Search

Background Previous studies have investigated patients’ treatment goals before starting a treatment for metastatic lung cancer. Data on the evaluation of treatment goals are lacking. Aim To determine if patients with metastatic lung cancer and their oncologists perceive the treatment goals they defined at the start of systemic treatment as achieved after treatment and if in hindsight they believe it was the right decision to start systemic therapy. Design and Participants A prospective multicenter study in 6 hospitals across the Netherlands between 2016 and 2018. Following systemic treatment, 146 patients with metastatic lung cancer and 23 oncologists completed a questionnaire on the achievement of their treatment goals and whether they made the right treatment decision. Additional interviews with 15 patients and 5 oncologists were conducted. Results According to patients and oncologists, treatment goals were achieved in 30% and 37% for ‘quality of life,’ 49% and 41% for ‘life prolongation,’ 26% and 44% for ‘decrease in tumor size,’ and 44% for ‘cure’, respectively. Most patients and oncologists, in hindsight, felt they had made the right decision to start treatment even if they had not achieved their goals (72% and 93%). This was related to the feeling that they had to do ‘something.’ Conclusions Before deciding on treatment, the treatment options, including their benefits and side effects, and the goals patients have should be discussed. It is key that these discussions include not only systemic treatment but also palliative care as effective options for doing ‘something.’

Aim of the study Patients with cancer might have an increased risk for severe outcome of coronavirus disease 2019 (COVID-19). To identify risk factors associated with a worse outcome of COVID-19, a nationwide registry was developed for patients with cancer and COVID-19. Methods This observational cohort study has been designed as a quality of care registry and is executed by the Dutch Oncology COVID-19 Consortium (DOCC), a nationwide collaboration of oncology physicians in the Netherlands. A questionnaire has been developed to collect pseudonymised patient data on patients’ characteristics, cancer diagnosis, and treatment. All patients with COVID-19 and a cancer diagnosis or treatment in the past 5 years are eligible. Results Between March 27th and May 4th, 442 patients were registered. For this first analysis, 351 patients were included of whom 114 patients died. In multivariable analyses, age ≥65 years (p, Highlights • Patients with cancer might have an increased risk for severe outcome of COVID-19. • This nationwide study investigated risk factors for fatal outcome of COVID-19. • Among 442 registered patients with cancer, 32.3% of patients died of COVID-19. • Haematological malignancy and lung cancer increased the risk of fatal outcome. • These results can guide treatment and vaccination decisions in patients with cancer.

Being able to work improves the quality of life of patients with cancer. Much is known about the return to work process of cancer survivors. Yet, studies focusing on the experiences of patients with advanced cancer who want to return to work or stay employed are scarce. Therefore, we aimed to explore the perceptions of patients with advanced cancer regarding work resumption and work retention and the barriers and facilitators they may experience.Semi-structured interviews were conducted. Patients were included if they: (1) were diagnosed with advanced cancer, (2) worked in paid employment at time of diagnosis, and (3) were currently back in paid employment or had the intention to return to paid employment. Participants were recruited through clinicians and patient organizations. Interviews were transcribed and thematically analysed using ATLAS.ti.Fifteen patients (87% female, mean age 52 (SD 4; range 41-64)) were individually interviewed. Four main themes emerged from the data: (1) holding on to normalcy, (2) high understanding and divergent expectations, (3) social discomfort calls for patient-initiated alignment, and (4) laws and regulations require patient empowerment.Paid employment can contribute to the quality of life of patients with advanced cancer. The findings of this study might correct erroneous preconceptions about the work ability and work intention of patients with advanced cancer. Tools already developed for employers to support reintegration of patients with cancer should be further explored and translated to patients with advanced cancer.

