2019 Spring Meeting Accepted Abstracts

* Indicates abstract chosen for podium presentation

Patient navigation for Women’s Health cancer screening, education, and resources for uninsured and homeless women.

Amy Boyington, BSN, RN, OCN (1), Beverly Thorpe, LCSW,  Jennifer Geistert, RN, BSN, Cynthia Stevens, RN, BSN

(1)  Maine Medical Center Cancer Institute

Background: Due to the increase of breast and cervical cancers, homeless and uninsured women were identified for screening for mammography and Pap tests.  Patient Navigators identify individuals at risk for barriers to healthcare.  A collaborative approach utilizing a physician champion, navigators, and community partners was developed.   A women’s homeless shelter was identified to host an informational session while screening for individuals needing access to free mammograms and community resources to assist with Pap tests.

Methods: A two-fold protocol was developed to target participants with social media advertisement along with personal contact with on-site homeless shelter residents to recruit for free mammograms to underserved/underinsured women.  A simple screening tool allowed Patient Navigators and mammography schedulers to educate and facilitate access to mammograms.  Resources from nationally identifiable cancer education and The Maine Breast and Cervical Health Program were made available to participants.  Complementary gift bags for completion of the screening tool were available at the homeless shelter.

Results: Twenty free screening mammograms were provided to underserved/uninsured women within a 135 mile radius of our clinic.   The screening project at the homeless shelter assessed 17 of 39 women in the residence.

Conclusions: To improve early identification and screening for women at risk, Patient Navigators utilize their skills to assess, educate, and facilitate linkage to community resources to overcome barriers and identify opportunities.


A Guided Web-Based Yoga Series for Pediatric Cancer Survivors

Andrew Chongaway, DPT Student, Alyssa Deardorff, DPT Student, Amy J. Litterini, PT, DPT

University of New England

Background: Yoga is an increasingly utilized modality in both pediatric and adult oncology, but regular practice can be challenging due to infection precautions or lack of access to formal classes. Physical therapy students from the University of New England developed and produced instructional yoga videos for pediatric cancer survivors with the purpose of providing safe and intensity level-appropriate videos for children to utilize remotely.

Methods: Grant funding was secured followed by a thorough literature review.  Collaboration occurred with oncology physical therapists with expertise in yoga and pediatric cancer survivorship to determine safe, effective parameters, and with parents of pediatric cancer survivors to gain their perspective and understand potential concerns.  A certified child yoga instructor was recruited to ensure appropriate instruction, and a videographer was consulted to produce the videos. Four child models, ranging in age from 5-14 and representing both genders and different races, were recruited to participate in the videos to broaden relatability.

Results: Two videos were completed (for young children and adolescents) with four progressive sequences each focusing on flexibility, strength, and balance, while providing clear safety parameters. Distribution is planned to pediatric oncology specialists through email, flash drives, and secure web-posting by the American Physical Therapy Association.

Conclusions: These videos may allow children to utilize yoga more regularly and conveniently. Additionally, these videos allow for potential future research to determine efficacy of this form of yoga as an intervention and analyze the utilization across multiple settings.


Referral for colorectal cancer screening: provider preferences and perceived barriers

Karin Cole, MD (1), Madeline Wetterhahn (2), Claudia Heise, MD (3)

(1)Portland Surgical Associates; (2)Tufts University School of Medicine; (3)Northern Light Mercy Primary Care

Background: Understanding primary care providers’ referral patterns and perceived provider- and patient-related barriers to colorectal cancer (CRC) screening are critical to optimizing early detection of this disease.

Methods: A short survey with three multi-component questions was administered to 23 PCP’s in the Northern Light Mercy Hospital system. Using a 0-4 scale, respondents reported how frequently they recommended various colorectal screening modalities, and rated the significance of various provider- and patient-related barriers to screening.  Descriptive statistics were used to report the frequency of responses to each survey item. Single-factor ANOVA was used to detect significant differences between likelihood of a response within each multi-component question.

Results: Fourteen of 23 providers (61%) responded.  Colonoscopy was the most frequently recommended screening modality with 93% of respondents recommending it frequently. Only two other modalities were cited as being frequently recommended: fecal occult blood testing (by 21% of respondents) and fecal immunochemical test (by 10% of respondents). The majority of respondents reported they never recommended barium enema (77%), CT colonography (77%), or flexible sigmoidoscopy (62%). Seventy-one percent of respondents reported patient refusal or noncompliance as a significant barrier to screening.  No significant difference in mean reported frequency of provider-related barriers was observed.

