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P96 The impact of chemotherapy on body composition and functional status in elderly cancer patients
S52
Critical Reviews in Oncology/Hematology 72S1 (2009)
10th SIOG Meeting, October 15–17, 2009, Berlin, Germany
the European product label for DA. In both age groups (<65 and 65 years) only 17% of patients needed RBC transfusions from week 5 to the EOTP. These data support the effectiveness of DA for managing CIA in elderly patients with a variety of solid tumours. Sponsored by Amgen (Europe) GmbH.
The empowerment of patients/families in self-care is necessary to prevent and manage neutropenia in the elderly.
P93 Significant pain relief with iv ibandronate in symptomatic bone metastases
A. Luciani1 *, P.B. Jacobsen2 , M. Extermann2 , D. Marussi1 , J.A. Overcash2 , P. Foa1 , L. Balducci2 . 1 S. Paolo Hospital, Milan, Italy, 2 H. Lee Moffitt Cancer Center, Tampa, Florida, USA
F. Geurs1 *, M. Gabrovska1 , I. Dedobbeleer2 , M. Horlait3 , K. Van Mulders3 . 1 Medical oncology and geriatrics department, Regionaal Ziekenhuis Sint Maria, Halle, Belgium, 2 Urology department, Regionaal Ziekenhuis Sint Maria, Halle, Belgium, 3 Support team for palliative care, Regionaal Ziekenhuis Sint Maria, Halle, Belgium
Purpose of the study: Fatigue is the most common symptom elderly cancer patients experience during their medical history and can be the cause of functional impairment and reduced quality of life. Even patients without biochemical alterations or toxicity report some form of fatigue. Nowadays, however, it is not well established which can be the relationship between functional decline and fatigue. We performed a prospective trial with the aim to determine the impact of fatigue on functional status in elderly patients undergoing chemotherapy. Method(s): Patients aged 70 or with a metastatic solid tumor not previously treated for advanced disease, were enrolled in two centers, S. Paolo Hospital and Moffitt Cancer Center. All patients were evaluated with a comprehensive geriatric assessment that included Performance Status, ADLs, IADLs, GDS, MMSE, CIRS-G scale and index. Polypharmacy and number of comorbidities were recorded. FSI (fatigue Symptom Inventory) a 14 multidimensional items tool, was administered before starting chemotherapy and at the end of three months of treatment. Descriptive statistics were calculated at the baseline. T-test was used to compare the means (before and after treatment) in continuous data and Mc Nemar test was used for categorical data. To determine the effect of multiple covariates on functional status, explanatory variables were regressed in a multiple logistic model, against adl and Iadl dependencies. The tests were set at a 5% significant level. Results: 129 patients, 80 males (62%) and 49 females (38%) were enrolled. The most common tumors’ site were lung (29%), followed by colorectal cancer (19%), breast cancer (15%) and non-Hodgkin lymphoma (10%). Mean number of drugs was 4.03 (0−12, SD 2.72), comorbidities 2.36 (0−6, SD 1.4). Mean CIRS-G score was 3.26 (0−12, SD 2.05), mean CIRS-G index was 1.61 (0−3, SD 0.53). 64% of patients (82) were married and 26% (34) were widow/er. Two items on severity of fatigue (question 2 and 4), Interference score, two items referred to daily pattern of fatigue (question 12 and 13) and hemoglobin significantly worsen after chemotherapy (p < 0.05). Among CGA items only IADLs significantly worsen (p 0.0001). In the regression model considering fatigue as covariate, polypharmacy was the only covariate that influenced ADLs and interference score significantly impacted on IADL (p 0.001). Conclusion(s): Almost all patients report some form of fatigue as well as functional status impairment during chemotherapy. We found a causal relationship between Fatigue and functional status at least for IADLs decline. The management of fatigue symptoms can be a strategy to preserve functional independence in elderly patients.
