- Email: [email protected]
Medication problems in older newly-diagnosed cancer patients in Canada, how often does it occur?
S32
Critical Reviews in Oncology/Hematology 68 (2008)
were irrelevant. For lung cancer patients it was sometimes necessary to do a proxy interview due to health reasons. Conclusions: Cancer is predominantly a disease of older patients but this population has not been included in many studies. This pilot study shows there are many feasibility issues in conducting older cancer patients. P.12 Medication problems in older newly-diagnosed cancer patients in Canada, how often does it occur? M.T.E. Puts1 *, B. Costa Lima1 , J. Monette1,2 , V. Girre2,3 , G. Batist4 , C. Wolfson1,5 , H. Bergman1,2 . 1 Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital Montreal, 2 Division of Geriatric Medicine, Jewish General Hospital, Montreal, Canada, 3 Institut Curie, Paris, France, 4 Department of Oncology, 5 Division of Clinical Epidemiology, McGill University Health Center, Montreal, Canada Introduction: Prescribing older patients is always a challenging and complex process. Several characteristics of aging increase the risk of drug related problems and affect decision making related to prescribing medication. Patients with cancer are also at a considerable risk of drug related problems because typically, they receive a large number of medications during the cancer treatment, for the cancer itself and for supportive care. Therefore the aim of this study was to investigate the prevalence of drug related problems in older newly-diagnosed cancer patients. Methods: Newly-diagnosed cancer patients (breast, colorectal, lung or hematological malignancies lymphoma or multiple myeloma) aged 65 and over were recruited in the Segal Cancer Center of the Jewish General Hospital, McGill University in the context of a pilot study on health and vulnerability in older newly diagnosed cancer patients. The medication lists were obtained from the pharmacist of the patient. Vigilance Sant´e software was used to identify the prevalence, type and severity of drug problems. The VS software gives a profile analysis of the medications prescribed based on patient’s characteristics, such as age, body mass index and creatinine clearance. Vigilance Sant´e identifies up to 30 categories of potential drug problems, within 7 were considered relevant to our study, as follow: (1) Drug interaction; (2) Additive toxicity; (3) Duplication; (4) Atypical association; (5) Contraindication; (6) Therapeutic duplication and (7) Miscellaneous warnings. Descriptive statistics were used to examine the prevalence and type of medication problems. Results: One-hundred twelve patients participated with the baseline interview and for all patients info on medication use was collected. The mean age was 73.3 years and 78 (70%) were women. Nine patients did not take any medications at baseline; mean 5.9 drugs (SD 4.4). 53 patients had no drug problems identified (46%), mean 2 (SD 3). Interaction was the most common problem (31 patients), followed by contraindication (27 patients), additive toxicity (14 patients), therapeutic duplication (9 patients), and duplication (9 patients). However, there was only 1 patient with a drug problem severity level 1 (most severe), 48 patients had drug problems of severity level 2 (moderate) and 44 patients at drug problems of severity level 3 (least severe). Conclusion: The majority of older newly-diagnosed patients at baseline took multiple drugs. More than half of the sample had one or more drug problem identified at baseline, most of moderate severity with interaction the most common identified problem. P.13 Comprehensive Geriatric Assessment in elderly cancer outpatients in a university hospital. Differences in functional status M.J. Molina-Garrido *, C. Guill´en-Ponce, M. Guirado-Risue˜no, M.J. Molina, M.A. Molina, A. Carrato. General University Hospital in Elche, Dept of Oncology, Elche, Alicante, Spain Background: Cancer incidence increases with age. Within the European Community, approximately one million cases of cancer are diagnosed per year, of which more than 55% occur in people aged over 65 years. By the year 2020, 60% of all malignances will affect this age group. Approximately 50–75% of elderly patients are expected to be in need of comprehensive, psychosocial and physical support. Since the early 1990s, oncologists and geriatricians have begun to work together to
