ALBERT

Description: Introduction: Nearly one in five cancer survivors report limitations in ability to work following diagnosis, with poor work-related outcomes particularly noted in the hematologic cancers. Although much is known about the efficacy, toxicity and direct costs of treatment for follicular lymphoma, there is no data assessing the impact of this diagnosis on productivity of affected individuals. Methods: We conducted a consecutive cross-sectional study of patients attending a malignant hematology clinic at a large multi-disciplinary cancer centre. Patients with a diagnosis of FL or other indolent NHL were asked to complete questionnaires assessing demographics, health status (EQ-5D), and work productivity and activity impairment (WPAI questionnaire). Results: Eighty-four patients completed the survey study (〉95% response rate). Mean age was 58.7 (+/−13.8 SD) and 55% were male. Diagnoses included FL (55%), CLL (25%), and other indolent NHL (20%). The majority of patients presented in advanced stage (stage III–IV; 65%) and had received some therapy, although 29% were still being observed without having received therapy by the time of survey administration. The median disclosed income was $40,000–$59,000; 76% had pursued post-secondary education. Over 61% were working full-time prior to diagnosis while 14% were retired. Patients reported a minimal impact on their work productivity (1.9+/−3.2 on a scale of 0 to 10; 0=no effect and 10=complete impairment of activity) and on their daily activities (2.4+/−3.1) attributable to their cancer diagnosis. However, following diagnosis of NHL (and at the time of survey completion), only 33% were able to continue full-time work, 7% were working part-time, 10% required disability, and 37% were retired. Of those still working, a mean of 2.1 days (+/−6.9) were missed due to illness in the preceding 4 weeks, with a mean of 16 days (+/−8.7) worked in that period. Only 6% received paid assistance, while 17% required unpaid care from a partner/spouse, relative, or friend. Unpaid caregivers missed a mean of 11.3 days (+/−16.2) of work and provided a mean of 9.8 days (+/−13.4) of care. There was a significant inverse correlation between daily activity scores (high values=complete impairment) and health status ratings (high values=excellent health status/utilities) ascertained by the EQ-5D instrument (Spearman correlation coefficient −0.69; p5) was predicted by poor self-rated health status (OR 32.1; 95% CI 5.9–174.2; p

Description: Introduction: Health utilities (HU) elicited directly from patients have immediate application in facilitating medical decision-making and cost-effectiveness determinations. Collection of HU using generic health status scales enable comparisons across diseases, but may not be sensitive to variations in health states within a particular disease. The EuroQOL EQ5D is a generic scale that has never been used to generate utilities in a broad spectrum of follicular/indolent lymphoma patients and has not been validated in this context. Methods: A consecutive, cross-sectional cohort of patients attending an outpatient malignant hematology clinic at a major cancer centre (Toronto, Canada) represented the eligible study population. Patients with a diagnosis of FL or other indolent NHL who consented to the study were asked to complete demographic and disease specific questionnaires in addition to the EuroQOL EQ-5D and Functional Assessment of Cancer Therapy (FACT)-Lymphoma quality of life assessment tools. Results: Eighty-four patients completed the survey study (〉95% response rate). Mean age was 58.7 (+/− 13.8 SD) and 55% were male. Diagnoses included FL (55%), CLL (25%), and other indolent NHL (20%). The majority of patients presented in advanced stage (stage III–IV; 65%) and had received some therapy to date, although 29% were still being observed at the time of survey administration. The mean utility score for the population was 0.84 (+/− 0.24; range 0–1). We evaluated the construct that patients receiving active treatment and those who were not in remission would have lower utility scores. Indeed, utilities were higher in patients being observed (0.91 +/− 0.16) compared to those in first remission (0.84 +/− 0.25), subsequent remissions (0.81 +/− 0.20), or those who were receiving active chemotherapy (0.75 +/− 0.27; p=0.049). Patients who were being followed in ongoing remission also trended to higher health status values (mean 0.88 +/− 0.21) compared to those who were not in remission (0.80 +/− 0.22; p=0.15). Utilities elicited from the EQ5D showed a moderate correlation with a criterion measure of quality of life, the FACT-Lymphoma scale (Spearman correlation coefficient 0.54, p

Description: Introduction: The assessment of adherence to health care quality indicators can provide a measure of the gap that exists between ideal evidence-based practice and actual care received by patients. Adherence to practice policies in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) has not previously been documented. Methods: To determine physician adherence to performance measures and local treatment policies we completed a retrospective review of consecutive patients diagnosed with CLL or SLL and managed at a large regional multidisciplinary cancer center between Jan 2000 and Jan 2005. Patients were identified from the center administrative database according to ICD-0 histology codes. We identified quality metrics (process measures) from a literature review of practice guidelines and from the recently-devised ASH quality measures. Data were analysed using the Statistical Package for the Social Sciences (SPSS version 11.0, SPSS Inc., Chicago, IL). Results: A total of 149 patients were diagnosed with CLL/SLL and assessed at the centre. Thirty-seven were excluded because they were not diagnosed on site and were referred more than 6 months from the time of their original diagnosis; therefore, 112 patients remained and were evaluated further. The majority of patients were diagnosed with CLL (92%) with few patients identified as CLL/SLL (4%), SLL exclusively (2%), or diagnosis not documented (2%). Half of the group (52%) presented with Rai clinical stage 0 disease, 22% were Rai stage I/II and 11% Rai stage III/IV. Flow cytometry studies were completed according to the ASH quality metrics for CLL in 89% of all patients. Seventy-two percent of patients underwent imaging with CT or ultrasound for the purposes of staging. After a median follow-up time of 2.2 years, 73% of the patients were still following a watch and wait (observation) management strategy without having received therapy. Overall survival at 3 years was 97%. Of those that had undergone their first treatment, the most common therapy was chlorambucil (67%), followed by fludarabine (13%), combination akylator-based chemotherapy (7%), and clinical trial options (3%). The majority of patients (68%) were counseled for smoking avoidance, while only 22% were counseled to obtain vaccinations. Few physicians (9%) routinely counseled their patients about the necessity for screening for second cancers. Physicians who saw a higher volume of CLL cases in the centre (〉10% of cohort) were compared to lower volume physicians with respect to policy adherence. High-volume physicians were more likely than low-volume physicians to counsel patients regarding the potential role for stem-cell transplantation in CLL (18% vs. 5%; p=0.033) and the importance of smoking cessation (74% vs. 43%; p=0.0065). Low-volume physicians were more likely to counsel patients regarding screening for secondary cancers (24% vs. 5%; p=0.007). There was no significant association between volume of practice and the performance of flow cytometry in diagnosis (91% vs. 81%; p=0.17). Conclusions: Physician adherence to guidelines is highest in process measures associated with diagnosis and staging, but is suboptimal with respect to patient counseling on lifestyle and preventive health measures.