Purpose of the study: Pain in bone metastases is usually diffuse and a selective treatment is therefore hard to find. Recent publications1−3 drew attention to the analgesic effect of loading dose of ibandronate (BONDRONAT). Method(s): Patients with painful bone metastases requiring opioid analgesics were treated with loading dose BONDRONAT (4mg/day on three subsequent days). VAS score and analgesic consumption were evaluated. 25 patients were treated from 1/2005 to 7/2009. All patients had diffuse bone metastases and severe pain (VAS > 5); initially even resistant to strong opioids. Median age 76 (range 50−86). Tumor types: prostate 5, lymphoma 2, myeloma 5, breast 5, lung 6, colon 2. VAS evaluation was done prior to bisphosphonate administration and on day 4 (24 hours after the last administration). Result(s): Median VAS dropped from 8/10 to 3/10 after administration of BONDRONAT. This effect was seen across tumor types, and also in sites of prior irradiation. There were no side effects noted, nor subsequent renal function deterioration. Conclusion(s): In symptomatic bone metastases with significant pain, refractory to standard analgesics and radiotherapy, loading dose ibandronate represents a simple and non toxic treatment to obtain significant pain relief in a very short time. Reference(s) [1] Mancini I, Body JJ; JCO 2004; 22; 3587- 92 [2] Heidenreich Eur J Cancer 2003; S270–273 [3] Ohlman Supportive Care Cancer 2002, 11; 396
P94 Interdisciplinary management of neutropenia in the elderly with lymphoma and breast cancer: retrospective study S. Joannette *, N. Moreau, A. Dufour, C. Prady, P. Desjardins. Centre int´egr´e de canc´erologie de la Mont´er´egie (CICM), Greenfield Park, Qu´ebec, Canada Purpose of the study: To compare the interdisciplinary clinical practice for the management of neutropenia for adherence to practice guidelines. Method(s): A retrospective review of patient records and of the Cancer Registry was conducted within two interdisciplinary oncology practices at the CICM between 2006 and 2009. Charts of patients aged 65 years or older indicating that they received chemotherapy were selected. 2 groups were included: 40 patients with breast cancer and 80 patients with lymphomas. Factors associated with neutropenia were assessed: febrile neutropenia risk, colony stimulating factor (CSF) as primary and secondary prophylaxis, maintaining chemotherapy dose intensity, dosing and formulation of CSFs, duration of therapy with CSFs, disease-specific recommendations, application of CICM neutropenia protocol and impact. Descriptive analysis. Result(s): Final analysis in course. Conclusion(s): Best practice with CSF can reduce: the risk of febrile neutropenia, the probability of hospitalization, and the unnecessary use of antibiotics. At the CICM, the interdisciplinary oncology practices promote the use of the Canadian practice guidelines. The impact of neutropenia on patients/families is not well-documented. The adherence of cancer teams to evidenced-based febrile neutropenia guidelines cannot guarantee safety without involving the patient/family in health care management.
