EAPC - ipac

438 EAPC Abstracts
competently within the limits of current care. They showed that adequate
self-management requires a constellation of skills and behaviours. They
were involved in pulmonary rehabilitation and had adopted this as a way of
life. Benefits and challenges to participation in these programmes were
identified. Conclusions: A minority of patients practiced self-management
and maintained an acceptable quality of life through self-acquired expertise
relating to symptoms, medication and help-seeking. Well-being needed to
be understood, not as the end point but as a precarious balance, needing
skillful maintenance and hard work. The findings have implications for
adherence, patient-involvement, and responsibility in the management of
COPD.
129 Oral Presentation
Other symptoms: Respiratory, Cognitive and Cachexia
Sympathetic nervous system activity in patients with cancer: a
pilot study
Authors: Ashika Sequeira Faculty of Medicine and Health Sciences
University of Nottingham UNITED KINGDOM
Alpna Chauhan Hayward House Macmillan Specialist Palliative Care Unit,
Nottingham University Hospitals NHS Trust Nottingham UNITED
KINGDOM
Cathann Manderson Hayward House Macmillan Specialist Palliative Care
Unit, Nottingham University Hospitals NHS Trust Nottingham UNITED
KINGDOM
David Wasley University of Wales Cardiff UNITED KINGDOM
Andrew Wilcock University of Nottingham Nottingham UNITED
KINGDOM
Background: Overactivity of the sympathetic nervous system (SNS) promotes
catabolism and may contribute to cachexia in chronic heart failure
and COPD. This study examined for evidence of SNS overactivity in
patients with cancer cachexia. Methods: Patients with weight loss of more
than 5% since diagnosis and age-matched healthy controls were studied.
Those with conditions or taking drugs known to impact the SNS, hypothalamic-pituitary-adrenal
axis or the measurement of heart rate variability
(HRV) were excluded. A 5min ECG recording was taken under controlled
breathing conditions. HRV was analysed by power spectral analysis (Chart
software v5.5.4, AD Instruments, Oxford, UK). Mean values of serum cortisol
and urinary catecholamines/metanephrines were calculated from two
consecutive 9am blood samples and 24h urine collections respectively.
Differences were analysed using the Mann-Whitney U test. Results:
9 patients with a mean (SD) age of 59 (13) years, percentage weight loss of
17 (12) and an ECOG performance status of 0–3 were recruited along with
9 healthy controls. Heart rate did not differ between the groups. Compared
to the control group, all seven aspects of HRV assessed were lower in the
patient group, four significantly so (table). Serum cortisol, urinary catecholamines
or metanephrines did not differ significantly. HRV component
(ms2) Median (range) P value Patients Controls Total power 336 (63–545)
902 (411–3999) 0.001 High frequency 78 (5–246) 313 (67–809) 0.030 Low
frequency 62 (13–136) 328 (95–1914) 0.004 Very low frequency 156
(28–295) 336 (153–1209) 0.012. Conclusions: Our results do not suggest
overactivity of the SNS in this group of patients. However, there is evidence
of a global reduction of autonomic modulation of cardiovascular tone with
impaired sympathetic and parasympathetic components. Possible explanations
include deconditioning and paraneoplastic neuropathy.
130 Oral Presentation
Other symptoms: Respiratory, Cognitive and Cachexia
Modafinil for cognitive dysfunction in advanced cancer:
A double-blind, randomized, cross-over, placebo-controlled trial
Authors: Lena Lundorff Department of Palliative Care Regions Hospitalet
Herning DENMARK
Birte Jønsson Regions hospitalet Herning Herning DENMARK
Per Sjøgren Multidisciplinary Pain Centre Copenhagen DENMARK
Background: Aim: To evaluate the effectiveness of single-dose Modafinil
compared with placebo in advanced cancer patients on cognitive function
Methods: Twenty-eight cancer patients with a fatigue score of 50 mm or
more on the Edmonton Symptom Assessment System (ESAS),
Hgb > 6,5mmol/l, creatinine< 150 mmol/l, total se-Ca < 2,7 mmol/l and
Karnofsky Performance Status 40–70 were included. All medications were
kept stable one week before and during the trial, however, the patients were
allowed to use supplemental doses of short acting opioids for breakthrough
pain. On day 1 the patients were randomly assigned to receive 200 mg
Modafinil orally or placebo and on day 4 crossed-over to the alternative
treatment. Finger Tapping Test (FTT), Trail Making Test (TMT) and ESAS
were evaluated before tablet intake and again 4,5 hours after. Side effects
were registered. Statistics: Wilcoxon signed rank test. Values of p