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A prospective study about the complementary medicine among patients with cancers
abstracts
Annals of Oncology
1824P
A prospective study about the complementary medicine among patients with cancers
W. Ben Kridis, A. Mnif, A. Khanfir Medical Oncology Department, University of Sfax - Hopital Habib Bourguiba, Sfax, Tunisia Background: There is limited information on the association among complementary medicin (CM), toxicities and overall survival of patients with cancer who receive CM compared with those who do not. Methods: This is a prospective study including 223 patients collected during 6 months between July 15, 2018 and January 15, 2019 in the department of medical oncology at the Habib Bourguiba university Hospital. All patients were questioned about the concept of taking herbs and botanicals such as gravila and Alinda. We analyzed the demographic data, the toxicities after the consumption of plants as well as the causal link. Then we compared overall survival among those who receive plants versus the nonusers. Results: The average age was 53 years (2-86 years old). There were 152 women and 71 men. 83 patients were illiterate (37.2%). 110 patients had breast cancer (49.3%), the others included colorectal, endometrial, cervical, gastric, ovarian, lung, bladder and head and neck cancers). 97 had metastatic disease (43.4%). 97 patients had taken plants (43.4%), during the medical treatment in 57 cases (58.7%). 60 patients had consumed Alinda (61.8%) and 36 patients had received Graviola (37.1%). 62 women had taken plants against 37 men (v2 ¼ 1.425, ddl ¼ 1, a ¼ 5%, p ¼ 0.147). 49 patients with metastatic disease had taken plants against 48 with localized cancer (v2 ¼ 3.468, ddl ¼ 2, a ¼ 5%, p ¼ 0.177). 10 patients have had diarrhea (10.3%), 10 cytolysis (10.3%), 11 cholestasis (11.3%), 15 thrombocytosis (15.4%), 17 leukocytosis (17.5%) and 13 anemia (13.4%). Only leukocytosis, thrombocytosis, and diarrhea were related to plant consumption with p ¼ 0.0001, p ¼ 0.016 and p ¼ 0.014 respectively. Overall survival at 5 years was 67.1%. It was lower in patients consuming the plants (54% vs 83% p ¼ 0.023). Conclusions: The consumption of Graviola and Alinda was associated with a decrease in the 5 years overall survival (p ¼ 0.023). It was associated with leukocytosis, thrombocytosis, and diarrhoea. This consumption was not statistically different between men and women nor between the localized or metastatic stage. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
1825P
Prevalence and management of potentially inappropriate medication use and potential omissions in medication in older cancer patients: The PIM POM study
F.M.A.M. van Loveren1, I.R.F. van Berlo - van de Laar1, A.L.T. Imholz2, K. Taxis3, F.G.A. Jansman1 1 Clinical Pharmacy, Deventer Hospital, Deventer, Netherlands, 2Internal Medicine, Deventer Hospital, Deventer, Netherlands, 3PharmacoTherapy, -Epidemiology and Economics, University of Groningen, Groningen, Netherlands Background: Older cancer patients are a vulnerable group of medication users. Pharmacist-led medication reviews may optimize treatment and thereby reduce the risk of harmful effects from medication use. This study aims to determine the prevalence and management of Potentially Inappropriate Medication use (PIM’s) and Potential Omissions in Medication (POM’s) in older cancer patients. Methods: In this prospective observational study (hospital) pharmacists conducted medication reviews with older cancer patients (aged 65 years) treated with parenteral chemo and/or immunotherapy to determine the prevalence of PIM’s and POM’s. PIM’s and POM’s were identified using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP), the screening Tool to Alert doctors to the Right Treatment (START) and pharmacists’ expert opinion. Recommendations
Volume 30 | Supplement 5 | October 2019
regarding PIM’s and POM’s were made to the patient’s oncologist/haematologist and follow-up was measured. Associations between covariates and the prevalence of PIM’s and POM’s were statistically analysed. Results: 117 (78%) of the 150 patients included (median age 72 years, 59% male, 68% solid tumours, mean number of medicines 11) had at least one PIM and/or PIM. In total 266 PIM’s and POM’s were identified, and these led to 195 (73%) follow-up actions (table). The number of medicines and Charlson Comorbidity Index score (as a measure of vulnerability) were both independently associated with having at least one PIM and/or POM (p ¼ .031 and p ¼ .002 respectively).