P95 The impact of fatigue on functional status in elderly cancer patients undergoing chemotherapy
P96 The impact of chemotherapy on body composition and functional status in elderly cancer patients A. Luciani1 *, G. Ascione1 , C. Bertuzzi1 , G. Di Maria1 , G. Colloca2 , S. Zonato1 , D. Ferrari1 , P. Foa1 . 1 Department of Medical Oncology: S. Paolo Hospital, Milan, Italy, 2 Department of Gerontology, Geriatrics and Psychiatry; Catholic University of the Sacred Heart, Rome, Italy Purpose of the study: Chemotherapy produces many significant changes in elderly cancer patients. These include decline in functional status, body changes and reduced quality of life. The impairment in quality of life can produce loss of independent life, need of assistance and premature end of treatment with adverse outcome. We explored the effect of chemotherapy on body composition and the impact on functional status. Method(s): Patients aged 70 or with a metastatic solid tumor not previously treated for advanced disease, were enrolled. All patients were evaluated by a Comprehensive Geriatric Assessment that included Performance Status, ADLs, IADLs, GDS, MMSE, CIRS-G scale and index. Polypharmacy and number of comorbidities were recorded. was administered to
Proffered papers, Posters explore any fatigue symptoms. To evaluate the body composition all patients were examined by DEXA scan. Descriptive statistics were calculated at the baseline. T-test was used to compare the means (before and after treatment) in continuous data and Mc Nemar test was used for categorical data. To determine the effect of multiple covariates on functional status, explanatory variables were regressed in a multiple logistic model, against ADL and IADL dependencies. The tests were set at a 5% significant level. Results: 97 patients, 28 females (29%) and 69 males (71%) were enrolled. Mean age 75 (70−89, SD 3.8) The most common tumors’ site were lung (46%), followed by colorectal cancer (16%), breast cancer (6. Mean number of drugs was 3.6 (0−12, SD 2.5), comorbidities 2.36 (0−6, SD 1.4). Mean CIRS-G score was 3.1 (0−12, SD 2.2), mean CIRS-G index was 1.6 (0−2, SD 0.6). 49% of patients (48) had a spouse as caregiver and 31% (30) their son/daughter. 85% of patients had PS 0−1. ADL impairment was recorded in 37/97 patients (38%) and IADL impariments were found in 42 (43%). During treatment the items that significantly changed were IADL, Appendicular Skeletal Mass (ASM) and femoral body mass density (BMD). In the regression model IADL were influenced significantly by CIRS-G score (p 0.039) while ADL were influenced by ASM (marker of sarcopenia) and CIRS-G score. Conclusion(s): Chemotherapy in our series produces a significant reduction in body mass and femoral bone density. Body mass as well as comorbidity index influence significantly functional status. Specific efforts should be done to maintain or improve physical training in patients under chemotherapy in order to limit functional decline. P97 Bevacizumab-induced hypertension in 70 years-old patients with metastatic solid tumors O. Mir1,2 *, V. Montheil1 , S. Ropert1 , I. Martin1 , R. Coriat1 , J.P. Durand1 , J. Alexandre1 , F. Goldwasser1 . 1 Department of Medical Oncology, University Paris Descartes, AP-HP, Teaching Hospital Cochin, Paris, France, 2 Clinical Research Unit, University Paris Descartes, AP-HP, Teaching Hospital Cochin, Paris, France Purpose of the study: Hypertension is a common toxicity of bevacizumab that may cause significant morbidity, but the optimal frequency of blood pressure measurements and standardized grading remain to define. The aim of this study was to describe the incidence of bevacizumab-induced hypertension, and to retrospectively assess its relation with activity in this cohort of 70 years-old patients. Method(s): Thirty-four patients with stage IV NSCLC (n = 12), colorectal cancer (n = 15) or ovarian cancer (n = 7) receiving bevacizumab (dose intensity: 2.5 mg/kg/week) and platinum-based chemotherapy were eligible for this analysis. Ten patients (29%) had a past history of hypertension controlled by mono- or bi-therapy (n = 8 and n = 2, respectively). Blood pressure was measured at home twice daily according to international guidelines, prospectively recorded, and graded according to the NCICTC v3.0 and the European Society of Hypertension (ESH) criteria. Tumor evaluation was performed every 4 cycles of treatment, or before if clinically indicated, according to WHO criteria. Result(s): Home measurements detected significantly more cases of hypertension that on-clinic measurements did, according to the ESH criteria (56% vs. 26%, p = 0.03) or the NCI-CTC v3.0 (47% vs. 21%, p = 0.04). Very early hypertension (i.e. occurring within 42 days of treatment, graded according to the ESH criteria) but not hypertension (occurring at any time during treatment period) was predictive of response to bevacizumab-based treatment at first evaluation, irrespectively to tumor type (p = 0.04). Conclusion(s): Our data indicate that twice-daily home-based measurement and grading according to the ESH criteria are a reliable method to detect bevacizumab-induced hypertension in elderly patients. Moreover, although this study was limited by its small size, it appears that very early hypertension (occurring within 42 days of treatment) rather than hypertension might represent a surrogate marker of bevacizumab activity that deserves validation in a prospective study.
