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Patterns of care and outcomes in elderly patients with glioblastoma in Sao Paulo, Brazil: A retrospective study
J O U RN A L OF GE R IAT RI C O N COL O G Y 3 ( 2 0 12 ) S3 3 –S 10 2
References [1] Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2012; 62:10-29. [2] Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011; 61:69-90. [3] Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase III trial of trimodality therapy with cisplatin, FU, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB9781. J Clin Oncol 2008; 26:1086-1092. [4] Stahl M, Walz MK, Stuschke M, et al. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 2009; 27:851-856. [5] Urba SG, Orringer MB, Ianettonni M, et al. Concurrent cisplatin, paclitaxel, and radiotherapy as preoperative treatment for patients with locoregional esophageal carcinoma. Cancer 2003; 98:2177-2183. [6] Meluch AA, Greco FA, Gray JR, et al. Preoperative therapy with concurrent paclitaxel/carboplatin/infusional 5-FU and radiation therapy in locoregional esophageal cancer: final results of a Minnie Pearl Cancer Research Network phase II trial. Cancer J 2003; 9:251-260. [7] Ajani JA, Walsh G, Komaki R, et al. Preoperative induction of CPT11 and cisplatin chemotherapy followed by chemoradiotherapy in patients with locoregional carcinoma of the esophagus or gastroesophageal junction. Cancer 2004; 100:2347-2354. [8] Pasini F, de Manzoni G, Pedrazzani C, et al. High pathological response rate in locally advanced esophageal cancer after neoadjuvant combined modality therapy: dose finding of a weekly chemotherapy schedule with protracted venous infusion of 5flurrouracil and dose escalation of cisplatin, docetaxel and concurrent radiotherapy. Ann Oncol 2005; 16:1133-1139. [9] van Meerten E, Muller K, Tilanus HW et al. Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study. Br J Cancer 2006; 94:1389-1394. [10] Lorenzen S, Brucher B, Zimmermann F, et al. Neoadjuvant continuous infusion of weekly 5-FU and escalating doses of oxaliplatin plus concurrent radiation in locally advanced oesophageal squamous cell carcinoma: results of a phase I/II trial. Br J Cancer 2008; 99:1020-1026. [11] De Vita F, Orditura M, Martinelli E, et al. A multicenter phase II study of induction chemotherapy with FOLFOX-4 and cetuximab followed by radiation and cetuximab in locally advanced oesophageal cancer. Br J Cancer 2011; 104:427-432. [12] Scher KS, Hurria A. Under-representation of older adults in cancer registration trials: known problem, little progress. J Clin Onc. 2012; 30:2036-2038. [13] Khushalani NI, Leichman CG, Proulx G, et al. Oxaliplatin in combination with protracted-infusion FU and radiation: report of a clinical trial for patients with esophageal cancer. J Clin Oncol 2002; 20:2844-2850.
P114 Patterns of care and outcomes in elderly patients with glioblastoma in Sao Paulo, Brazil: A retrospective study L.B. Pontes1, L.V.M. Loureiro1, L.O. Koch1, T. Karnakis⁎2, R.A. Kaliks1, E. Weltman3, S.M.F. Malheiros4. 1Department of Clinical Oncology, Brazil, 2 Department of Geriatrics Oncology, Brazil, 3Department of Radiation Oncology, Brazil, 4Department of Neuro-oncology, Albert Einstein Israelit Hospital, Sao Paulo, Brazil
Purpose of the Study: Survival of elderly patients with glioblastoma (GB) is poor and the selection of the optimal treatment, which usually includes a combination of surgery and chemoradiation, is not a straightforward decision in this patient population.1 We performed a retrospective analysis of medical records from a cancer care center in Sao Paulo, Brazil, in order to gather information about how elderly patients with GB are managed. Methods: We identified 30 patients with age ≥65 years who had been treated at Albert Einstein Hospital (HIAE, in Sao Paulo, Brazil) between 2003 and 2011. The medical records and the electronic institutional databases were reviewed to obtain information about clinical variables and treatment characteristics (extent of surgery, radiotherapy and use of concurrent temozolamide) and outcomes. Estimates of overall survival were evaluated using Kaplan–Meier method and compared using a Wilcoxon log-rank test. Results: The mean age of the patients was 73 years old (range 65–83). All patients received some type of surgical intervention, with partial resection of the tumor being performed in 46.6%. Following surgery, 80% received radiotherapy (RT) with curative intent, with a dose range between 58 and 61 Gy, and among them, 63.3% were treated with concurrent temozolamide (TMZ). Records were incomplete regarding the