Table: 1825P Identification and follow-up of PIM’s and POM’s PIM’s and POM’s n (%) PIM’s, total Using STOPP Using expert opinion Using both POM’s, total Using START Using expert opinion Follow-up actions By oncologist/haematologist By general practitioner No follow-up action
180 89 (49) 85 (47) 6 (3) 86 66 (77) 20 (23) 266 77 (29) 118 (44) 71 (27)
Conclusions: PIM’s and POM’s are highly prevalent among older cancer patients. A pharmacist-led medication review using STOPP/START criteria and pharmacists’ expert opinion is an excellent way to identify these PIM’s and POM’s and to optimize patients’ medication use. The majority of recommendations made regarding PIM’s and POM’s leads to a follow-up action. Legal entity responsible for the study: Deventer Teaching Hospital. Funding: Has not received any funding. Disclosure: F.G.A. Jansman: Advisory / Consultancy, 2016: Amgen; Advisory / Consultancy, 2016: Servier. All other authors have declared no conflicts of interest.
1826P
Immunogenicity and optimal timing of 13-valent pneumococcal conjugate vaccination during adjuvant chemotherapy in gastric and colorectal cancer: A randomized controlled trial
W. Choi1, J.G. Kim2, S-H. Beom3, J.E. Hwang1, H-J. Shim1, S-H. Cho1, M-H. Shin4, S-H. Jung5, I-J. Chung1, J.Y. Song6, W.K. Bae1 1 Medical Oncology, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea, 2Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea, 3Medical Oncology, Yonsei Cancer Center, Seoul, Republic of Korea, 4 Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Republic of Korea, 5Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA, 6Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea Background: Pneumococcal vaccination (PCV13) is recommended to cancer patients undergoing systemic chemotherapy. However, the optimal time interval between vaccine administration and initiation of chemotherapy has been little studied in adult patients with solid malignancies. Methods: We conducted a prospective randomized controlled trial to evaluate whether administering PCV13 on the first day of chemotherapy is non-inferior to vaccinating two weeks prior to chemotherapy initiation. Patients were randomly assigned to two study arms, and serum samples were collected at baseline and 4 weeks after vaccination to analyze the serologic response against Streptococcus pneumonia using a multiplexed opsonophagocytic killing assay. Results: Of the 92 patients who underwent randomization, 43 patients in Arm A (vaccination 2 weeks before chemotherapy) and 44 patients in Arm B (vaccination on the first day of chemotherapy) were analyzed. Immunogenicity was assessed by geometric mean and fold-increase of post-vaccination titers, seroprotection rates (percentage of patients with post-vaccination titers > 1:64), and seroconversion rates (percentage of patients with > four-fold increase in post-vaccination titers). Serologic responses to PCV13 did not differ significantly between the two study arms according to all three types of assessments. Conclusions: The overall antibody response to PCV13 is adequate in patients with gastric and colorectal cancer during adjuvant chemotherapy, and no significant difference was found when patients were vaccinated two weeks before or on the day of chemotherapy initiation. Clinical trial identification: KCT0003379. Legal entity responsible for the study: The authors. Funding: National Research Foundation of Korea (NRF), Ministry of Health and Welfare of Korea. Disclosure: All authors have declared no conflicts of interest.
