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6 Is one single question a reliable screening tool for depression in elderly cancer patients: a prospective study
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Critical Reviews in Oncology/Hematology 60 (2006)
Abstracts
pulmonary diseases (20 vs. 5%) accounted for the increased co-morbidity in the older age group. More young lung cancer patients received standard therapy; in stage IIIB chemotherapy + radiotherapy (<65: 63%; 65: 29%) and in stage IV chemotherapy (<65: 75%; 65: 42%). However, more patients in the older age group refused chemotherapy (65 y: 29% vs <65 y: 8%). Conclusions: Patients 65 years had worse WHO performance as well as more severe co-morbidity. There was a difference in standard treatment between both age groups in st IIIB and IV lung cancer. However, these differences may be partly due to the patients’ preferences. Regarding the larger number of treatment refusals in the older age group in stage IV disease, it can be hypothesized whether older individuals are probably partly responsible themselves for the differences in treatment. 6 Is one single question a reliable screening tool for depression in elderly cancer patients: a prospective study E.D. Capovilla1 *, S. Vigorelli1 , S. D’Accordi1 , U. Basso2 , F. Morgana1 , D. Visentin1 , S. Cannone1 . 1 Psycho-Oncology Unit and 2 Medical Oncology Department, Istituto Oncologico Veneto, Padova, Italy Background: Depression is a common finding in the elderly, and Geriatric Depression Scale-GDS (Brink J Am Geriatr Soc. 1989) has long been the reference assessment tool for emotional status within the Multidimensional Geriatric Assessment of elderly cancer patients. Yet, time and staff limitations have prompted pioneer authors to suggest the use of one single question in the common clinical practice in order to identify elderly cancer patients deserving full evaluation with GDS (Balducci Oncology 2000). Objective and Methods: To assess prospectively if the single question “Do you often feel depressed or sad” (yes or not) accurately correlates with scores of full GDS (0−5: normal, 6−15: depressed) in a consecutive cohort of elderly cancer patients undergoing full MGA at our Geriatric Oncology Unit. Both tests were performed by the same psychologist at the same visit independently of the results of each test. Patients with Folstein’s MMS < 15 were excluded. Results: 240 elderly pts were enrolled from October 2005 to July 2006, age range 70−95 years, 88 males. 191 patients were interviewed at first visit, 49 at follow-up. Fifty patients screened positive at the single question (20.8%), while 62 were judged as depressed after full GDS (25.8%). 13 patients with positive screening test had a normal GDS (7.3% false positive), as well as 25 patients with normal answer to the single question had an altered GDS score (40.3% false negative), with an overall concordance rate of 84.2% (table 1). Sensibility and specificity of the screening test were 59.7 and 92.7%, respectively, with positive and negative predictive value being 74 and 86.8%, respectively. Table 1: Patients’ numbers
Normal score at GDS (0−5) Depressed at GDS (6−15) Total
Normal screening test
Altered screening test
Total
165 25 (false negative) 190
13 (false positive) 37 50
178 62 240
Conclusions: With the limitation that our study was non-blinded, the results show that almost one half of patients with altered GDS may be missed by the single question, which is therefore insufficiently sensitive for the purpose of screening the presence of depression in elderly cancer patients. The screening test has very low false positive rate. Whenever allowed by time and personnel resources, full evaluation with GDS should remain the standard reference method for assessing the emotional status of elderly cancer patients, and should guide for referral to more structured psychological interventions, with or without the adjunct of pharmacological therapies.
7 High response rate to Epoetin Beta in elderly patients with myelodysplasia (MDS): results of a prospective study P. Chaibi1,2 *, I. Gouin1 , S. Berigaud1 , V. Siguret1 , E. Pautas1 , M.H. Schlageter2 , E. Raffoux2 , F. Piette1 . 1 Hˆopital Charles Foix, Ivry, 94200; 2 Hˆopital Saint Louis, Paris, France Background: Anemia of MDS is common in elderly patients. Recombinant Erythopoietin (EPO) alfa or beta, when used alone, improves anemia in 20 to 30 % of MDS in general population. In older patients with MDS, anemia is usually treated by transfusion supportive regimens. We report the results of a prospective study we conducted on the use of Epoetin Beta in anemic elderly patients with MDS. Patients and Treatment: Inclusion criteria were (i) patient aged 75 years and over with MDS, (ii) chronic anemia requiring transfusion or Hb < 10 g/dl, (iii) exclusion of other causes of anemia. Patients were treated with Epoetin beta 150 IU/kg ×3/week during at least 8 weeks. In the absence of response, Epoetin beta dose was increased to 300 IU/kg ×3/week and a new evaluation made after 8 weeks. Response was evaluated based on IWG criteria. In patients responding to Epoetin Beta, intervals between injections were adjusted to maintain Hb levels between 11 and 13 g/dl. Seventy-five patients (25 men, 50 women), median age 87.7 years (75–103), median creatinine clearance (CrCl) 36 ml/min (15– 86) were included. They were classified as follows, 1 RARS, 54 RCMD, 17 RAEB1, 2 RAEB2, 1 5q syndrome. There was not statistically significant correlation between pretreatment serum epo level and CrCl. Anemia was associated with neutropenia and/or thrombopenia in 19 patients and required transfusion in 44 patients. Karyotype was not performed in most of the patients. The median interval between onset of anemia and study treatment was 9 months (range 4−48). None of the patients had previously received EPO alfa or beta or Darbopoetin. Results: Sixty-one of the 75 patients (81%), including the patient with 5q- syndrome, had major erythroid haematological improvement (EHI) (transfusion independence in formerly transfused patients or rise of at least 2 g/dl of haemoglobin level in formerly non transfused patients). EHI was obtained with Epoetin beta lowest dose in 50/61 patients. No effect was seen on granulocytes and platelets. No side effects were observed. The response rates were 85%, 68.5% for RCMD and RAEB, respectively (p = NS). Pre-treatment serum epo level was lower in responding patients than in non responding patients (median level 34 and 104 UI/l respectively, p < 0.05). Response rate was lower in transfused than in non transfused patients (72% and 93% respectively, p < 0.05). Similar response rates were found in patients with CrCl > or < to 40 ml/min (88% and 78% respectively). Median response duration was not reached with a median follow up of 13 months (4–36). In responding patients, median adjusted Epoetin Beta dose was 190 IU/kg /week. Conclusion: In elderly patients with MDS, EPO appears to be an effective treatment to correct anemia. Our results may be superior to those obtained in general population because of lowest pre-treatment serum EPO levels and more frequent low risk MDS in elderly patients. 8 Geriatric assessment: a prospective study in older patients with AML and high-risk MDS B. Deschler *, G. Ihorst, M. Kuhn, B. R¨uter, M. L¨ubbert. Medical Center, Dept. of Hematology-Oncology, University of Freiburg, Germany Purpose of the study: Therapeutic options for older patients (pts) with AML and high-risk MDS include induction therapy, best supportive care (with or without low-dose chemotherapy or novel agents such as TKI’s, FTI’s, demethylating agents, etc.). No firm guidelines exist when evaluating individual therapeutic strategies for these pts. As only scarce data is available on the inter-individual heterogeneity of physical and mental capacities, Geriatric Assessment (GA) is expected to markedly advance the therapeutic decision-making process. While predictive prognostic models are being developed using clinical and hematologic parameters, there is a clear need for validated instruments also for age-specific functional and quality of life (QOL)-assessment. Summarized description of the project: Using patient- and age-specific evaluations of self-assessed and physician-guided scores of psycho-social
Critical Reviews in Oncology/Hematology 60 (2006)
Abstracts
pulmonary diseases (20 vs. 5%) accounted for the increased co-morbidity in the older age group. More young lung cancer patients received standard therapy; in stage IIIB chemotherapy + radiotherapy (<65: 63%; 65: 29%) and in stage IV chemotherapy (<65: 75%; 65: 42%). However, more patients in the older age group refused chemotherapy (65 y: 29% vs <65 y: 8%). Conclusions: Patients 65 years had worse WHO performance as well as more severe co-morbidity. There was a difference in standard treatment between both age groups in st IIIB and IV lung cancer. However, these differences may be partly due to the patients’ preferences. Regarding the larger number of treatment refusals in the older age group in stage IV disease, it can be hypothesized whether older individuals are probably partly responsible themselves for the differences in treatment. 6 Is one single question a reliable screening tool for depression in elderly cancer patients: a prospective study E.D. Capovilla1 *, S. Vigorelli1 , S. D’Accordi1 , U. Basso2 , F. Morgana1 , D. Visentin1 , S. Cannone1 . 1 Psycho-Oncology Unit and 2 Medical Oncology Department, Istituto Oncologico Veneto, Padova, Italy Background: Depression is a common finding in the elderly, and Geriatric Depression Scale-GDS (Brink J Am Geriatr Soc. 1989) has long been the reference assessment tool for emotional status within the Multidimensional Geriatric Assessment of elderly cancer patients. Yet, time and staff limitations have prompted pioneer authors to suggest the use of one single question in the common clinical practice in order to identify elderly cancer patients deserving full evaluation with GDS (Balducci Oncology 2000). Objective and Methods: To assess prospectively if the single question “Do you often feel depressed or sad” (yes or not) accurately correlates with scores of full GDS (0−5: normal, 6−15: depressed) in a consecutive cohort of elderly cancer patients undergoing full MGA at our Geriatric Oncology Unit. Both tests were performed by the same psychologist at the same visit independently of the results of each test. Patients with Folstein’s MMS < 15 were excluded. Results: 240 elderly pts were enrolled from October 2005 to July 2006, age range 70−95 years, 88 males. 191 patients were interviewed at first visit, 49 at follow-up. Fifty patients screened positive at the single question (20.8%), while 62 were judged as depressed after full GDS (25.8%). 13 patients with positive screening test had a normal GDS (7.3% false positive), as well as 25 patients with normal answer to the single question had an altered GDS score (40.3% false negative), with an overall concordance rate of 84.2% (table 1). Sensibility and specificity of the screening test were 59.7 and 92.7%, respectively, with positive and negative predictive value being 74 and 86.8%, respectively. Table 1: Patients’ numbers
Normal score at GDS (0−5) Depressed at GDS (6−15) Total
Normal screening test
Altered screening test
Total
165 25 (false negative) 190
13 (false positive) 37 50
178 62 240
Conclusions: With the limitation that our study was non-blinded, the results show that almost one half of patients with altered GDS may be missed by the single question, which is therefore insufficiently sensitive for the purpose of screening the presence of depression in elderly cancer patients. The screening test has very low false positive rate. Whenever allowed by time and personnel resources, full evaluation with GDS should remain the standard reference method for assessing the emotional status of elderly cancer patients, and should guide for referral to more structured psychological interventions, with or without the adjunct of pharmacological therapies.
