Cancer patients show the signs and symptoms of a failing circadian organization. Melatonin, secreted only during nightly darkness, promotes nightly sleep and synchronizes daily molecular and physiologic clocks. Using a placebo-controlled randomized double-blind clinical trial, we determined whether the hypothesized proper physiologic daily timing, the evening, is essential for cancer patients to benefit from melatonin. Eighty-four advanced non-small cell lung cancer (NSCLC) patients from two centers (42 each) receiving standard etoposide/cisplatin therapy, were randomly assigned to one of three arms (I, 8AM & 8PM placebo; II, 8AM 20 mg melatonin and 8PM placebo; III, 8AM placebo and 8PM 20 mg melatonin. Each patient was followed until death. After adjusting for covariates, the Cox proportional hazards regression analysis found that the overall survival was enhanced only among those patients randomized to receive evening melatonin (p = 0.031 HR = 0.39). Survival benefit in the PM melatonin arm was optimized in patients who reported normal sleep quality. After adjusting for significant covariates at baseline, we found an overall survival advantage for PM melatonin when compared against placebo. Moreover, PM melatonin's therapeutic effect was optimal in patients who self-reported normal sleep quality.

We have previously reported that higher patient satisfaction (PS) with service quality is associated with favorable survival outcomes in a variety of cancers. However, we argued that patients with greater satisfaction might be the ones with better self-rated health (SRH), a recognized predictor of cancer survival. We therefore investigated whether SRH can supersede patient satisfaction as a predictor of survival in prostate cancer.

Despite the recognized relevance of symptom burden in breast cancer, there has been limited exploration of whether an individual patient's assessment of the overall quality of care received might influence outcome. We therefore evaluated the relationship between patient-reported satisfaction with service quality and survival in breast cancer.

Background/AimsPreviously we reported that higher patient satisfaction (PS) with service quality is associated with favorable survival outcomes in a variety of cancers. However, we cautioned the readers that patients with greater satisfaction might be the ones with better self-rated health (SRH), a well-established prognosticator of cancer survival. In other words, SRH could potentially confound the PS and survival relationship. We investigated this hypothesis in non-small cell lung cancer (NSCLC).Methods778 NSCLC patients (327 males and 451 females; mean age 58.8 years) treated at 4 Cancer Treatment Centers of America hospitals between July 2011 and March 2013. PS was measured on a 7-point scale ranging from "completely dissatisfied" to "completely satisfied". SRH was measured on a 7-point scale ranging from "very poor" to "excellent". Both were dichotomized into 2 categories: top box response (7) versus all others (1-6). Patient survival was the primary end point. Cox regression was used to evaluate the association between PS and survival controlling for covariates.Results74, 70, 232 and 391 patients had stage I, II, III and IV disease respectively. 631 (81.1%) patients were "completely satisfied". 184 (23.7%) patients had "excellent" SRH. There was a weak but significant correlation between overall PS and SRH (Kendall's tau b = 0.19; p<0.001). On univariate analysis, "completely satisfied" patients had a significantly lower risk of mortality (HR = 0.75; 95% CI: 0.57 to 0.99; p = 0.04). Similarly, patients with "excellent" SRH had a significantly lower risk of mortality (HR = 0.61; 95% CI: 0.46 to 0.81; p = 0.001). On multivariate analysis controlling for stage at diagnosis, treatment history and gender, SRH was found to be a significant predictor of survival (HR = 0.67; 95% CI: 0.50 to 0.89; p = 0.007) while PS was not (HR = 0.86; 95% CI: 0.64 to 1.2; p = 0.32). Among the individual PS items, the only significant independent predictor of survival was "teams communicating with each other concerning your medical condition and treatment" (HR = 0.59; 95% CI: 0.36 to 0.94; p = 0.03).ConclusionSRH appears to confound the PS-survival relationship in NSCLC. SRH should be used as a control/stratification variable in analyses involving PS as a predictor of clinical cancer outcomes.