doi:10.1093/annonc/mdz265 | v741
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz265.069/5577838 by guest on 03 October 2019
placebo is lasting for 6 weeks and evaluated every week by NCI degree, NRS pain scores. Assess quality of life using DLQI (dermatology life quality index) scale and IADL (instrumental activity of daily living) scale at the beginning one week later and the end. Results: NCI degree and NRS pain scores between two groups are significant difference (p < 0.001). HFS effective rate (70.4%) and pain alleviated rate (81.9%) of treatment group are significantly higher than control group (p < 0.001). There is no intense evidence identify the effect for quality of life with LC09 after assessing by DLQI scale and IADL scale. Chemical completion rate between two groups is significantly different, P ¼ 0.0021. Conclusions: Chinese herbal compound LC09 can decrease NCI degree and alleviate pain significantly. Besides, it can also increase chemical completion rate. But effect for quality of life still needs to search with more specific scale. Legal entity responsible for the study: The authors. Funding: Ministry of Science and Technology of the People’s Republic of China (2015BAI04B07). Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology
1824P
A prospective study about the complementary medicine among patients with cancers
W. Ben Kridis, A. Mnif, A. Khanfir Medical Oncology Department, University of Sfax - Hopital Habib Bourguiba, Sfax, Tunisia Background: There is limited information on the association among complementary medicin (CM), toxicities and overall survival of patients with cancer who receive CM compared with those who do not. Methods: This is a prospective study including 223 patients collected during 6 months between July 15, 2018 and January 15, 2019 in the department of medical oncology at the Habib Bourguiba university Hospital. All patients were questioned about the concept of taking herbs and botanicals such as gravila and Alinda. We analyzed the demographic data, the toxicities after the consumption of plants as well as the causal link. Then we compared overall survival among those who receive plants versus the nonusers. Results: The average age was 53 years (2-86 years old). There were 152 women and 71 men. 83 patients were illiterate (37.2%). 110 patients had breast cancer (49.3%), the others included colorectal, endometrial, cervical, gastric, ovarian, lung, bladder and head and neck cancers). 97 had metastatic disease (43.4%). 97 patients had taken plants (43.4%), during the medical treatment in 57 cases (58.7%). 60 patients had consumed Alinda (61.8%) and 36 patients had received Graviola (37.1%). 62 women had taken plants against 37 men (v2 ¼ 1.425, ddl ¼ 1, a ¼ 5%, p ¼ 0.147). 49 patients with metastatic disease had taken plants against 48 with localized cancer (v2 ¼ 3.468, ddl ¼ 2, a ¼ 5%, p ¼ 0.177). 10 patients have had diarrhea (10.3%), 10 cytolysis (10.3%), 11 cholestasis (11.3%), 15 thrombocytosis (15.4%), 17 leukocytosis (17.5%) and 13 anemia (13.4%). Only leukocytosis, thrombocytosis, and diarrhea were related to plant consumption with p ¼ 0.0001, p ¼ 0.016 and p ¼ 0.014 respectively. Overall survival at 5 years was 67.1%. It was lower in patients consuming the plants (54% vs 83% p ¼ 0.023). Conclusions: The consumption of Graviola and Alinda was associated with a decrease in the 5 years overall survival (p ¼ 0.023). It was associated with leukocytosis, thrombocytosis, and diarrhoea. This consumption was not statistically different between men and women nor between the localized or metastatic stage. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
1825P
Prevalence and management of potentially inappropriate medication use and potential omissions in medication in older cancer patients: The PIM POM study
F.M.A.M. van Loveren1, I.R.F. van Berlo - van de Laar1, A.L.T. Imholz2, K. Taxis3, F.G.A. Jansman1 1 Clinical Pharmacy, Deventer Hospital, Deventer, Netherlands, 2Internal Medicine, Deventer Hospital, Deventer, Netherlands, 3PharmacoTherapy, -Epidemiology and Economics, University of Groningen, Groningen, Netherlands Background: Older cancer patients are a vulnerable group of medication users. Pharmacist-led medication reviews may optimize treatment and thereby reduce the risk of harmful effects from medication use. This study aims to determine the prevalence and management of Potentially Inappropriate Medication use (PIM’s) and Potential Omissions in Medication (POM’s) in older cancer patients. Methods: In this prospective observational study (hospital) pharmacists conducted medication reviews with older cancer patients (aged 65 years) treated with parenteral chemo and/or immunotherapy to determine the prevalence of PIM’s and POM’s. PIM’s and POM’s were identified using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP), the screening Tool to Alert doctors to the Right Treatment (START) and pharmacists’ expert opinion. Recommendations
Volume 30 | Supplement 5 | October 2019
regarding PIM’s and POM’s were made to the patient’s oncologist/haematologist and follow-up was measured. Associations between covariates and the prevalence of PIM’s and POM’s were statistically analysed. Results: 117 (78%) of the 150 patients included (median age 72 years, 59% male, 68% solid tumours, mean number of medicines 11) had at least one PIM and/or PIM. In total 266 PIM’s and POM’s were identified, and these led to 195 (73%) follow-up actions (table). The number of medicines and Charlson Comorbidity Index score (as a measure of vulnerability) were both independently associated with having at least one PIM and/or POM (p ¼ .031 and p ¼ .002 respectively).