Conclusions: PCP’s in our system favor colonoscopy over less invasive CRC screening modalities.  Patient refusal or noncompliance with screening recommendations was perceived as a significant barrier to screening, while there was no consistent pattern in reporting of provider-related barriers.  These results may help guide future efforts to improve the CRC screening rate in our population.


Functional Mobility for a Patient with Myelodysplastic Syndrome, Chronic GVHD, and Corticosteroid Use: A Case Report*

Alyssa Deardorff, Amy Litterini, PT, DPT

University of New England

Background: The benefits of physical therapy (PT) intervention for the long-term complications of chronic graft-versus-host-disease (cGVHD) and prolonged use of corticosteroids have not been reported.  The purpose of this case report was to document the impact of PT interventions for an individual with a cancer diagnosis having received an allogenic-stem cell transplant (allo-SCT) with complications associated with cGVHD, long-term corticosteroid use, and cancer survivorship.

Methods: The patient was a 73-year-old male diagnosed with Myelodysplastic Syndrome who received an allo-SCT two years prior to initial PT evaluation. His primary diagnosis was paraplegia with unclear etiology secondary to weakness in his proximal bilateral lower extremity musculature and loss of bowel/bladder function. The plan of care included therapeutic exercise, neuromuscular re-education, self-care/home management, and gait training.  Primary outcome measure was the Functional Independence Measure (FIM).

Results: After receiving both corticosteroid and PT interventions, the patient demonstrated increased functional mobility as shown by his improvement with transfers (FIM score from 4 to 6), ambulatory endurance (2 to 850 feet), and ability to complete balance and strength exercises consecutively and independently. When discharged, he could ambulate with an assistive device and navigate his home and community environments safely and independently.

Conclusions: Despite the lack of evidence for therapeutic interventions in patients post allo-SCT with chronic corticosteroid use and cGVHD, this specific example shows the potential progress one can make with PT to optimize functional independence. Future research requires a greater focus on rehabilitation management for patients with long-term complications of allo-SCTs.


Review of time to treatment for head and neck cancer patients at a rural Maine cancer center*

Antoine Harb, MD, Adam Curtis

Northern Light Lafayette Family Cancer Institute

Background: Time to Treatment (TTT) for head and neck malignancies were reviewed for all patients treated at Eastern Maine Medical Center (EMMC), from 2013 to 2017. A total of 297 cases were identified.

Methods: TTT was defined as time of tissue diagnosis by biopsy to the first treatment day.   Data was compared to a comprehensive study of 51,655 cases conducted by Murphy et al (JCO, 34;2, Jan 10, 2016).    Median days to treatment were compared to these findings by tumor site and by treatment modality.  Comparison of the distribution of cases where TTT exceeded the critical time point of 67 days (determined by Murphy) was also made.

Results: (Comparative data from Murphy in parentheses).  Median TTT by treatment modality was 40 days (34) for chemo-radiation patients, 42 (31) for radiation only, and 34 (17) for surgery. TTT for surgery was significantly less than the other two treatment modalities (p<0.05).  There were no significant differences in TTT based on primary site. All comparisons to Murphy (treatment and primary site) were significantly lower than our median values (p<0.05).  Median TTT over 5 years maintained the same relationship between the treatment modalities. 29.2% of our patients were treated within 30 days, 50.0% from 31-52 days, 10.6% from 53-67 days, and 10.2% > 67 days, compared with 59.5, 23.3, 8.3, and 9% respectively found by Murphy.

Conclusions: TTT for head and neck cancers have been relatively stable over the 5 year time course examined.  The majority of our patients (50.0%) are treated in the 31-52 day time frame compared with the first 30 days (59.5%) with Murphy.  Our data suggest similar percentages after which patients have a higher risk of poor outcome.



Case series of breast angiosarcomas following radiation. Experience of a single institution in Maine.