Abstract Background: Patient satisfaction with quality of care is being increasingly recognized and reported as an important outcome measure in oncology. However, it has been argued by some that patients with greater satisfaction with care quality might be the ones with better self-reported quality of life (QoL). In other words, patient satisfaction has been simply purported to be a marker of underlying patient QoL. We asked the question if cancer patients who report higher satisfaction with quality of their care are indeed the ones with better QoL. Methods: 6,914 returning cancer patients treated at four Cancer Treatment Centers of America® hospitals completed a patient satisfaction survey between July 2011 and March 2013. All patients who had not responded to a service quality questionnaire within the preceding 60 days of treatment were eligible. Overall QoL (How would you rate your overall health during the last week?) was measured on a 7-point Likert scale ranging from “very poor” to “excellent”. Overall patient satisfaction (“considering everything, how satisfied are you with your overall experience?”) was also measured on a 7-point Likert scale ranging from “completely dissatisfied” to “completely satisfied”. Spearman correlation was used to investigate the association between patient satisfaction and QoL. Results: A total of 8,642 eligible cancer patients were contacted to participate in the survey. 6,914 patients responded. As a result, the response rate for this study was 80%. The median time duration between the date first seen and the date of first survey was 7.5 months. The mean age at the time of survey was 56.6 years. 4,116 patients were newly diagnosed while 2,798 had been previously treated. 2,778 were males and 4,136 were females. The most common cancer types were breast (27.6%), prostate (13.3%), lung (11.3%), colorectal (8.9%) and pancreas (5.2%). 20%, 28%, 24% and 28% patients had stage I, II, III and IV disease respectively. 1,916 (27.7%) patients reported “excellent” QoL while 5,553 (80.3%) patients were “completely satisfied” with their care. Spearman correlation coefficient between QoL and patient satisfaction for the entire patient population was 0.20 (p<0.001). These correlations in different patient subgroups were as follows: males (0.21), females (0.20), early-stage disease (0.19), late-stage disease (0.22), newly diagnosed (0.19), previously treated (0.20), breast (0.17), colorectal (0.24), lung (0.23), pancreas (0.18), prostate (0.20); with p <0.001 for all. Conclusions: Self-reported QoL has a low correlation with patient satisfaction with care quality. Contrary to what one might expect, higher levels of self-reported QoL do not translate into higher satisfaction with oncology care. This analysis shows that self-reported QoL and satisfaction with care are weakly related dimensions of the larger cancer care quality umbrella. Citation Format: Digant Gupta, James F. Grutsch, Mark Rodeghier, Christopher G. Lis. Do cancer patients with better quality of life report higher satisfaction with the quality of care they receive. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3849. doi:10.1158/1538-7445.AM2014-3849

e19068 Background: Melatonin secreted only during nightly darkness promotes sleep and sets daily clocks. Cancer disrupts daily rhythms, nighttime sleep, and causes daytime fatigue. Meta-analyses report that melatonin improves cancer response and patient survival. We hypothesized that proper daily timing is essential to melatonin benefit. Methods: Eighty-four ANSCLC patients (20 Stage IIB, 64 Stage IV) from one of two centers (42 each) each receiving etoposide/cisplatin therapy, were blindly and randomly assigned to one of three arms (I, 8AM & 8PM placebo n=29; II, 8AM 20mg melatonin and 8PM placebo, n=27; III, 8AM placebo and 8PM 20mg melatonin, n=28). Each patient was followed to death; 49 were evaluable for objective response assessment by RECIST criteria. Sleep quality and quality of life (QOL) queries were made at baseline and every three months. Results: Overall survival was not significantly impacted by melatonin in a univariate analysis. Multivariate analyses reveal better survival only for those receiving evening melatonin (p=0.04, RR of death 0.454). Objective partial tumor response occurred in 10.5% of placebo, 7.7% of morning melatonin, and 29.4% of evening melatonin-treated patients. Sleep quality was enhanced and QOL declined less rapidly when PM melatonin was employed. Conclusions: Physiologic evening timing of the chronobiotic hormone melatonin is critical to its salutary effect in ANSCLC patients.