Aim of the study: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cancer care. In this study, clinical patient characteristics related to COVID-19 outcomes and advanced care planning, in terms of non-oncological treatment restrictions (e.g. do not-resuscitate codes), were studied in patients with cancer and COVID-19. Methods: The Dutch Oncology COVID-19 Consortium registry was launched in March 2020 in 45 hospitals in the Netherlands, primarily to identify risk factors of a severe COVID-19 outcome in patients with cancer. Here, an updated analysis of the registry was performed, and treatment restrictions (e.g. do-not-intubate codes) were studied in relation to COVID19 outcomes in patients with cancer. Oncological treatment restrictions were not taken into account. Results: Between 27th March 2020 and 4th February 2021, 1360 patients with cancer and COVID-19 were registered. Follow-up data of 830 patients could be validated for this analysis. Overall, 230 of 830 (27.7%) patients died of COVID-19, and 60% of the remaining 600 patients with resolved COVID-19 were admitted to the hospital. Patients with haematological malignancies or lung cancer had a higher risk of a fatal outcome than other solid tumours. No correlation between anticancer therapies and the risk of a fatal COVID-19 outcome was found. In terms of end-of-life communication, 50% of all patients had restrictions regarding life prolonging treatment (e.g. do-not-intubate codes). Most identified patients with treatment restrictions had risk factors associated with fatal COVID-19 outcome. Conclusion: There was no evidence of a negative impact of anticancer therapies on COVID-19 outcomes. Timely end-of-life communication as part of advanced care planning could save patients from prolonged suffering and decrease burden in intensive care units. Early discussion of treatment restrictions should therefore be part of routine oncological care, especially during the COVID-19 pandemic. 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background: The aim of this study is to compare long-term health-related quality of life (HRQOL) and survival in metastatic NSCLC patients with (M+) and without (M−) a targetable driver mutation. Methods: An observational study was performed within the prospective SYMPRO-lung study (NL7897). HRQOL questionnaires were completed at baseline, 15 weeks, and 6 months. Generalized estimating equations (GEE) were used to assess clinically significant declines in HRQOL (&gt, 10 points) over time. Kaplan–Meier survival curves were plotted for both progression-free survival (PFS) and overall survival (OS). Results: 81 metastatic NSCLC patients were included (M+ patients, 16 (20%)). M+ patients had a significantly better global HRQOL (mean difference 12.8, ES 0.61), physical functioning (mean difference 13.4, ES 0.63), and less appetite loss (mean difference 23.1, ES 0.73) at 15 weeks of follow-up compared to M− patients. Patients with a clinically relevant decline in HRQOL at 6 months of follow-up had a significantly shorter PFS (5 months vs. 12 months, p-value &lt, 0.001) and OS (11 months vs. 16 months, p-value 0.002). Conclusions: M− NSCLC patients have less favorable HRQOL over time compared to M+ patients. Furthermore, clinically relevant HRQOL declines over time were significantly associated with worse survival. HRQOL can therefore play an important role in in shaping patients’ expectations of their prognosis.

Purpose: Stepped care (SC), consisting of watchful waiting, guided self-help, problem-solving therapy, and psychotherapy/medication is, compared to care-as-usual (CAU), effective in improving psychological distress. This study presents secondary analyses on subgroups of patients who might specifically benefit from watchful waiting, guided self-help, or the entire SC program. Methods: In this randomized controlled trial, head and neck and lung cancer patients with distress (n = 156) were randomized to SC or CAU. Univariate logistic regression analyses were performed to investigate baseline factors associated with recovery after watchful waiting and guided self-help. Potential moderators of the effectiveness of SC compared to CAU were investigated using linear mixed models. Results: Patients without a psychiatric disorder, with better psychological outcomes (HADS: all scales) and better health-related quality of life (HRQOL) (EORTC QLQ-C30/H&N35: global QOL, all functioning, and several symptom domains) were more likely to recover after watchful waiting. Patients with better scores on distress, emotional functioning, and dyspnea were more likely to recover after guided self-help. Sex, time since treatment, anxiety or depressive disorder diagnosis, symptoms of anxiety, symptoms of depression, speech problems, and feeling ill at baseline moderated the efficacy of SC compared to CAU. Conclusions: Patients with distress but who are relatively doing well otherwise, benefit most from watchful waiting and guided self-help. The entire SC program is more effective in women, patients in the first year after treatment, patients with a higher level of distress or anxiety or depressive disorder, patients who are feeling ill, and patients with less speech problems. Trial: NTR1868.