S53
Psychosocial issues P98 Depression and quality of life among postmenopausal patients with metastatic breast cancer in program of palliative cancer care: a prospective and cross-sectional study L. Slovacek1,2 , B. Slovackova3 , P. Priester1 *, I. Slanska1 , J. Petera1 . 1 Charles University Hospital and Faculty of Medicine, Department of Clinical Oncology and Radiation Therapy, Hradec Kralove, Czech Republic, 2 Faculty of Military Health Sciences, Department of Field Internal Medicine, Hradec Kralove, Czech Republic, 3 Charles University Hospital and Faculty of Medicine, Department of Psychiatry, Hradec Kralove, Czech Republic Purposes of the study: Depression is seen in many cancer patients. It occurs in approximately 25% of palliative care patients. The quality of life term contains the information on an individual’s physical, psychological, social and spiritual condition. The study is evaluated incidence and relevance of depression and level of quality of life (QoL) among postmenopausal patients with metastatic breast cancer in programme of palliative cancer care. Methods: This study was local, prospective and cross-sectional. It was carried at Department of Clinical Oncology and Radiation Therapy of Charles University Hospital in Hradec Kr´alov´e, Czech Republic. Dates were obtained during year 2008 among 41 postmenopausal patients with metastatic breast cancer in programme of palliative cancer care. The mean age for all 41 subjects was 58 years old (aged 41−80 years old). The Czech version of Zung self-rating depression scale was perfomed for evaluation of depression. The Czech version of generic EuroQol Questionnaire EQ5D was performed for evaluation of level of QoL. Results: The statistical evaluation presents that mean ZSDS (Zung selfrating depression score) certifies the presence of signs of moderately depression among postmenopausal patients with metastatic breast cancer (ZSDS range was 60−69). The mean ZSDS in all subjects was 60.6. The mean ZSDS in group of healthy females was 38.9 (normal range of ZSDS). The incidence of depression was 61% (25 of all 41 subjects). The relevance of depression is characterized: severely depressed was proved in 5 of all 25 subjects, the moderately depressed in 10 subjects of all 25 subjects and mildly depressed in 10 of all 25 subjects. The statistical evaluation not presents statistically significant dependence of ZSDS on age, number of associated diseases and type of palliative cancer care. The QoL among postmenopausal patients with metastatic breast cancer is on very low level. The mean EQ-5D score (dimension of QoL) was 55%. The mean EQ-5D VAS (subjective health condition) was 59.2%. The mean EQ5D score in group of healthy females was 78.4% and the mean EQ-5D VAS was 85% (both QoL parameters show very good of QoL level). The statistical evaluation not presents statistically significant dependence of EQ-5D score and EQ-5D VAS on age, number of associated diseases and type of palliative cancer care. Conclusions: The results had shown that subsist clear association between metastatic breast cancer and depression. Also, the results had shown that subsist low level of QoL of patients with metastatic breast cancer. Supported by the Research Project of the Ministry of Defense of the Czech Republic No. 0FVZ0000503 and the Research Project of the Ministry of Health of the Czech Republic No. 00179906. P99 Therapeutic decisions in oncology during Alzheimer’s disease S. Moulias *, T. Cudennec, L. Teillet. Unit´e de Court s´ejour g´eriatrique, CHU A. Par´e, Boulogne, France Purpose of the study: Numerous patients presenting both an Alzheimer’s disease and a cancer do not gain at present from curative treatment, nor even from symptomatic treatment, because of their neurological chronic disease. What are the criteria of decision of a chemotherapy at a patient presenting an Alzheimer’s disease and a cancer? This reflection require an update of current bias and a priori to each of the decision-makers of the treatment.