performance status of the sample, but according to the available information, at least half of the patients had a Karnofsky performance status (KPS) N70. For all patients, the median progression free survival and overall survival (OS) were 5 and 10.6 months, respectively. Patients with a KPS N70 had a median OS of 16.2 m, compared to 6.4 m for those with a KPS b70 (p = 0.0316). According to the type of surgery, for the group in whom only biopsy was performed the median OS was 5.3 m, as compared to 7.8 m for those who underwent subtotal resection and 18.6 m for those treated with gross total resection (p = 0.0213). The same pattern was seen in patients that received RT, with a significantly longer survival among the group that received RT versus those that did not (11 m vs. 1 m, p = 0.0031), as well as for those treated with chemoradiation (14 m vs. 2.7 m, p b 0.0001). Conclusions: This study shows that elderly patients who are eligible for and undergo cytoreductive surgery and adjuvant RT with concurrent TMZ do better than those with less aggressive treatment. Although these observations could have been the result of selection bias, they do
Table 1 Patient demographics and tumor characteristics. Patient Age KPS Dysphagia Weight loss
Major co-morbidity
Location
Histology
1 2
82 82
3 2
No No
b5% N10%
Past MI, s/p PTCA; history of colon cancer Diabetes mellitus
EGJ EGJ
3
74
3
No
b5%
EGJ
4 5 6 7 8 9
59 76 59 69 68 74
0 1 2 1 1 1
No Yes Yes Yes Yes Yes
b5% 5–10% N10% b5% 5-10% b5%
Low grade lymphoma, s/p 2 lines of chemotherapy No No s/p femoral stent placement for claudication s/p prostatectomy for prostate cancer Major depression Diabetes mellitus; anemia
Adenocarcinoma Poorly differentiated adenocarcinoma with prominent signet-ring cell feature Adenocarcinoma
EGJ EGJ Esophagus EGJ Esophagus EGJ
Adenocarcinoma Adenocarcinoma Squamous cell carcinoma Poorly differentiated sqamous carcinoma Adenocarcinoma Adenocarcinoma
Abbreviation: MI: myocardial infarction. PTCA: percutaneous transluminal coronary angioplasty.
doi:10.1016/j.jgo.2012.10.114
S93
S94
J O U RN A L OF GE R IAT RI C O N COL O G Y 3 ( 2 0 12 ) S3 3 –S 10 2
suggest that elderly patients with GB should not be excluded from intensive treatment modalities based only on their chronological age. References [1] Brandes AA, Franceschi E. Primary brain tumors in the elderly population. Current treatment options in neurology 2011; 13:427-435. doi:10.1016/j.jgo.2012.10.115
P115 Safety and efficacy of electron beam radiation therapy for epithelial skin cancer in geriatric patients G. Sokol⁎1,2,3, S. McIntyre3, L. Loftus1, G. Wright3. 1Moffitt Cancer Center, Tampa, Florida, USA, 2Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA, 3Florida Cancer Specialists, Tampa, Florida, USA Purpose of the Study: Radiation therapy is a well-recognized modality of treatment for squamous and basal cell cancers of the skin. The purpose of this study was to evaluate the response rate, cosmesis, and safety of electron beam radiation therapy in geriatric patients with non-melanoma skin cancers. Methods: One hundred and two patients with 332 separate epithelial skin cancers were treated definitively with superficial electron beam spray typically utilizing 6 MeV electrons to a depth dose of 90% utilizing topically applied bolus appropriate to the depth and size of the lesion. The ratio of squamous cell carcinomas to basal cell lesions was 1:3 with a small percentage of mixed basal and squamous cell components (~ 4%). The age range extended from ages 60–99 (average age 78, median age 75). Patients were treated with varying fractionation schedules depending on size and depth of invasion from 400 cGy in 12 fractions to 5000 cGy in 25 fractions. Tumor response was evaluated weekly during treatment, monthly after treatment for 2 visits, and every 4 months thereafter indeterminately. Cosmesis was graded on a 1–4 scale with 1 representing excellent cosmesis and 4 representing poor cosmesis. Patients were evaluated for complete or partial response at each visit. 