Patient Reported Outcomes/QoL/Survivorship

SS 09 - Patient Reported Outcomes/Quality of Life/Survivorship

68 - The Impact of Specialized Gastroenterology Services for Late Pelvic Radiation Disease: Results From the Prospective Multicenter EAGLE Study

Monday, October 22
8:15 AM - 8:25 AM
Location: Room 008

The Impact of Specialized Gastroenterology Services for Late Pelvic Radiation Disease: Results From the Prospective Multicenter EAGLE Study
J. Staffurth1,2, S. Sivell3, S. Ahmedzai4, J. Andreyev5, D. Farnell6, J. Green7, D. Sanders8, C. L. Ferguson8, S. Pickett9, L. Smith10, D. Cohen11, R. O'Shea12, S. Campbell12, S. Taylor13, and A. Nelson3; 1Velindre Cancer Centre, Cardiff, United Kingdom, 2Cardiff University, Cardiff, United Kingdom, 3Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom, 4National Institute for Health Research, Clinical Research Network - Cancer Cluster Office, University of Leeds, Leeds, United Kingdom, 5Department of Gastroenterology, Lincoln County Hospital, Lincoln, United Kingdom, 6School of Dentistry, Cardiff University, Cardiff, United Kingdom, 7, Institute of Medical Education, School of Medicine, Cardiff University and Department of Gastroenterology, University Hospital Llandough, Cardiff and Vale UHB, Vale of Glamorgan, Cardiff, United Kingdom, 8University of Sheffield Medical School, Sheffield, United Kingdom, 9Swansea Centre for Health Economics, Swansea University, Swansea, United Kingdom, 10Living With and Beyond Cancer Programme at NHS England, Kingston-Upon-Thames, United Kingdom, 11University of South Wales, Pontypridd, United Kingdom, 12c/o Marie Curie Palliative Care Research Centre, Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom, 13Senior Research Assistant, Macmillan Cancer Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom

Scale Measure (mean 6 ms – mean baseline) ÷ SD baseline (mean 12 ms – mean baseline) ÷ SD baseline
EPIC Bowel scale 0.44 0.53
GSRS Diarrhea scale 0.04 0.90
EPIC Urinary Irritative / Obstructive scale 0.11 0.37
EPIC Urinary Incontinence -.0.07 0.22
EQ-5D-5L Pain 0.03 -0.06
EPIC Sexual Scale 0.16 0.23
EPIC Hormonal Scale 0.14 0.37
EQ-5D-5L Anxiety / Depression -0.12 0.07
Negative scores MEAN a decrease in QoL/symptoms; positive scores indicate an increase in QoL/symptoms

Purpose/Objective(s): Results of a mixed-methodology implementation study aiming to improve the well-being of men with gastrointestinal late effects following radical radiation therapy for prostate cancer.

Materials/Methods: Men (n=339) from 3 UK cancer centers who had had radical radiation therapy for prostate cancer at least 6 months previously. All men completed a novel screening tool for late bowel effects (ALERT-B) and the Gastrointestinal Symptom Rating Score; men with a positive score on ALERT-B were referred to one of 3 new specialized services following a peer reviewed management algorithm for PRD. In addition we assessed: health-related quality of life (HRQoL) at baseline/6 and 12 months; healthcare resource usage (HRU); patient, support giver, staff experience and acceptability of staff training (qualitative analysis).

Results: Each center successfully implemented the service, with either a nurse specialist (n=2) or medically-led (n=1) model. Overall 58 participants (17.1%) had symptoms and accepted referral to gastroenterology, albeit fewer than expected. The range of diagnoses was similar to previous reports, including: radiation proctopathy(n=18); adenomas(n=5); non-prostate cancers(n=3); bile acid malabsorption (n=15); fructose or lactose intolerance and/or small intestinal bacterial overgrowth(n=20); vitamin B12/D deficiency(n=20). We observed: increase in quality of life; reduction in specific symptoms (eg bowel-related or urinary); increase in sexual activity and/or sexual function between 6 and 12 months. The table shows selected results as the standardized difference from baseline. The strongest improvements occurred in the bowel domain. HRU modelling (limited due to low numbers) suggested staff costs of £117-£185, dependent on service model, and total costs including investigations and treatment of an average of £2393 per patient. The qualitative study found that the new service was welcomed by staff and patients, including gastroenterologists not directly involved in the service; but there was concern about long-term funding and sustainability beyond the time-frame of the study. Staff noticed increasing numbers of referrals, likely due to increasing awareness among oncologists.

Conclusion: PRD is increasingly recognized in the UK as an ongoing consequence of curative pelvic radiation therapy across all tumor sites, despite widespread implementation of advanced radiation therapy techniques. Specialized services following national guidelines should be embedded within gastroenterology.

Author Disclosure: J. Staffurth: None. S. Sivell: None. S. Ahmedzai: Unpaid role; Chair. Chair of Research Group on Cancer & Nutrition; Chair. Trustee & Council Member; Trustee & Council Member. J. Andreyev: None. D. Farnell: None. J. Green: None. C.L. Ferguson: None. L. Smith: Pelvic Radiation Disease Association; Trustee.

John Staffurth, MD, MB, BS

Disclosure:
Employment
Cardiff University: Professor in Clinical Oncology: Employee; Velindre Cancer Centre: Consultant Clinical Oncologist: Employee

Compensation
BAYER: Advisory Board, Travel Expenses

Presentation(s):

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