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1512 A Korean nationwide survey for breakthrough cancer pain in an inpatient setting
S208 1511 POSTER Symptom burden among patients with newly diagnosed incurable cancer S. Alsirafy1 , R. Radwan1 , R. Fawzy2 , W. El-Sherief1 , H. Abd El-Aal1 , D. Farag1 . 1 Kasr Al-Ainy School of Medicine, Cairo University, Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine NEMROCK, Cairo, Egypt; 2 Kasr Al-Ainy School of Medicine, Cairo University, Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine NEMROCK, Cairo, Egypt Background: The World Health Organization (WHO) said that palliative care and cancer pain control are the only realistic treatment option for the majority of cancer patients who present in an advanced incurable stage, especially in lower-income countries. Ideally, palliative care is integrated from the point of diagnosis of incurable cancer. This would allow earlier identification and better management of symptoms in this group of patients. This study explores the symptom burden among patients with recently diagnosed incurable cancer in a lower-income setting. Materials and Methods: The study included patients with incurable cancer who presented to an Egyptian cancer center. Thirty-eight patients were interviewed within four weeks of diagnosis. Initially patients were asked to report voluntarily the symptoms they are experiencing and to name the most distressing one. This was followed by the systematic assessment of 57 symptoms. Symptoms were rated using a 4 point verbal rating scale (none, mild, moderate and severe). Results: The median age of patients was 51 years and 58% were males. The most common primary cancer site was the lung (21%) followed by the gastrointestinal system (18%). In addition to the 57 systematically assessed symptoms, patients voluntarily reported another 6 symptoms. The total number of symptom entries was 589, of which 74 (12.6%) were voluntary reported and 515 (87.4%) were found on systematic assessment. The average number of symptoms per patient was 16 and the median was 14 (range: 1−43). The average number of severe symptoms per patient was 3. The severity of symptoms was mild in 274 (46.5%) symptom entries, moderate in 200 (34%) and severe in 115 (19.5%). The total number of symptom entries related to the assessed 57 symptoms was 582. Patients voluntarily reported 2% of mild symptoms, 17% of moderate and 32% of severe. The ten most common symptoms were pain (71%), anxiety (58%), appetite loss (58%), fatigue (55%), weight loss (55%), insomnia (53%), weakness (50%), depressed mood (47%), shortness of breath (47%) and dry mouth (45%). The most distressing symptom was pain in 37% of patients, respiratory symptoms in 11% and weakness in 8%. Conclusions: In a lower-income setting, patients with recently diagnosed incurable cancer experience high symptom burden, especially pain. This supports the WHO advice to integrate palliative care and cancer pain control as early as possible in the course of disease of these patients. The majority of symptoms experienced by patients with incurable cancer are not voluntary reported, especially mild symptoms. Systematic assessment of symptoms is necessary to identify them early and to initiate management appropriately. No conflict of interest. 1512 POSTER A Korean nationwide survey for breakthrough cancer pain in an inpatient setting S.K. Baek1 , D.Y. Kim2 , S.Y. Kang3 , S.J. Sym4 , J.Y. Lee5 , Y.S. Kim6 . 1 Kyung Hee University Hospital, Hemato-oncology, Seoul, Korea; 2 Dongguk Univerity Ilsan Hospital, Hematology-Oncology, Goyang, Kyunggi-Do, Korea; 3 Ajou University School of Medicine, Hematology-Oncology, Suwon, Kyunggi-Do, Korea; 4 Gachon University Gil Hospital, Hematology-Oncology, Inchon, Korea; 5 Korea University College of Medicine, Biostatistics, Seoul, Korea; 6 National Health Insurance Service Ilsan Hospital, Family Medicine, Seoul, Korea Background: We evaluated the prevalence and characteristics of breakthrough cancer pain (BTcP) in Korean patients admitted with cancer pain. Materials and Methods: In-hospital patients with cancer pain completed a questionnaire about the severity of background cancer pain (BCP), prevalence and treatment for BCP, sleep disorders, and satisfaction with cancer pain treatment. Medical records about medications for BCP and BTcP were also investigated. Of the 1,841 patients, 609 (33.1%) complained of pain with a numerical rating scale pain score 3 and were analyzed. Results: Mean age was 59.5 years old, and 59% of the patients were male. Of all patients, 177 (29%) complained of BTcP. No clinical characteristic predicted BTcP. Of the 177 patients with BTcP, 56% did not receive a drug to control BTcP. Patients with BTcP were significantly associated with a
