P03.04 Signaling questions assessing brain tumor patients’ distress in clinical routine - a feasibility study

BACKGROUND

Approximately 20%-35% of patients with intracranial tumors show depressive symptoms and distress. Assessment in these patients remains challenging due to cognitive and/or neurological deficits. We developed 3 signaling questions in order to assess patients during patient-doctor consultation. The aim is to implement them in clinical routine and to compare the results with patient reported outcome measures (PROMs) along disease trajectory.

MATERIAL AND METHODS

Patients were prospectively examined in a structured interview applying the 3 following questions: 1),Has your mood worsened? (I)”; 2),Are you strained by physical changes? (II)”; 3),Has your faculty of thought decreased? (III)”. Simultaneously, patients filled in the Distress Thermometer (DT) and the EORTC QLQ-C30 + BN20. The first patient group was assessed twice pre- and postoperatively in the very early disease trajectory (A), the second patient group once in the outpatient setting during adjuvant therapy or follow-up (B). The results of the 3 signaling questions were compared to the results of the PROMs.

RESULTS

A total of n=62 patients gave informed consent and n= 61 were assessed so far. In general, the signaling questions were feasible to answer for all patients. However, patients frequently needed more detailed examples for symptoms emphasizing the intention of the question.

In group A (n= 20), patients had a mean age of 59 years, n= 12 (60%) were male. Main diagnoses were glioblastomas, meningiomas and metastases. The results of the signaling questions did not reflect the screening by DT: N= 11 (55%) reported that their mood has worsened (I) prior to the operation, which then improved to n= 5 (31%) patients afterwards. The same applied to physical changes (II, 10 (50%) vs. 7 (44%), as well as lower cognition (III, 7 (35%) vs. 4 (25%) respectively). In contrast, mean DT (5.7 vs. 6 after) as well as the mean number of positive responses to the problem lists on the DT was similar pre- and postoperatively (8.7 pre-op vs. 9.4 post-op).

Group B, (n= 41) consisted of patients harboring malignant gliomas, n= 27 (66%) were male. Patients had a mean DT score = 6.8, n= 22 (53%) named a worse mood (I), n= 23 (56%) patients reported physical changes (II) and n= 22 (54%) patients reported lower cognition (III), global health scale (GHS) according to the EORTC instrument was 60 (0–100). The majority of patients with a DT ≥6 also reported strain in the signaling questions and had a lower mean GHS = 54,8. DT ≥ 6 was linked to worse mood (I, Fishers exact, p=0.02).

CONCLUSION

According to our preliminary data, the signaling questions seem to be more useful in the outpatient setting in glioma patients than perioperatively. “Has your mood worsened” was associated with higher burden according to DT. Screening in brain tumor patients could probably complemented by direct questions in order to avoid missing patients who are not able to fill in questionnaires.

[Patient-centered care. Improvement of communication between university medical centers and general practitioners for patients in neuro-oncology]

INTRODUCTION

Communication between university medical centers and general practitioners (GP) is becoming increasingly more important in supportive patient care. A survey among GPs was performed with the primary objective to assess their opinion on current workflow and communication between GPs and the university medical center.

METHODS

The GPs were asked to score (grades 1-6) their opinion on the current interdisciplinary workflow in the care of patients with brain tumors, thereby rating communication between a university medical center in general and the neuro-oncology outpatient center in particular.

RESULTS

Questionnaires were sent to1000 GPs and the response rate was 15 %. The mean scored evaluation of the university medical center in general was 2.62 and of the neuro-oncological outpatient clinic 2.28 (range 1-6). The most often mentioned issues to be improved were easier/early telephone information (44 %) and a constantly available contact person (49 %). Interestingly, > 60 % of the GPs indicated they would support web-based tumor boards for interdisciplinary and palliative neuro-oncological care.

CONCLUSION

As interdisciplinary care for neuro-oncology patients is an essential part of therapy, improvement of communication between GPs and university medical centers is indispensable. Integrating currently available electronic platforms under data protection aspects into neuro-oncological palliative care could be an interesting tool in order to establish healthcare networks and could find acceptance with GPs.