- Email: [email protected]
The multidimensional prognostic index (MPI), based on a comprehensive geriatric assessment (CGA), predicts mortality in elderly cancer patients (ECP)
S72
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
Conclusions: The answers obtained from those two surveys by geriatricians and oncologists showed an increase in the number of elderly patients with cancer treated and the difficulty in the management of complex oncogeriatric patient. The mutual request is for a more active collaboration. The majority of respondents, in both specialties request the availability of more knowledge by training course and the development of common intervention protocols.
Reference: Gallagher P, Ryan C, Byrne S, Kennedy J and O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment): consensus validation. International Journal of Clinical Pharmacology and Therapeutics; 2008; 46: 72–83. doi:10.1016/j.jgo.2012.10.078
doi:10.1016/j.jgo.2012.10.077
P77 Drugs prescribed for elderly oncologic patients hospitalized in the geriatric oncology unit of Institut Jules Bordet: Polypharmacy and impact of clinical pharmacist C. Deliens1, M.C. Vanderbeeken2, A. Georgala3, O. Filleul2, B. Papadopoulou2, G. Deliens4, A. De Beer1, D. de Valeriola2, M. Piccart2, A. Awada2, Y. Lalami2, J.P. Praet5, L. Dal Lago⁎2. 1Division of Pharmacy, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, 2 Belgium, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium, 3Department of Infectious Diseases, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium, 4 UR2NF, Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles, Brussels, Belgium, 5Department of Geriatric Medicine, C.H.U. St.-Pierre, Brussels, Belgium Purpose of the Study: STOPP and START lists are used to disclaim potential inappropriate medications (PIMs) prescribed at home in older persons. The main objective of this study was to measure the impact of clinical pharmacist on the number of PIMs in a Geriatric Oncology Unit. Methods: Prospective study in consecutive elderly (≥70 yrs) patients admitted to a geriatric oncology unit in a cancer center from July 2011 to April 2012. PIMs were identified by a clinical pharmacist using the STOPP and START lists. The number of PIMs was compared from the admission to the discharge of the patient, after clinical pharmacist interventions. Polymedication was defined as the use of ≥5 drugs. Results: Ninety one elderly oncologic patients were included in the study. The mean age was 78.10 ± 9.92 years (60.4% female). Screening geriatric profile was: ISAR score at 3.4 ± 1.6/6, G8 score at 11.3 ± 2.9/ 17, and Charlson Index at 1.7 ± 2.13/37. Polymedication was found in 72.5%. START identified 44 PIMs at the admission affecting 33 persons (36.3%) compared to 9 PIMs at the hospitalization discharge affecting 7 persons (8%). STOPP identified 52 PIMs at the admission affecting 31 persons (34%) compared to 17 PIMs at the hospitalization discharge affecting 14 persons (16.3%). Dependent Student's T-test for paired samples reveals a significant lower score for discharge START (mean = 0.10) compared to admission START (mean = 0.49; p b 0.001). There was also a significant lower score for exit STOPP (mean = 0.20) compared to admission STOPP (mean = 0.6; p b 0.001). The top three PIMs according to the START list were: calcium and vitamin D supplements (60%), antidepressants in the presence of moderate–severe depressive symptoms (6%) and angiotensin converting enzyme inhibitors with chronic heart failure (5%). The top three according to the STOPP list were: calcium channel blockers with chronic constipation (15.4%), regular opioids in patients with chronic constipation without concurrent use of laxatives (15.4%) and the presence of duplicate drug class prescription (15.4%). Conclusion: Polymedication was common in hospitalized elderly cancer patients. Most of them had an abnormal geriatric profile. The screening tools START and STOPP with multidisciplinary assessment by the oncogeriatric team, including a clinical pharmacist allowed identifying PIMs and changing prescriptions for elderly oncologic patients.
