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

9008 Oral Abstract Session, Mon, 8:00 AM-11:00 AM
Electronic self-report assessment for cancer: Results of a multisite randomized
trial. Presenting Author: Donna Lynn Berry, Dana-Farber Cancer
Institute, Boston, MA
Background: Attending to symptoms and side effects promotes safe and
effective delivery of cancer therapies. Providing focus to the patient’s
report in the clinic can efficiently address the most important concerns,
without extending visit times. The web-based electronic self report assessment
for cancer (ESRA-C) and clinician summary has been shown to
improve patient-clinician communication about symptoms and quality of
life issues (SQI). The purpose of this trial was to evaluate the impact of an
enhanced ESRA-C intervention (ESRA-C INT) on symptom outcomes.
Methods: Patients (planned N�702) with all cancer types treated in stem
cell transplant, medical oncology and radiation oncology at two comprehensive
cancer centers used ESRA-C to self-report SQI during and after new
anti-cancer therapy, with summary reports delivered to clinicians. Patients
were randomized to standard ESRA-C (control) or ESRA-C INT adding the
opportunity to self-monitor SQI between clinic visits and receive self-care
SQI management education, plus custom coaching on how to report SQI to
clinicians, all delivered via a secure web sites. We analyzed the intervention
effect on Symptom Distress Scale (SDS) scores using a two-sided t-test and
multivariate linear regression, adjusting for pre-selected covariates, including
baseline SDS, age, service, and work status. Results: Among 757
patients (increased N due to involuntary attrition), demographic variables
were balanced between groups except age (t�2.13; p�.03) with a younger
INT group (mean 1.97 year difference). Of the 562 patients who completed
final reports, the control group reported significantly higher SDS scores (t�
1.98; p � .048). A significant interaction between study group and age was
observed; significantly lower SDS scores were found in the ESRA-C INT
group among patients � 50 years (-1.95; p�.002), and no significant
difference among patients � 50. Conclusions: Adding self-care and
communication coaching to ESRA-C, a system to allow self-report and
clinician notification of SQI, reduced symptom distress in a large sample of
patients during and after active cancer treatment compared with ESRA-C
alone. Patients over the age of 50, in particular, may benefit from the
intervention.
9010 Clinical Science Symposium, Sat, 3:00 PM-4:30 PM
EXCAP exercise to improve fatigue, cardiopulmonary function, and strength:
A phase II RCT among older prostate cancer patients receiving radiation
and androgen deprivation therapy. Presenting Author: Karen Michelle
Mustian, University of Rochester Medical Center, Rochester, NY
Background: Radiation therapy (RT) and androgen deprivation therapy
(ADT) result in cancer-related fatigue (CRF), decreased cardiopulmonary
function (CPF) and decreased strength. Research suggests exercise can
improve CRF during RT and ADT, through physical conditioning responses
that improve CPF and strength. We explored the influence of an individuallytailored,
home-based exercise intervention (EXCAP), including progressive
resistance and aerobic training, on CRF, CPF and strength. Methods: Older
prostate cancer patients (N�58; mean age�67), receiving RT (47%) or
ADT (53%), were randomized to 6 wks of EXCAP (7 days/wk) or standard
care (RT or ADT with no exercise). CPF (VO2 max) was assessed via graded
exercise testing (GXT) or a 6-minute walk test when GXT was contraindicated.
Muscular strength was assessed using multiple repetition maximum
testing (chest press and leg extension). CRF was assessed via valid
self-report questionnaires (BFI, POMS-FI, MFSI). All assessments were
pre- and post-intervention. Results: ANCOVAs, controlling for baseline,
revealed significant differences between groups in mean levels of CRF on
the BFI and POMS-FI (all p�0.05), and a trend toward differences on the
MFSI (p�0.10) with significant baseline interactions (all p�0.05) postintervention:
exercisers decreased CRF while controls increased. ANCOVAs
revealed a trend toward differences between groups in mean levels of CPF
(VO2 max) and strength (all p�0.10): exercisers improved while controls
declined in performance. Pearson correlations revealed significant inverse
associations between changes in CRF (BFI) and CPF (p�0.05;r�-0.0.36),
and CRF and strength (p�0.05;r�-0.0.31). MANOVA revealed that changes
in CPF and strength significantly predicted changes in CRF (p�0.05,
r�0.67) and accounted for 45% of the variance. Conclusions: Exercise
improves CRF and these improvements may be mediated, in part, by
improvements in CPF and strength. Future phase III RCTs with prostate
cancer patients receiving RT and ADT are needed to confirm these
relationships. Funding: DOD W81XWH-07-1-0341, NCI K07CA120025,
NCI 1R25CA102618.
