777 - Utilization of Physical Medicine & Rehabilitation (PM&R) Among Non-Small Cell Lung Cancer (NSCLC) Patients on Immunotherapy: Findings from the Enhanced EHR-facilitated Cancer Symptom Control (E2C2) Pragmatic Trial

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

Andrea L. Cheville, MD

Consultant Physician/Professor, PM&R/Cancer Rehabilitation and Hospice & Palliative Medicine
Mayo Clinic
Rochester, Minnesota, United States

Co-Author(s)

RL

Ryan Lewis, MBBS

Fellow Physician, Hospice & Palliative Medicine
Mayo Clinic
Stewartville, Minnesota, United States

Co-Author(s)

BL

Bolun Liu, MD

Senior Associate Consultant, Department of Hospital Internal Medicine
Mayo Clinic Health System
Mankato, Minnesota, United States
TB

Toure Barksdale, MD

Consultant Physician/Instructor, PM&R/Cancer Rehabilitation and Hospice & Palliative Medicine
Mayo Clinic
Rochester, Minnesota, United States

Objectives:

Background: Patients with advanced-stage or metastatic NSCLC on immunotherapy report a high prevalence of physical dysfunction and fatigue, which can adversely impact their quality of life. While there appears to be a role for PM&R in addressing these unmet care needs, the utilization of this specialty in this patient population is not clearly elucidated.

Purpose: To examine how PM&R services are being utilized among NSCLC patients on immunotherapy and whether patients with significant functional deficits and fatigue are being evaluated by Physiatrists.

Design:

Methods: Data was analyzed from the Enhanced, EHR-facilitated Cancer Symptom Control (E2C2) study, a stepped-wedge pragmatic cluster-randomized trial designed to evaluate a symptom management intervention in routine practice (NCT03892967). Patients with advanced-stage or metastatic NSCLC on immunotherapy monotherapy as first-line therapy who enrolled in the E2C2 trial from March 2019 to November 2022 were identified. Patients were excluded if they did not complete a baseline survey. Physical dysfunction and fatigue symptoms were assessed using a 10 point Likert scale prior or between Oncology clinic visits. Electronic medical records were retrospectively reviewed to determine whether patients were referred and evaluated by a Physiatrist during the same time frame.

Results: Out of 50 NSCLC patients who were identified, 13 were referred to PM&R and 8 were evaluated by PM&R, translating to a 16% overall utilization rate. 31 patients reported severe physical dysfunction (score 7-10) at least once during the treatment course and 6 (19.4%) of these patients were evaluated by PM&R. Similarly, 29 patients reported severe fatigue at least once during the treatment course and 6 (20.7%) were seen by a Physiatrist.

Conclusions: PM&R is underutilized among NSCLC patients on immunotherapy monotherapy and particularly in the subset of patients experiencing significant functional deficits and fatigue. This study highlights the need for improved access to PM&R in these high need groups.