P78 The multidimensional prognostic index (MPI), based on a comprehensive geriatric assessment (CGA), predicts mortality in elderly cancer patients (ECP) C. Falci⁎1, V. Giantin2, E. Valentini2, M. Lasevoli2, E. De Luca2, P. Siviero3, S. Maggi3, B. Martella4, G. Orrù2, G. Crepaldi3, S. Monfardini5, O. Terranova4, E. Manzato2. 1Medical Oncology Unit II, Istituto Oncologico Veneto-IRCCS, Padova, Italy, 2Geriatric Clinic, Department of Medical and Surgical Science, University of Padova, Italy, 3 CNR Aging Section, Institute of Neuroscience, Padova, Italy, 4Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padova, Italy, 5Program of Geriatric Oncology, Istituto Palazzolo, Fondazione Don Gnocchi, Milano, Italy Introduction and aims: Although it is strongly recommended that ECP receive a CGA before any treatment decision, there is no consensus about the best form of multidimensional evaluation.1 Recently, the MPI has been validated as a strong predictor of 6 and 12-month mortality in independent cohorts of elderly hospitalized patients with acute or re-emerging chronic diseases. The MPI derives from 8 geriatric items related to functional, cognitive and nutritional conditions, comorbidities, pressure score risk, medications and social aspects. The aim of the present observational, prospective study was to firstly ascertain the prognostic value of the MPI at 6 and 12-months in ECP. Patients and methods: Patients aged ≥70 yrs admitted to our Program of Geriatric Oncology with a recent histologically confirmed diagnosis of locally advanced or metastatic solid cancer were enrolled if able to sign the informed consent and available to receive a CGA. The CGA was administered by the medical oncologist, geriatrician and psychologist at the time of the first oncological visit and included ADLs, IADLs, Short Portable Mental Status Questionnaire, Mini Mental Status Examination (MMSE), Cumulative Illness Rating Scale-Comorbidity Index and Severity Index (CIRS-SI), Mini Nutritional Assessment, Exton Smith Scale, the number of drugs for concomitant diseases, household composition, the Geriatric Depression Scale (GDS) and the Visual Numeric Scale. The MPI score was calculated and interpreted as reported by Pilotto et al.2 Results: Between 17th April 2008 and 19th April 2010 one hundredsixty patients, 88 females (55%), mean age 79.4 ± 5.7 years (range 69–93), entered the study. The overall mortality rate was 34.4% (55 patients) at 6-months and 46.9% (75 patients) at 12-months. Ninety-six patients (60%) had a low MPI, 48 (30%) a moderate MPI and 16 (10%) a severe MPI. Fig. 1 shows the age- and sex-adjusted survival curves for the three subgroups with low, moderate and severe MPI scores; high MPI scores were significantly associated with higher mortality rate than lower MPI scores (p b 0.0001). A high MPI was associated with a HR of 8.094 (95%CI 3.749–17.475, p b 0.0001) at 6-months compared to 5.655 (95%CI 2.866-11.158, p b 0.0001) at 12-months. When the MPI was considered as a continuous variable, any increase by 0.2 units was associated with a 2.347-fold increase in mortality risk at 6months and a 2.051-fold increase at 12-months. The age- and sex-adjusted AUC of ROC curve for MPI score were 0.81 (95%CI, 0.74–0.88) and 0.78 (95%CI, 0.71–0.85), respectively, at 6 and 12-months of follow-up. A regression model adjusted for age, sex,
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
GDS, MMSE, CIRS-SI, chemotherapy delivery and diagnosis of lung cancer seems to be better able to predict mortality both at 6-months (AUC = 0.94, p b 0.0001) and 12-months (AUC = 0.87, p b 0.0001) of follow-up. Conclusions: The present study confirms the prognostic value of the MPI in elderly patients with advanced cancer. This index may consequently be used in the daily practice for the proper risk assessment of ECP. Further studies are nonetheless needed to confirm these findings in larger populations and assess the potential for integrating the MPI with the CIRS severity index and the GDS.
Fig. 1. Age- and sex-adjusted survival curves for different grades of MPI at 6-months (left) and 12 months (right).
