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Annals of Oncology
evidence should include: side effects, schedule of treatment, support services, storage,
handling, disposal and interactions.
Results: During the review period, 35 patients receiving OAT were identified. Of
these, 12 patients had documentation of education by a doctor (34%), 15 (43%) by a
nurse. Documentary evidence of education about side effects was noted in 22 cases
(63%), schedule of treatment in 16 cases (46%), support services in 16 (46%), safe
storage in 3 cases (9%), safe disposal, safe handling and interactions in 2 cases each
(6%). Recommendations: A standardised tool has been developed to enable
healthcare staff to accurately document issues discussed during patient education for
OAT. This is in the form of a checklist to ensure that all elements including safety,
timing of medication, interactions, monitoring and support are documented
accurately. All patients prescribed OAT will be referred to a nurse-led OAT clinic to
facilitate education. Healthcare staff in the oncology department will be educated
about the tool and clinic and, following a pilot period, a repeat audit will be
performed to assess the effectiveness of the tool. These results will also be presented.
Disclosure: All authors have declared no conflicts of interest.
1635 INTENSIVE CARE AS A KEY PLAYER IN THE CHANGING
PARADIGM OF MODERN CANCER CARE: A SINGLE
INSTITUTION EXPERIENCE
L.C. Connell 1 , F. Othman 2 , B. Marsh 2 , D.N. Carney 1 , J.A. McCaffrey 1 ,P.
O Gorman 3 and C.M. Kelly 4
1 Medical Oncology, Mater Misericordiae University Hospital, Dublin, IRELAND,
2 Department of Intensive Care, Mater Misericordiae University Hospital, Dublin,
IRELAND, 3 Haematology, Mater Misericordiae University Hospital, Dublin,
IRELAND, 4 Medical Oncolgy, Mater Misericordiae University Hospital, Dublin,
IRELAND
Background: Many metastatic cancers are now treated similar to other chronic
diseases. Expanding treatment options, increasing age; co-morbid illness; and
improving cancer-specific survival means that decisions regarding the timeliness &
appropriateness of transfer to the Intensive Care Unit (ICU) are complex. We sought
to examine the clinical, demographic & outcome characteristics of oncology/
haematology patients (pts) transferred to ICU at a large academic teaching hospital.
Methods: Data was extracted from a prospectively maintained database for all pts
with documented malignancy admitted to ICU between September 2009 &
December 2011. Clinicopathological variables examined included; cancer type;
tumour stage; time from diagnosis; age; co-morbidities; and treatment history. The
Sequential Organ Failure Assessment (SOFA), an ICU-specific scoring system, was
reviewed for each patient (pt). We report 30 day & 6-month mortality.
Results: A total of 52 of an eligible 83 pts have been analysed in detail to date. The
common cancer types were well represented; breast (11.5%),colorectal(11.5%), lung
(11.5%) & acute leukaemia(19.2%). Mean age at time of ICU admission was 60 years
(range 29-82). The maximum number of prior lines of chemotherapy (CT) was 5
(range 0-5). Approximately 50% of pts had metastatic disease at time of ICU
admission. The most frequent reasons for admission were sepsis (n = 16, 31%) &
respiratory distress (n = 15, 29 %). Use of mechanical ventilation, vasopressors &
renal dialysis was 51.9%, 61.5% & 21.1% respectively. Four pts (7.7 %) received CT in
the ICU setting. ICU-specific mortality was 28.8% (n = 15). Thirty-day and 6-month
mortality rates were 38.5% & 61.5% respectively. Data on the remaining 31 pts is
currently being analysed and will be available for presentation at the meeting.
Conclusions: A significant proportion of pts admitted to ICU had advanced disease
& had received multiple lines of CT previously. The ICU-specific mortality rate was
lower than expected at 28.8% and may reflect stringent selection criteria. Pts
transferred tended to have had long periods of disease remission/stabilisation or had
a new diagnosis of malignancy with unknown CT sensitivity status. Analysis of pt
selection at ward level is on-going and will identify other factors influencing ICU
transfer decisions.
Disclosure: All authors have declared no conflicts of interest.
1636 A PROSPECTIVE STUDY OF SUBACUTE THYROID
DYSFUNCTION FOLLOWING SUPRACLAVICULAR
IRRADIATION IN THE MANAGEMENT OF CARCINOMA OF THE
BREAST
S. Akyurek 1 , I. Babalioglu 1 , S. Yuksel 2 and S. Cakir Gokce 1
1 Radiation Oncology, Ankara University School of Medicine, Ankara, TURKEY,
2 Biostatistic, Ankara University School of Medicine, Ankara, TURKEY
Purpose: To evaluate the relationship between irradiation and early thyroid
dysfunction, focusing on radiation dose-volume factors.
Patients and methods: Between December 2010 and January 2012 a total of 21
patients with breast cancer received supraclavicular irradiation were evaluated
Thyroid function tests, including serum thyroid stimulating hormone (TSH), free
thyroxine (fT4), free triiodothyronine (fT3), were analyzed prior to irradiation and
every three months the first year and then 18th month after radiotherapy. Based on
each patient’s dose volume histogram (DVH), total volume of the thyroid, mean
radiation dose the thyroid and percentages of thyroid volume which received
radiation doses 10-60Gy (V10-V60) were considered for statistical analysis.
Results: Mean TSH levels before irradiation, at 3, 6, 9 and 12 months were 1.4 µIU/
ml, 1.5 µIU/ml, 1.7 µIU/ml, 3.6 µIU/ml and 4.6 µIU/ml, respectively. Serum TSH
levels did not change significantly at 3 and 6 months after irradiation (p = 0.1).
