Modeling symptom drivers of oral intake in long-term head and neck cancer survivors

PURPOSE

This study examined the relationship between self-reported symptom severity and oral intake in long-term head and neck cancer (HNC) survivors.

METHODS

An observational survey study with retrospective chart abstraction was conducted. HNC patients who had completed an MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) questionnaire and also had clinician graded oral intake ratings (Functional Oral Intake Scale [FOIS]) were included. Correlation coefficients were computed. FOIS scores were regressed on MDASI-HN symptom items using stepwise backwards elimination for multivariate models.

RESULTS

One hundred and fifty-two survey pairings were included in the analysis (median 44 months follow-up, range 7-198). Per FOIS, 28% of survivors maintained a total oral diet with no restrictions, 67% reported a restricted oral diet (without tube), 3% were partially tube-dependent with some oral intake, and 2% were NPO. Of the 22 symptom items, the most severe items in decreasing order were dry mouth, difficulty swallowing\chewing, problems with mucus, tasting food, and choking/coughing. Significant bivariate correlations, after Bonferroni correction for multiple comparisons, were present for 8 of 22 symptoms with FOIS. On multivariate analysis, symptom severity for difficulty swallowing and problems with teeth/gums remained significantly associated with FOIS.

CONCLUSIONS

Oral intake in HNC survivorship is a multidimensional issue and functional outcome that is impacted not only by dysphagia but also by dental status. Symptom drivers of oral intake likely differ in acute survivorship. Nonetheless, these findings highlight the lack of specificity in this end point and also the need for multidisciplinary supportive care to optimize oral intake in survivors.

Overhead costs (OC) associated with quality oncology care (QOC) monitoring to ensure compliance with national treatment guidelines (TG)

6637

Background: QOC is a goal of all oncology practices (op), healthcare insurance plans (hip), HMOs, and payers for health insurance. In order to ensure compliance with TG and maintain QOC in a multi-site op, we adapted an electronic medical record (EMR) to evaluate tumor and stage specific compliance in oncology treatments. This report evaluates the OC associated with development and operation of that monitoring system and its application to an HMO patient population of 75,000 covered lives. Methods: OC included 25% (proportion of HMO to total patients )of the emr system developmental costs (DC) and operational costs (OpC). Personnel time included entering data and treatments, training, data coordination, and data analysis. Salaries were based on regional averages for physicians, administrators, clerks, and nurses. Time estimates were made for monitoring quality data only, excluding standard patient care. Compliance data is reported separately. Results: 1,250 patients over 18 months were treated by 5 of the op physicians. DC for this program included computer hardware $25,000, personnel training $10,900, and EMR licensing $12,500. Annualized operational costs (OpC) included emr maintenance fees $1000, IT consultants $4500, physician time to enter individual patient data at first consultation and follow up visits $58,000, nursing time to enter treatment data and continued training $7650, physician continued training $11,250, senior administrator coordination $30,000, administrative supervision $17,900, clerical data analysis $22,500, and senior physician supervision $50,000. Costs per covered life for DC were $0.645 and for OC were $2.704 per year. Conclusions: The costs to maintain QOC and ensure TG compliance are substantial and must be reimbursed by hips and HMOs. Understanding these costs is essential to negotiating care contracts with hips that will monitor care appropriately. Investing in EMR methods to ensure QOC will be important to patients and op, as well as hips. Monitoring continuing OC to determine if they decrease with additional experience is essential. Standardizing EMR data sets aad op methodologies for compliance monitoring will further improve efficiencies and cost efficacy in documenting delivered QOC.

No significant financial relationships to disclose.

Evaluating compliance (com) with hematology (H) -oncology (O) quality (Q) standards in a community-based managed care population

17050

Background: Better Q and outcomes in HO practice are associated with com with national treatment guidelines (TG). Institution of an O specific electronic medical record (EMR) within a community HO specialty practice allowed analysis of com with TG as well use of high cost treatments (HCT) data from an HMO population in a multi site HO practice are presented. Methods: HO physicians agreed to treat patients (pts) using common EMR, TG and regular treatment (tx) reviews. EMR data over 18 months for the HMO population was reviewed for diagnosis, stage, and tx. This was compared to TG of NCCN. A panel of high cost therapies (HCT) was identified by the HMO medical director, and pt treatment com with TG was tabulated. Non-com was further evaluated as acceptable alternative practice (acc) by NCCN description, recommended (rec) by academic specialist consultation or not appropriate by TG (non-app). Results: Between 1/1/04 and 6/31/05, the HMO had ∼75,000 covered lives at risk. 1210 evaluable HO pts were treated by 5 oncologists. 163 pts had benign H diagnoses (dx), 155 had malignant H dx, and 892 had solid tumor dx (breast 373, colorectal 76, lung 63, prostate 28, ovary 15). Of pt with cancer (ca), 49 had active ca but no rx, 639 had ca in complete remission and had no tx, and 256 had active ca and received tx. 102 had clinical diagnosis but incomplete evaluations, none received tx. Of HMO chosen HCT, Rituximab was given to 25 pt, and all rx was com to TG. Bevacizumab was given to 14 pt and was com in 11, acc in 1, and non-com/acc in 2. Trastuzumab was given to 8 pt, and was com in 4, acc in 3, and rec in 1 pt. IVIG was com in 1 and rec in 1 pt. Of a total 49 HCT, 8 were non-com with TG (16%), but only 2 were non-com, non-acc, and non-rec (4%). Both were associated with 1 new physician whose performance improved after pre tx review of HCT by a senior physician prior to pt tx. Conclusions: Ongoing review and feedback to physicians using EMR and national TG allows objective monitoring and improvement of Q in HO practice. Issues of concern, such as HCT, can also be detailed. Payors and practices can consider using such methods and data to negotiate fair payment for Q care. .

No significant financial relationships to disclose.

Ninety-day oral toxicity study of lycopene from Blakeslea trispora in rats

Lycopene, as a suspension in sunflower oil (20% w/w), was tested for subchronic toxicity by administration at dietary concentrations of 0, 0.25, 0.50, and 1.0% to groups of 20 male and 20 female Wistar rats for a period of 90 days. The lycopene examined in this study was derived from a fungal biomass (Blakeslea trispora). Lycopene intake was calculated to be 0, 145, 291, and 586mg/kg body weight/day in control through high-dose males and 0, 156, 312, and 616mg/kg body weight/day in control through high-dose females. The results from this study do not provide any evidence of toxicity of lycopene at dietary levels up to 1.0% as demonstrated by the findings of clinical observations, neurobehavioral observations, motor activity assessment, body weight and food consumption measurements, ophthalmoscopic examinations, hematology, clinical chemistry, urinalysis, organ weights, gross pathology, or histopathology. The No-Observed-Effect Level (NOEL) was 1.0% in the diet, the highest dietary concentration tested.