Here - American Geriatrics Society

P APER
A BSTRACTS
Paper Session
Clinical Decision-Making
Thursday, May 3
7:30 am – 9:00 am
P1
Lagtime to Benefit for Colorectal Cancer Screening: A Survival
Meta-Analysis.
S. J. Lee, 1 W. J. Boscardin, 1,2 I. Stijacic-Cenzer, 1,2 J. Conell-Price, 1
S. O’Brien, 1 L. C. Walter. 1,2 1. Division of Geriatrics, SFVAMC, UCSF,
San Francisco, CA; 2. Department of Epidemiology and Biostatistics,
University of California, San Francisco, San Francisco, CA.
Supported By: Dr. Sei Lee was supported by Hartford Geriatrics
Health Outcomes Research Scholars Award, the Hellman Family
Award for Early Career Faculty at UCSF and the KL2RR024130
from the National Center for Research Resources, a component of
the NIH.
Dr. Louise Walter was supported by R01CA134425 from the
National Cancer Institute, which was administered by the Northern
California Institute for Research and Education.
This work was supported with resources of the Veterans Affairs
Medical Center, San Francisco, California.
Background: Guidelines recommend targeting colorectal cancer
(CRC) screening to healthy patients whose life expectancy exceeds
the cancer screening’s lagtime to benefit (i.e. time between screening
and when the benefits of screening are seen). However, the lagtime of
CRC screening is uncertain. Our goal was to determine a pooled,
quantitative estimate of the lagtime to benefit for CRC screening
from randomized controlled trial (RCT) data.
Methods: We conducted a survival meta-analysis of CRC
screening RCTs focusing on older patients (age greater than 50) identified
by Cochrane and USPSTF reviews as high quality. Four population-based
RCTs of fecal occult blood testing from Denmark, England,
Sweden, and the United States (n=327,043) were included in
our meta-analysis.
Results: 4.9 years (95%CI: 2.1 to 9.5) passed before one CRC
death was prevented for 5000 persons screened (absolute risk reduction
or ARR=0.0002). It took 10.4 years (95%CI: 6.1 to 16.6) before
one CRC death was prevented for 1000 persons screened
(ARR=0.001) and 14.6 years (95%CI: 9.7 to 21.2) for 2 CRC deaths
to be prevented for 1000 persons screened (ARR=0.002).
Conclusions:The lagtime to prevent one CRC death per 1000 persons
screened is 10.4 years suggesting that CRC screening should be
targeted toward patients with a life expectancy greater than ten years.
P2
Preferences for Deactivation of Implantable Cardioverter
Defibrillators in the Setting of Advanced Illness.
J. A. Dodson, 1 T. Fried, 1 P. H. Van Ness, 1 N. Goldstein, 2 R. Lampert. 1
1. Yale University School of Medicine, New Haven, CT; 2. Mount Sinai
School of Medicine, New York, NY.
Background: Some implantable cardioverter defibrillator (ICD)
recipients with advanced illness receive painful shocks at the end of
life. The purpose of our study was to explore preferences for ICD deactivation
in the setting of hypothetical advanced illness.
Methods: We conducted a cross-sectional telephone survey of
patients age ≥50 with ICDs followed in a single electrophysiology
practice in New Haven, CT. Sociodemographic and clinical characteristics,
as well as self-reported functional status, were obtained. Patients
were then asked whether they would opt for ICD deactivation
in five distinct scenarios: (1) permanently unable to get out of bed, (2)
permanent memory problems, (3) burden to family members, (4) on
breathing machine >1 month, (5) advanced incurable disease. Patients
who answered “possibly yes” or “definitely yes” to any scenario
were categorized as considering deactivation.
Results: Surveys were completed in 100 patients. Mean age was 71
years, 28% were female, and 18% were nonwhite.Among respondents,
71 patients (71%) would consider ICD deactivation in one or more
scenarios. Responses varied considerably by scenario. Patients considered
deactivation most often in the setting of advanced incurable disease
(61%), and least often if permanently unable to get out of bed
(25%) (Figure). Patients were more likely to consider deactivation if
they were white, had not received a prior ICD shock, or were disabled.
Conclusions: The majority of patients with ICDs would consider
deactivation in at least one scenario reflecting advanced illness.This preference
was most common in the setting of incurable disease, but also not
uncommon in the setting of cognitive impairment or burden to family.
P3 Encore Presentation
Self-rated Health and Walking Ability Predict 10-year Mortality in
Older Women with Breast Cancer.
J. A. Eng, 1,2 K. M. Clough-Gorr, 3,4 R. A. Silliman. 1,2 1. Medicine-
Geriatrics, Boston University School of Medicine, Boston, MA; 2.
Boston University School of Public Health, Boston, MA; 3. Institute
of Social and Preventive Medicine, University of Bern, Bern,
Switzerland; 4. National Institute for Cancer Epidemiology and
Registration, Institute of Social and Preventive Medicine, University of
Zurich, Zurich, Switzerland.
Supported By: John A. Hartford Foundation, Health Resources and
Services Administration (D01HP08796-05-00), National Institutes of
Health (K05 CA92395), National Cancer Institute (R01 CA106979,
R01 CA/AG 70818, R01 CA84506)
Background: Self-rated health (SRH) and mobility predict mortality
in general populations but have not been well-studied in older
women with breast cancer. Methods: Women aged ≥65 years with primary
stage I-IIIA breast cancer were enrolled at 4 sites. Data were
collected over 10 years from medical records, annual interviews, and
AGS 2012 ANNUAL MEETING
S1