Antoine Harb, MDAdam Curtis, Sarah Sinclair

Northern Light Lafayette Family Cancer Institute (NLCI)

Background: Radiation-induced angiosarcoma of the breast is an extremely rare complication of breast cancer treatment. It is reported to be <1/1000, with a usually poor prognosis. We report the case of 4 patients who developed breast angiosarcoma (BA) after receiving breast radiation (RT).

Methods: We searched through the cancer registry for all the patients with the diagnosis of angiosarcoma during the last 25years (15 patients). From these patients, we identified the patients who had a previous diagnosis of breast cancer as well as BA.

Results: 4 women satisfied the inclusion criteria. All of them were previously diagnosed with either a stage 0/I breast cancer.  The median age of all women at the time of the BA diagnosis was 63.5 years. They were all treated with breast surgery followed by breast radiation.  The mean dose of radiation was 5645 cGy. Median time from RT to BA diagnosis was 64 months. All the patients presented with localized disease. 3 were treated with upfront surgery. One patient received neo-adjuvant chemotherapy followed by surgery. Two patients are still in remission after surgery. One had local recurrence, underwent re-excision surgery and went into remission. One patient developed metastatic disease and was treated with palliative chemotherapy but eventually succumbed to her disease after a long course.

Conclusions: Radiation-induced BA is associated with poor survival and high recurrence rates. Prognosis may be mainly determined by the disease’s aggressive biology.  We report the case of 4 women with this entity who have done surprisingly well given the prognosis.


Non-V600-BRAF mutation in non-small cell lung cancer: experience of a single institution in Maine. Antoine Harb(1), Michael Babcock(2), Marek Skacel(2), Adam Curtis(1)

(1) Northern Light Lafayette Family Cancer Institute (NLCI), (2) Dahl-Chase Pathology Associates

Background: BRAF is an oncogenic driver mutation in multiple malignancies including non-small cell lung cancer (NSCLC). V600 BRAF mutation has been recognized as an actionable mutation. We are trying to determine the frequency, PD-L1 status, treatment modalities, survival and other characteristics of non-V600-BRAF mutated non-small cell lung cancer (NSCLC).

Methods: We examined all NSCLC BRAF mutations diagnosed at NLCI during 2017-18. Four patients with V600E (1.4%) and 9 with non-V600 BRAF (3.19%) mutations were identified out of 282 NSCL adenocarcinomas tested.

Results: Out of the 9 patients with non-V600 BRAF mutations, 6 had mutations in exon 11; G469A (2), G469V (2), G455V (1), and G466V (1).  Three had mutations in exon 15; N581I  (1), N581T (1), and W604*(1) .  The mean age was 73.7 (+/- 3.9).  All patients were active or former smokers.  Five were men, 5 patients had stage IV and 2 had stage I.  Four patients had high PD-L1 expression. One year progression free survival was 53.3% and one year overall survival was 66.6%.  Patients with early stage disease had surgery +/- adjuvant chemotherapy.  One patient with metastatic disease did not receive treatment, 2 with advanced disease had palliative radiation.  One patient with stage IV disease received chemotherapy and radiation and one had chemotherapy/radiation, surgery and immunotherapy.

Conclusions:  Non-V600-BRAF mutations are uncommon, and their significance and prognostic value is unknown at the time being due to the small number of patients with these mutations. It seems that most of these patients were men, current/former smokers and had an advanced stage at diagnosis.



Outcomes from Bemobile: A technology-based intervention to support physical activity among cancer survivors

Emma O'Brien BSJessica Symonds BS, Nancy Gell PT, PhD

Department of Rehabilitation and Movement Science, University of Vermont

Background:Physical activity (PA) provides multiple benefits to cancer survivors.

Sustained engagement in exercise is a challenge once structured, facility-based programs end.

Innovative strategies are needed to support cancer survivors’ physical activity intentions, particularly in rural areas.