However, a significant elevation was noted at 9 months (p = 0.005). Mean thyroid
dose was 32 Gy (19-48 Gy) and mean thyroid volume was 35 cc (24-64 cc). Median
values of V10-20-30-40-50-60 were 68%, 58%, 55%, 53%, 48% and 0%, respectively.
With a median follow-up was 9 months (range, 3-18 months), only one patient (5%)
developed clinical hypothyroidism requiring thyroid replacement treatment.
Conclusion: According to early results of our study, irradiation of the thyroid
develops early thyroid dysfunction. This damage is initially manifested within 9
months after radiotherapy. However we could not analyze the radiation dose-volume
factors of the peak level of serum TSH because of inefficient follow up time.
Disclosure: All authors have declared no conflicts of interest.
1637 COMBINATION OF SERUM PROCALCITONIN AND
C-REACTIVE PROTEIN LEVEL AS A DIAGNOSTIC MARKER OF
DISCRIMINATING INFECTION FROM NEOPLASTIC FEVER IN
FEBRILE LUNG CANCER PATIENTS
K. Miyamoto 1 , R. Seki 2 , D. Taniyama 1 , H. Kamata 1 and F. Sakamaki 1
1 Pulmonary Medicine, Saiseikai Central Hospital, Minato-ku, Tokyo, JAPAN,
2 Pathology, Saiseikai Central Hospital, Tokyo, JAPAN
Background: Neoplastic fever in lung cancer is assessed on clinical course only, and
is difficult to discriminate from infection.
Objective: To evaluate the diagnostic role of procalcitonin (PCT) and C-reactive
protein (CRP) in discriminating neoplastic fever and infection.
Methods: We reviewed the medical records of 112 consecutive febrile episodes of 52
patients (39 males, mean age 67.1y/o), who were diagnosed as lung cancer from
November 2009 to April 2012 at our Saiseikai Central Hospital in Tokyo, Japan.
Based on clinical, laboratory, and bacteriological results, patients were classified as
having neoplastic fever (NF, n = 53), suspected or definite bacterial infection (BI, n = 59).
Values of white blood cell count (WBC), PCT, and CRP were measured on day 1 of
onset of fever. Microbiological specimen and radiological imaging study were also
performed to diagnose infectious diseases or other febrile conditions.
Results: The most common infection was pneumonia (38.4 %). Mean WBC (12000
vs. 14800) were not statistically significant. Mean values of PCT were significantly
higher in patients with BI compared with NF (0.14 vs. 3.95 ng/ml, p < 0.05). Mean
values of CRP were also significantly higher in patients with BI compared with NF
(8.6 vs. 15.2 mg/dl, p < 0.05). Combination of CRP level at the threshold value of
10.2 mg/dl and PCT level at the threshold value of 0.32 ng/ml were the most
sensitive from ROC curve for discriminating infection to neoplastic fever.
Conclusions: Combination of PCT and CRP on the day of onset of fever is useful in
discriminating neoplastic fever from infection in febrile lung cancer patients.
Disclosure: All authors have declared no conflicts of interest.
1639 INCIDENCE OF THROMBOEMBOLIC EVENTS IN PATIENTS
TREATED WITH CISPLATIN-BASED CHEMOTHERAPY
A.C. Fernandes 1 , S.R. Meireles 2 , I. Augusto 2 , L. Aguas 2 and M. Damasceno 2
1 Oncologia Médica, Hospital de São João, Porto, PORTUGAL, 2 Medical
Oncology Department, Hospital São João, Porto, PORTUGAL
Introduction: Cancer patients on chemotherapy have higher risk in developing
thromboembolic events (TEE), with great impact on morbidity and mortality. The
aim of this study is to determine the incidence of venous and arterial TEE in patients
treated with cisplatin-based chemotherapy. We also analysed the prognostic value of
patientś baseline and treatment characteristics in predicting TEE occurrence.
Methods: We performed a retrospective analysis of all patients with cancer treated
with cisplatin-based chemotherapy between January 1, 2011, and April 10, 2012,
with at least 4 weeks of follow-up after their last cisplatin dose. A TEE was
considered cisplatin-associated if it occurred between the time of the first dose of
cisplatin and 4 weeks after the last dose.
Results: Among 141 patients, 27 (19.1%) experienced a TEE. The TEE observed
were: deep vein thrombosis (DVT) in 9.9% (14), pulmonary embolism (PE) in 5.7%
(8), DVT plus PE in 0.7% (4) and arterial thrombosis in 2.8%. The majority of
patients (51.9%) had a TEE after 63 days, and after the 3 rd dose of cisplatin, with a
cumulative dose of 160 mg/m 2 . By univariate analysis, active smoking (p = 0.016),
hypertension (p = 0.007), site of cancer (p = 0.025), Khorana site of cancer (p =
0.001), Khorana score (p = 0.049) and risk group (p = 0.04) were all identified as risk
factors. However, by multivariate analysis, only hypertension (p = 0.18; HR 3.59; 95%
CI, 1.25 to 10.34) and Khorana site of cancer (p = 0.03) retained statistic significance.
Conclusion: As we expected, gastric and pancreatic cancers had the highest
incidence of TEE. We verified a very high incidence of TEE in patients treated with
cisplatin-based regimens, also described in other published studies. It is therefore
Volume 23 | Supplement 9 | September 2012 doi:10.1093/annonc/mds416 | ix525