were associated with reduced VTE events (RR 0.58; 95% CI 0.48-0.69, p < 0.001) and (RR 0.39; 95% CI 0.24-0.63, p < 0.001), respectively. LMWH compared with placebo was associated with decreased VTE, and all-cause mortality (P < 0.05). While DOACs was associated with decreased PE events only compared with placebo (RR 0.28; 95% CI 0.11-0.71, P = 0.008). Regarding the safety outcome, LMWH and DOACs were associated with an increased risk of major bleeding compared with placebo, but this did not reach statistical significance in this study (RR 1.26; 95% CI 0.92-1.74, p = 0.16 and RR 1.76; 95% CI 0.83-3.73, p = 0.14). Results regarding VTE events and major bleeding were consistent in both lung and pancreatic cancers. Conclusions: Both LMWH and DOACs were associated with a lower number of VTE events compared with placebo. However, this potentially protective effect must be balanced against a possible increased risk of bleeding for some patients.

Detecting geriatric needs in older patients with breast cancer through use of a brief geriatric screening tool

Identification of geriatric syndromes is important for determining functional age and optimizing care for people with cancer. Based on administration of a geriatric screening tool, we aimed to describe needed resources for geriatric syndromes, including lack of social support, depressed mood, deficits in instrumental and activities of daily living (IADL/ADL), falls, nutritional issues, polypharmacy, ability to pay for medications, and memory deficits, in a population of patients with breast cancer. Consecutive medical oncology patients with breast cancer age 65 years and older, seen at a tertiary care center, completed a screening tool, adapted from Overcash 2006, consisting of a nurse-administered memory assessment and a one-page, self-administered questionnaire. Responses identified geriatric syndromes. Demographics and clinical information were retrospectively gathered. Frequencies and means were used to describe data. From January 2012 through July 2014, patients (n = 429) completed the screening tool as part of routine care. Study group had mean age 76 years (range 65-89), mean time since diagnosis 6.5 years, 91% non-metastatic disease, mean Charlson Comorbidity score 1.8 (range 0-10). Treatment included partial mastectomy (49%), adjuvant radiation (43%), chemotherapy (25%), and endocrine therapy (61%). The screening tool identified need for social support (8%); depression (31%); mobility issues (20%); falls (28%); nutritional needs (33%); polypharmacy (83%); and memory deficit (19%). This screening tool identified geriatric syndromes requiring attention in many patients with breast cancer presenting for medical oncology appointments. In oncology practice, need for referral networks to address geriatric syndromes should be assessed.

The iPROMOS protocol: a stepped-wedge study to implement routine patient-reported outcomes in a medical oncology outpatient setting

IntroductionPatient-reported outcome measures (PROMs) are data capture tools that collect information directly from patients. Several large research studies provide evidence that the use of PROMs in routine care provides benefits...

The Integrated Care Service: Impact of a Multidisciplinary Supportive Care Service on Hospice Discharge Rates for Medical Oncology Patients in a NCI-Designated Cancer Center (SA511B)

The Integrated Care Service: Impact of a Multidisciplinary Supportive Care Service on Hospice Discharge Rates for Medical Oncology Patients in a NCI-Designated Cancer Center (SA511B)

Platelet compatibility and platelet antibodies detection: A step towards resolving dilemma in management of platelet refractoriness in oncology patients

Background: Platelet refractoriness complicates the provision of platelet transfusions- a critical and essential part in management of thrombocytopenia in Oncology patients. Platelet refractoriness poses challenge due to alloimmunization to HLA (Class I) and human platelet antigens (HPAs) and is associated with adverse clinical outcomes and increases health care costs. Aim: A prospective, observational study was planned in medical oncology patients having thrombocytopenia to analyse result of platelet compatibility with post-transfusion platelet count increment and to ascertain presence of platelet antibodies as causative factor in platelet refractory patients. Methods: Eighty oncology patients having thrombocytopenia in a tertiary care centre; both solid organ and hematological malignancies, requiring platelet transfusion were included in this study. ABO-compatible, leucoreduced, random donor platelets with less than 72 hours storage and platelet cross matched were transfused. In case of platelet refractoriness and presence of platelet incompatibility, platelet antibody screening test was performed using SPRCA technique. A P-value

Opioid prescribing upon discharge for patients with solid malignancies.

