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

9032 Poster Discussion Session (Board #16), Mon, 1:15 PM-5:15 PM and
4:45 PM-5:45 PM
Social environment as a predictor of smoking cessation and recidivism in
lung cancer survivors. Presenting Author: Lawson Eng, Princess Margaret
Hospital, University of Toronto, Toronto, ON, Canada
Background: Smoking during cancer treatment negatively impacts treatment,
survival and quality of life. Lung cancer patients with a smoking
history often continue to smoke; some ex-smokers re-start after diagnosis.
Social environment impacts cessation and recidivism rates in non-cancer
patients. We assessed whether the same influences occur among lung
cancer patients. Methods: Lung cancer patients, recruited from Princess
Margaret Hospital, completed a baseline questionnaire about their demographics
and smoking history (at diagnosis). A follow-up questionnaire was
administered at a median of two years, assessing changes in smoking
habits, exposure at home/work/among friends, healthcare use, social
support and alcohol use since diagnosis. The relationship between each
variable with cessation/recidivism was analyzed. Odds ratios (OR) and 95%
confidence intervals (95% CI) were calculated. Results: 478 patients
completed both questionnaires. Of the 100 current smokers at diagnosis;
52 quit by the time of the follow-up questionnaire. Among 294 ex-smokers,
15 started to smoke after diagnosis. None of the 84 never smokers at
baseline started to smoke after diagnosis. Exposure to smoking at home was
associated with continued smoking and relapse (OR�5.1, 95% CI:
1.8–14.3, p�0.001; and OR�3.9, 95% CI: 0.8–14.4, p�0.04, respectively).
Specifically, spousal smoking was associated with both continued
smoking (OR�7.3, 95% CI: 2.4–21.7, p�2.0E-04) and recidivism
(OR�3.7, 95% CI: 0.6–16.6, p�0.08). Having more than a few friends
who smoke is associated with continued smoking (OR�3.5, 95% CI:
1.4–8.7, p�0.005) and relapse (OR�4.8, 95% CI: 1.5–15.0, p�0.004).
Not completing high school was also associated with continued smoking
(OR�3.0, 95% CI: 1.2–7.6, p�0.02). Multivariate analysis identified
spousal smoking as the major single predictor of continued smoking
(OR�8.8, 95% CI: 2.2–34.8, p�0.002). Conclusions: Smoking cessation
programs for lung cancer patients should not only target the patient but
also include the immediate family, consider a patient’s peers and be
tailored to the patient’s education level. Involvement of the immediate
family and consideration of peers may help prevent smoking relapse.
9034 Poster Discussion Session (Board #19), Mon, 1:15 PM-5:15 PM and
4:45 PM-5:45 PM
Factors associated with life expectancy (LE) < 3 months (mo) among older
adults receiving palliative chemotherapy (chemo). Presenting Author: Arti
Hurria, City of Hope, Duarte, CA
Background: Optimal treatment decision-making for older adults with
advanced cancer requires a better understanding of risk factors associated
with limited LE. Our objective was to evaluate the factors associated with
LE� 3mo among patients (pts) age � 65 who were beginning a new chemo
regimen. Methods: We conducted a secondary analysis of a multi-site cohort
study of pts �65 years receiving chemo (Hurria et al, JCO 2011). This
analysis included only pts receiving palliative chemo. Bivariate analysis
and multivariate logistic regression were utilized to identify factors associated
with LE � 3 mo including: sociodemographics, labs [hemoglobin
(Hb), albumin, liver function, creatinine clearance], and geriatric assessment
(GA) variables (functional status, social support, comorbidity, psychological,
cognitive, and nutritional status). Results: Among 290 pts (median
age 72 [range 65-91], 52% female) with advanced cancer (gastrointestinal
28%, lung 31%, breast/gyn 22%, other 19%), 13.4% died within 3 mo of
chemo initiation. In bivariate analysis, pts with LE � 3mo were more likely
(p�0.05 for each variable) to have lower albumin and Hb, unintentional
weight loss, and poorer physical function [defined as need for assistance
with instrumental activities of daily living (IADL), lower score on Medical
Outcomes Survey (MOS) Physical Health, MD-rated and patient-rated
Karnofsky performance status (KPS), and MOS Social Activity score].
Measures of functional status were highly correlated with one another and
therefore one functional status measure (in addition to measures significant
in bivariate analysis) was included in each multivariate logistic
regression. In multivariate analyses, (controlling for age, comorbidity, and
line of chemo) poorer physical function (as evaluated by need for assistance
with IADLs, MOS Physical �70, or MD-rated KPS �70) and unintentional
weight loss were independently associated with LE�3mo (p�0.05).
Conclusions: Among older pts with advanced cancer who were prescribed a
new chemo regimen for palliative intent, physical function measures (as
evaluated by geriatric assessment and MD report) and unintentional weight
loss were associated with LE � 3months.