Methods:

Participants:

  • 65 rural cancer survivors (81% female; mean age 61.1±9.9)
  • Recruited during last month of exercise-based oncology rehabilitation
  • Randomized to full intervention (n=34) or Fitbit-only control group (n=31) stratified by age (±65) and sex

Intervention (8 weeks):

  • Feedback on baseline physical activity
  • Tailored Text Messages: Prompts and feedback
  • Health Coach: 1 in-person + 3 phone calls for goals & barriers
  • Fitbit One: Step count self-monitoring

Measures:

  • Actigraph GT3xt+: Step counts & moderate to vigorous physical activity (MVPA) pre-post intervention

Questionnaire:

  • Self-efficacy, social support, self-regulation skills, fatigue, sleep disturbance, depressive symptoms, intervention acceptability

Data Analysis:

  • Pre-post change in MVPA and Steps (Wilcoxon)
  • Robust regression for group differences in MVPA
  • Effect size (Cohen’s D)
  • Summary statistics for acceptability

Results: 

Acceptability of the Intervention:

  • 92% were satisfied/very satisfied with text message content  and with the health coach sessions
  • 94% satisfied/very satisfied with number of texts
  • 56% found the texts motivating
  • 72% found the health coach sessions motivating

Conclusions:Technology-based, remote interventions can promote continued engagement in MVPA outside of a structured program.

The text messages and health coaching enhance perception of the benefits of the Fitbit.

Feedback on exercise levels + use of Fitbit alone were not sufficient to prevent expected decline in MVPA and step counts.

Effect sizes suggest that a larger trial of the intervention could prevent moderate but potentially clinically significant decreases in MVPA and Steps that occur once structured programs end.



Patient self-disconnect of home chemotherapy infusion pumps

Megan O'Neil, OCN, RNElizabeth B. McGrath DNP, APRN, AGACNP-BC, AOCNP

DHMC - Norris Cotton Cancer Center

Background: In colorectal cancer patients FOLFOX is a commonly prescribed chemotherapy regimen. This regimen requires patients’ wear a continuous infusion fluorouracil (5FU) pump for 46-48 hours. Historically the patients have been required to return to the hospital to have the pump disconnected. The Norris Cotton Cancer Center decided to investigate the efficacy of patient self-disconnect with the goal of increased patient satisfaction and convenience of the patient as well as freeing up infusion room space.

Methods: A committee made up of a physician champion, two nurse coordinators for GI Oncology, infusion room manger, and nurse manger were convened to develop a process for education and implementation of the project.

Results:  The nurses developed a teaching protocol to ensure standardized education and developed a short video for the patients to review. Once educated by the clinic nurse and the video viewed the patient is required to complete a “teach back” session with the infusion room RN. Documentation of the education is entered into the medical record utilizing a smart phrase to include all the necessary information. The smart phrase was developed by the RN and reviewed by risk management. In addition a policy was developed by the nurse manger to standardize and educate the infusion room nurses.

Conclusions: Patient self-disconnect from home infusion 5FU is a safe option for patients who would prefer to avoid an additional visit to the hospital.


Neutropenic Diet: Standardizing the Practice
Using Evidence-Based Practice*

Mary Kate Visnic

Boston Medical Center

Background: 

  • Neutropenia is a low level of neutrophils
  • People who have neutropenia have a higher risk of developing serious infections
  • Chemotherapy or bone marrow disorders can lead to neutropenia
  • Patients throughout the Norris Cotton Caner Center (NCCC) at the Dartmouth-Hitchcock Medical Center report inconsistent information regarding neutropenic diet recommendations
  • There is no evidence to support benefit of restrictive neutropenic diets for patients with neutropenia
  • Primary cause of food borne illness is unsafe handling of food

Methods: 

  • 9-item survey adapted with permission by Dr. Arno Mank and Michelle Davies (2008)
  • Survey link was emailed to NCCC Health Care
  • Providers stating “Please complete the survey about your beliefs and practices regarding dietary advice for patients with cancer"
  • The completion of the survey was considered consent to participate
  • Surveyed NCCC healthcare providers on
  • Different practices regarding what food items are restricted for patients with neutropenia and what different names they call this special diet
  • At what point in the patient’s treatment might restrictions be implemented/ discontinued 
  • What might account for differences amongst practitioner/practice settings.

Results: Results support assumptions regarding inconsistent neutropenic diet instructions

Conclusions:

  • Individual practice of neutropenic diet precautions varies among providers
  • Results support assumptions regarding inconsistent neutropenic diet instructions
  • Standardized and up to date education is needed for staff
  • The data will guide the work of standardizing education for NCCC providers




Northern New England Clinical Oncology Society
P.O. Box 643
Sandown, NH 03873-0643
Telephone (603) 887-1948
info@nnecos.org

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