50 Background: Pain is a common symptom associated with cancer resulting in increased health care utilization. We aim to study patients admitted with uncontrolled pain and review their discharge medications after development of an effective pain regimen while hospitalized. Anecdotally, we observe patients are being discharged with suboptimal regimens resulting in increased Emergency Department (ED) visits or readmissions. By identifying suboptimal opioid prescriptions we hope to improve care and patient satisfaction and minimize ED visits or readmission rates. The primary objective is to identify opportunities for improvement of opioid prescribing upon discharge for medical oncology patients. Methods: Retrospective study exempt from IRB review. We reviewed admitted patients with a solid tumor cancer diagnosis and consult to inpatient medical oncology at a safety-net hospital in an urban Southeastern population from June to November 2017 with data collected on 29 patients. Data was analyzed using descriptive statistics. Potential health-system cost avoidance was calculated. Results: 51% of patients were discharged with a lower daily oral morphine equivalent (DOME) than received while inpatient, with a median of 12 days until scheduled follow-up appointment. While 75% of patients were prescribed an adequate supply for long acting opioids, only 39% received an adequate supply of short acting opioids. 12 patients (41%) returned to the ED or urgent clinic within 30 days. 4 events were associated with a lower DOME and/or inadequate supply compared to their inpatient regimen. The total amount billed for missed opportunities showed the hospital was reimbursed only 25%. Conclusions: Opportunities to prevent discrepancies in discharge regimens exist. Pain regimens should be assessed for accuracy and supply at discharge and appointments. Patients should be discharged with a sufficient amount of opioids until their follow up, including ensuring insurance coverage of medication prescribed, with emphasis on patients maintaining their outpatient appointments. We plan to continue analysis post continuous QI initiative to improve clinical practice in pain management for patients with solid tumor malignancy.

The integrated care service: Impact of a multidisciplinary supportive care service for medical oncology patients in a NCI-designated cancer center.

134 Background: Palliative care (PC) has shown benefits to inpatient length of stay (LOS), symptom burden reduction, utilization decrease, and time on hospice. It has shown less impact on the rate of hospice referrals. We assessed the impact of an integrated care model on these outcomes. Methods: From Jan-July, 2018, the Department of Supportive Care Medicine collaborated with medical oncology (med onc), nursing and administration to create the Integrated Care Service (ICS). Multi-disciplinary rounds include med onc, supportive care (PC, social work, spiritual care, psychiatry, psychology, hospice liaison), nursing, case management, nutrition, and physical and occupational therapy. The admission criteria include: 1) Later-stage disease; 2) Non-curative intent therapy; 3) High distress burden; and 4) Poor prognosis. The ICS was designed to have geographic co-location, morning PC and med onc rounds, multidisciplinary rounds, and post-acute management. The ICS was compared with other med onc patients (non-ICS) and Mantel-Haenszel Chi-Square statistical significance (p<0.05) was calculated using Epi Info StatCalc. Results: In 6 months, 190 med onc patients (pts) were admitted to ICS versus 537 non-ICS pts. Compared with non-ICS, the ICS pts had a higher Case Mix Index (1.81 vs. 1.56) and metastatic disease incidence (95% vs. 78%, p=0.008). Discharge to hospice was higher from ICS versus non-ICS (23% vs. 7%, p=<0.001), and average time on hospice increased from 9 to 15 days. No chemotherapy was given in the last two weeks of life to any pts on ICS (0 vs. 6 non-ICS pts). Length of stay (LOS) was higher on ICS as compared to non-ICS (8.45 vs. 5.26 days) and readmission rates were similar (12% vs. 13%). Conclusions: For medical oncology pts in a comprehensive cancer center, the ICS, an integrated, multidisciplinary supportive care service, significantly improved discharge rates to hospice, increased LOS on hospice by almost a week, avoided patients receiving chemotherapy, and maintained similar readmission rates. LOS was higher for complex ICS patients as compared to non-ICS. Based on this pilot, the ICS is planning for expansion to include hematology and surgical services.