Patient and Survivor Care
575s
9033 Poster Discussion Session (Board #18), Mon, 1:15 PM-5:15 PM and
4:45 PM-5:45 PM
Strength and endurance training in the treatment of lung cancer patients
staged IIIA/IIIB/IV. Presenting Author: Corinna C. Henke, Department of
Oncology and Hematology, Vivantes Klinikum Neukölln, Berlin, Germany
Background: This RCT tested the effect of a specially designed strength and
endurance training on the independence in activities of daily living and
quality of life in lung cancer patients staged IIIA/IIIB/IV while receiving
palliative chemotherapy. The aim was to break the vicious circle created
through the connection of physical inactivity and the worsening of symptoms
and side effects. Methods: Between August 2010 and December
2011 lung cancer patients staged IIIA/IIIB/IV with a good performance
status receiving an inpatient palliative chemotherapy treatment at the
Vivantes Hospital Neukölln/Berlin, were randomized into an intervention
and control group. The Barthel Index and the EORTC QLQ-C30/ LC13
questionnaire were used for evaluation. The Six-Minute-Walk-Test and stair
walking in combination with the Modified Borg Scale have been used to test
the patient´s endurance capacity. Furthermore muscle strength was examined.
Non-parametrical data were statistically analyzed with the Wilcoxon
and Mann-Whitney-U test. For parametric data student t- tests were used. A
significance level of p� .05 was accepted. Results: Out of 46 patients, who
signed the informed consent, 29 patients completed the trial (18�
Intervention group, 11� Control group). Significant differences between
the groups were detectable in the Barthel Index (IGmean(SD)�92.08
(15.15); CGmean�81.67 (14.98); p�.041), and in single scores of the
EORTC QLQ C-30/LC-13 questionnaire (Physical Functioning p�.025;
Haemoptysis p�.019, Pain in Arms or Shoulder p�.048, Peripheral
Neuropathy p�.050, Cognitive functioning p�.050). Significant differences
were found between the groups concerning the 6MWT, stair walking
and strength capacity (IG�CG). Additionally the level of dyspnoea decreased
significantly in the IG while performing submaximal walking
activities. Conclusions: The training program has a positive impact on the
patient´s independence in carrying out activities of daily living. Although it
does not have a significant impact on the patient´s quality of life, single
factors can be significantly improved. Moreover it has a positive effect on
the patient´s endurance and strength capacity. The dyspnoea perception is
improved.
9035 Poster Discussion Session (Board #20), Mon, 1:15 PM-5:15 PM and
4:45 PM-5:45 PM
The influence of age plus standard clinical approach with or without
comprehensive geriatric assessment (CGA) on treatment decisions in older
cancer patients: Final results. Presenting Author: Lore Decoster, Department
of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis
Brussel, Brussel, Belgium
Background: The aim of this prospective study was to examine how age and
standard clinical approach with and without CGA results determine
treatment decisions in older cancer patients (pts). Methods: This study,conducted
in 2 Belgian university hospitals, included pts � 70 years with a
malignant tumor (breast, colorectal, ovarian, lung, prostate and hematological)
if a new cancer therapy was considered. All pts underwent a uniform
CGA. Results were communicated to the treating physician. After the
treatment decision, an interview with the treating physician was performed,
using a predefined questionnaire: 1/ What would be your oncological
treatment proposal in case the pt was 55y without other comorbidity? 2/ Is
this different from your treatment proposal for this pt according to age and
standard clinical approach without CGA results? 3/ Is this different from
your treatment proposal for this pt with CGA results? Results: From October
2009 till July 2011, 937 pts were included in the study. Median age was
76y (range 70-95) and 63.5% was female. A total of 902 (96.3%)
questionnaires were completed and 56.2% of the physicians were aware of
the CGA results at treatment decision. In 381 pts (42.2%; 95%CI
39.0-45.5) age and standard clinical approach led to a different treatment
decision compared to younger pts without comorbidity. This influence was
most prominent for chemotherapy decisions: 309 patients did not receive
standard chemotherapy (reduced dose (13), less toxic regimen (163), less
toxic regimen at reduced dose (5) or no chemotherapy (128)). When the
physician was aware of the CGA, these results influenced their treatment in
6.7% (95%CI: 4.5-8.9), mostly concerning chemotherapy. In 8 pts CGA
results encouraged the treating physician to choose a more aggressive
chemotherapy regimen and in 11 pts CGA results led to a decision of
palliative care. Conclusions: Based on this prospective trial, we conclude
that physicians use adapted treatment regimens in older versus younger
pts, only based on age and standard clinical approach. CGA results change
the treatment decision in 6.7% and sometimes trigger the use of a more
aggressive treatment.
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