91 Background: More than 65 million people will serve as caregivers and about 1.6 million new cancer cases will be diagnosed in the US in 2013. These staggering numbers serve as the impetus on evaluating the quality of medical care. To this end, we conducted a national cancer survey to evaluate caregiver experience with service quality. Methods: An online survey was conducted among a national random sample of 1000 cancer caregivers in Aug-Sept 2012. Importance of 15 service quality items was measured on a 5-point Likert scale ranging from “not at all important” to “extremely important”. Caregiver experience with those 15 service quality items was captured as a yes/no response. Caregiver satisfaction was measured on a 5-point Likert scale ranging from “completely dissatisfied” to “completely satisfied”. Results: The top 3 areas of gaps between importance and experience were ‘having a specific individual to coordinate care’ (33%, p<.01), ‘after-treatment care and support’ (25%, p < 0.01) and ‘providing a comforting and stress-free environment’ (25%, p < 0.01). Among respondents who rated these areas as very/extremely important, only 45%, 63% and 64% experienced it, respectively. Conclusions: These national findings illustrate that information on caregiver satisfaction can be useful for healthcare managers in the exercise of quality assurance and identification of unmet needs. [Table: see text]

e17502 Background: Evaluation of patient experience provides important data on the patient’s perception of the quality of care and treatment delivered by physicians, paramedical staff and the hospital as a whole. There are limited data on the most significant determinants of patient experience in the oncology setting. In a national sample of cancer patients, we investigated the key self-reported factors influencing overall patient experience. Methods: A national random sample of 724 patients undergoing treatment for cancer in a hospital setting between Jan 2009 and Dec 2011. Using a combination of professional and scholarly literature and focus groups, the survey instrument was developed employing an identified set of 13 patient experience factors, an overall patient experience measure and relevant demographic variables. Patients were invited via messages appearing randomly on oncology-oriented physician profile pages, content pages and hospital profile pages from the Healthgrades web properties. Patients were asked to rate their cancer treatment experience on a 5-point scale from “very poor” to “very good” on the 13 patient experience factors. Participants were also asked to identify factors that contributed the most to their overall patient experience. Results: 181 were males and 543 were females. Age distribution was 5-24 (n=8), 25-44 (n=95), 45-54 (n=197), 55-64 (n=259) and 65+ (n=159). Top 5 tumor types were breast (n=284), gynecological (n=78), colorectal (n=47), lung (n=34) and prostate (n=28). Tumor stage at the time of receiving care was I, 210; II, 149; III, 133; IV, 128; and unknown, 104.481 (66.4%) patients were “very satisfied” with their overall experience. The three most important determinants of patient experience as reported by patients were "a compassionate team of care providers" (49.2%), "a knowledgeable, competent physician” (48.9%) and "treatment as a human being and not just a person with a disease" (28.3%). Conclusions: We identified three key determinants of overall patient experience in oncology. Oncology care providers can use data on patient experience to design and track quality improvement over time as well as recognize and expeditiously resolve unmet needs of patients in real-time.

This phase I clinical trial evaluated the safety, tolerability, and pharmacokinetics of high-dose intravenous (i.v.) ascorbic acid as a monotherapy in patients with advanced solid tumors refractory to standard therapy.

460 Background: Assessment of quality of life (QoL) with validated instruments has been increasing in the clinical oncology community, but to date few studies have examined its prognostic significance in renal cell carcinoma (RCC). We investigated the association between QoL at presentation and survival in RCC. Methods: A consecutive series of 138 RCC patients treated between January 2001 and December 2009. QoL was evaluated at baseline using EORTC-QLQ-C30 which incorporates 1 global, 5 functional and 8 symptom scales. Scores range from 0-100 with higher scores in the global/functional scales and lower scores in the symptom scales indicating better QoL. Patient survival was the primary endpoint. Cox regression was performed to evaluate the prognostic significance of QoL. Results: Mean age at diagnosis was 53.8 years. 51 patients were newly diagnosed at our hospital, while 87 were previously treated elsewhere. Stage at diagnosis was I, 32; II, 19; III, 32; and IV, 55. Median overall survival was 17.2 months (95% CI: 10.1-24.2 months). QoL scales predictive of survival upon univariate analysis were physical (p=0.003), role (p=0.02), social (p=0.03), fatigue (p=0.02), pain (p=0.03), and constipation (p=0.04). Upon multivariate analyses, after adjusting for age, gender, stage, and treatment history, physical (HR=0.89; 95% CI=0.78, 0.99; p=0.04), social (HR=0.91; 95% CI=0.83, 0.99; p=0.04), fatigue (HR=1.10; 95% CI=1.01, 1.19; p=0.03) and constipation (HR=1.11; 95% CI=1.02, 1.20; p=0.01) scales were significantly associated with survival, such that patients with higher (better) physical and social scores and lower (better) fatigue and constipation scores had better survival. For newly diagnosed patients, physical scale was significant, while for previously treated patients, physical, fatigue, and constipation scales were significant. Conclusions: Baseline QoL elements that reflect specific functional and symptomatic attributes provide useful prognostic information in RCC. Significantly, this held true for physical function for both newly diagnosed and previously treated patients. Such determinations should be considered when designing clinical trials with survival endpoints and may aid decision-making in clinical practice.