References 1. Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, et al. Task Force on CGA of the International Society of Geriatric Oncology. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol. 2005 Sep; 55(3):241–52. Review. 2. Pilotto A, Ferrucci L, Franceschi M, D'Ambrosio LP, Scancelli C, Cascavilla L, et al. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008; 11(1): 151–161. doi:10.1016/j.jgo.2012.10.079
S73
study, all patients were assessed by the VES13 (Vulnerable Elders Survey — 13 — vulnerability defined by VES-13 score ≥ 3) and the hand grip strength test (impaired grip strength is a marker of frailty) by a research nurse before their medical consultation. At the end of the consultation, the oncologist ranked the patient as either fit, intermediate or frail (modified Balducci classification) without knowledge of the previous test result. Patients were then classified as vulnerable if they were in the intermediate or frail category. Other clinical information was obtained from medical records. The prevalence of vulnerability is given with a 95% confidence interval (CI). The concordance between VES13 and the oncologist's assessment is estimated by the kappa coefficient. Grip test results are compared in vulnerable and fit patients. Results: From March to August 2011, 209 patients agreed to participate. Eleven patients without cancer were excluded. Data was complete for 198 eligible patients. The median age was 76 years and 59% were women. The prevalence of vulnerability was 48.5% (95%CI: 41.3–55.7%) according to VES13 and 47.4% (95%CI: 40.2–54.7%) according to the oncologist's assessment. Patient distribution according to the three categories was significantly different between VES13 and oncologist (p = 0.0044), with a moderate concordance coefficient (κ = 0.551). The Grip test result was significantly higher for fit patients and lower for frail patients according both to oncologist and VES13 assessment (p b 0.0001). Conclusions: Vulnerability prevalence among elderly cancer patients seen in our center is similar to estimates encountered in the literature. Oncologists are partially able to recognize vulnerability in this population without specific tools. One explanation is that physicians consider not only the health status but also the oncologic therapeutic strategy in defining vulnerability, so they include the risk for a patient to become vulnerable with oncologic treatment in their assessment. Besides vulnerability status, the oncologist needs tools to evaluate life expectancy not considering cancer and to evaluate the risk of treatment intolerance in this specific population. The grip test could be a marker of frailty in these patients. Further studies are needed to evaluate its interest in clinical practice. doi:10.1016/j.jgo.2012.10.080
P79 Vulnerability assessment of the elderly Concordance between screening tests physician evaluation
cancer patients: and subjective
V. Servent1, H. Bricout2, C. Gaxatte⁎3, E. Tresch1, S. Clisant1, F. Puisieux3. 1Centre Oscar Lambret, Lille Cedex, France, 2Centre de Référence Régional en Cancérologie, CHRU de Lille, Lille Cedex, France, 3 Clinique de Gérontologie, CHRU de Lille, Lille Cedex, France Purpose of the Study: To respond to the elderly cancer concern, the French National Cancer Institute (INCa) promoted the development of geriatric oncology by creating 15 Pilot Oncogeriatric Coordination Units in 2005. Despite the creation of such a unit in our center, the number of geriatric cancer patients who benefit from a comprehensive geriatric assessment (CGA) remains lower than expected. We hypothesize that one of the reasons is that the vulnerability status of elderly patients is underestimated by many oncologists, but this has never been quantified. The main objective of this project is to determine the vulnerability prevalence among elderly cancer patients referred to our cancer center using specific screening tests and subjective physician evaluations. The secondary objective is to assess the concordance between these two evaluations of vulnerability status. Methods: We performed a four-month observational study among 70-year and older consecutive cancer patients attending the Oscar Lambret center for the first time. After the patient's consent for the
P80 Including geriatricians in a cancer hospital in Brazil K. Gil-Jr⁎, K. Theodora, Wilson Jacob-Filho. Division of Geriatrics, Department of Internal Medicine, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil Purpose of the Study: To describe an oncogeriatric service in a Brazilian Cancer Hospital. Methods/Summarised Description of the Project: The increase in the elderly population over the past decades led to concomitant increase in the prevalence of cancer in this population. It is currently estimated that two thirds of solid cancers are diagnosed in patients aged 65 years or more, and the largest number of deaths related to cancer is mostly seen in this group. Our purpose is to describe a Brazilian new geriatric service in an Oncologic Hospital. As in other countries, population aged over 60 is the fastest growing in Brazil. According to the demographic data from the Brazilian Institute of Geography and Statistics (IBGE), the elderly accounted for 6.75% of the population in 1990. That number grew, reaching 8.1% in the 2000 census and 9.5% in 2010. An estimated further growth of this group in the coming years should reach 13.7% of the population in 2020, or about 30 million people. Opened in May 2008, the Institute of Cancer of São Paulo Octavio Frias de Oliveira is the largest hospital that specialized in the
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
Conclusions: The answers obtained from those two surveys by geriatricians and oncologists showed an increase in the number of elderly patients with cancer treated and the difficulty in the management of complex oncogeriatric patient. The mutual request is for a more active collaboration. The majority of respondents, in both specialties request the availability of more knowledge by training course and the development of common intervention protocols.