Abstracts integrate principles of geriatrics into oncology care, for instance by using a comprehensive geriatric assessment (CGA). CGA identifies many of the existing problems in older people with cancer and may improve the prognosis for these patients and predict morbidity and mortality. We have tested the performance of CGA and the relationship between ECOG and ADL and IADL in cancer outpatients in the University Hospital in Elche. Methods: Between June 2006 and June 2008, a total of 88 oncologic patients older than 72 years were approached to enrol in our study to analyze their functional, physical, mental, nutritional and pharmacotherapeutic state. They were analysed ECOG, Activities of Daily Living (ADL) measured by Barthel Scale, Instrumental Activities of Daily Living (IADL) measured by Lawton-Brody Scale, cognitive evaluation measured by Pfeiffer Test, risk of malnutrition measured by Nutritional Screening Initiative test, number of geriatric syndromes, and medication intake. A Chi Squared test was used for analysing relationship between ECOG score and ADL and IADL; p-value <0.05 was considered significant. Results: Median age was 82.10 years (range 72.11 to 95.98). 53.4% were female. Gynaecological cancer (36.4%), digestive tract tumors (17%) and lung cancer (15.9%) were the most frequent kind of tumors. 45 patients (52.3%) were aged between 72 and 82 years old. These 88 elderly cancer patients presented with not good functional status as measured by the ADL scale (37.9% were independent), IADL (27.1% were independent). Conversely, 57.5% of them had a ECOG lower then 2, 72.8% of the patients presented with good mental status as measured by the Pfeiffer test and 51.9% of patients had no risk of malnutrition. 56.1% of patients had geriatric syndromes and 58.5% took more than 4 medications. 83.8% of patients with ECOG 2–4 were dependent in ADL and 85.7% of patients with ECOG 2–4 were dependent in IADL. There was statistic significative association between ECOG and Barthel Scale (p = 0.000) and LawtonBrody (p = 0.020). Conclusions: This abstract reviews the findings regarding a comprehensive geriatric assessment (CGA) in older oncologic outpatients. Most of them were dependent in ADL (62.1%) or IADL (82.9%) measured by Barthel or Lawton-Brody Scale, but had good functional status measured by ECOG (57.5%). Conversely, there was significative association between these scales. The mental status was very good and the risk of malnutrition was intermediate. Most of then had geriatric syndromes and had high medication intake. P.14 Prospective nutritional survey of older patients receiving heavy treatment for malignant hemopathies M. Cserg¨o, P. Crombez, C. Sti´evenart, M.F. Jaivenois, F. Schauwaers, M. Paesmans, L. Plat, N. Meuleman, D. Bron. Department of hematology, Institut J. Bordet, ULB, Brussels, Belgium Introduction: Several studies have demonstrated the importance of weight loss as a prognostic factor for survival in patients with cancer. However limited information is available in older cancer patients heavily treated by chemotherapy with a curative intent. Objectives: To further evaluate the nutritional status before and during chemotherapy in older patients (>60 yo) compared to younger patients. Population and methods: Between 2005 and 2008, 72 hematological patients were admitted in our department for heavy treatment (autoand allogeneic stem cell transplantation, chemotherapy for leukemia) and prospectively followed by a dietetician. The nutritional screening is done using the classical tools: BMI, % loss of weight, minimal nutritional assessment (MNA), geriatric nutritional risk index (GNRI), pre-albumin level before treatment and 1 to 3 times a week during hospitalisation. Results: Among 72 patients with severe malignant hemopathies, 21 were above 60 years old (up to 79 yo). The most frequent underlying diseases were acute myeloid leukemia (AML) (15 patients) and multiple myeloma (MM) (4 patients). One patient had chronic lymphocytic leukemia and one patient had lymphoma. Loss of weight was more important in older patients treated by high dose melphalan and autologous stem cell transplantation for MM (6%) or treated by chemotherapy for AML (7%). At admission pre-albumin was lower in the older population (0.15 g/l) versus 0.18 g/l within the total population.
