Congress Abstracts 2004

68

METASTATIC BREAST CANCER IN A CURATIVE CANCER SETTING: USING EVIDENCE-BASED PRACTICE TO IDENTIFY PALLIATIVE CARE NEEDS. Margaret Rosenzweig, PhD, CRNP-C, AOCN^®, University of Pittsburgh School of Nursing, Pittsburgh, PA; Rachel Rosenfield, RN, BSN, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Laura Bower RN, BSN, and Heather Alt, University of Pittsburgh School of Nursing, Pittsburgh, PA; and Adam Brufsky, MD, PhD, University of Pittsburgh School of Medicine/University of Pittsburgh Cancer Institute, Pittsburgh, PA.

Background/Purpose: Increased metastatic breast cancer (MBC) treatment options have changed the definition of MBC care to encompass not only symptom management, but also therapies aimed at tumor control. Consequently, women with MBC may receive sequential chemotherapy regimens in a traditional chemotherapy setting until close to death. Oncology nurses at the Magee Women’s Cancer Center at the University of Pittsburgh Cancer Institute (UPCI) were concerned that the palliative care needs of MBC women were overlooked because of the curative cancer setting’s chemotherapy focus.

Intervention: Treatment practices and potential palliative care needs were analyzed through a retrospective cohort analysis (January 1999–April 2003) of women with MBC receiving third-line chemotherapy. A database of 310 patients with MBC (147 living patients, 152 deceased, and 11 lost to follow-up) was created with monthly assessments. Third-line chemotherapy experience was analyzed via chart review for treatment duration, survival, Eastern Co-Operative Oncology Group (ECOG) performance status, and mention of prognosis or end-of-life care. Fifty (16%) (26 deceased, 24 alive) of the women with MBC had received more than two chemotherapy regimens with fourteen separate treatment regimens. Mean time-to-treatment discontinuation (disease progression or poor tolerance) for all treatments was 2.3 months (range 0–18 months). ECOG performance status was “3” for two months of a total of 116 treatment months (25%) and “2” or less for all other months of treatment. Nineteen of the 50 subjects (38%) received forth-line chemotherapy. Mean survival from third line chemotherapy treatment discontinuation until death (n = 26) was 4.1 months. Prognosis or end-of-life discussions were not well documented by clinic physicians, nurse practitioners, or nurses.

Interpretation: These results indicate that progressive courses of MBC chemotherapy are relatively common and well tolerated but that response time and survival following disease progression after third-line chemotherapy is short. Clinical attention was focused on chemotherapy, with little attention to palliative care.

Discussion: A prospective investigation of symptom distress, informational, and end-of-life needs in these women is underway. Ultimately, the evidence gained in these two studies will define nursing interventions for better integration of palliative care into the curative cancer setting.