Reference: Gallagher P, Ryan C, Byrne S, Kennedy J and O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment): consensus validation. International Journal of Clinical Pharmacology and Therapeutics; 2008; 46: 72–83. doi:10.1016/j.jgo.2012.10.078
doi:10.1016/j.jgo.2012.10.077
P77 Drugs prescribed for elderly oncologic patients hospitalized in the geriatric oncology unit of Institut Jules Bordet: Polypharmacy and impact of clinical pharmacist C. Deliens1, M.C. Vanderbeeken2, A. Georgala3, O. Filleul2, B. Papadopoulou2, G. Deliens4, A. De Beer1, D. de Valeriola2, M. Piccart2, A. Awada2, Y. Lalami2, J.P. Praet5, L. Dal Lago⁎2. 1Division of Pharmacy, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, 2 Belgium, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium, 3Department of Infectious Diseases, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium, 4 UR2NF, Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles, Brussels, Belgium, 5Department of Geriatric Medicine, C.H.U. St.-Pierre, Brussels, Belgium Purpose of the Study: STOPP and START lists are used to disclaim potential inappropriate medications (PIMs) prescribed at home in older persons. The main objective of this study was to measure the impact of clinical pharmacist on the number of PIMs in a Geriatric Oncology Unit. Methods: Prospective study in consecutive elderly (≥70 yrs) patients admitted to a geriatric oncology unit in a cancer center from July 2011 to April 2012. PIMs were identified by a clinical pharmacist using the STOPP and START lists. The number of PIMs was compared from the admission to the discharge of the patient, after clinical pharmacist interventions. Polymedication was defined as the use of ≥5 drugs. Results: Ninety one elderly oncologic patients were included in the study. The mean age was 78.10 ± 9.92 years (60.4% female). Screening geriatric profile was: ISAR score at 3.4 ± 1.6/6, G8 score at 11.3 ± 2.9/ 17, and Charlson Index at 1.7 ± 2.13/37. Polymedication was found in 72.5%. START identified 44 PIMs at the admission affecting 33 persons (36.3%) compared to 9 PIMs at the hospitalization discharge affecting 7 persons (8%). STOPP identified 52 PIMs at the admission affecting 31 persons (34%) compared to 17 PIMs at the hospitalization discharge affecting 14 persons (16.3%). Dependent Student's T-test for paired samples reveals a significant lower score for discharge START (mean = 0.10) compared to admission START (mean = 0.49; p b 0.001). There was also a significant lower score for exit STOPP (mean = 0.20) compared to admission STOPP (mean = 0.6; p b 0.001). The top three PIMs according to the START list were: calcium and vitamin D supplements (60%), antidepressants in the presence of moderate–severe depressive symptoms (6%) and angiotensin converting enzyme inhibitors with chronic heart failure (5%). The top three according to the STOPP list were: calcium channel blockers with chronic constipation (15.4%), regular opioids in patients with chronic constipation without concurrent use of laxatives (15.4%) and the presence of duplicate drug class prescription (15.4%). Conclusion: Polymedication was common in hospitalized elderly cancer patients. Most of them had an abnormal geriatric profile. The screening tools START and STOPP with multidisciplinary assessment by the oncogeriatric team, including a clinical pharmacist allowed identifying PIMs and changing prescriptions for elderly oncologic patients.
