The Financial and Psychosocial Impact of Medicinal Cannabis

Introduction: Therapeutic utilization of medicinal cannabis for symptom management in oncology patients is a burgeoning area of research focus. We hypothesize that medicinal cannabis use can result in subjective improvements in quality of life (QOL) metrics for cancer patients. Methods: Adult palliative care patients at a medical oncology clinic are consented to the study after being certified to access medicinal cannabis. After three months, subjective changes in QOL, including well-being, financial burden, pain, chemotherapy induced nausea and vomiting (CINV), and other categories are recorded via telephone interview. Responses are documented with a numerical Likert scale (from 1-5, with a score of 1 = greatly decreased satisfaction, and 5 = greatly increased satisfaction; a score of 3 is no change from baseline). Scores \u3e3.5 were deemed meaningful in terms of improvement. Results: An aggregate of 35 patient scores showed meaningful increases in subjective satisfaction across most metrics. Satisfaction with CINV symptoms showed the most marked improvement, with an average score of 3.63. While pain scores were similar at 3.53, more general QOL metrics were lower, at 3.46. Most patients did not find the cost to be burdensome, with an average score of 3.03. Discussion: The initial 35 interviews of our desired n of 120 suggest that medicinal cannabis may provide analgesic, antiemetic, and anxiolytic benefits for cancer patients. We anticipate that additional interviews will follow this pattern. If so, our study could bolster the evidence that therapeutic use of medicinal cannabis may be helpful for patients undergoing cancer treatment

Firing Up Instead of Burning Out: Tales from the front line of the Cake Committee

This presentation will focus on an underutilized model of supportive care that can help bring back some of the human moments that can often be lost in delivering supportive oncology care. Handling the often complicated issues that arise in oncology care can take a toll on social workers and our oncology co-workers in other disciplines. In oncology care, especially in an outpatient setting, social workers often fulfill the role of emotional support not just for our patients but also for other oncology professionals. Though we are not employed to act as such, we dually assume the position of therapist and co-worker and are left to bear not only our own burdens, but the emotional burdens of our co-workers. Which leaves the question that we often ask the family members of our patients: Who is caring for the caregiver? The literature that looks at collective supportive care for social workers is extremely scarce and focuses largely on models of self-care and supervision. The narrative seemingly articulated by this dearth of research is “help others, and on top of taking care of others, don’t forget to help yourself.” For oncology social workers, a statement easier said than done. How do we sustain ourselves and continue to support our patients and our co-workers? Simply avoiding burn-out is not adequate. It’s critical that social workers have an opportunity to be supported, to celebrate accomplishments, to grieve our losses, and equally important, to laugh at ourselves and some of the situations we find ourselves in on any given day. In short, find ways to be “fired up” about ourselves and the important, and at times, excruciating work we do. In our setting, we have developed, and are continually amending, a supportive care model to address these needs. This model first requires the admission that we, as caregivers, have needs ourselves. Strategies include more formal “rituals” of celebrating staff members’ birthdays, special occasions and accomplishments and incorporating time in staff meetings to discuss what inspires us, to more fluid approaches including acknowledging the value of different clinical approaches and recognizing the value of humor and laughter. In this interactive workshop, we will discuss what motivated our team to recognize how our work was affecting us and our own needs for support. We will share how small changes can lead to big improvements in morale. Whether new to oncology social work or a seasoned oncology social worker, attendees of this workshop will learn and practice strategies to keep the fire of “job love” burning. Poster presented at: Association of Oncology Social Workers 2017 in Atlanta Georgia, United States

Engaging Patients with Late-Stage Non-Small Cell Lung Cancer in Shared Decision Making about Treatment.

Few treatment decision support interventions (DSIs) are available to engage patients diagnosed with late-stage non-small cell lung cancer (NSCLC) in treatment shared decision making (SDM). We designed a novel DSI that includes care plan cards and a companion patient preference clarification tool to assist in shared decision making. The cards answer common patient questions about treatment options (chemotherapy, chemotherapy plus immunotherapy, targeted therapy, immunotherapy, clinical trial participation, and supportive care). The form elicits patient treatment preference. We then conducted interviews with clinicians and patients to obtain feedback on the DSI. We also trained oncology nurse educators to implement the prototype. Finally, we pilot tested the DSI among five patients with NSCLC at the beginning of an office visit scheduled to discuss treatment with an oncologist. Analyses of pilot study baseline and exit survey data showed that DSI use was associated with increased patient awareness of the alternatives\u27 treatment options and benefits/risks. In contrast, patient concern about treatment costs and uncertainty in treatment decision making decreased. All patients expressed a treatment preference. Future randomized controlled trials are needed to assess DSI implementation feasibility and efficacy in clinical care