Critical Reviews in Oncology/Hematology 72S1 (2009)
10th SIOG Meeting, October 15–17, 2009, Berlin, Germany
the European product label for DA. In both age groups (<65 and 65 years) only 17% of patients needed RBC transfusions from week 5 to the EOTP. These data support the effectiveness of DA for managing CIA in elderly patients with a variety of solid tumours. Sponsored by Amgen (Europe) GmbH.
The empowerment of patients/families in self-care is necessary to prevent and manage neutropenia in the elderly.
P93 Significant pain relief with iv ibandronate in symptomatic bone metastases
A. Luciani1 *, P.B. Jacobsen2 , M. Extermann2 , D. Marussi1 , J.A. Overcash2 , P. Foa1 , L. Balducci2 . 1 S. Paolo Hospital, Milan, Italy, 2 H. Lee Moffitt Cancer Center, Tampa, Florida, USA
F. Geurs1 *, M. Gabrovska1 , I. Dedobbeleer2 , M. Horlait3 , K. Van Mulders3 . 1 Medical oncology and geriatrics department, Regionaal Ziekenhuis Sint Maria, Halle, Belgium, 2 Urology department, Regionaal Ziekenhuis Sint Maria, Halle, Belgium, 3 Support team for palliative care, Regionaal Ziekenhuis Sint Maria, Halle, Belgium
Purpose of the study: Fatigue is the most common symptom elderly cancer patients experience during their medical history and can be the cause of functional impairment and reduced quality of life. Even patients without biochemical alterations or toxicity report some form of fatigue. Nowadays, however, it is not well established which can be the relationship between functional decline and fatigue. We performed a prospective trial with the aim to determine the impact of fatigue on functional status in elderly patients undergoing chemotherapy. Method(s): Patients aged 70 or with a metastatic solid tumor not previously treated for advanced disease, were enrolled in two centers, S. Paolo Hospital and Moffitt Cancer Center. All patients were evaluated with a comprehensive geriatric assessment that included Performance Status, ADLs, IADLs, GDS, MMSE, CIRS-G scale and index. Polypharmacy and number of comorbidities were recorded. FSI (fatigue Symptom Inventory) a 14 multidimensional items tool, was administered before starting chemotherapy and at the end of three months of treatment. Descriptive statistics were calculated at the baseline. T-test was used to compare the means (before and after treatment) in continuous data and Mc Nemar test was used for categorical data. To determine the effect of multiple covariates on functional status, explanatory variables were regressed in a multiple logistic model, against adl and Iadl dependencies. The tests were set at a 5% significant level. Results: 129 patients, 80 males (62%) and 49 females (38%) were enrolled. The most common tumors’ site were lung (29%), followed by colorectal cancer (19%), breast cancer (15%) and non-Hodgkin lymphoma (10%). Mean number of drugs was 4.03 (0−12, SD 2.72), comorbidities 2.36 (0−6, SD 1.4). Mean CIRS-G score was 3.26 (0−12, SD 2.05), mean CIRS-G index was 1.61 (0−3, SD 0.53). 64% of patients (82) were married and 26% (34) were widow/er. Two items on severity of fatigue (question 2 and 4), Interference score, two items referred to daily pattern of fatigue (question 12 and 13) and hemoglobin significantly worsen after chemotherapy (p < 0.05). Among CGA items only IADLs significantly worsen (p 0.0001). In the regression model considering fatigue as covariate, polypharmacy was the only covariate that influenced ADLs and interference score significantly impacted on IADL (p 0.001). Conclusion(s): Almost all patients report some form of fatigue as well as functional status impairment during chemotherapy. We found a causal relationship between Fatigue and functional status at least for IADLs decline. The management of fatigue symptoms can be a strategy to preserve functional independence in elderly patients.