P78 The multidimensional prognostic index (MPI), based on a comprehensive geriatric assessment (CGA), predicts mortality in elderly cancer patients (ECP) C. Falci⁎1, V. Giantin2, E. Valentini2, M. Lasevoli2, E. De Luca2, P. Siviero3, S. Maggi3, B. Martella4, G. Orrù2, G. Crepaldi3, S. Monfardini5, O. Terranova4, E. Manzato2. 1Medical Oncology Unit II, Istituto Oncologico Veneto-IRCCS, Padova, Italy, 2Geriatric Clinic, Department of Medical and Surgical Science, University of Padova, Italy, 3 CNR Aging Section, Institute of Neuroscience, Padova, Italy, 4Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padova, Italy, 5Program of Geriatric Oncology, Istituto Palazzolo, Fondazione Don Gnocchi, Milano, Italy Introduction and aims: Although it is strongly recommended that ECP receive a CGA before any treatment decision, there is no consensus about the best form of multidimensional evaluation.1 Recently, the MPI has been validated as a strong predictor of 6 and 12-month mortality in independent cohorts of elderly hospitalized patients with acute or re-emerging chronic diseases. The MPI derives from 8 geriatric items related to functional, cognitive and nutritional conditions, comorbidities, pressure score risk, medications and social aspects. The aim of the present observational, prospective study was to firstly ascertain the prognostic value of the MPI at 6 and 12-months in ECP. Patients and methods: Patients aged ≥70 yrs admitted to our Program of Geriatric Oncology with a recent histologically confirmed diagnosis of locally advanced or metastatic solid cancer were enrolled if able to sign the informed consent and available to receive a CGA. The CGA was administered by the medical oncologist, geriatrician and psychologist at the time of the first oncological visit and included ADLs, IADLs, Short Portable Mental Status Questionnaire, Mini Mental Status Examination (MMSE), Cumulative Illness Rating Scale-Comorbidity Index and Severity Index (CIRS-SI), Mini Nutritional Assessment, Exton Smith Scale, the number of drugs for concomitant diseases, household composition, the Geriatric Depression Scale (GDS) and the Visual Numeric Scale. The MPI score was calculated and interpreted as reported by Pilotto et al.2 Results: Between 17th April 2008 and 19th April 2010 one hundredsixty patients, 88 females (55%), mean age 79.4 ± 5.7 years (range 69–93), entered the study. The overall mortality rate was 34.4% (55 patients) at 6-months and 46.9% (75 patients) at 12-months. Ninety-six patients (60%) had a low MPI, 48 (30%) a moderate MPI and 16 (10%) a severe MPI. Fig. 1 shows the age- and sex-adjusted survival curves for the three subgroups with low, moderate and severe MPI scores; high MPI scores were significantly associated with higher mortality rate than lower MPI scores (p b 0.0001). A high MPI was associated with a HR of 8.094 (95%CI 3.749–17.475, p b 0.0001) at 6-months compared to 5.655 (95%CI 2.866-11.158, p b 0.0001) at 12-months. When the MPI was considered as a continuous variable, any increase by 0.2 units was associated with a 2.347-fold increase in mortality risk at 6months and a 2.051-fold increase at 12-months. The age- and sex-adjusted AUC of ROC curve for MPI score were 0.81 (95%CI, 0.74–0.88) and 0.78 (95%CI, 0.71–0.85), respectively, at 6 and 12-months of follow-up. A regression model adjusted for age, sex,
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
GDS, MMSE, CIRS-SI, chemotherapy delivery and diagnosis of lung cancer seems to be better able to predict mortality both at 6-months (AUC = 0.94, p b 0.0001) and 12-months (AUC = 0.87, p b 0.0001) of follow-up. Conclusions: The present study confirms the prognostic value of the MPI in elderly patients with advanced cancer. This index may consequently be used in the daily practice for the proper risk assessment of ECP. Further studies are nonetheless needed to confirm these findings in larger populations and assess the potential for integrating the MPI with the CIRS severity index and the GDS.
Fig. 1. Age- and sex-adjusted survival curves for different grades of MPI at 6-months (left) and 12 months (right).