Abstracts sleep disorder and dissatisfaction with pain control, compared with those without BTcP (p < 0.0001, p = 0.0498, respectively). Oxycodone-immediate release was the most commonly used short-acting analgesic, followed by intravenous morphine. Conclusion: The prevalence of BTcP was 29% in patients admitted with controlled BCP. Although the patients had well-controlled BCP, BTcP was associated with a lower quality of life in patients with cancer. More attention to detect and manage BTcP is needed in this era of new immediate-release analgesics. No conflict of interest. 1513 POSTER Is involved field target delineation safe in spinal palliative radiotherapy? Y.L. Lai1 , J.A. Liang1 , C.R. Chien1 . 1 China Medical University Hospital, Radiation Oncology, Taichung City, Taiwan Background: Bone metastases are a common manifestation of malignancy and cause pain and disability. Multiple randomized controlled trials and several systematic reviews have demonstrated that radiotherapy (RT) can provide significant palliation of painful bone metastases in 50−80% of patients. However, consensus definitions for target delineation in spinal palliative conventional fractionated radiotherapy have yet to be established. This study aimed to analyze the outcome after the involved field (tumor and adjacent sectors of spine) spinal palliative conventional fractionated radiotherapy [IF-SPCF-RT] following the International Spine Radiosurgery Consortium Consensus Guidelines for Target Volume Definition used in spinal stereotactic radiotherapy [Int J Radiation Oncol Biol Phys 2012; 83: e597-e605]. Material and Methods: Based on a prospectively established registry, we retrospectively collected clinical data on patients treated with IF-SPCF-RT within 2012–2014. Patients who received previous surgery or RT to the spine were excluded. We only included those with prescribed dose 30 to 37 Gray (Gy), with 2.5 to 3.0 Gy per fraction. Local failure was defined as image recurrence, retreatment (surgery or RT), or pain progression to the irradiated site. The local control (LC) rate was assessed based on each spinal segment treated and pain relief rate according to each patient treated. LC was calculated from the start of RT, using the Kaplan–Meier method. Results: We identified 38 patients with 95 treated spinal segments. The median follow-up was 4.7 months (range 0.6–30.2 months). 27 patients (71.1%) experienced pain relief. The 1, 3, 6, and 12 months LC rates were 90.5%, 74.6%, 47.2%, and 40.8%, respectively. There were only 10 in-field failures observed, including one with image alone, 3 with re-RT, and 6 with surgical treatment. No out-field failure was noted. Conclusions: IF-SPCF-RT yields acceptable rates of local tumor control and pain relief in patients with spinal bone metastasis. The possibility of out-field failure when target definition follows the International Spine Radiosurgery Consortium Consensus Guidelines for Target Volume Definition might be negligible. No conflict of interest. 1514 POSTER Impact of outpatient palliative care on aggressiveness of end-of-life care in patients with metastatic colorectal cancer S.W. Lee1 , S.Y. Kim2 , J.Y. Baek2 , E.K. Shim2 , H.M. Kim2 , J.Y. Ku2 , E.J. Nam3 , H.J. Jho3 , Y.J. Chang3 . 1 National Cancer Center, Department of Internal Medicine, Gyeonggi-do, Korea; 2 National Cancer Center, Center for colorectal cancer, Gyeonggi-do, Korea; 3 National Cancer Center, Department of Hospice Palliative Service, Gyeonggi-do, Korea Background: Outpatient palliative care (OPC) is known to help advanced cancer patients (pts) in terms of symptom control and transition to hospice care, but outpatient clinic dedicated to palliative care is generally not feasible in Korean cancer centers. We aimed to evaluate quality of endof-life care and use of medical resources in pts with metastatic colorectal cancer (mCRC) according to OPC attendance. Material and Methods: We performed retrospective review for 132 pts who were diagnosed with mCRC and died between 2011 and 2014 in National Cancer Center, Korea. Pts who were seen at OPC clinic through outpatient consultation or voluntary visit were classified into OPC group (n = 53), while those who weren’t seen at OPC ever or were introduced to OPC through inpatient consultation were assigned as non-OPC group (n = 79). Results: Baseline characteristics such as age, performance status, or comorbidities were balanced between OPC group and non-OPC group. The median survival since diagnosis of mCRC was similar between the two
