Annual Meeting Proceedings Part 1 - American Society of Clinical ...

6110 General Poster Session (Board #10C), Mon, 1:15 PM-5:15 PM
Frequency of cognitive impairment (CI) in elderly patients (pts) suffering
from malignancies and impact on therapeutic decision. Presenting Author:
Thibault De La Motte Rouge, Medical Oncology Department, AP-HP,
Salpetriere Hospital, University Paris VI, Paris, France
Background: Therapeutic decision remains complex when a cancer is
diagnosed in elderly pts. Our aim was to evaluate the frequency of CI in this
population and its impact on therapeutic decision. Methods: An oncogeriatric
evaluation including Comprehensive Geriatric Assessment (CGA) is
systematically performed for all elderly cancer pts referred in our unit. We
reviewed data of all pts assessed by geriatric oncologist at our institution
from January 2009 to June 2011. Results: 378 pts were identified, among
them a CI was noted in 87. Median age was 84 years (range 71 –94), 70 %
� 80 years. Most of the pts (78/87) were referred at the time of diagnosis.
Metastatic disease was diagnosed in 32 pts (52%) and Diffuse Large B Cell
Lymphoma stage III or IV in 21 pts (81 %). In 41 pts, CI was already
diagnosed: Alzheimer disease (AD) (n�38) and Vascular Dementia (n�3).
CGA help to identify CI in 46 additional pts: AD (n�36); Vascular Dementia
(n�2) and Mild Cognitive Impairment (n�8). 45/87 pts (52 %) were
dependant for at least one activity of daily living (ADL). As a result of CGA
and benefit/risk oncologic assessment, best supportive care was recommended
in 12 pts. Among them, only 4 pts presented with advanced
metastatic disease (main reason for palliative care). Pts in whom “best
supportive care” decision (n�12) was recommended were more dependants
than those who received specific anticancer therapy (n�75):
dependence for at least 2 ADL: 10/12 pts (83%) versus 16/75 (21%); and
presented more AD already diagnosed (11/12 versus 30/75). In the
remaining 75 pts, specific cancer therapy was proposed, including chemotherapy
(n�67), surgery (n�5), radiotherapy (n�3) and hormonotherapy
(n�9). Treatment was initiated as recommended in all but 4 pts (best
supportive care decision taken following discussion with pts and relatives).
During the follow-up, only 11/75 pts needed to be placed in nursing home
because of loss of autonomy. A survival � 1 year was observed in 27/75
(36%) pts. An update of cognitive performance will be presented.
Conclusions: Our data support that even if CI is frequent in elderly pts with
malignancies, specific anticancer therapy remains feasible and should be
considered in most elderly pts with CI.
6112 General Poster Session (Board #10E), Mon, 1:15 PM-5:15 PM
An integrated analysis of comprehensive geriatric assessment (CGA) in elderly
patients with non-small cell lung cancer (NSCLC) (JCOG1115-A). Presenting
Author: Hiroshi Katayama, JCOG Operations Office, National Cancer Center,
Tokyo, Japan
Background: The number of elderly NSCLC patients is increasing all over the
world. Actual age and ECOG PS is not always efficient to select �fit-elderly� for
chemotherapy. We integrated the data from two phase III trial (JCOG0207,
JCOG0803/WJOG4307L) and evaluated 4 CGA items as well as age and PS to
determine whether they would predict survival, response and toxicities. Methods:
Eligibility criteria of both trials included histologically or cytologically proven
NSCLC; stage III/IV; age 70 or more; ECOG PS of 0-1; unfit for bolus cisplatin; no
prior treatment; adequate organ function. Patients were randomized to receive
either weekly docetaxel (D) or D plus cisplatin (DP) in J0207, and either
3-weekly D or DP in J0803/W4307L. This study included all eligible pts for
whom all of 4 CGA items (Activity of Daily Living [ADL], Instrumental Activity of
Daily Living [IADL], Mini-Mental State Examination [MMSE], Geriatric Depression
Scale [GDS-15]) were assessed before treatment. Primary endpoint was
overall survival (OS). Survival curves are estimated by Kaplan-Meier method and
multivariate analysis for OS adjusting baseline factors were performed by using
stratified Cox regression model. Results: This analysis included 331 pts (J0207/
J0803-W4307L: 105/226) in total. The result of multivariate analysis for OS
was shown in the table. After adjusting baseline factors, MMSE as well as sex and
PS was significantly associated with OS. None of the CGA items were associated
with response and toxicities. Conclusions: It is not actual age but MMSE and PS
that is useful for predicting prognosis of elderly pts. MMSE should be taken into
consideration to determine the indication of chemotherapy for elderly pts.
