Supportive care updates from ASCO

There was a poster display this weekend in the patient care/survivor track at ASCO. I am pleased to report 25 posters on display during this session. The scientific committee members also alerted us to the presence of other important posters that will be presented throughout the other poster sessions at ASCO. All told the sheer number of projects looking at patient care and supportive care has increased dramatically over the past 25 years--when there were eight supportive abstracts at ASCO, six regarding chemotherapy induced nausea/vomiting.

Some highlights from this session included confirmation that age, by itself, is not a predictor of dose-limiting toxicity in phase-1 clinical trials. Dr. LoConte et al., Wisconsin, (#9525) showed that, although elderly patients are infrequently referred for phase-1 trials, age does not predict for dose-limiting toxicity. She did find that higher weight, BSA, chemotherapy dose, alkaline phosphatase, hemoglobin, and LDH predicted toxicity. These findings are not surprising given one would anticipate increased likelihood of dose-limiting toxicity in patients receiving more chemotherapy (high weight, high BSA, higher dose) or patients with worse disease (high LDH, alkaline phosphatase) or heavily pretreated patients (low hemoglobin).

Dr. Bruera et al, from M.D. Anderson, examined the level of distress caused by delerium in terminally ill patients. They surveyed patients, who recovered from their delirium within three days, and their caregivers. The interesting findings were that physicians/nurses underestimated the distress caused by delirium; caregivers overestimated the distress; and that psychomotor agitation was the most distressing to caregivers. This highlights the need for the care team to quickly and aggressively intervene in attempts to correct or control delirium, especially psychomotor agitation.

Dr. Cella, in his discussion of the quality-of-life posters, reminded us all that quality-of-life assessments should be an important component in many treatment trials. Collecting information on how therapy influences quality of life can help in the determination of whether a drug moves forward in clinical trials and whether it will demonstrate meaningful effect for patients. He showed us his perception of how to interpret trials that show clinical disease benefit as they related to quality-of-life outcomes (better, worse, no change). In essence, he made the point that a strongly positive clinical outcome should move forward irrespective of quality-of-life outcome, but should stimulate consideration if quality of life was worse. A trial with marginal or no clinical benefit and negative quality-of-life outcome should not move forward, but the same drug with strongly positive influence on quality of life may move forward even without demonstrated disease response. A bank of assessment tools can be found here.