7 High response rate to Epoetin Beta in elderly patients with myelodysplasia (MDS): results of a prospective study P. Chaibi1,2 *, I. Gouin1 , S. Berigaud1 , V. Siguret1 , E. Pautas1 , M.H. Schlageter2 , E. Raffoux2 , F. Piette1 . 1 Hˆopital Charles Foix, Ivry, 94200; 2 Hˆopital Saint Louis, Paris, France Background: Anemia of MDS is common in elderly patients. Recombinant Erythopoietin (EPO) alfa or beta, when used alone, improves anemia in 20 to 30 % of MDS in general population. In older patients with MDS, anemia is usually treated by transfusion supportive regimens. We report the results of a prospective study we conducted on the use of Epoetin Beta in anemic elderly patients with MDS. Patients and Treatment: Inclusion criteria were (i) patient aged 75 years and over with MDS, (ii) chronic anemia requiring transfusion or Hb < 10 g/dl, (iii) exclusion of other causes of anemia. Patients were treated with Epoetin beta 150 IU/kg ×3/week during at least 8 weeks. In the absence of response, Epoetin beta dose was increased to 300 IU/kg ×3/week and a new evaluation made after 8 weeks. Response was evaluated based on IWG criteria. In patients responding to Epoetin Beta, intervals between injections were adjusted to maintain Hb levels between 11 and 13 g/dl. Seventy-five patients (25 men, 50 women), median age 87.7 years (75–103), median creatinine clearance (CrCl) 36 ml/min (15– 86) were included. They were classified as follows, 1 RARS, 54 RCMD, 17 RAEB1, 2 RAEB2, 1 5q syndrome. There was not statistically significant correlation between pretreatment serum epo level and CrCl. Anemia was associated with neutropenia and/or thrombopenia in 19 patients and required transfusion in 44 patients. Karyotype was not performed in most of the patients. The median interval between onset of anemia and study treatment was 9 months (range 4−48). None of the patients had previously received EPO alfa or beta or Darbopoetin. Results: Sixty-one of the 75 patients (81%), including the patient with 5q- syndrome, had major erythroid haematological improvement (EHI) (transfusion independence in formerly transfused patients or rise of at least 2 g/dl of haemoglobin level in formerly non transfused patients). EHI was obtained with Epoetin beta lowest dose in 50/61 patients. No effect was seen on granulocytes and platelets. No side effects were observed. The response rates were 85%, 68.5% for RCMD and RAEB, respectively (p = NS). Pre-treatment serum epo level was lower in responding patients than in non responding patients (median level 34 and 104 UI/l respectively, p < 0.05). Response rate was lower in transfused than in non transfused patients (72% and 93% respectively, p < 0.05). Similar response rates were found in patients with CrCl > or < to 40 ml/min (88% and 78% respectively). Median response duration was not reached with a median follow up of 13 months (4–36). In responding patients, median adjusted Epoetin Beta dose was 190 IU/kg /week. Conclusion: In elderly patients with MDS, EPO appears to be an effective treatment to correct anemia. Our results may be superior to those obtained in general population because of lowest pre-treatment serum EPO levels and more frequent low risk MDS in elderly patients. 8 Geriatric assessment: a prospective study in older patients with AML and high-risk MDS B. Deschler *, G. Ihorst, M. Kuhn, B. R¨uter, M. L¨ubbert. Medical Center, Dept. of Hematology-Oncology, University of Freiburg, Germany Purpose of the study: Therapeutic options for older patients (pts) with AML and high-risk MDS include induction therapy, best supportive care (with or without low-dose chemotherapy or novel agents such as TKI’s, FTI’s, demethylating agents, etc.). No firm guidelines exist when evaluating individual therapeutic strategies for these pts. As only scarce data is available on the inter-individual heterogeneity of physical and mental capacities, Geriatric Assessment (GA) is expected to markedly advance the therapeutic decision-making process. While predictive prognostic models are being developed using clinical and hematologic parameters, there is a clear need for validated instruments also for age-specific functional and quality of life (QOL)-assessment. Summarized description of the project: Using patient- and age-specific evaluations of self-assessed and physician-guided scores of psycho-social