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Method and results: A total of 317 cancerous ascites cases with diverse tumor
origins were treated with KM-CART during 2009 to 2012. The volume of ascites
extracted ranged between 2 to 15 L with an average of 5.9 L. The average KM-CART
processing time was 51 minutes to produce a protein concentrate volume of 80 to
2,000 ml with a total protein concentration range of 8.0 - 21.0 g/dl. The protein
concentrates were administered intravenously with an average infusion volume of
630ml. In all the cases, patients had an immediate benefit of KM-CART treatment
including relief of discomfort of abdomen distension, malaise, respiratory distress
and improved resumption of ADL. A total of 3.5L protein concentrates including
611g of albumin and globulin was re-infused into one 37 year old female patient
with colon cancer over 3 periods of KM-CART treatment. Dendritic cell vaccine was
prepared using total of 1.4x108 cancer cells which were collected from hollow fiber
membrane filters.
Conclusion: KM-CART treated patients were observed to reliably respond to
treatment. It is concluded that processing a large quantity of ascites fluid using the
KM-CART system offers a safe and effective means to enhance refractory ascites
patient care.
Disclosure: All authors have declared no conflicts of interest.
1429P ASSESSMENT OF QUALITY OF LIFE OF PATIENTS WITH
CERVICAL CANCER DURING AND AFTER TREATMENT WITH
RADIOTHERAPY IN INSTITUTO DE MEDICINA INTEGRAL
PROFESSOR FERNANDO FIGUEIRA, RECIFE, BRAZIL
A.A. Santos, C. Lima Santos, J.F.P. Moura, A.I. Souza
Medical Oncology, IMIP, Recife, BRAZIL
Introduction: Cervical cancer is the 2nd most frequent neoplasm among women in
Brazil. Radiotherapy is one of the modalities used in the treatment of cervical cancer
and may cause adverse events that compromise quality of life. The purpose of this
study was assess quality of life in women with cervical cancer before, during the last
week and six months after radiotherapy at a hospital in Northeast, Brazil.
Method: We performed an exploratory, before and after longitudinal study, with 35
women with cervical cancer treated with adjuvant radiotherapy, exclusively or
concurrently with chemotherapy in Instituto de Medicina Integral Prof. Fernando
Figueira (IMIP) between August 2012 and May 2012. The patients underwent three
interviews (pre-treatment, last week and six months after treatment). To assess the
quality of life it was used FACT-Cx score (Functional Assessment of Cancer
Therapy-Cervix). The mean scores were compared using Student’s t and ANOVA
test, with significance level of 5%.
Results: The mean age was 50 (± 13.9) years. Most were single or widowed (58.8%)
and only 2.9% were employed. About 75% attended just until elementary school. The
FACT-Cx pre-treatment average scores was 110.9 and in the last week was 110.8,
with no statistically significant difference (p = 0.966). The results corresponding to
six months after therapy will be presented at the Meeting.
Conclusion: The immediate results after radiotherapy showed no difference in
quality of life. Analysis after six months may be different. These findings may modify
therapeutic decision.
Disclosure: All authors have declared no conflicts of interest.
1430P OPTIMAL CUT-POINTS FOR QLQ-C30 SCALES ASSOCIATED
WITH OVERALL SURVIVAL IN PATIENTS WITH ADVANCED
HEPATOCELLULAR CARCINOMA (AHCC): A COMPARISON
OF TWO METHODS
M. Diouf 1 , F. Bonnetain 2 , J. Barbare 1 , O. Bouché 3 , J. Meynier 1 , L. Dahan 4 ,
X. Paoletti 5 , T. Filleron 6
1 Clinical Research, Amiens University Hospital, Amiens, FRANCE, 2 Biostatistic
and Epidemiological Unit(EA 4184), Centre Georges François Leclerc, Dijon,
FRANCE, 3 Hepatology-Gastroenterology, Hopital Robert Debré, Reims,
FRANCE, 4 Service d’Hépato-Gastroentérologie et Oncologie Digestive, AP-HM,
Marseille, FRANCE, 5 Service de Biostatistique, Institut Curie, Paris, FRANCE,
6 Biostatistics, Institut Claudius Regaud, Toulouse, FRANCE
Introduction: Health-related quality of life (QoL) has been validated as prognostic
factor for patients with aHCC. However, to be used in routine practice, QoL should
be dichotomized. Usually, cut-points were based on arbitrary percentile value. The
main objective of this study was to identify optimal cut-offs for 5 scales: global health
(GH), physical functioning (PF), role functioning (RF), fatigue (FA) and diarrhea
(DIA). Two published methods were used to compare distributions of cut-offs and
their risk-ratio. We finally evaluated the improvement of existing prognostic
classifications (PC) by dichotomized QoL.