331 of the lesions were stage T1–T3. One lesion was T4. Results: One hundred and one patients and 331 separate cancers sustained a complete response. A total of 3 patients subsequently failed with recurrent cancer in the treatment site. One of those patients had deep bone invasion (T4) and 2 patients sustained a geographical marginal recurrence. Cosmesis was excellent in 85% depending on initial presentation with respect to size, previous treatment or local tissue damage. Fifteen percent of responses were considered good with no unacceptable cosmetic results. There were no RTOG long term Grade 2 or above complications from treatment. Acute side effects consisted of moist desquamation and/or scabbing which consistently healed within 4–6 weeks or sooner. Conclusions: Electron beam spray radiation results in efficacy and safety comparable to any other form of treatment without the need for surgical intervention. There is no need for discontinuation of anticoagulants and minimal need for bandaging or other post treatment support. The treatment is generally painless, consumes less than 5 min for a treatment, and requires no significant skin or wound care. The only disadvantage is the number of visits required to complete treatment ranging from 10–25 depending on the size and depth of tumor involvement. This form of treatment for epithelial skin cancer represents an excellent noninvasive treatment for geriatric subjects. Surgery, postoperative wound care, suturing, cessation of anticoagulants and antibiotics are essentially unnecessary. X-ray irradiation is unnecessary, and electron beam treatment exposes only the treated area to irradiation. doi:10.1016/j.jgo.2012.10.116
Supportive care P116 The unmet supportive care needs and symptom burden in older breast cancer survivors in Singapore K.K.F. Cheng1, W.H. Wong2, L. Ge1, P. Khalechelvam1, C. Koh2. National University of Singapore, Singapore, 2National University Cancer Institute, Singapore 1
Background and Objectives: Experiencing late symptoms/side effects associated with cancer and its treatment is noted to be one of the most important aspects impeding the transition and can lead to multiple unmet needs for older breast cancer survivors. The current paper describes the prevalence and levels of perceived unmet supportive care needs, as well as the relationships between their unmet needs and symptom burden/quality of life of older breast cancer survivors. Methods: Subjects with breast cancer aged 50 or above and completed cancer treatment to 5 years were recruited from the National University Cancer Institute in Singapore. Measuring instruments included the Supportive Care Needs Survey (SCNS-34), Memorial Symptom Assessment Scale (MSAS), and Medical Outcomes Study Short Form Health Survey version 2.0 (SF-12). Results: Among the subjects who participated in the survey, the mean age was 58.7 years (SD 5.8; range 50–74). Half were diagnosed with stage II breast cancer (50%). The mean time of last cancer treatment was 25.6 months (SD 17.4; range 1–60). Majority had undergone mastectomy (n= 66; 60%), 47 (42.7%) treated with chemo-radiotherapy, and 75 (68.2%) receiving hormonal therapy. Subjects reported the greatest unmet need in Health Care System/ Information needs (24.9 ± 13.8; score range 0–100, with higher scores representing high levels of unmet needs), followed by Patient Care Support needs (16.8± 12.0), and Psychological needs (13.0 ± 14.6). Of the ten highest frequencies of moderate-to-high unmet needs items, five were related to the Health Care System/Information domain, and four were related to the Psychological needs domain. The most prevalent reported symptoms were lack of energy (45.5%), numbness/tingling in hands/feet (44.5%), and pain (36.4%) (Table 1). The most frequent, severe and distressing symptom was numbness/tingling in hands/feet. The PSYCH and PHYS subscales, Global Distress Index (GDI), and Total MSAS scores were 0.45 ± 0.6, 0.29 ± 0.3, 0.53 ± 0.5, 0.31±0.3, respectively, (score range 0–4, with higher scores representing high subscale score). Those reporting high levels of PSYCH score reported greater unmet Psychological needs (r=0.64, pb 0.01). Significant strong correlations were noted between PHYS, GDI and TMSAS scores, and unmet Physical/Daily Living needs (r=0.74–0.76, pb 0.01). The SF-12 Physical Composite Score (PCS) and Mental Composite Score (MCS) were 49.8 ± 9.1 and 53.6 ± 10.8, respectively, (score range 0–100, with lower scores representing poor quality of life). Significant moderate negative correlation was noted between PCS score and unmet Physical/Daily Living needs (r = − 0.41, p b 0.05). The unmet Psychological needs was correlated significantly with the MCS score (r = − 0.62, p b 0.01). Conclusion: Our data suggest that older breast cancer survivors continue to experience severe and distressing physical and psychological symptoms. Also older breast cancer survivors have many unmet needs across a range of domains. Result from this study suggests that older survivors with unmet needs had poor quality of life. Hence, regular assessment of symptoms and unmet needs is essential for good cancer survivorship care.