Malnutrition screening: A screening tool for outpatient oncology patients, leveraging EMR data.

275 Background: The provision of adequate nutritional care in outpatient cancer centers was the focus of a 2016 NAS Workshop, “Assessing Nutrition Care in Outpatient Oncology.” Here we report our internal project evaluating ongoing documentation of a malnutrition screening tool (MST) at 3 national cancer centers (CC). Methods: Screening scores from a validated 2 question MST scale were entered into the EMR. Questions probe for: 1) unintentional weight loss; and 2) eating poorly because of a decreased appetite. A score of ≥ 2 indicated nutrition risk. De-identified oncology clinic visit data were examined monthly to assess MST utilization and scores for radiation and medical oncology patients across the CC’s. Results: Approximately two-thirds (67%) of unique medical oncology patients that visited the CC’s had documented MST data with 9% (n = 144,129) scoring at nutritional risk. MST completion rates were higher in radiation oncology clinics secondary to staff education. Of those that had a valid MST score in radiation clinics, 13% (n = 23,202) of MST scores indicated nutritional risk. Conclusions: The MST is a valid malnutrition screening tool for outpatient oncology patients, yet this tool is not uniformly being utilized nationally. Consistent use of the MST in the electronic medical record and leveraging data on utilization are needed to inform staff compliance, consistency in care, future dietitian staffing patterns, cost/benefit analysis, and health outcomes for oncology patients. [Table: see text][Table: see text]

Improving support for smoking cessation in medical oncology patients: A quality improvement initiative.

148 Background: Smoking cessation is integral to cancer care. Active smoking is associated with increased toxicity of treatment, poorer response to therapy and is associated with worse overall survival. Patients who quit smoking at diagnosis have better survival outcomes. Cancer Care Ontario has aimed to improve rates of smoking screening and referral to smoking cessation programs based on the validated Ottawa model. Methods: We aimed to implement an “opt-out” referral process for recent or current smokers to a smoking cessation program at the Credit Valley Hospital. We aimed to achieve a referral rate of 20%, based on an institutional baseline of 8.5% and a provincially defined target of 20%. Key stakeholders targeted included nursing, administration, physicians, smoking cessation counsellors and patients. Sequential education interventions were delivered to address gaps in patient and provider knowledge; these included grand rounds, an informal lecture and an educational pamphlet. Results: After the initiative was launched, the referral rate increased from 8.5% to 14.3%. The impact of each intervention is summarized in Table 1. Conclusions: Smoking cessation referrals increased with new process but not to target. Patient refusals lead to a low rate of referral, warranting efforts aimed at addressing patient barriers. Future outcome measures may include smoking cessation rates. [Table: see text]

AOL-3 - Medical oncology group of Australia: taking a leading role in medical oncology education, patient care & research

Background: The Medical Oncology Group of Australia (MOGA) is the leading professional organisation for medical oncology in Australia and is a specialty society of the Royal Australasian College of Physicians. Founded in 1973, MOGA is the key point of reference on all matters relating to medical oncology education, patient management and research in Australia. Membership: MOGA brings together 660 medical oncologists (519 consultants: 141 trainees); representing approximately 98% of the Australian medical oncology workforce. Supporting members: MOGA supports its members through: “Post-graduate medical oncology training; “Developing career development initiatives; “Developing Scientific and Academic meetings, programs & workshops; “Contributing to the development and promotion of evidence-based standards for cancer care, management and clinical practice; “Advocacy, lobbying and professional representation; “Research activities and special projects; and “Consumer and Community Support via key organisations. Education and research: MOGA takes a leading role in advancing medical oncology training and education through several initiatives including; Communications Skills Training, Young Oncologists Education Programs, a Sciences of Oncology Program as well as an Annual Scientific Meeting. MOGA organises the Australia Asia Pacific Oncology Research Development (ACORD) Workshop that has trained more than 498 oncology professionals in clinical trials design. Patient management and clinical practice: MOGA is committed to ensuring that the highest standards of international best practice clinical care. Initiatives include the preparation and dissemination of practice guidelines and tools, and advocacy through major organisations. MOGA is proactive in working for oncology treatment access. Conclusion: MOGA takes pride in its place as a hub for all Australian medical oncology issues nationally, speaking with a strong voice for the discipline and members of the profession.