Abstracts sleep disorder and dissatisfaction with pain control, compared with those without BTcP (p < 0.0001, p = 0.0498, respectively). Oxycodone-immediate release was the most commonly used short-acting analgesic, followed by intravenous morphine. Conclusion: The prevalence of BTcP was 29% in patients admitted with controlled BCP. Although the patients had well-controlled BCP, BTcP was associated with a lower quality of life in patients with cancer. More attention to detect and manage BTcP is needed in this era of new immediate-release analgesics. No conflict of interest. 1513 POSTER Is involved field target delineation safe in spinal palliative radiotherapy? Y.L. Lai1 , J.A. Liang1 , C.R. Chien1 . 1 China Medical University Hospital, Radiation Oncology, Taichung City, Taiwan Background: Bone metastases are a common manifestation of malignancy and cause pain and disability. Multiple randomized controlled trials and several systematic reviews have demonstrated that radiotherapy (RT) can provide significant palliation of painful bone metastases in 50−80% of patients. However, consensus definitions for target delineation in spinal palliative conventional fractionated radiotherapy have yet to be established. This study aimed to analyze the outcome after the involved field (tumor and adjacent sectors of spine) spinal palliative conventional fractionated radiotherapy [IF-SPCF-RT] following the International Spine Radiosurgery Consortium Consensus Guidelines for Target Volume Definition used in spinal stereotactic radiotherapy [Int J Radiation Oncol Biol Phys 2012; 83: e597-e605]. Material and Methods: Based on a prospectively established registry, we retrospectively collected clinical data on patients treated with IF-SPCF-RT within 2012–2014. Patients who received previous surgery or RT to the spine were excluded. We only included those with prescribed dose 30 to 37 Gray (Gy), with 2.5 to 3.0 Gy per fraction. Local failure was defined as image recurrence, retreatment (surgery or RT), or pain progression to the irradiated site. The local control (LC) rate was assessed based on each spinal segment treated and pain relief rate according to each patient treated. LC was calculated from the start of RT, using the Kaplan–Meier method. Results: We identified 38 patients with 95 treated spinal segments. The median follow-up was 4.7 months (range 0.6–30.2 months). 27 patients (71.1%) experienced pain relief. The 1, 3, 6, and 12 months LC rates were 90.5%, 74.6%, 47.2%, and 40.8%, respectively. There were only 10 in-field failures observed, including one with image alone, 3 with re-RT, and 6 with surgical treatment. No out-field failure was noted. Conclusions: IF-SPCF-RT yields acceptable rates of local tumor control and pain relief in patients with spinal bone metastasis. The possibility of out-field failure when target definition follows the International Spine Radiosurgery Consortium Consensus Guidelines for Target Volume Definition might be negligible. No conflict of interest. 1514 POSTER Impact of outpatient palliative care on aggressiveness of end-of-life care in patients with metastatic colorectal cancer S.W. Lee1 , S.Y. Kim2 , J.Y. Baek2 , E.K. Shim2 , H.M. Kim2 , J.Y. Ku2 , E.J. Nam3 , H.J. Jho3 , Y.J. Chang3 . 1 National Cancer Center, Department of Internal Medicine, Gyeonggi-do, Korea; 2 National Cancer Center, Center for colorectal cancer, Gyeonggi-do, Korea; 3 National Cancer Center, Department of Hospice Palliative Service, Gyeonggi-do, Korea Background: Outpatient palliative care (OPC) is known to help advanced cancer patients (pts) in terms of symptom control and transition to hospice care, but outpatient clinic dedicated to palliative care is generally not feasible in Korean cancer centers. We aimed to evaluate quality of endof-life care and use of medical resources in pts with metastatic colorectal cancer (mCRC) according to OPC attendance. Material and Methods: We performed retrospective review for 132 pts who were diagnosed with mCRC and died between 2011 and 2014 in National Cancer Center, Korea. Pts who were seen at OPC clinic through outpatient consultation or voluntary visit were classified into OPC group (n = 53), while those who weren’t seen at OPC ever or were introduced to OPC through inpatient consultation were assigned as non-OPC group (n = 79). Results: Baseline characteristics such as age, performance status, or comorbidities were balanced between OPC group and non-OPC group. The median survival since diagnosis of mCRC was similar between the two