Abstract Background: A recently published meta-analysis suggests that melatonin administered concurrently with chemotherapy leads to significant improvements in tumor response and survival in solid tumors, however, the role of melatonin in cancer treatment still remains disputable. We investigated the impact of chronotherapeutic administration of melatonin on tumor response and overall survival in stage IIIB and IV non-small cell lung cancer (NSCLC) patients undergoing conventional chemotherapy. Methods: Veteran Affairs Medical Center (VAMC) and Cancer Treatment Centers of America® at Midwestern Regional Medical Center (MRMC), a non-VA site, entered 42 patients each. The patients were randomized to receive placebo 8 am and placebo 8 pm (arm 1; n=29), or melatonin 20 mg 8 am and placebo 8 pm (arm 2; n=27), or placebo 8 am and melatonin 20 mg 8 pm (arm 3; n=28). All study participants received treatment with cisplatin (25 mg/m2/day) followed by etoposide (100 mg/m2/day) chemotherapy. Patient survival was defined as the time between the study start date and date of death from any cause/date of last contact. Kaplan-Meier analysis with log-rank test was used to evaluate the equality of survival distributions across the three treatment arms. Tumor response was evaluated using the RECIST guidelines. Results: 64 patients had stage IV while 20 had stage IIIB disease. 65 patients were males while 19 were females. All patients had expired at the time of this analysis. Mean age at study entry was 61.3 years (57 years for MRMC versus 65.7 for VAMC). There were no significant differences in the three treatment arms with respect to age, gender, tumor stage and performance status. Median survival time in the 3 treatment arms was 10.4 (arm 1), 6.8 (arm 2) and 8.0 (arm 3) months respectively (log rank p=0.81). Similarly, there was no significant difference in the treatment arms with regard to tumor response, such that 48.3%, 37.0% and 32.1% patients had stable disease in arm 1, arm 2 and arm 3 respectively (Chi-square p=0.49). Conclusions: Contrary to the recently reported meta-analysis, we found that neither the addition nor the timing of a high oral dose of melatonin added therapeutically to the combination of cisplatin and etoposide. The melatonin dose used in this study is at least 20x the usual replacement dose and this may have resulted in melatonin being inappropriately present in the circulation during both day and night, an un-physiologic state, which might be responsible for the apparent lack of efficacy of this particular regimen. Citation Format: Robert D. Levin, James F. Grutsch, Christopher G. Lis, Digant Gupta, Patricia A. Wood, William JM Hrushesky. A randomized, double-blind, multicenter trial evaluating the chronotherapeutic role of concomitant melatonin in the treatment of stage IIIB and IV non-small cell lung carcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4673. doi:10.1158/1538-7445.AM2013-4673