1746P - Comparing cancer patients’ and support persons’ preferences for the type of consultation and the format of information provided when making a treatment decision

Background: Cancer patients and their support persons often feel overwhelmed when being confronted with their diagnosis and treatment options. Such information is commonly provided during one consultation with their clinician. We compared cancer patients’ and their support persons’ preferences for: i) attending one 40-minute consultation or two 20-minute consultations when making a treatment decision; and ii) receiving additional information in written form only or in both written and online forms. Methods: An Australian cross-sectional survey, using a discrete choice experiment (DCE), of 159 adult medical oncology patients, and 64 of their support persons. Participants were presented with four hypothetical scenarios and asked to indicate their most and least preferred option. They were told that both treatments would have the same impact on participants’ life expectancy, and that there would be no difference between the scenarios in terms of when treatment would start. Results: 147 patients and 59 support persons completed the DCE. The proportions of patients and support persons choosing each scenario did not differ statistically significantly from each other (p > 0.05). Of the four scenarios, most patients and support persons preferred to receive two consultations along with written and online information (n = 65, 44% and n = 30, 51% respectively). Significantly more participants preferred to receive two shorter consultations rather than one longer consultation when this was combined with written and online information (p < 0.05). Conclusions: When making a cancer treatment decision, both patients and support persons seem to prefer to receive two shorter consultations combined with written and online information. Clinicians should consider offering this consultation style. Legal entity responsible for the study: Anne Herrmann. Funding: This study was funded by a Strategic Research Partnership Grant [CSR 11-02] from the Cancer Council New South Wales to the Newcastle Cancer Control Collaborative (New-3C), and by a Partnership Project [APP1059760] from the National Health & Medical Research Council (NHMRC). The authors also received funding support from the Hunter Cancer Research Alliance Implementation Science Flagship Program, the Hunter New England Local Health District, and the Australian Research Council. Infrastructure funding was provided by the University of Newcastle and Hunter Medical Research Institute. Disclosure: All authors have declared no conflicts of interest.

Exploring health literacy and preferences for risk communication among medical oncology patients.

ObjectiveTo explore adult medical oncology outpatients’ understanding of and preferences for the format of health risk information.MethodsTwo surveys, one assessing sociodemographic characteristics and a second survey examining perceptions of risk information.ResultsOf the 361 (74%) consenting patients, 210 completed at least one question on risk communication. 17% to 65% of patients understood numeric risk information, depending on the format of the information. More than 50% of people interpreted a “very good” chance of remission as greater than 80%, greater than 90% or 100%. The most preferred format of information was in both words and numbers (38% to 43%) followed by words alone (28% to 30%).ConclusionNumeric risk information is understood by 17% to 65% of respondents, depending on the format. Interpretation of verbal risk information is highly variable, posing a risk of misunderstanding. Provision of information in both words and numbers may assist in aiding comprehension.

Assessing dietary intake in accordance with guidelines: Useful correlations with an ingesta-Verbal/Visual Analogue Scale in medical oncology patients