Purpose of the study: Pain in bone metastases is usually diffuse and a selective treatment is therefore hard to find. Recent publications1−3 drew attention to the analgesic effect of loading dose of ibandronate (BONDRONAT). Method(s): Patients with painful bone metastases requiring opioid analgesics were treated with loading dose BONDRONAT (4mg/day on three subsequent days). VAS score and analgesic consumption were evaluated. 25 patients were treated from 1/2005 to 7/2009. All patients had diffuse bone metastases and severe pain (VAS > 5); initially even resistant to strong opioids. Median age 76 (range 50−86). Tumor types: prostate 5, lymphoma 2, myeloma 5, breast 5, lung 6, colon 2. VAS evaluation was done prior to bisphosphonate administration and on day 4 (24 hours after the last administration). Result(s): Median VAS dropped from 8/10 to 3/10 after administration of BONDRONAT. This effect was seen across tumor types, and also in sites of prior irradiation. There were no side effects noted, nor subsequent renal function deterioration. Conclusion(s): In symptomatic bone metastases with significant pain, refractory to standard analgesics and radiotherapy, loading dose ibandronate represents a simple and non toxic treatment to obtain significant pain relief in a very short time. Reference(s) [1] Mancini I, Body JJ; JCO 2004; 22; 3587- 92 [2] Heidenreich Eur J Cancer 2003; S270–273 [3] Ohlman Supportive Care Cancer 2002, 11; 396
P94 Interdisciplinary management of neutropenia in the elderly with lymphoma and breast cancer: retrospective study S. Joannette *, N. Moreau, A. Dufour, C. Prady, P. Desjardins. Centre int´egr´e de canc´erologie de la Mont´er´egie (CICM), Greenfield Park, Qu´ebec, Canada Purpose of the study: To compare the interdisciplinary clinical practice for the management of neutropenia for adherence to practice guidelines. Method(s): A retrospective review of patient records and of the Cancer Registry was conducted within two interdisciplinary oncology practices at the CICM between 2006 and 2009. Charts of patients aged 65 years or older indicating that they received chemotherapy were selected. 2 groups were included: 40 patients with breast cancer and 80 patients with lymphomas. Factors associated with neutropenia were assessed: febrile neutropenia risk, colony stimulating factor (CSF) as primary and secondary prophylaxis, maintaining chemotherapy dose intensity, dosing and formulation of CSFs, duration of therapy with CSFs, disease-specific recommendations, application of CICM neutropenia protocol and impact. Descriptive analysis. Result(s): Final analysis in course. Conclusion(s): Best practice with CSF can reduce: the risk of febrile neutropenia, the probability of hospitalization, and the unnecessary use of antibiotics. At the CICM, the interdisciplinary oncology practices promote the use of the Canadian practice guidelines. The impact of neutropenia on patients/families is not well-documented. The adherence of cancer teams to evidenced-based febrile neutropenia guidelines cannot guarantee safety without involving the patient/family in health care management.