Critical Reviews in Oncology/Hematology 68 (2008)
were irrelevant. For lung cancer patients it was sometimes necessary to do a proxy interview due to health reasons. Conclusions: Cancer is predominantly a disease of older patients but this population has not been included in many studies. This pilot study shows there are many feasibility issues in conducting older cancer patients. P.12 Medication problems in older newly-diagnosed cancer patients in Canada, how often does it occur? M.T.E. Puts1 *, B. Costa Lima1 , J. Monette1,2 , V. Girre2,3 , G. Batist4 , C. Wolfson1,5 , H. Bergman1,2 . 1 Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital Montreal, 2 Division of Geriatric Medicine, Jewish General Hospital, Montreal, Canada, 3 Institut Curie, Paris, France, 4 Department of Oncology, 5 Division of Clinical Epidemiology, McGill University Health Center, Montreal, Canada Introduction: Prescribing older patients is always a challenging and complex process. Several characteristics of aging increase the risk of drug related problems and affect decision making related to prescribing medication. Patients with cancer are also at a considerable risk of drug related problems because typically, they receive a large number of medications during the cancer treatment, for the cancer itself and for supportive care. Therefore the aim of this study was to investigate the prevalence of drug related problems in older newly-diagnosed cancer patients. Methods: Newly-diagnosed cancer patients (breast, colorectal, lung or hematological malignancies lymphoma or multiple myeloma) aged 65 and over were recruited in the Segal Cancer Center of the Jewish General Hospital, McGill University in the context of a pilot study on health and vulnerability in older newly diagnosed cancer patients. The medication lists were obtained from the pharmacist of the patient. Vigilance Sant´e software was used to identify the prevalence, type and severity of drug problems. The VS software gives a profile analysis of the medications prescribed based on patient’s characteristics, such as age, body mass index and creatinine clearance. Vigilance Sant´e identifies up to 30 categories of potential drug problems, within 7 were considered relevant to our study, as follow: (1) Drug interaction; (2) Additive toxicity; (3) Duplication; (4) Atypical association; (5) Contraindication; (6) Therapeutic duplication and (7) Miscellaneous warnings. Descriptive statistics were used to examine the prevalence and type of medication problems. Results: One-hundred twelve patients participated with the baseline interview and for all patients info on medication use was collected. The mean age was 73.3 years and 78 (70%) were women. Nine patients did not take any medications at baseline; mean 5.9 drugs (SD 4.4). 53 patients had no drug problems identified (46%), mean 2 (SD 3). Interaction was the most common problem (31 patients), followed by contraindication (27 patients), additive toxicity (14 patients), therapeutic duplication (9 patients), and duplication (9 patients). However, there was only 1 patient with a drug problem severity level 1 (most severe), 48 patients had drug problems of severity level 2 (moderate) and 44 patients at drug problems of severity level 3 (least severe). Conclusion: The majority of older newly-diagnosed patients at baseline took multiple drugs. More than half of the sample had one or more drug problem identified at baseline, most of moderate severity with interaction the most common identified problem. P.13 Comprehensive Geriatric Assessment in elderly cancer outpatients in a university hospital. Differences in functional status M.J. Molina-Garrido *, C. Guill´en-Ponce, M. Guirado-Risue˜no, M.J. Molina, M.A. Molina, A. Carrato. General University Hospital in Elche, Dept of Oncology, Elche, Alicante, Spain Background: Cancer incidence increases with age. Within the European Community, approximately one million cases of cancer are diagnosed per year, of which more than 55% occur in people aged over 65 years. By the year 2020, 60% of all malignances will affect this age group. Approximately 50–75% of elderly patients are expected to be in need of comprehensive, psychosocial and physical support. Since the early 1990s, oncologists and geriatricians have begun to work together to