mOS Multivariate analysis
n
(months) HR 95%CI p
Sex
Male 243 12.8 1
Female
Stage
88 24.1 0.44 0.30-0.66 �.001
III 102 15.4 1
IV
PS
229 14.5 1.25 0.89-1.75 0.194
0 119 21.2 1
1
Age
212 11.7 1.66 1.18-2.32 0.0033
70-74 96 17.1 1
75-79 181 15.0 0.96 0.67-1.37 0.810
80-
ADL
54 11.3 1.45 0.91-2.29 0.119
20 300 15.0 1
-19
IADL
31 11.3 1.15 0.68-1.95 0.591
5 267 15.0 1
-4
MMSE
64 14.1 1.01 0.69-1.49 0.956
30 133 21.2 1
-29
GDS-15
198 13.5 1.46 1.05-2.03 0.025
-4 207 14.8 1
5- 124 15.0 0.84 0.61-1.15 0.268
Health Services Research
409s
6111 General Poster Session (Board #10D), Mon, 1:15 PM-5:15 PM
Cancer survivorship outcomes in immigrants. Presenting Author: Phyllis
Noemi Butow, University of Sydney, Sydney, Australia
Background: Immigration is increasing world-wide. Cancer survivorship is
now recognised as a period of difficult adjustment for all patients, and
possibly more so for immigrants. We explored disparities in quality of life
outcomes for immigrant (IM) versus Anglo-Australian (AA) cancer survivors.
Methods: In a cross-sectional design, cancer survivors were recruited
through the New South Wales, Queensland and Victorian Cancer Registries
in Australia. IM participants, their parents and grandparents were born in a
country where Chinese, Greek, or Arabic is spoken and spoke one of those
languages. AAs were born in Australia and spoke English. All were
diagnosed with cancer 1-3 years previously. Questionnaires (completed in
preferred language) included the Hospital Anxiety and Depression Scale
(anxiety/ depression), FACT-G (quality of life) and Supportive Care Needs
Survey (unmet needs). Outcomes were compared between AA and IM
groups in adjusted regression models that included age, gender, socioeconomic
status, education, marital status, religion, time since diagnosis
and cancer type (prostate, colorectal, breast and other). Results: There were
599 participants (response rate 41%). Consent was unrelated to demographic
and disease variables. AA and IM groups were similar except that
immigrants had higher proportions in the low and highly educated groups (p
� 0.0001), and higher socioeconomic status (p � 0.0003). In adjusted
analyses (see table), IMs had clinically significant higher depression
(possible range 0-21), greater unmet information and physical needs, and
lower quality of life than AAs. The possible range for the latter three is
0-100. Conclusions: Immigrants experience poorer outcomes in cancer
survivorship, even after adjusting for socio-economic, demographic and
disease differences. Interventions are required to improve their adjustment
after cancer. Results highlight areas of unmet need that might be better
addressed by the health system (particularly with regard to provision of
information and support.
Outcome
(possible range) Immigrant Anglo-Australian P
Depression
4.6 2.7 �.0001
(0-21)
Unmet information needs 19.2 10.7 �.0001
(0-100)
Unmet physical needs
14.8 10.2 .0006
(0-100)
Quality of life
76.6 82.7 �.0001
(0-100)
6113 General Poster Session (Board #10F), Mon, 1:15 PM-5:15 PM
Implications of smoking for quality of life and illness perceptions of lung
cancer patients. Presenting Author: Sarah Danson, Academic Unit of
Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom
Background: Adverse publicity about smoking may lead to feelings of guilt
among lung cancer patients or pessimism about their future, potentially
compromising health-related quality of life (QoL) and adherence with
medical advice. QoL is an important outcome in clinical trials, particularly
where survival rates are low. We aim to compare QoL and illness perceptions
of lung cancer patients depending on smoking history. Methods:
Clinical data, measures of QoL (EORTC-QLQ-C30�LC13) and illness
perceptions (Brief IPQ – includes items to assess perceived severity,
causality, timeline, understanding, emotional impact, and control over
illness) were completed by 190 newly diagnosed lung cancer patients
(Non-small cell: 75%; Mean age: 68 years, range: 48-85 years; 58%
males). Of these, 24% were current smokers, 69% former smokers, and
7% never smoked. Results: Although overall QoL was similar between the
three smoker groups, there was a significant effect of smoking status on
QoL subscale emotional function (EF)(F(2,168)�4.08,p�.019). Those
who never smoked had significantly higher EF than current smokers
(p�.03). There was also a significant effect of smoking history on cough
(F(2,166);�5.40 ,p�.005) with smokers reporting significantly greater
levels than former smokers (p�.004). Smokers were more likely than
former smokers (p�.015) to attribute their lung cancer to smoking
(F(2,161)�16.49,p�.000). Furthermore, there was a significant effect of
smoking on the perceived timeline of illness (F(2,144)�3.33,p�.039),
with smokers being more pessimistic about this than former smokers
(p�.043). Conclusions: These findings have implications for planning the
care of lung cancer patients. In addition to the different treatment needs of
smokers and former smokers, smokers may need greater support to cope
with the emotional effects of their illness. Our findings suggest that
smokers blame their illness on their own behaviour, and have a more
pessimistic view of likely survival time, so they may need more encouragement
to accept life-prolonging treatments. These results may also inform
tailored smoking-cessation advice.
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