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

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9032 Poster Discussion Session (Board #16), Mon, 1:15 PM-5:15 PM and<br />

4:45 PM-5:45 PM<br />

Social environment as a predictor <strong>of</strong> smoking cessation and recidivism in<br />

lung cancer survivors. Presenting Author: Lawson Eng, Princess Margaret<br />

Hospital, University <strong>of</strong> Toronto, Toronto, ON, Canada<br />

Background: Smoking during cancer treatment negatively impacts treatment,<br />

survival and quality <strong>of</strong> life. Lung cancer patients with a smoking<br />

history <strong>of</strong>ten continue to smoke; some ex-smokers re-start after diagnosis.<br />

Social environment impacts cessation and recidivism rates in non-cancer<br />

patients. We assessed whether the same influences occur among lung<br />

cancer patients. Methods: Lung cancer patients, recruited from Princess<br />

Margaret Hospital, completed a baseline questionnaire about their demographics<br />

and smoking history (at diagnosis). A follow-up questionnaire was<br />

administered at a median <strong>of</strong> two years, assessing changes in smoking<br />

habits, exposure at home/work/among friends, healthcare use, social<br />

support and alcohol use since diagnosis. The relationship between each<br />

variable with cessation/recidivism was analyzed. Odds ratios (OR) and 95%<br />

confidence intervals (95% CI) were calculated. Results: 478 patients<br />

completed both questionnaires. Of the 100 current smokers at diagnosis;<br />

52 quit by the time <strong>of</strong> the follow-up questionnaire. Among 294 ex-smokers,<br />

15 started to smoke after diagnosis. None <strong>of</strong> the 84 never smokers at<br />

baseline started to smoke after diagnosis. Exposure to smoking at home was<br />

associated with continued smoking and relapse (OR�5.1, 95% CI:<br />

1.8–14.3, p�0.001; and OR�3.9, 95% CI: 0.8–14.4, p�0.04, respectively).<br />

Specifically, spousal smoking was associated with both continued<br />

smoking (OR�7.3, 95% CI: 2.4–21.7, p�2.0E-04) and recidivism<br />

(OR�3.7, 95% CI: 0.6–16.6, p�0.08). Having more than a few friends<br />

who smoke is associated with continued smoking (OR�3.5, 95% CI:<br />

1.4–8.7, p�0.005) and relapse (OR�4.8, 95% CI: 1.5–15.0, p�0.004).<br />

Not completing high school was also associated with continued smoking<br />

(OR�3.0, 95% CI: 1.2–7.6, p�0.02). Multivariate analysis identified<br />

spousal smoking as the major single predictor <strong>of</strong> continued smoking<br />

(OR�8.8, 95% CI: 2.2–34.8, p�0.002). Conclusions: Smoking cessation<br />

programs for lung cancer patients should not only target the patient but<br />

also include the immediate family, consider a patient’s peers and be<br />

tailored to the patient’s education level. Involvement <strong>of</strong> the immediate<br />

family and consideration <strong>of</strong> peers may help prevent smoking relapse.<br />

9034 Poster Discussion Session (Board #19), Mon, 1:15 PM-5:15 PM and<br />

4:45 PM-5:45 PM<br />

Factors associated with life expectancy (LE) < 3 months (mo) among older<br />

adults receiving palliative chemotherapy (chemo). Presenting Author: Arti<br />

Hurria, City <strong>of</strong> Hope, Duarte, CA<br />

Background: Optimal treatment decision-making for older adults with<br />

advanced cancer requires a better understanding <strong>of</strong> risk factors associated<br />

with limited LE. Our objective was to evaluate the factors associated with<br />

LE� 3mo among patients (pts) age � 65 who were beginning a new chemo<br />

regimen. Methods: We conducted a secondary analysis <strong>of</strong> a multi-site cohort<br />

study <strong>of</strong> pts �65 years receiving chemo (Hurria et al, JCO 2011). This<br />

analysis included only pts receiving palliative chemo. Bivariate analysis<br />

and multivariate logistic regression were utilized to identify factors associated<br />

with LE � 3 mo including: sociodemographics, labs [hemoglobin<br />

(Hb), albumin, liver function, creatinine clearance], and geriatric assessment<br />

(GA) variables (functional status, social support, comorbidity, psychological,<br />

cognitive, and nutritional status). Results: Among 290 pts (median<br />

age 72 [range 65-91], 52% female) with advanced cancer (gastrointestinal<br />

28%, lung 31%, breast/gyn 22%, other 19%), 13.4% died within 3 mo <strong>of</strong><br />

chemo initiation. In bivariate analysis, pts with LE � 3mo were more likely<br />

(p�0.05 for each variable) to have lower albumin and Hb, unintentional<br />

weight loss, and poorer physical function [defined as need for assistance<br />

with instrumental activities <strong>of</strong> daily living (IADL), lower score on Medical<br />

Outcomes Survey (MOS) Physical Health, MD-rated and patient-rated<br />

Karn<strong>of</strong>sky performance status (KPS), and MOS Social Activity score].<br />

Measures <strong>of</strong> functional status were highly correlated with one another and<br />

therefore one functional status measure (in addition to measures significant<br />

in bivariate analysis) was included in each multivariate logistic<br />

regression. In multivariate analyses, (controlling for age, comorbidity, and<br />

line <strong>of</strong> chemo) poorer physical function (as evaluated by need for assistance<br />

with IADLs, MOS Physical �70, or MD-rated KPS �70) and unintentional<br />

weight loss were independently associated with LE�3mo (p�0.05).<br />

Conclusions: Among older pts with advanced cancer who were prescribed a<br />

new chemo regimen for palliative intent, physical function measures (as<br />

evaluated by geriatric assessment and MD report) and unintentional weight<br />

loss were associated with LE � 3months.<br />

Patient and Survivor Care<br />

575s<br />

9033 Poster Discussion Session (Board #18), Mon, 1:15 PM-5:15 PM and<br />

4:45 PM-5:45 PM<br />

Strength and endurance training in the treatment <strong>of</strong> lung cancer patients<br />

staged IIIA/IIIB/IV. Presenting Author: Corinna C. Henke, Department <strong>of</strong><br />

Oncology and Hematology, Vivantes Klinikum Neukölln, Berlin, Germany<br />

Background: This RCT tested the effect <strong>of</strong> a specially designed strength and<br />

endurance training on the independence in activities <strong>of</strong> daily living and<br />

quality <strong>of</strong> life in lung cancer patients staged IIIA/IIIB/IV while receiving<br />

palliative chemotherapy. The aim was to break the vicious circle created<br />

through the connection <strong>of</strong> physical inactivity and the worsening <strong>of</strong> symptoms<br />

and side effects. Methods: Between August 2010 and December<br />

2011 lung cancer patients staged IIIA/IIIB/IV with a good performance<br />

status receiving an inpatient palliative chemotherapy treatment at the<br />

Vivantes Hospital Neukölln/Berlin, were randomized into an intervention<br />

and control group. The Barthel Index and the EORTC QLQ-C30/ LC13<br />

questionnaire were used for evaluation. The Six-Minute-Walk-Test and stair<br />

walking in combination with the Modified Borg Scale have been used to test<br />

the patient´s endurance capacity. Furthermore muscle strength was examined.<br />

Non-parametrical data were statistically analyzed with the Wilcoxon<br />

and Mann-Whitney-U test. For parametric data student t- tests were used. A<br />

significance level <strong>of</strong> p� .05 was accepted. Results: Out <strong>of</strong> 46 patients, who<br />

signed the informed consent, 29 patients completed the trial (18�<br />

Intervention group, 11� Control group). Significant differences between<br />

the groups were detectable in the Barthel Index (IGmean(SD)�92.08<br />

(15.15); CGmean�81.67 (14.98); p�.041), and in single scores <strong>of</strong> the<br />