Patients and methods: 271 patients with aHCC were included in CHOC trial. QoL
was assessed in the 2 weeks prior to randomization with the EORTC QLQ-C30.
Identification of optimal cut-points was based on two univariate methods proposed
by Mazumdar and Farragi respectively. Mazumdar method was based on the
« minimum p-value » approach. Adjustment of type I error were based on Altman
formula. For Farragi method, the total sample was divided into two sub-samples:
Annals of Oncology
learning and validation. A cut-point was derived for each sub-sample using
« minimal p-value » and each patient was classified according to the cut-point for
the sub-sample to which it does not belong. The final cut-point was the one that
minimize the p-value in the total sample. Stability of the results was evaluated using
boostrap procedure (n = 500). Improvement of PC was studied with multivariate Cox
model, QoL being dichotomized at its optimal cut-point.
Results: QoL was available in 234 patients (86%). For RF, the most frequent
cut-point was 30 with the two methods (Mazumdar: 496/500 – Farragi: 500/500).
Univariate HR (95%CI) were 2.99 [1.62 – 5.52] and 2.80 [2.58 – 3.04] respectively
for Mazumdar and Farragi. In Farragi method, the 2 sub-samples found the same
cut-offs in 486/500B. The recommended cut-points were respectively 45, 50, 30, 30
and 5 for GH, PF, FA, RF and DIA. Compared to CLIP + WHO PS, CLIP + QoL +
clinical factors rose the C-index from 0.65 [0.62 – 0.69] to 0.70 [0.66 – 0.74].
Conclusion: The stability of the cut-points was good and precision of CI acceptable
for both methods, but better for Farragi. Interestingly, this categorization of QoL
increased the performance of all PC and should be considered as competing factor to
WHO performance status.
Disclosure: All authors have declared no conflicts of interest.
1431P REVIEW OF PATIENT DEATHS OCCURRING OFF THE END
OF LIFE PATHWAY: A UK ONCOLOGY CENTRES’
EXPERIENCE
C.L. Mitchell, T. Colby, R. Berman
Medical Oncology, The Christie NHS Foundation Trust, Manchester, UNITED
KINGDOM
Background: Within the UK national audits have been performed to assess the care
of the dying within the NHS and those receiving systemic cancer therapies. The
National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report
looked at aspects of end of life care in cancer patients in relation to the
appropriateness of the decisions taken and the level of seniority at which clinical
decisions were made. We performed an audit to assess patient deaths which did not
occur on the end of life pathway (EoLP); specifically the input from senior clinicians
in decision making and the appropriateness of ongoing interventions.
Methods: All in-patient deaths within our centre for the 6 month period of April
2010 until September 2010 were identified. Patients whose death occurred whilst on
the EoLP were identified and excluded from the analysis. A retrospective case note
review was then performed for the remaining patients.
Results: In the six month period 82 patient deaths occurred, of these 27% (n = 21)
were not on the EoLP at the time of death. 90% of these patients received at least one
consultant review during their admission with 58% of the patients having a
consultant review within 48hrs of death. At the time of death 84% of the patients
were receiving ongoing medical intervention:
Intervention Patients %
Intravenous antibiotics 27
Intravenous fluids 26
Diuretics 15
Steroids 12
Blood Products 8
Table 1: Medical interventions at time of death 95% of the patients had a
documented management plan, with a do not resuscitate order present in 73%. 63%
of patients had input from the hospital in-patient palliative care team. On review of
the clinical notes 68% of the patients fulfilled the criteria for the EoLP.
Conclusions: The audit highlighted that within our current clinical practice a
proportion of patients continue to receive ongoing medical intervention despite
entering the terminal phase of illness, with clinical decisions often being made at a
junior level. Focus on education and training of clinical staff with increased
consultant led input into patient care will be aimed at improving end of life care for
our patient population.
Disclosure: All authors have declared no conflicts of interest.
1432P THE IMPACT OF PALLIATIVE CARE ON THE
AGGRESSIVENESS OF END-OF-LIFE CANCER CARE IN
PATIENTS WITH ADVANCED PANCREATIC CANCER
R.W. Jang 1 , M.K. Krzyzanowska 1 , C. Zimmermann 2 , S. Alibhai 3
1 Department of Medical Oncology, Princess Margaret Hospital, Toronto,
CANADA, 2 Department of Psychosocial Oncology and Palliative Care, Princess
Margaret Hospital, Toronto, CANADA, 3 Medicine, University Health Network,
Toronto, CANADA
Background: To improve end-of-life care, quality indicators have been developed to
avoid overly aggressive care in patients with advanced cancer. Advanced pancreatic
cancer is a highly lethal disease with few life-prolonging options. Specialized palliative
ix464 | Abstracts Volume 23 | Supplement 9 | September 2012