Abstracts integrate principles of geriatrics into oncology care, for instance by using a comprehensive geriatric assessment (CGA). CGA identifies many of the existing problems in older people with cancer and may improve the prognosis for these patients and predict morbidity and mortality. We have tested the performance of CGA and the relationship between ECOG and ADL and IADL in cancer outpatients in the University Hospital in Elche. Methods: Between June 2006 and June 2008, a total of 88 oncologic patients older than 72 years were approached to enrol in our study to analyze their functional, physical, mental, nutritional and pharmacotherapeutic state. They were analysed ECOG, Activities of Daily Living (ADL) measured by Barthel Scale, Instrumental Activities of Daily Living (IADL) measured by Lawton-Brody Scale, cognitive evaluation measured by Pfeiffer Test, risk of malnutrition measured by Nutritional Screening Initiative test, number of geriatric syndromes, and medication intake. A Chi Squared test was used for analysing relationship between ECOG score and ADL and IADL; p-value <0.05 was considered significant. Results: Median age was 82.10 years (range 72.11 to 95.98). 53.4% were female. Gynaecological cancer (36.4%), digestive tract tumors (17%) and lung cancer (15.9%) were the most frequent kind of tumors. 45 patients (52.3%) were aged between 72 and 82 years old. These 88 elderly cancer patients presented with not good functional status as measured by the ADL scale (37.9% were independent), IADL (27.1% were independent). Conversely, 57.5% of them had a ECOG lower then 2, 72.8% of the patients presented with good mental status as measured by the Pfeiffer test and 51.9% of patients had no risk of malnutrition. 56.1% of patients had geriatric syndromes and 58.5% took more than 4 medications. 83.8% of patients with ECOG 2–4 were dependent in ADL and 85.7% of patients with ECOG 2–4 were dependent in IADL. There was statistic significative association between ECOG and Barthel Scale (p = 0.000) and LawtonBrody (p = 0.020). Conclusions: This abstract reviews the findings regarding a comprehensive geriatric assessment (CGA) in older oncologic outpatients. Most of them were dependent in ADL (62.1%) or IADL (82.9%) measured by Barthel or Lawton-Brody Scale, but had good functional status measured by ECOG (57.5%). Conversely, there was significative association between these scales. The mental status was very good and the risk of malnutrition was intermediate. Most of then had geriatric syndromes and had high medication intake. P.14 Prospective nutritional survey of older patients receiving heavy treatment for malignant hemopathies M. Cserg¨o, P. Crombez, C. Sti´evenart, M.F. Jaivenois, F. Schauwaers, M. Paesmans, L. Plat, N. Meuleman, D. Bron. Department of hematology, Institut J. Bordet, ULB, Brussels, Belgium Introduction: Several studies have demonstrated the importance of weight loss as a prognostic factor for survival in patients with cancer. However limited information is available in older cancer patients heavily treated by chemotherapy with a curative intent. Objectives: To further evaluate the nutritional status before and during chemotherapy in older patients (>60 yo) compared to younger patients. Population and methods: Between 2005 and 2008, 72 hematological patients were admitted in our department for heavy treatment (autoand allogeneic stem cell transplantation, chemotherapy for leukemia) and prospectively followed by a dietetician. The nutritional screening is done using the classical tools: BMI, % loss of weight, minimal nutritional assessment (MNA), geriatric nutritional risk index (GNRI), pre-albumin level before treatment and 1 to 3 times a week during hospitalisation. Results: Among 72 patients with severe malignant hemopathies, 21 were above 60 years old (up to 79 yo). The most frequent underlying diseases were acute myeloid leukemia (AML) (15 patients) and multiple myeloma (MM) (4 patients). One patient had chronic lymphocytic leukemia and one patient had lymphoma. Loss of weight was more important in older patients treated by high dose melphalan and autologous stem cell transplantation for MM (6%) or treated by chemotherapy for AML (7%). At admission pre-albumin was lower in the older population (0.15 g/l) versus 0.18 g/l within the total population.