doi:10.1016/j.jgo.2012.10.117
References [1] Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2012; 62:10-29. [2] Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011; 61:69-90. [3] Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase III trial of trimodality therapy with cisplatin, FU, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB9781. J Clin Oncol 2008; 26:1086-1092. [4] Stahl M, Walz MK, Stuschke M, et al. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 2009; 27:851-856. [5] Urba SG, Orringer MB, Ianettonni M, et al. Concurrent cisplatin, paclitaxel, and radiotherapy as preoperative treatment for patients with locoregional esophageal carcinoma. Cancer 2003; 98:2177-2183. [6] Meluch AA, Greco FA, Gray JR, et al. Preoperative therapy with concurrent paclitaxel/carboplatin/infusional 5-FU and radiation therapy in locoregional esophageal cancer: final results of a Minnie Pearl Cancer Research Network phase II trial. Cancer J 2003; 9:251-260. [7] Ajani JA, Walsh G, Komaki R, et al. Preoperative induction of CPT11 and cisplatin chemotherapy followed by chemoradiotherapy in patients with locoregional carcinoma of the esophagus or gastroesophageal junction. Cancer 2004; 100:2347-2354. [8] Pasini F, de Manzoni G, Pedrazzani C, et al. High pathological response rate in locally advanced esophageal cancer after neoadjuvant combined modality therapy: dose finding of a weekly chemotherapy schedule with protracted venous infusion of 5flurrouracil and dose escalation of cisplatin, docetaxel and concurrent radiotherapy. Ann Oncol 2005; 16:1133-1139. [9] van Meerten E, Muller K, Tilanus HW et al. Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study. Br J Cancer 2006; 94:1389-1394. [10] Lorenzen S, Brucher B, Zimmermann F, et al. Neoadjuvant continuous infusion of weekly 5-FU and escalating doses of oxaliplatin plus concurrent radiation in locally advanced oesophageal squamous cell carcinoma: results of a phase I/II trial. Br J Cancer 2008; 99:1020-1026. [11] De Vita F, Orditura M, Martinelli E, et al. A multicenter phase II study of induction chemotherapy with FOLFOX-4 and cetuximab followed by radiation and cetuximab in locally advanced oesophageal cancer. Br J Cancer 2011; 104:427-432. [12] Scher KS, Hurria A. Under-representation of older adults in cancer registration trials: known problem, little progress. J Clin Onc. 2012; 30:2036-2038. [13] Khushalani NI, Leichman CG, Proulx G, et al. Oxaliplatin in combination with protracted-infusion FU and radiation: report of a clinical trial for patients with esophageal cancer. J Clin Oncol 2002; 20:2844-2850.
P114 Patterns of care and outcomes in elderly patients with glioblastoma in Sao Paulo, Brazil: A retrospective study L.B. Pontes1, L.V.M. Loureiro1, L.O. Koch1, T. Karnakis⁎2, R.A. Kaliks1, E. Weltman3, S.M.F. Malheiros4. 1Department of Clinical Oncology, Brazil, 2 Department of Geriatrics Oncology, Brazil, 3Department of Radiation Oncology, Brazil, 4Department of Neuro-oncology, Albert Einstein Israelit Hospital, Sao Paulo, Brazil
Purpose of the Study: Survival of elderly patients with glioblastoma (GB) is poor and the selection of the optimal treatment, which usually includes a combination of surgery and chemoradiation, is not a straightforward decision in this patient population.1 We performed a retrospective analysis of medical records from a cancer care center in Sao Paulo, Brazil, in order to gather information about how elderly patients with GB are managed. Methods: We identified 30 patients with age ≥65 years who had been treated at Albert Einstein Hospital (HIAE, in Sao Paulo, Brazil) between 2003 and 2011. The medical records and the electronic institutional databases were reviewed to obtain information about clinical variables and treatment characteristics (extent of surgery, radiotherapy and use of concurrent temozolamide) and outcomes. Estimates of overall survival were evaluated using Kaplan–Meier method and compared using a Wilcoxon log-rank test. Results: The mean age of the patients was 73 years old (range 65–83). All patients received some type of surgical intervention, with partial resection of the tumor being performed in 46.6%. Following surgery, 80% received radiotherapy (RT) with curative intent, with a dose range between 58 and 61 Gy, and among them, 63.3% were treated with concurrent temozolamide (TMZ). Records were incomplete regarding the performance status of the sample, but according to the available information, at least half of the patients had a Karnofsky performance status (KPS) N70. For