Abstract 6057
Background
Streamlining oncology (Onc) and specialist palliative care (SPC) into integrated patient (pt) care is increasingly a gold standard of optimized cancer care. The ways that integrated Onc/SPC manifests in clinical practice may change over time. Little is known about factors that drive evolution in integrated care practices.
Methods
From a pt’s first appointment with outpatient SPC, all visits were chronologically color coded for Onc, SPC, and Neutral (e.g. emergency) or joint visits (Onc/SPC same day). Visual Graphic Analysis revealed 4 patterns of integration (Onc only; SPC only; CONCurrent: permanent exchange of Onc and SPC, ≥5 switches, joint visits; SEGmented: alternating periods of Onc or SPC, <4 switches), independent researchers approved reliability of patterns definitions. Data from 2006-2009 (presented 34-ESMO 2009) were compared with 2016-2017. Explanatory factors for patterns evolution were derived from multi-professional, consensual discussion reviewing descriptive statistics (e.g. impact of inpt admission on patterns, pattern stability over 3 months intervals, anticancer treatment administered by SPC, pt characteristics) and further explored in the data.
Results
345 pts from 2006-09 and 64 from 2016 met eligibility criteria and were included. CONC occurred in 18% in 2006-09 and 45% in 2016 (Χ2 (1, N = 409) = 22.66, p < .001)], and 14% vs 50% remained in the CONC pattern comparing 3 months intervals. Elimination of inpt visits left 3/4 of patterns unchanged. A double-boarded Onc/SPC physician saw 94% of pts in the 2016 sample and prescribed systemic anticancer treatment in > 1/3 of these visits, 77% of these pts were in the CONC Pattern. Joint Onc/SPC visits were increasing over time, also (bi-)weekly alternating visits by Onc and SPC (double-boarded). Pts of CONC had complex and high needs for palliative interventions, were in phase I studies, or refused standard anticancer treatment, but accepted later.
Conclusions
Concurrent Onc/SPC is an increasing and consistent pattern, not explained by mere bed availability. Prescribing anticancer therapy by a double-boarded physician may foster integration. Further research may determine how CONC affects pt outcomes and the influence of pt and physicians’ characteristics.
Clinical trial identification
Legal entity responsible for the study
Cantonal Hospital St.Gallen.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
4596 - Neoadjuvant Trial of nab-paclitaxel and Atezolizumab (Atezo), a PD-L1 inhibitor, in patients (pts) with chemo-insensitive Triple Negative Breast Cancer (TNBC)
Presenter: Jennifer Litton
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
5349 - Prognostic implications of circulating tumor cells (CTCs) after neoadjuvant chemotherapy for triple negative breast cancer (TNBC)
Presenter: Carolyn Hall
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
2568 - A prediction model for pathological complete response after neoadjuvant chemotherapy of HER2-negative breast cancer patients
Presenter: Lothar Häberle
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
5413 - Evaluation of the MammaTyper® as a molecular predictor for pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) and outcome in patients with different breast cancer (BC) subtypes
Presenter: Peter A. Fasching
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
2260 - Impact of clinical, morphologic and molecular characteristics on response to neoadjuvant systemic therapy (NAST) in metaplastic breast cancer (MpBC)
Presenter: Clinton Yam
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
4722 - Evaluation of Human epidermal growth factor receptor 2 overexpression (HER2+) after administration of neoadjuvant treatment (NAT) and prognostic impact in breast cancer (BC)
Presenter: Duarte Machado
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
4307 - Complete response (CR) to anthracycline-based chemotherapy using magnetic resonance imaging (MRI) predicts high rates of pathologic complete response (pCR) for triple negative breast cancer (TNBC) patients treated preoperatively with anthracycline and taxane-based regimens
Presenter: Maria Marin Alcala
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
5018 - Immunomonitoring of triple negative breast cancer patients undergoing neoadjuvant therapy (GBG89, Geparnuevo trial)
Presenter: Barbara Seliger
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
3203 - Impact of breast cancer subtype on survival after lumpectomy versus mastectomy for early stage invasive breast cancer
Presenter: YU-CHEN Tsai
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
4887 - Survival Outcomes of Dose Dense Neoadjuvant and Adjuvant Chemotherapy in Triple-Negative Breast Cancer Patients – Indian Scenario
Presenter: TANVI Sood
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract