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