Table: 1825P Identification and follow-up of PIM’s and POM’s PIM’s and POM’s n (%) PIM’s, total Using STOPP Using expert opinion Using both POM’s, total Using START Using expert opinion Follow-up actions By oncologist/haematologist By general practitioner No follow-up action
180 89 (49) 85 (47) 6 (3) 86 66 (77) 20 (23) 266 77 (29) 118 (44) 71 (27)
Conclusions: PIM’s and POM’s are highly prevalent among older cancer patients. A pharmacist-led medication review using STOPP/START criteria and pharmacists’ expert opinion is an excellent way to identify these PIM’s and POM’s and to optimize patients’ medication use. The majority of recommendations made regarding PIM’s and POM’s leads to a follow-up action. Legal entity responsible for the study: Deventer Teaching Hospital. Funding: Has not received any funding. Disclosure: F.G.A. Jansman: Advisory / Consultancy, 2016: Amgen; Advisory / Consultancy, 2016: Servier. All other authors have declared no conflicts of interest.
1826P
Immunogenicity and optimal timing of 13-valent pneumococcal conjugate vaccination during adjuvant chemotherapy in gastric and colorectal cancer: A randomized controlled trial
W. Choi1, J.G. Kim2, S-H. Beom3, J.E. Hwang1, H-J. Shim1, S-H. Cho1, M-H. Shin4, S-H. Jung5, I-J. Chung1, J.Y. Song6, W.K. Bae1 1 Medical Oncology, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea, 2Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea, 3Medical Oncology, Yonsei Cancer Center, Seoul, Republic of Korea, 4 Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Republic of Korea, 5Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA, 6Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea Background: Pneumococcal vaccination (PCV13) is recommended to cancer patients undergoing systemic chemotherapy. However, the optimal time interval between vaccine administration and initiation of chemotherapy has been little studied in adult patients with solid malignancies. Methods: We conducted a prospective randomized controlled trial to evaluate whether administering PCV13 on the first day of chemotherapy is non-inferior to vaccinating two weeks prior to chemotherapy initiation. Patients were randomly assigned to two study arms, and serum samples were collected at baseline and 4 weeks after vaccination to analyze the serologic response against Streptococcus pneumonia using a multiplexed opsonophagocytic killing assay. Results: Of the 92 patients who underwent randomization, 43 patients in Arm A (vaccination 2 weeks before chemotherapy) and 44 patients in Arm B (vaccination on the first day of chemotherapy) were analyzed. Immunogenicity was assessed by geometric mean and fold-increase of post-vaccination titers, seroprotection rates (percentage of patients with post-vaccination titers > 1:64), and seroconversion rates (percentage of patients with > four-fold increase in post-vaccination titers). Serologic responses to PCV13 did not differ significantly between the two study arms according to all three types of assessments. Conclusions: The overall antibody response to PCV13 is adequate in patients with gastric and colorectal cancer during adjuvant chemotherapy, and no significant difference was found when patients were vaccinated two weeks before or on the day of chemotherapy initiation. Clinical trial identification: KCT0003379. Legal entity responsible for the study: The authors. Funding: National Research Foundation of Korea (NRF), Ministry of Health and Welfare of Korea. Disclosure: All authors have declared no conflicts of interest.
doi:10.1093/annonc/mdz265 | v741
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz265.069/5577838 by guest on 03 October 2019
placebo is lasting for 6 weeks and evaluated every week by NCI degree, NRS pain scores. Assess quality of life using DLQI (dermatology life quality index) scale and IADL (instrumental activity of daily living) scale at the beginning one week later and the end. Results: NCI degree and NRS pain scores between two groups are significant difference (p < 0.001). HFS effective rate (70.4%) and pain alleviated rate (81.9%) of treatment group are significantly higher than control group (p < 0.001). There is no intense evidence identify the effect for quality of life with LC09 after assessing by DLQI scale and IADL scale. Chemical completion rate between two groups is significantly different, P ¼ 0.0021. Conclusions: Chinese herbal compound LC09 can decrease NCI degree and alleviate pain significantly. Besides, it can also increase chemical completion rate. But effect for quality of life still needs to search with more specific scale. Legal entity responsible for the study: The authors. Funding: Ministry of Science and Technology of the People’s Republic of China (2015BAI04B07). Disclosure: All authors have declared no conflicts of interest.