EORTC QLQ C-30/LC-13 questionnaire (Physical Functioning p�.025;<br />

Haemoptysis p�.019, Pain in Arms or Shoulder p�.048, Peripheral<br />

Neuropathy p�.050, Cognitive functioning p�.050). Significant differences<br />

were found between the groups concerning the 6MWT, stair walking<br />

and strength capacity (IG�CG). Additionally the level <strong>of</strong> dyspnoea decreased<br />

significantly in the IG while performing submaximal walking<br />

activities. Conclusions: The training program has a positive impact on the<br />

patient´s independence in carrying out activities <strong>of</strong> daily living. Although it<br />

does not have a significant impact on the patient´s quality <strong>of</strong> life, single<br />

factors can be significantly improved. Moreover it has a positive effect on<br />

the patient´s endurance and strength capacity. The dyspnoea perception is<br />

improved.<br />

9035 Poster Discussion Session (Board #20), Mon, 1:15 PM-5:15 PM and<br />

4:45 PM-5:45 PM<br />

The influence <strong>of</strong> age plus standard clinical approach with or without<br />

comprehensive geriatric assessment (CGA) on treatment decisions in older<br />

cancer patients: Final results. Presenting Author: Lore Decoster, Department<br />

<strong>of</strong> Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis<br />

Brussel, Brussel, Belgium<br />

Background: The aim <strong>of</strong> this prospective study was to examine how age and<br />

standard clinical approach with and without CGA results determine<br />

treatment decisions in older cancer patients (pts). Methods: This study,conducted<br />

in 2 Belgian university hospitals, included pts � 70 years with a<br />

malignant tumor (breast, colorectal, ovarian, lung, prostate and hematological)<br />

if a new cancer therapy was considered. All pts underwent a uniform<br />

CGA. Results were communicated to the treating physician. After the<br />

treatment decision, an interview with the treating physician was performed,<br />

using a predefined questionnaire: 1/ What would be your oncological<br />

treatment proposal in case the pt was 55y without other comorbidity? 2/ Is<br />

this different from your treatment proposal for this pt according to age and<br />

standard clinical approach without CGA results? 3/ Is this different from<br />

your treatment proposal for this pt with CGA results? Results: From October<br />

2009 till July 2011, 937 pts were included in the study. Median age was<br />

76y (range 70-95) and 63.5% was female. A total <strong>of</strong> 902 (96.3%)<br />

questionnaires were completed and 56.2% <strong>of</strong> the physicians were aware <strong>of</strong><br />

the CGA results at treatment decision. In 381 pts (42.2%; 95%CI<br />

39.0-45.5) age and standard clinical approach led to a different treatment<br />

decision compared to younger pts without comorbidity. This influence was<br />

most prominent for chemotherapy decisions: 309 patients did not receive<br />

standard chemotherapy (reduced dose (13), less toxic regimen (163), less<br />

toxic regimen at reduced dose (5) or no chemotherapy (128)). When the<br />

physician was aware <strong>of</strong> the CGA, these results influenced their treatment in<br />

6.7% (95%CI: 4.5-8.9), mostly concerning chemotherapy. In 8 pts CGA<br />

results encouraged the treating physician to choose a more aggressive<br />

chemotherapy regimen and in 11 pts CGA results led to a decision <strong>of</strong><br />

palliative care. Conclusions: Based on this prospective trial, we conclude<br />

that physicians use adapted treatment regimens in older versus younger<br />

pts, only based on age and standard clinical approach. CGA results change<br />

the treatment decision in 6.7% and sometimes trigger the use <strong>of</strong> a more<br />

aggressive treatment.<br />

Visit abstract.asco.org and search by abstract for the full list <strong>of</strong> abstract authors and their disclosure information.

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