Objective. To evaluate the relationship between self-reported satisfaction with service quality and overall survival in non-small cell lung cancer (NSCLC).Design. A prospective cohort study.Setting. Cancer Treatment Centers of America (R) from July 2007 and December 2010.Participants. Nine hundred and eighty-six returning NSCLC patients.Intervention. Overall patient experience 'considering everything, how satisfied are you with your overall experience' was measured on a 7-point Likert scale ranging from 'completely dissatisfied' to 'completely satisfied.'.Main Outcome Measure. Patient survival was the primary end point.Results. The response rate for this study was 69%. Six hundred patients were newly diagnosed, while 386 were previously treated. Four hundred sixty-nine were males, while 517 were females. 101, 59, 288 and 538 patients had stage I, II, III and IV disease, respectively. Mean age was 58.9 years. Six hundred and thirty (63.9%) patients had expired at the time of this analysis. Seven hundred and sixty-two (77.3%) patients were 'completely satisfied'. Median overall survival was 12.1 months (95% confidence interval (CI): 10.9-13.2 months). On univariate analysis, 'completely satisfied' patients had a significantly lower risk of mortality compared with those not 'completely satisfied' [hazard ratio (HR) = 0.70; 95% CI: 0.59-0.84; P < 0.001]. On multivariate analysis controlling for stage at diagnosis, prior treatment history, age and gender, 'completely satisfied' patients demonstrated significantly lower mortality (HR = 0.71; 95% CI: 0.60-0.85; P < 0.001) compared with those not 'completely satisfied'.Conclusions. Self-reported experience with service quality was an independent predictor of survival in NSCLC patients under-going oncologic treatment, a novel finding in the literature. Based on these provocative findings, further exploration of this relationship is warranted in well-designed prospective studies.

90 Background: There are expected to be an excess of 1.6 million new cancer cases in the US in 2013. Recent emphasis has shifted to patient-centered care. However, data is lacking on what oncology patients value in their care. We therefore conducted a national survey to evaluate patient experience with service quality. Methods: An online survey was conducted in a national random sample of 1000 cancer patients in Aug-Sept 2012. Importance of 15 service quality items was measured on a 5-point Likert scale ranging from “not at all important” to “extremely important”. Patient experience with those 15 service quality items was captured as a yes/no response. Patient satisfaction was measured on a 5-point Likert scale ranging from “completely dissatisfied” to “completely satisfied”. Results: The top 3 areas of gaps between importance and experience were ‘having a specific individual to coordinate care’ (32%, p < 0.01), ‘after-treatment care and support’ (15%, p<.01) and ‘the presence of an integrated care team’ (15%, p<0.01). Among respondents who rated these areas as very/extremely important, only 43%, 65% and 75% experienced it, respectively. Conclusions: These national findings illustrate a significant void between patients’ desires and care delivered. This survey demonstrates the emphasis patients put on the need for more coordinated cancer care, after-treatment care and an integrated approach. [Table: see text]

Purpose. Although breast cancer is a highly treatable disease, some women reject conventional treatment opting for unproven “alternative therapy” that may contribute to poor health outcomes. This study sought to understand why some women make this decision and to identify messages that might lead to greater acceptance of evidence-based treatment. Patients and Methods. This study explored treatment decision making through in-depth interviews with 60 breast cancer patients identified by their treating oncologists. Thirty refused some or all conventional treatment, opting for alternative therapies, whereas 30 accepted both conventional and alternative treatments. All completed the Beck Anxiety Inventory and the Rotter Locus of Control scale. Results. Negative first experiences with “uncaring, insensitive, and unnecessarily harsh” oncologists, fear of side effects, and belief in the efficacy of alternative therapies were key factors in the decision to reject potentially life-prolonging conventional therapy. Refusers differed from controls in their perceptions of the value of conventional treatment, believing that chemotherapy and radiotherapy were riskier (p < .0073) and less beneficial (p < .0001) than did controls. Controls perceived alternative medicine alone as riskier than did refusers because its value for treating cancer is unproven (p < .0001). Refusers believed they could heal themselves naturally from cancer with simple holistic methods like raw fruits, vegetables, and supplements. Conclusion. According to interviewees, a compassionate approach to cancer care plus physicians who acknowledge their fears, communicate hope, educate them about their options, and allow them time to come to terms with their diagnosis before starting treatment might have led them to better treatment choices.

Malnutrition is a significant factor in predicting cancer patients’ quality of life (QoL). We systematically reviewed the literature on the role of nutritional status in predicting QoL in cancer. We searched MEDLINE database using the terms “nutritional status” in combination with “quality of life” together with “cancer”. Human studies published in English, having nutritional status as one of the predictor variables, and QoL as one of the outcome measures were included. Of the 26 included studies, 6 investigated head and neck cancer, 8 gastrointestinal, 1 lung, 1 gynecologic and 10 heterogeneous cancers. 24 studies concluded that better nutritional status was associated with better QoL, 1 study showed that better nutritional status was associated with better QoL only in high-risk patients, while 1 study concluded that there was no association between nutritional status and QoL. Nutritional status is a strong predictor of QoL in cancer patients. We recommend that more providers implement the American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines for oncology patients, which includes nutritional screening, nutritional assessment and intervention as appropriate. Correcting malnutrition may improve QoL in cancer patients, an important outcome of interest to cancer patients, their caregivers, and families.