P95 The impact of fatigue on functional status in elderly cancer patients undergoing chemotherapy
P96 The impact of chemotherapy on body composition and functional status in elderly cancer patients A. Luciani1 *, G. Ascione1 , C. Bertuzzi1 , G. Di Maria1 , G. Colloca2 , S. Zonato1 , D. Ferrari1 , P. Foa1 . 1 Department of Medical Oncology: S. Paolo Hospital, Milan, Italy, 2 Department of Gerontology, Geriatrics and Psychiatry; Catholic University of the Sacred Heart, Rome, Italy Purpose of the study: Chemotherapy produces many significant changes in elderly cancer patients. These include decline in functional status, body changes and reduced quality of life. The impairment in quality of life can produce loss of independent life, need of assistance and premature end of treatment with adverse outcome. We explored the effect of chemotherapy on body composition and the impact on functional status. Method(s): Patients aged 70 or with a metastatic solid tumor not previously treated for advanced disease, were enrolled. All patients were evaluated by a Comprehensive Geriatric Assessment that included Performance Status, ADLs, IADLs, GDS, MMSE, CIRS-G scale and index. Polypharmacy and number of comorbidities were recorded. was administered to
Proffered papers, Posters explore any fatigue symptoms. To evaluate the body composition all patients were examined by DEXA scan. Descriptive statistics were calculated at the baseline. T-test was used to compare the means (before and after treatment) in continuous data and Mc Nemar test was used for categorical data. To determine the effect of multiple covariates on functional status, explanatory variables were regressed in a multiple logistic model, against ADL and IADL dependencies. The tests were set at a 5% significant level. Results: 97 patients, 28 females (29%) and 69 males (71%) were enrolled. Mean age 75 (70−89, SD 3.8) The most common tumors’ site were lung (46%), followed by colorectal cancer (16%), breast cancer (6. Mean number of drugs was 3.6 (0−12, SD 2.5), comorbidities 2.36 (0−6, SD 1.4). Mean CIRS-G score was 3.1 (0−12, SD 2.2), mean CIRS-G index was 1.6 (0−2, SD 0.6). 49% of patients (48) had a spouse as caregiver and 31% (30) their son/daughter. 85% of patients had PS 0−1. ADL impairment was recorded in 37/97 patients (38%) and IADL impariments were found in 42 (43%). During treatment the items that significantly changed were IADL, Appendicular Skeletal Mass (ASM) and femoral body mass density (BMD). In the regression model IADL were influenced significantly by CIRS-G score (p 0.039) while ADL were influenced by ASM (marker of sarcopenia) and CIRS-G score. Conclusion(s): Chemotherapy in our series produces a significant reduction in body mass and femoral bone density. Body mass as well as comorbidity index influence significantly functional status. Specific efforts should be done to maintain or improve physical training in patients under chemotherapy in order to limit functional decline. P97 Bevacizumab-induced hypertension in 70 years-old patients with metastatic solid tumors O. Mir1,2 *, V. Montheil1 , S. Ropert1 , I. Martin1 , R. Coriat1 , J.P. Durand1 , J. Alexandre1 , F. Goldwasser1 . 1 Department of Medical Oncology, University Paris Descartes, AP-HP, Teaching Hospital Cochin, Paris, France, 2 Clinical Research Unit, University Paris Descartes, AP-HP, Teaching Hospital Cochin, Paris, France Purpose of the study: Hypertension is a common toxicity of bevacizumab that may cause significant morbidity, but the optimal frequency of blood pressure measurements and standardized grading remain to define. The aim of this study was to describe the incidence of bevacizumab-induced hypertension, and to retrospectively assess its relation with activity in this cohort of 70 years-old patients. Method(s): Thirty-four patients with stage IV NSCLC (n = 12), colorectal cancer (n = 15) or ovarian cancer (n = 7) receiving bevacizumab (dose intensity: 2.5 mg/kg/week) and platinum-based chemotherapy were eligible for this analysis. Ten patients (29%) had a past history of hypertension controlled by mono- or bi-therapy (n = 8 and n = 2, respectively). Blood pressure was measured at home twice daily according to international guidelines, prospectively recorded, and graded according to the NCICTC v3.0 and the European Society of Hypertension (ESH) criteria. Tumor evaluation was performed every 4 cycles of treatment, or before if clinically indicated, according to WHO criteria. Result(s): Home measurements detected significantly more cases of hypertension that on-clinic measurements did, according to the ESH criteria (56% vs. 26%, p = 0.03) or the NCI-CTC v3.0 (47% vs. 21%, p = 0.04). Very early hypertension (i.e. occurring within 42 days of treatment, graded according to the ESH criteria) but not hypertension (occurring at any time during treatment period) was predictive of response to bevacizumab-based treatment at first evaluation, irrespectively to tumor type (p = 0.04). Conclusion(s): Our data indicate that twice-daily home-based measurement and grading according to the ESH criteria are a reliable method to detect bevacizumab-induced hypertension in elderly patients. Moreover, although this study was limited by its small size, it appears that very early hypertension (occurring within 42 days of treatment) rather than hypertension might represent a surrogate marker of bevacizumab activity that deserves validation in a prospective study.
