At the American Society of Clinical Oncology (ASCO) Annual Meeting (May 29-31, 2020), Stewart B Fleishman, MD, Coachella Valley Volunteers in Medicine (Indio, CA), highlighted three abstracts presented at the meeting that have particular importance in enhancing health services utilization or quality improvement efforts in cancer care.
Among the five aspects of patient care he touched on were enriched nursing care at home or in the inpatient setting, depression-limiting adherence to ongoing hormonal breast cancer treatment, and CT evidence of skeletal muscle mass and density in patient survival and symptoms.
In the first study, Dr Fleishman noted that investigators looked at an intermittent inpatient-level nursing care program done at home vs in the facility to reduce admissions and ED visits. The study was innovative because the patients (n = 367) were given many more services at home than they would receive in a traditional certified home care program.
Researchers of the study found that the mean length of stay, unplanned admissions, and costs were significantly reduced. Importantly, there was a reduction in ED visits that approached significance. “Follow-up can now be thought of in a surgical way to determine if location of these services can affect survival or quality of life, caregiver burden, or satisfaction. This was a great first attempt to standardize interventions, logistics, and geography, and then correlate a cost-saving to survival, quality of life, caregiver burden, and reimbursement issues,” Dr Fleishman stated.
Next, Dr Fleishman highlighted a side study of the TAILORx study that was interested in identifying patients and reasoning for discontinuing endocrine therapies in less than 4 years. A total of 864 patients were evaluable in the ECOG trial, and certain patients had more endocrine symptoms, a worse self-rating of physical and social well-being, depression as a comorbidity, and were less than 40 years of age. “We often do not ask about current mood and history of depression at the time of diagnosis, and specific questions about depression may be necessary” he posited.
This study helped showcase the need to work on the wording of questions that elicit more useful information. A specific question could be, “Have you ever had depression bad enough to seek treatment, or has a close blood relative” rather than “Are you depressed or have you had depression.” As a result, health care workers should be focused on increasing patient education on common menopausal symptoms. Additionally, Dr Fleishman implored the audience to consider selective serotonin reuptake inhibitors for these patients.
Lastly, Dr Fleishman spoke to a study that looked at the importance of lean body mass in cancer. This study was very innovative in that it correlated CT scan muscle mass, CT scan muscle density, and clinical outcomes in evaluable patients (n = 677) with advanced cancers.
Researchers of the study found that a decreased muscle mass in older, female, and lower-BMI patients was associated with decreased survival. Importantly, the study also found that decreased muscle density in older, female, and higher-BMI patients was associated with not only decreased survival, but also longer hospital stays and higher symptom burden. “Maintenance of ideal body weight (mass plus density) is often disregarded in treatment centers,” Dr Fleishman said, noting two other abstracts that looked at this issue.
“The importance of this study is to anticipate patient needs to withstand treatment and get a more complete history about weight and eating,” he asserted, adding that a fix for this would be more meaningful interdisciplinary involvement early in the course of treatment.
In his concluding remarks, Dr Fleishman implored the audience to involve the entire cancer treatment team from time of diagnosis and first treatment; this involves collecting important patient history (eg, personal and family history of “depression bad enough to need treatment” and a detailed assessment of activity level, nutritional state, and restorative rest and sleep) at the time of first consult, as well as evaluating if care can be done on an ambulatory basis or if home care programs can be helpful for select patient cases.—Zachary Bessette
