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

570s Patient and Survivor Care
9012 Clinical Science Symposium, Sat, 3:00 PM-4:30 PM
Prognostic factors of the loss of autonomy (LoA) in older patients with
cancer receiving first-line chemotherapy. Presenting Author: Pierre-Louis
Soubeyran, Institut Bergonie, Bordeaux, France
Background: Actual data on prognostic geriatric factors of health outcomes
are lacking. We aimed to examine whether a decrease in autonomy for
activities of daily living (ADL) after a first cycle of chemotherapy influences
elderly cancer pts prognosis, and to determine prognostic factors of this
LoA from a range of biological and geriatric evaluation factors. Methods:
Pts� 70 years receiving 1st-line chemotherapy for a range of cancers were
included in this multicentre prospective study. A LoA was defined as a
decrease of 0.5 or more points on the ADL scale between the beginning of
treatment and the 2nd cycle (ADL scored 6 to 0). The association between
a LoA and OS was examined and prognostic factors were sought from the
pre-treatment Geriatric Assessment data (CIRS-G, IADL, MNA, MMSE,
GDS et Get up and Go) and from baseline biological and clinical information
(age, sex, tumor extension and localization, performance status, BMI,
weight loss, albumin, CRP, haemoglobin levels, leucocyte and platelet
count, creatinine clearance). Pts completely dependent at baseline (ADL
score 0) were excluded as a LoA was not possible. Results: Among 364 pts
included, 299 pts were evaluable and 50 experienced a LoA. A LoA was
significantly associated with an increased risk of death (RR 1.518,
95%CI[1.079-2.135]). Biological and clinical factors were not associated
with LoA but pre-treatment low GDS15, dependencies on the IADL, low
MMS, slow Get Up and Go, low ECOG-PS and poor MNA were found to be
prognostic of a LoA in univariate analyses. In the multivariate model, low
GDS (OR 2.4, p�0.01, 95%CI [1.23-4.66]) and dependencies on the
IADL (OR 3.0, p� 0.027, 95%CI � [1.13-9.09]) were independently
associated with an increased risk of LoA. Conclusions: Our study underlines
the close link between LoA during treatment and poorer prognosis of elderly
pts with cancer. Pts with a pre-treatment low GDS15 and IADL-dependent
were the most likely to experience LoA after the 1st chemotherapy cycle.
This research suggests that the GDS15 and IADL should be included as
part of any screening for elderly pts before treatment.
9014 Clinical Science Symposium, Tue, 9:45 AM-11:15 AM
Falls, physical performance deficits, and functional losses in cancer
survivors with chemotherapy-induced neuropathy (CIPN): A University of
Rochester CCOP study. Presenting Author: Supriya Gupta Mohile, University
of Rochester Medical Center, Rochester, NY
Background: CIPN impairs quality of life in cancer survivors. Little is known
about the prevalence of falls, physical performance (PP) deficits, and
functional losses or their association with CIPN toxicities in cancer
survivors. Methods: We conducted an analysis of baseline assessments from
a phase III randomized clinical trial in cancer survivors with CIPN self
reported pain scores of � 4 reflecting leg and foot pain from neuropathy
over the past 24 hours on a scale from 0 (“no pain”) to 10 (“pain as bad as
you can imagine”). Patients also completed EORTC QLQ-CIPN-20 sensory
and motor scales for neuropathy toxicities and self reported falls in the
previous 3 months. A PP deficit was defined as “a lot of difficulty” or
“unable to do” any of 6 physical tasks (e.g., lifting objects, walking a
quarter of a mile). Functional losses were defined as “a lot of difficulty” or
“unable to do” any of 5 functional tasks (e.g., managing money, bathing).
We examined the association of baseline characteristics and CIPN toxicities
with falls, PP deficits and functional losses using logistic regression.