PURPOSE:Despite the recognized relevance of symptom burden in pancreatic cancer, there has been limited exploration of whether an individual patient's satisfaction with the overall quality of care received might influence outcome. We evaluated the relationship between patient satisfaction with health service quality and survival in patients with pancreatic cancer. PATIENTS AND METHODS:A random sample of 496 pancreatic cancer patients treated at Cancer Treatment Centers of America(®) (CTCA) between July 2007 and December 2010. A questionnaire that covered several dimensions of patient satisfaction was administered. Items were measured on a seven-point Likert scale ranging from "completely dissatisfied" to "completely satisfied." Patient survival was the primary end point. Cox regression was used to evaluate the association between patient satisfaction and survival. RESULTS:The response rate for this study was 72%. Of the 496 patients, 345 (69.6%) reported being "completely satisfied" with the care provided. Median overall survival was 7.9 months. On univariate analysis, patients reporting they were "completely satisfied" experienced superior survival compared with patients stating they were "not completely satisfied" (hazard ratio = 0.62; 95% confidence interval: 0.50-0.77; P < 0.001). On multivariate analysis controlling for stage at diagnosis, treatment history, and specific CTCA treatment center, "completely satisfied" patients demonstrated significantly lower mortality (hazard ratio = 0.63; 95% confidence interval: 0.51-0.79; P < 0.001). CONCLUSION:In this exploratory analysis, patient satisfaction with health service quality was an independent predictor of survival in pancreatic cancer. Further exploration of a possible meaningful relationship between patient satisfaction with the care they have received and outcome in this difficult malignancy is indicated.

e14697 Background: Despite the recognized relevance of symptom burden in pancreatic cancer, there has been limited exploration of whether an individual patient’s assessment of the overall quality-of-care received might influence outcome. To assess this issue we evaluated the relationship between patient-reported experience with service quality and overall survival. Methods: We evaluated 496 returning pancreatic cancer patients treated at Cancer Treatment Centers of America between July 2007 and December 2010. Overall patient experience “considering everything, how satisfied are you with your overall experience with CTCA?” was measured on a 7-point Likert scale ranging from “completely dissatisfied” to “completely satisfied.” It was dichotomized into 2 categories: top box response (7) versus all others (1-6). Patient survival was the primary end point. Cox regression was used to evaluate the association between patient experience and survival. Results: 317 patients were newly diagnosed while 179 were previously treated. 16, 93, 81 and 306 patients had stage I, II, III and IV disease respectively. 292 were males and 204 females. Mean age was 57.3 years. 387 (78%) patients had expired at the time of this analysis. 345 patients were “completely satisfied” while 151 were not. Median overall survival was 7.9 months (95% CI: 7.3-8.6 months). On univariate analysis, “completely satisfied” patients had a significantly lower risk of mortality compared to those not “completely satisfied” (HR=0.62; 95% CI: 0.50-0.78; p<0.001). On multivariate analysis controlling for stage at diagnosis, treatment history, age and gender, “completely satisfied” patients demonstrated significantly lower mortality (HR=0.61; 95% CI: 0.49-0.76; p<0.001) compared to those not “completely satisfied”. Conclusions: Patient experience with service quality was an independent predictor of survival in pancreatic cancer. This finding underscores the importance of psychosocial factors in patient prognosis. Patients who evaluate their quality of care more favorably may in turn have more positive attitudes toward their treatment outcomes, and may engage in other health behaviors that could potentially increase survival.