S53
Psychosocial issues P98 Depression and quality of life among postmenopausal patients with metastatic breast cancer in program of palliative cancer care: a prospective and cross-sectional study L. Slovacek1,2 , B. Slovackova3 , P. Priester1 *, I. Slanska1 , J. Petera1 . 1 Charles University Hospital and Faculty of Medicine, Department of Clinical Oncology and Radiation Therapy, Hradec Kralove, Czech Republic, 2 Faculty of Military Health Sciences, Department of Field Internal Medicine, Hradec Kralove, Czech Republic, 3 Charles University Hospital and Faculty of Medicine, Department of Psychiatry, Hradec Kralove, Czech Republic Purposes of the study: Depression is seen in many cancer patients. It occurs in approximately 25% of palliative care patients. The quality of life term contains the information on an individual’s physical, psychological, social and spiritual condition. The study is evaluated incidence and relevance of depression and level of quality of life (QoL) among postmenopausal patients with metastatic breast cancer in programme of palliative cancer care. Methods: This study was local, prospective and cross-sectional. It was carried at Department of Clinical Oncology and Radiation Therapy of Charles University Hospital in Hradec Kr´alov´e, Czech Republic. Dates were obtained during year 2008 among 41 postmenopausal patients with metastatic breast cancer in programme of palliative cancer care. The mean age for all 41 subjects was 58 years old (aged 41−80 years old). The Czech version of Zung self-rating depression scale was perfomed for evaluation of depression. The Czech version of generic EuroQol Questionnaire EQ5D was performed for evaluation of level of QoL. Results: The statistical evaluation presents that mean ZSDS (Zung selfrating depression score) certifies the presence of signs of moderately depression among postmenopausal patients with metastatic breast cancer (ZSDS range was 60−69). The mean ZSDS in all subjects was 60.6. The mean ZSDS in group of healthy females was 38.9 (normal range of ZSDS). The incidence of depression was 61% (25 of all 41 subjects). The relevance of depression is characterized: severely depressed was proved in 5 of all 25 subjects, the moderately depressed in 10 subjects of all 25 subjects and mildly depressed in 10 of all 25 subjects. The statistical evaluation not presents statistically significant dependence of ZSDS on age, number of associated diseases and type of palliative cancer care. The QoL among postmenopausal patients with metastatic breast cancer is on very low level. The mean EQ-5D score (dimension of QoL) was 55%. The mean EQ-5D VAS (subjective health condition) was 59.2%. The mean EQ5D score in group of healthy females was 78.4% and the mean EQ-5D VAS was 85% (both QoL parameters show very good of QoL level). The statistical evaluation not presents statistically significant dependence of EQ-5D score and EQ-5D VAS on age, number of associated diseases and type of palliative cancer care. Conclusions: The results had shown that subsist clear association between metastatic breast cancer and depression. Also, the results had shown that subsist low level of QoL of patients with metastatic breast cancer. Supported by the Research Project of the Ministry of Defense of the Czech Republic No. 0FVZ0000503 and the Research Project of the Ministry of Health of the Czech Republic No. 00179906. P99 Therapeutic decisions in oncology during Alzheimer’s disease S. Moulias *, T. Cudennec, L. Teillet. Unit´e de Court s´ejour g´eriatrique, CHU A. Par´e, Boulogne, France Purpose of the study: Numerous patients presenting both an Alzheimer’s disease and a cancer do not gain at present from curative treatment, nor even from symptomatic treatment, because of their neurological chronic disease. What are the criteria of decision of a chemotherapy at a patient presenting an Alzheimer’s disease and a cancer? This reflection require an update of current bias and a priori to each of the decision-makers of the treatment.