all patients, the median progression free survival and overall survival (OS) were 5 and 10.6 months, respectively. Patients with a KPS N70 had a median OS of 16.2 m, compared to 6.4 m for those with a KPS b70 (p = 0.0316). According to the type of surgery, for the group in whom only biopsy was performed the median OS was 5.3 m, as compared to 7.8 m for those who underwent subtotal resection and 18.6 m for those treated with gross total resection (p = 0.0213). The same pattern was seen in patients that received RT, with a significantly longer survival among the group that received RT versus those that did not (11 m vs. 1 m, p = 0.0031), as well as for those treated with chemoradiation (14 m vs. 2.7 m, p b 0.0001). Conclusions: This study shows that elderly patients who are eligible for and undergo cytoreductive surgery and adjuvant RT with concurrent TMZ do better than those with less aggressive treatment. Although these observations could have been the result of selection bias, they do
Table 1 Patient demographics and tumor characteristics. Patient Age KPS Dysphagia Weight loss
Major co-morbidity
Location
Histology
1 2
82 82
3 2
No No
b5% N10%
Past MI, s/p PTCA; history of colon cancer Diabetes mellitus
EGJ EGJ
3
74
3
No
b5%
EGJ
4 5 6 7 8 9
59 76 59 69 68 74
0 1 2 1 1 1
No Yes Yes Yes Yes Yes
b5% 5–10% N10% b5% 5-10% b5%
Low grade lymphoma, s/p 2 lines of chemotherapy No No s/p femoral stent placement for claudication s/p prostatectomy for prostate cancer Major depression Diabetes mellitus; anemia
Adenocarcinoma Poorly differentiated adenocarcinoma with prominent signet-ring cell feature Adenocarcinoma
EGJ EGJ Esophagus EGJ Esophagus EGJ
Adenocarcinoma Adenocarcinoma Squamous cell carcinoma Poorly differentiated sqamous carcinoma Adenocarcinoma Adenocarcinoma
Abbreviation: MI: myocardial infarction. PTCA: percutaneous transluminal coronary angioplasty.
doi:10.1016/j.jgo.2012.10.114
S93
S94
J O U RN A L OF GE R IAT RI C O N COL O G Y 3 ( 2 0 12 ) S3 3 –S 10 2
suggest that elderly patients with GB should not be excluded from intensive treatment modalities based only on their chronological age. References [1] Brandes AA, Franceschi E. Primary brain tumors in the elderly population. Current treatment options in neurology 2011; 13:427-435. doi:10.1016/j.jgo.2012.10.115
P115 Safety and efficacy of electron beam radiation therapy for epithelial skin cancer in geriatric patients G. Sokol⁎1,2,3, S. McIntyre3, L. Loftus1, G. Wright3. 1Moffitt Cancer Center, Tampa, Florida, USA, 2Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA, 3Florida Cancer Specialists, Tampa, Florida, USA Purpose of the Study: Radiation therapy is a well-recognized modality of treatment for squamous and basal cell cancers of the skin. The purpose of this study was to evaluate the response rate, cosmesis, and safety of electron beam radiation therapy in geriatric patients with non-melanoma skin cancers. Methods: One hundred and two patients with 332 separate epithelial skin cancers were treated definitively with superficial electron beam spray typically utilizing 6 MeV electrons to a depth dose of 90% utilizing topically applied bolus appropriate to the depth and size of the lesion. The ratio of squamous cell carcinomas to basal cell lesions was 1:3 with a small percentage of mixed basal and squamous cell components (~ 4%). The age range extended from ages 60–99 (average age 78, median age 75). Patients were treated with varying fractionation schedules depending on size and depth of invasion from 400 cGy in 12 fractions to 5000 cGy in 25 fractions. Tumor response was evaluated weekly during treatment, monthly after treatment for 2 visits, and every 4 months thereafter indeterminately. Cosmesis was graded on a 1–4 scale with 1 representing excellent cosmesis and 4 representing poor cosmesis. Patients were evaluated for complete or partial response at each visit. 