Results: Of 421 patients, 11.9% experienced recent falls, 58.6% reported
a PP deficit, and 26.6% reported a functional loss. Patients with falls
and/or PP deficits were more likely to be older (mean age 60.9 vs 58.9,
p�0.02), female (75.3% vs 65.2%, p�0.03) and have less education
(�high school: 7.1% vs 0.6%, p�.01). Cancer and chemotherapy history
were not different between groups. Patients with falls and/or PP deficits
reported higher severity of CIPN toxicities: pain (6.82 vs 6.05, p�0.01),
sensory (23.3 vs 19.6, p�0.01), and motor (17.4 vs 12.7, p�0.01). In
multivariable analysis, factors associated with having a fall and/or PP
deficit included: older age (OR 1.03, p�0.04), low education (OR 9.34,
p�0.04), and motor toxicity (OR 1.21, p�0.01). Factors associated with
functional losses included: non-white race (OR 3.16, p�0.01), Hispanic
ethnicity (OR 5.32, p�0.05), motor toxicity (OR 1.19, p�0.01), and PP
deficit (OR 4.94, p�.01). Conclusions: CIPN toxicities, primarily motor, are
significantly associated with falls, physical performance deficits, and
functional losses.
CRA9013 Clinical Science Symposium, Tue, 9:45 AM-11:15 AM
CALGB 170601: A phase III double blind trial of duloxetine to treat painful
chemotherapy-induced peripheral neuropathy (CIPN). Presenting Author:
Ellen M. Lavoie Smith, University of Michigan, Ann Arbor, MI
The full, final text of this abstract will be available at
abstract.asco.org at 12:01 AM (EDT) on Monday, June 4,
2012, and in the Annual Meeting Proceedings online
supplement to the June 20, 2012, issue of Journal of
Clinical Oncology. Onsite at the Meeting, this abstract will
be printed in the Monday edition of ASCO Daily News.
9015 Clinical Science Symposium, Tue, 9:45 AM-11:15 AM
Rates and risks of suicidality in young adults (YAs) with advanced cancer.
Presenting Author: Kelly Marie Trevino, Dana-Farber Cancer Institute,
Boston, MA
Background: Suicide rates in YA cancer patients are higher than in the
general population. Although cancer is associated with a four-fold increase
in the likelihood of a suicide attempt, little is known about suicidality in
YAs with cancer. This study examined rates and clinical risk factors
associated with suicidality in a sample of YAs with advanced cancer.
Methods: Structured interviews were conducted between 4/2010 and
9/2011 with 70 YA advanced cancer patients (range 20-40 yrs, M�33.97,
SD�5.61) receiving care at the Dana-Farber Cancer Institute. Validated
measures assessed suicidality (i.e., Yale Evaluation of Suicidality), quality
of life, major depressive disorder, grief over cancer-related losses, and
social support. Scores on the suicidality measure were dichotomized into
positive screen � 1 and negative screen � 0. Chi-square, t-test, and
logistic regression analyses evaluated the relationship between suicidality
and participant characteristics and psychosocial variables, controlling for
confounding variables. Results: Over one-fifth (21.4%) of the sample
screened positive for suicidality. Female gender �2 (1, N � 70) � 4.95, p �
.026), breast compared with other cancer diagnosis �2 (1, N � 70) � 5.66,
p � .017), and better performance status (t(68) � 3.13, p � .01) were
associated with lower rates of suicidality. Participants who met criteria for
current (OR [95% CI] 8.67 [1.78, 42.22]) or lifetime major depressive
disorder (5.38 [1.60, 18.12]) endorsed higher rates of suicidality. Better
overall (.97 [.94, .99]), psychological (.93 [.87, .94]), and existential
quality of life (.91 [.85, .98]) were associated with reduced suicidality risk.
More severe grief was associated with greater risk (1.15 [1.04, 1.28])
whereas greater social support was associated with lower suicidality risk
(.85 [.74, .97]). Conclusions: YAs with advanced cancer reported higher
rates of suicidality than observed in other age groups. Developmentally
targeted interventions that promote physical function, effectively treat
depression, improve quality of life and reduce grief, and provide opportunities
for social support may reduce rates of and risk for suicidality in this
population.
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