Validation of the Living With Cancer (LWC) PRO tool for identifying patients (pts) with cancer appropriate for end-of-life care consultations.

Abstract

85 Background: End-of-life care (EOLC) discussions for pts with advanced malignancies are often delayed resulting in unwanted, wasteful treatment. COTA Inc has developed a 7-item PRO instrument (LWC) to facilitate identification of pts in distress. A pilot study of 433 pts at a single institution was able to determine a threshold distress score (> 28) correlating with physician assessment of appropriateness for EOLC consultation (2015 ASCO Palliative Care Symposium). Methods: LWC explores 4 personhood and clinical domains (performance status, pain, burden, and depression). Each question presents a 5-level Likert scale supplemented by a pt derived weighting of importance. The PRO was completed by 700 pts at Regional Cancer Care Associates throughout NJ between Sept 2015 and Apr 2016. The primary oncologists separately/independently classified 611 pts as appropriate to continue therapy (Group 1) and 89 pts as appropriate to curtail therapy (Group 2). Results: A score of 29 on LWC (range 0-112) was the threshold achieving optimal sensitivity (51%) and specificity (78%) in identifying pts in Group 2 (51% of pts whose oncologists felt appropriate to curtail therapy scored > 29; 78% of pts whose oncologists felt appropriate to continue therapy scored < 29). The threshold had positive predictive value 25% and 8% false omission rate (1 - negative predictive value) (25% pts scoring > 29 should be in Group 2; 8% scoring < 29 should be in group 2). A score 29 was 2.3 times more likely in pts belonging to Group 2 (likelihood ratio), and was a predictor of physician category (logistic regression p < 0.0001). LWC had a Cronbach’s alpha coefficient 0.85, indicating internal consistency and ability to measure a single latent construct. 3 questions (Performance Status, Wants, and Lack of Pleasure) contained the most information (estimate the latent trait with precision) and had high discrimination parameters (discriminate between pts lacking latent trait and displaying latent trait). Conclusions: The LWC instrument is able to identify cancer pts for whom EOLC discussions may be appropriate. A study to determine the correlation between the threshold score, EOLC consultation rate and overall survival is underway.