Energy intake and food ingesta are central in nutritional screening and assessment. Cancer patients are at nutritional risk of losing weight, and clinicians need quick and easy tools to identify patients for nutritional support. This study aimed to evaluate the feasibility and the accuracy of a Visual/Verbal Analogue Scale of food ingesta (ingesta-VVAS) to assess energy food intake and nutritional risk in medical oncology patients. Dieticians administered prospectively the ingesta-VVAS in 1762 medical oncology patients. The external validity of the ingesta-VVAS was determined against daily energy intake based on a 24-hdietary recall. Patients had to estimate how they currently ate on a scale from 0 "nothing at all" to 10 "as usual". Area Under the Receiver-Operating Characteristics (ROC) curve served as determine the optimal cut-off and provide the discriminative power of the tool to detect patients who ingested less or more than 25kcalkg-1day-1. The feasibility of the ingesta-VVAS was 97.7%. The scores were significantly correlated with energy intake (ρ=.67, p<.05), whatever the specific situation (i.e. malnutrition or not). With a cut-off of ≤7, the ingesta-VVAS exhibited a good power discrimination (AUC=.804) to detect patients who ingested less or more than 25kcalkg-1day-1, with a sensitivity of 80.8%, a positive predictive value of 83.6%, a specificity of 67.5%, and a negative predictive value of 63.3%. Patients with a score ≤7 on the ingesta-VVAS score were at 12-fold higher probability of nutritional risk [OR 12.3; 95% CI (8.7-17.4); p<.001]. Sensitivity to detect patients with a significant weight loss was 71%, and a positive predictive value of 75.9%. This easy-to-use ingesta-VVAS is well-correlated with energy intake and may be useful in clinical practice. An ingesta-VVAS score is≤7 could be used to detect patients with nutritional risk of weight loss in medical oncology.

End-of-life care of oncology inpatients: Are we getting it right?

To examine the current patterns of end-of-life care of medical oncology patients dying in an Australian tertiary acute hospital setting in order to determine potential areas for improvement. A retrospective observational study was undertaken of 295 consecutive adult medical oncology inpatients dying between 2010 and 2015. Charts were reviewed for evidence of (1) resuscitation plans, (2) acute interventions in the 48-h period prior to death, (3) palliative care involvement and (4) recognition of the dying patient and comfort care plans. At the time of death, 98% of patients had a resuscitation plan, 71% of which were completed by the medical oncology team. Fifty-nine percent of medical emergency team reviews occurred in patients without a documented resuscitation plan. Within 48 h of death, active interventions were still being given to 64% of patients in the total patient population. Comfort care plans were documented in 86% of patients; however, 62% of these were only documented within 48 h of death and 20% of patients with a documented comfort care plan still received noncomfort measures. There was a high level of documented resuscitation plans, comfort care plans and recognition of dying. However, active interventions were common within 48 h of death, and comfort care plans and recognition of dying often occurred late. These data indicate a gap between documenting a resuscitation plan and providing timely and appropriate end-of-life care. Understanding the gaps in delivering appropriate care provides an opportunity for improving end-of-life care.

The timeliness of patients reporting the side effects of chemotherapy.

To explore the actions cancer patients reported they would take in response to a range of common side effects of chemotherapy and whether these were considered appropriate based on current guidelines and evidence; and to explore the sociodemographic and cancer-related variables associated with patients selecting the appropriate action (immediate medical attention or reporting) for two potentially life-threatening side effects: fever, and unusual bleeding and bruising. Four hundred thirty-six medical oncology and haematology patients receiving chemotherapy completed two surveys to provide demographic, disease and treatment characteristics, and details on how they would respond if they experienced a range of specified side effects of chemotherapy (for example, nausea and vomiting, fatigue, and skin rash or nail changes). The proportion of patients reporting the appropriate action for each side effect was calculated. Multiple logistic regressions examined the patient demographic and cancer characteristics associated with selecting the appropriate action (seeking immediate medical attention) for two potentially life-threatening side effects of chemotherapy: high fever of 38°C or more, and unusual bleeding or bruising. Two thirds of patients indicated that they would seek immediate medical attention for high fever (67%), but only 41% would seek immediate attention for bleeding or bruising. Cancer type and time since diagnosis were significantly associated with patients indicating that they would seek immediate medical attention for high fever; while time since diagnosis was the only variable significantly associated with patients reporting that they would seek immediate medical attention for unusual bleeding or bruising. For chronic side effects, like skin rash or nail changes, and tingling or numbness, which usually do not require urgent reporting, only between 12 and 16% would report them immediately. A significant proportion of patients reported that they would "do nothing" about fatigue or tiredness (24%). By comparison, less than 10% patients reported that they would do nothing for the other side effects investigated. Tools need to be created so that patients better understand the side effects after being treated with chemotherapy and what action they should take.