Patient and Survivor Care
569s
9009 Clinical Science Symposium, Sat, 3:00 PM-4:30 PM
Physical activity participation and functional limitations in geriatric cancer
survivors. Presenting Author: Lisa Sprod, University of Rochester Medical
Center, Rochester, NY
Background: Functional limitations (FL) increase with age, as does cancer
incidence. Treatments for cancer may exacerbate age-related FL. Physical
activity (PA) reduces the risk of recurrence of some cancers and may
improve survival. FL may reduce PA participation in geriatric cancer
survivors (�65 yrs.) which could increase the risk of recurrence and reduce
survival. This investigation describes and compares patterns of PA and FL
in geriatric cancer survivors versus those without a cancer history. Methods:
Using a national sample of community-dwelling elders (� 65 yrs.) from the
2003 Medicare Current Beneficiary Survey (N�14,887), we characterized
the differences between cancer survivors and those without a cancer history
in FL, current amount of PA, and current amount of PA compared to PA one
year prior. Respondents rated FL on a 1-5 scale (1�no difficulty, 5�can’t
do): stooping, crouching, or kneeling (stoop), carrying objects up to 10 lbs
(lift), extending arms above shoulder level (reach), grasping small objects
(grasp), and walking ¼ of a mile (walk). Frequency of walking for a least 10
minutes (1-5 rating scale; 1�daily, 5�never), weekly participation in PA,
exercise, or sports (yes/no), and time spent doing moderate or vigorous PA
(hrs/wk) were reported. Multivariate logistic regression was used to determine
associations. Results: Of the 14,887 participants, 2,603 (6%)
reported a history of cancer. Compared to those without a cancer history, a
greater proportion of cancer survivors reported having difficulty or being
unable to stoop, lift, reach, grasp or walk (all p�0.01). Cancer survivors
who had more FL were less likely to engage in PA (all p�0.01). Cancer
survivors reported a lower frequency of walking at least 10 minutes at a
time (p�0.01). Cancer survivors were more likely to decrease PA from the
previous year (p�0.01) and spent less time doing moderate (p�0.01) or
vigorous activity (p�0.01) than those without a cancer history. Conclusions:
Older cancer survivors engage in less PA and are at greater risk of FL than
those without a history of cancer. This may lead to reduced independence,
a greater risk of cancer recurrence, and reduced survival. Therefore, PA
interventions are important in this population.
9011 Clinical Science Symposium, Sat, 3:00 PM-4:30 PM
Correlation of short telomeres (ST) with vulnerability, toxicity, and early
death in elderly AOC patients receiving carboplatin: A multicenter GINECO
trial. Presenting Author: Claire Falandry, Centre Hospitalier Lyon Sud,
Lyon, France
Background: Age induces a progressive decline in the functional reserve and
interferes with cancer treatments. As aging is heterogeneous, this decline
has to be assessed individually. Telomere attrition leads to tissue senescence.
We tested the hypothesis that telomere lenght (TL) could predict pts
vulnerability and outcome during cancer treatment. Methods: This study
was performed in the “Elderly women” GINECO trial designed to evaluate
the impact of geriatric covariates on survival in AOC pts over 70 receiving 6
courses of carboplatin. TL was estimated in duplicate using standard
Terminal Restriction Fragment analysis from peripheral blood cells at
inclusion and tested for its correlation with geriatric covariates and pts
outcomes (TC and tolerance, overall survival: OS). Results: TL (in base pair)
was estimated for 109/111 pts (median 5997; extremes [4517-8333]).
No significant correlation was found with any pts characteristics. With a
cutoff of 5770 bp, TL discriminated two groups with significantly different
Treatment Completion (TC) rates: 0.80 (95CI[0.71-0.89]) and 0.59
(95CI[0.41-0.76]), OR�2.8, p�0.02 for long telomere (LT) and short
telomere groups, respectively . ST pts were at higher risk of severe adverse
events (SAE, OR�2.7; p�0.02) and tended to have more unplanned
hospital admissions (OR�2.1; p�0.08). Considering OS, after adjustment
on FIGO stage, TL shorter than the median was a nearly significant risk
factor of premature death (HR�1.57; p�0.06. Finally, we addressed if TL
correlated with our previously validated geriatric vulnerability score (GVS)c
including ADL score�6, IADL score�25, albuminemia�35g/l,
lymphopenia�1G/L, HADS score£15 as risk factors of poorer survival.
Despite no significant correlation with any of these factors, GVS³3) and ST
tended to be correlated (OR�2.1; p�0.08). Conclusions: This exploratory
study identifies TL as predictive factor of decreased TC, SAE risk,
unplanned hospital admissions and OS after adjustment on FIGO stage.
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