Despite the recognized relevance of symptom burden in colorectal cancer, there has been limited exploration of whether an individual patient's assessment of the overall quality-of-care received might influence outcome. We evaluated the relationship between patient-reported experience with service quality and survival in 702 returning colorectal cancer patients treated at our institution between July 2007 and December 2010. Overall patient experience "considering everything, how satisfied are you with your overall experience?" was measured on a 7-point Likert scale ranging from completely dissatisfied to completely satisfied. It was dichotomized into two categories: top box response (7) versus all others (1-6). Cox regression was used to evaluate the association between patient experience and survival. Of 702 patients, 506 were "completely satisfied" while 196 were not. On univariate analysis, "completely satisfied" patients had a significantly lower risk of mortality compared to those "not completely satisfied" (hazard ratio [HR] = 0.78; 95% confidence interval [CI]: 0.61-0.98; p = .04). Similarly, on multivariate analysis controlling for stage at diagnosis, treatment history, age, and gender, "completely satisfied" patients demonstrated significantly lower mortality (HR = 0.74; 95% CI: 0.58-0.95; p = .02). Patient experience with service quality was an independent predictor of survival in colorectal cancer, a novel finding in the literature.

39 Background: Prostate cancer is the second leading cause of cancer death among U.S. men. While self-reported quality of life has been shown to be prognostic of survival, there has been limited exploration of whether a patient’s assessment of the overall quality-of-care received might influence survival in prostate cancer. We evaluated the relationship between patient-reported experience with service quality and overall survival in prostate cancer. Methods: 832 returning prostate cancer patients treated at Cancer Treatment Centers of America between July 2007 and December 2010. Overall patient experience (“considering everything, how satisfied are you with your overall experience?”) was measured on a 7-point Likert scale ranging from “completely dissatisfied” to “completely satisfied”. It was dichotomized into 2 categories: top box response (7) versus all others (1-6). Cox regression was used to evaluate the association between patient experience and survival. Results: 560 patients were newly diagnosed while 272 had been previously treated. Majority of patients (n=570, 68.5%) had stage II disease at diagnosis. The mean age was 63.6 years. By the time of this analysis, 93 (11.2%) patients had expired. 710 (85.3%) patients were “completely satisfied” with the service quality they received while 122 (14.7%) patients were not. Median overall survival was 47.9 months. On univariate Cox regression analysis, “completely satisfied” patients had a significantly lower risk of mortality compared to those not “completely satisfied” (HR=0.48; 95% CI: 0.30-0.78; p=0.003). On multivariate Cox regression analysis controlling for stage at diagnosis, treatment history and age, “completely satisfied” patients demonstrated significantly lower mortality (HR=0.50; 95% CI: 0.29-0.87; p=0.01) compared to those not “completely satisfied”. Conclusions: Patient experience with service quality was an independent predictor of survival in prostate cancer. Based on this provocative observation, it is reasonable to suggest that further exploration of a possible meaningful relationship between patient perceptions of the care they have received and outcome in prostate cancer is indicated.

Background: Many cancer patients report poor sleep quality, despite having adequate time and opportunity for sleep. Satisfying sleep is dependent on a healthy circadian time structure and the circadian patterns among cancer patients are quite abnormal. Wrist actigraphy has been validated with concurrent polysomnography as a reliable tool to objectively measure many standard sleep parameters, as well as daily activity. Actigraphic and subjective sleep data are in agreement when determining activity-sleep patterns and sleep quality/quantity, each of which are severely affected in cancer patients. We investigated the relationship between actigraphic measurement of circadian organization and self-reported subjective sleep quality among patients with advanced lung cancer. Methods: This cross-sectional and case control study was conducted in 84 patients with advanced non-small cell lung cancer in a hospital setting for the patients at Midwestern Regional Medical Center (MRMC), Zion, IL, USA and home setting for the patients at WJB Dorn Veterans Affairs Medical Center (VAMC), Columbia, SC, USA. Prior to chemotherapy treatment, each patient's sleep-activity cycle was measured by actigraphy over a 4-7 day period and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Results: The mean age of our patients was 62 years. 65 patients were males while 19 were females. 31 patients had failed prior treatment while 52 were newly diagnosed. Actigraphy and PSQI scores showed significantly disturbed daily sleep-activity cycles and poorer sleep quality in lung cancer patients compared to healthy controls. Nearly all actigraphic parameters strongly correlated with PSQI self-reported sleep quality of inpatients and outpatients. Conclusions: The correlation of daily activity/sleep time with PSQI-documented sleep indicates that actigraphy can be used as an objective tool and/or to complement subjective assessments of sleep quality in patients with advanced lung cancer. These results suggest that improvements to circadian function may also improve sleep quality.