References 1. Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, et al. Task Force on CGA of the International Society of Geriatric Oncology. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol. 2005 Sep; 55(3):241–52. Review. 2. Pilotto A, Ferrucci L, Franceschi M, D'Ambrosio LP, Scancelli C, Cascavilla L, et al. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008; 11(1): 151–161. doi:10.1016/j.jgo.2012.10.079
S73
study, all patients were assessed by the VES13 (Vulnerable Elders Survey — 13 — vulnerability defined by VES-13 score ≥ 3) and the hand grip strength test (impaired grip strength is a marker of frailty) by a research nurse before their medical consultation. At the end of the consultation, the oncologist ranked the patient as either fit, intermediate or frail (modified Balducci classification) without knowledge of the previous test result. Patients were then classified as vulnerable if they were in the intermediate or frail category. Other clinical information was obtained from medical records. The prevalence of vulnerability is given with a 95% confidence interval (CI). The concordance between VES13 and the oncologist's assessment is estimated by the kappa coefficient. Grip test results are compared in vulnerable and fit patients. Results: From March to August 2011, 209 patients agreed to participate. Eleven patients without cancer were excluded. Data was complete for 198 eligible patients. The median age was 76 years and 59% were women. The prevalence of vulnerability was 48.5% (95%CI: 41.3–55.7%) according to VES13 and 47.4% (95%CI: 40.2–54.7%) according to the oncologist's assessment. Patient distribution according to the three categories was significantly different between VES13 and oncologist (p = 0.0044), with a moderate concordance coefficient (κ = 0.551). The Grip test result was significantly higher for fit patients and lower for frail patients according both to oncologist and VES13 assessment (p b 0.0001). Conclusions: Vulnerability prevalence among elderly cancer patients seen in our center is similar to estimates encountered in the literature. Oncologists are partially able to recognize vulnerability in this population without specific tools. One explanation is that physicians consider not only the health status but also the oncologic therapeutic strategy in defining vulnerability, so they include the risk for a patient to become vulnerable with oncologic treatment in their assessment. Besides vulnerability status, the oncologist needs tools to evaluate life expectancy not considering cancer and to evaluate the risk of treatment intolerance in this specific population. The grip test could be a marker of frailty in these patients. Further studies are needed to evaluate its interest in clinical practice. doi:10.1016/j.jgo.2012.10.080
P79 Vulnerability assessment of the elderly Concordance between screening tests physician evaluation
cancer patients: and subjective
V. Servent1, H. Bricout2, C. Gaxatte⁎3, E. Tresch1, S. Clisant1, F. Puisieux3. 1Centre Oscar Lambret, Lille Cedex, France, 2Centre de Référence Régional en Cancérologie, CHRU de Lille, Lille Cedex, France, 3 Clinique de Gérontologie, CHRU de Lille, Lille Cedex, France Purpose of the Study: To respond to the elderly cancer concern, the French National Cancer Institute (INCa) promoted the development of geriatric oncology by creating 15 Pilot Oncogeriatric Coordination Units in 2005. Despite the creation of such a unit in our center, the number of geriatric cancer patients who benefit from a comprehensive geriatric assessment (CGA) remains lower than expected. We hypothesize that one of the reasons is that the vulnerability status of elderly patients is underestimated by many oncologists, but this has never been quantified. The main objective of this project is to determine the vulnerability prevalence among elderly cancer patients referred to our cancer center using specific screening tests and subjective physician evaluations. The secondary objective is to assess the concordance between these two evaluations of vulnerability status. Methods: We performed a four-month observational study among 70-year and older consecutive cancer patients attending the Oscar Lambret center for the first time. After the patient's consent for the
P80 Including geriatricians in a cancer hospital in Brazil K. Gil-Jr⁎, K. Theodora, Wilson Jacob-Filho. Division of Geriatrics, Department of Internal Medicine, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil Purpose of the Study: To describe an oncogeriatric service in a Brazilian Cancer Hospital. Methods/Summarised Description of the Project: The increase in the elderly population over the past decades led to concomitant increase in the prevalence of cancer in this population. It is currently estimated that two thirds of solid cancers are diagnosed in patients aged 65 years or more, and the largest number of deaths related to cancer is mostly seen in this group. Our purpose is to describe a Brazilian new geriatric service in an Oncologic Hospital. As in other countries, population aged over 60 is the fastest growing in Brazil. According to the demographic data from the Brazilian Institute of Geography and Statistics (IBGE), the elderly accounted for 6.75% of the population in 1990. That number grew, reaching 8.1% in the 2000 census and 9.5% in 2010. An estimated further growth of this group in the coming years should reach 13.7% of the population in 2020, or about 30 million people. Opened in May 2008, the Institute of Cancer of São Paulo Octavio Frias de Oliveira is the largest hospital that specialized in the