331 of the lesions were stage T1–T3. One lesion was T4. Results: One hundred and one patients and 331 separate cancers sustained a complete response. A total of 3 patients subsequently failed with recurrent cancer in the treatment site. One of those patients had deep bone invasion (T4) and 2 patients sustained a geographical marginal recurrence. Cosmesis was excellent in 85% depending on initial presentation with respect to size, previous treatment or local tissue damage. Fifteen percent of responses were considered good with no unacceptable cosmetic results. There were no RTOG long term Grade 2 or above complications from treatment. Acute side effects consisted of moist desquamation and/or scabbing which consistently healed within 4–6 weeks or sooner. Conclusions: Electron beam spray radiation results in efficacy and safety comparable to any other form of treatment without the need for surgical intervention. There is no need for discontinuation of anticoagulants and minimal need for bandaging or other post treatment support. The treatment is generally painless, consumes less than 5 min for a treatment, and requires no significant skin or wound care. The only disadvantage is the number of visits required to complete treatment ranging from 10–25 depending on the size and depth of tumor involvement. This form of treatment for epithelial skin cancer represents an excellent noninvasive treatment for geriatric subjects. Surgery, postoperative wound care, suturing, cessation of anticoagulants and antibiotics are essentially unnecessary. X-ray irradiation is unnecessary, and electron beam treatment exposes only the treated area to irradiation. doi:10.1016/j.jgo.2012.10.116
Supportive care P116 The unmet supportive care needs and symptom burden in older breast cancer survivors in Singapore K.K.F. Cheng1, W.H. Wong2, L. Ge1, P. Khalechelvam1, C. Koh2. National University of Singapore, Singapore, 2National University Cancer Institute, Singapore 1
Background and Objectives: Experiencing late symptoms/side effects associated with cancer and its treatment is noted to be one of the most important aspects impeding the transition and can lead to multiple unmet needs for older breast cancer survivors. The current paper describes the prevalence and levels of perceived unmet supportive care needs, as well as the relationships between their unmet needs and symptom burden/quality of life of older breast cancer survivors. Methods: Subjects with breast cancer aged 50 or above and completed cancer treatment to 5 years were recruited from the National University Cancer Institute in Singapore. Measuring instruments included the Supportive Care Needs Survey (SCNS-34), Memorial Symptom Assessment Scale (MSAS), and Medical Outcomes Study Short Form Health Survey version 2.0 (SF-12). Results: Among the subjects who participated in the survey, the mean age was 58.7 years (SD 5.8; range 50–74). Half were diagnosed with stage II breast cancer (50%). The mean time of last cancer treatment was 25.6 months (SD 17.4; range 1–60). Majority had undergone mastectomy (n= 66; 60%), 47 (42.7%) treated with chemo-radiotherapy, and 75 (68.2%) receiving hormonal therapy. Subjects reported the greatest unmet need in Health Care System/ Information needs (24.9 ± 13.8; score range 0–100, with higher scores representing high levels of unmet needs), followed by Patient Care Support needs (16.8± 12.0), and Psychological needs (13.0 ± 14.6). Of the ten highest frequencies of moderate-to-high unmet needs items, five were related to the Health Care System/Information domain, and four were related to the Psychological needs domain. The most prevalent reported symptoms were lack of energy (45.5%), numbness/tingling in hands/feet (44.5%), and pain (36.4%) (Table 1). The most frequent, severe and distressing symptom was numbness/tingling in hands/feet. The PSYCH and PHYS subscales, Global Distress Index (GDI), and Total MSAS scores were 0.45 ± 0.6, 0.29 ± 0.3, 0.53 ± 0.5, 0.31±0.3, respectively, (score range 0–4, with higher scores representing high subscale score). Those reporting high levels of PSYCH score reported greater unmet Psychological needs (r=0.64, pb 0.01). Significant strong correlations were noted between PHYS, GDI and TMSAS scores, and unmet Physical/Daily Living needs (r=0.74–0.76, pb 0.01). The SF-12 Physical Composite Score (PCS) and Mental Composite Score (MCS) were 49.8 ± 9.1 and 53.6 ± 10.8, respectively, (score range 0–100, with lower scores representing poor quality of life). Significant moderate negative correlation was noted between PCS score and unmet Physical/Daily Living needs (r = − 0.41, p b 0.05). The unmet Psychological needs was correlated significantly with the MCS score (r = − 0.62, p b 0.01). Conclusion: Our data suggest that older breast cancer survivors continue to experience severe and distressing physical and psychological symptoms. Also older breast cancer survivors have many unmet needs across a range of domains. Result from this study suggests that older survivors with unmet needs had poor quality of life. Hence, regular assessment of symptoms and unmet needs is essential for good cancer survivorship care.
doi:10.1016/j.jgo.2012.10.117