12060 Background: The use of patient reported outcomes (PROs) to monitor symptoms during and after cancer treatment can improve symptom management, health-related quality of life (HRQoL), and overall survival, especially when linked to an alert system. Previous studies used alerts to the health care provider (HCP), but will this also work when patients receive the alerts? The aim is to compare a reactive (patient receives alert) and an active (HCP receives alert) method of PRO symptom monitoring on symptom incidence and management during the first 15 weeks of treatment. Methods: SYMPRO-Lung is a Dutch multicenter stepped wedge RCT performed among lung cancer (LC) patients to monitor symptoms, using a PRO-CTCAE LC subset. The NCI scoring algorithm assessed the symptom severity. If symptoms exceeded a predefined threshold an alert was sent by email to the HCP (active arm) or to the patient (reactive arm). Differences between both study arms in baseline characteristics, symptom incidence and management, were assessed using chi-square tests. Results: In total, 244 patients (active arm n = 155, 64%, reactive arm n = 89, 37%) completed 2412 symptom checklists during the first 15 weeks of treatment, with a mean of 10 per patient (pp) (SD 4.3). A total of 673 alerts (28%) were triggered, with a mean of 3 (SD 2.1) pp in both arms. The top 3 symptoms that caused the app to send an alert were fatigue (n = 231, 19%), pain (n = 188, 16%), and constipation (n = 144, 12%). Decreased appetite, diarrhea, and nausea were significantly higher in the reactive arm compared to the active arm (see table). For 313 alerts (74%), telephone contact with a HCP was the only intervention needed. 57 Alerts (13%) were discussed during a planned outpatient’s consultation in the week of the alert. For 39 alerts (9%) the patients were referred to another specialty (see table). However, ‘no need to follow-up’ (FU) was requested after 237 alerts (35%). For all symptoms, the no FU request was significantly higher in the reactive arm (n = 135, 32% vs n = 102, 40%), compared to the active arm (p-values between 0.02 and < 0.001). Conclusions: In both arms an average of 3 alerts pp were triggered. In the reactive arm, significantly more patients chose not to contact their HCP compared to the active arm. Future research needs to unravel the underlying mechanisms and the potential consequences of this observed difference between study arms. Clinical trial information: Trial NL7897. [Table: see text]

Supplemental material, sj-docx-1-mdm-10.1177_0272989X21998951 for Patients with Metastatic Lung Cancer and Oncologists’ Views on Achievement of Treatment Goals and Making the Right Treatment Decision by Adinda Mieras, Annemarie Becker-Commissaris, Hanna T. Klop, H. Roeline, W. Pasman, Denise de Jong, Lemke Pronk and Bregje D. Onwuteaka-Philipsen in Medical Decision Making

Purpose. Lung cancer has a high impact on both patients and relatives. Previous studies looked into treatment goals patients have before starting a treatment. However, studies on relatives’ perceptions of treatment at the end of life are scarce. Therefore, we studied the perspectives of relatives in hindsight on the achievement of treatment goals and the choice to start treatment for metastatic lung cancer of their loved one.Methods. We conducted a semi-structured telephone interview study in six hospitals across the Netherlands, one academic and five non-academic hospitals between February 2017 and November 2019. We included 118 relatives of deceased patients diagnosed with metastatic lung cancer who started a systemic treatment and who completed a questionnaire on their treatment goals before start of the treatment and when treatment was finished. We asked the relatives about the achievement of patients’ treatment goals and relatives’ satisfaction with the choice to start treatment.Results. Relatives reported the goals ‘quality of life’, ‘decrease tumour size’ and ‘life prolongation’ as achieved in 21%, 37% and 41% respectively. Most of the relatives (78%) were satisfied with the choice to start a treatment. Also, when none of the goals were achieved, 70% of the relatives were satisfied. About one in two relatives who were satisfied with the patient’s choice did mention negative aspects of the treatment choice, such as that the treatment did not work, that there were side effects or that it would not have been the relatives choice. This was four in five for relatives who were not satisfied. Most mentioned positive aspects were that they tried everything and that it was the patient’s choice. Conclusion. Relatives reported patients’ treatment goals as not achieved in a majority of cases. They were, however, in majority of the cases satisfied about the treatment choice. Being satisfied does not provide a full picture of their experience with the treatment decision as a majority mentions negative aspects of this decision. At the time of making the treatment decision it is important to manage expectations about chance of success and possible side effects of the treatment.