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Association between geriatric depression scale-15 and social support in older lymphoma patients in Brazil
2013 SIOG Poster Abstracts
Methods: These are preliminary results of a cross-sectional study that is being developed in a cancer referral hospital in Rio de Janeiro, Brazil. Patients were interviewed with a structured questionnaire containing sociodemographic and clinical variables and a Multidimensional Geriatric Assessment, covering various domains, including nutrition. A descriptive analysis of the study population was performed with measures of central tendency and frequency distributions. To verify the presence of statistically significant differences between strata of independent variables, the statistical tests chi-square and Fisher's exact were used, considering a significance level of 5%. Results: This analysis included 78 elders, whose mean age was 68.79 (±6.71) years. Men constituted more than half of the sample (40; 51.3%) and most of the individuals were married (46, 59.0%) or widowed (14, 17.9%). Regarding education, 32 (41.0%) had lower education and only 9 (11.5%) subjects had a college degree. We identified a high proportion of individuals with severe comorbidity (62, 79.5%, based on the number of categories affected -CIRSG) and 15 (19.2%) subjects with depressive symptoms, based on GDS. As for functionality, 12 (15.4%) individuals were dependent in basic activities of daily living (ADL) and 37 (47.4%) in instrumental activities of daily living (IADL). Average weight of the sample was 71.39 (±13.29) kg (48 kg - 105 kg), mean height of 1.67 (±0.15) m (1.48 m - 2.70 m) and Body Mass Index average was 21.50 (±3.62) kg/m 2 (kg/m2 16.20 31.40 kg/m 2). The prevalence of adequate nutritional status was 43.6%, with 43.6% of patients at nutritional risk and 12.8% with malnutrition. Stratified analysis showed that 67.6% of those who were at nutritional risk or malnourished had 70 years or over, 71.1% were women, 73.0% were dependent in IADL, 83% in ADL and 80% had depressive symptoms. Conclusion: We identified nutritional risk or malnutrition in 56.4% of the patients. The majority of the individuals with nutritional problems also had deficiencies in other health domains, which points to the importance of a multidisciplinary team for the care of older cancer patients. Disclosure of Interest: None Declared
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OMS whatever the disease staging. Therapy has been chosen in a collaborative multidisciplinary discussion and care has been organized in the multicentric regional network of a local hospital in Limousin, HEMATOLIM. It was first line chemotherapy or not. Pts had geriatric assessment according to the SIOG recommendations for CGA. We describe CRASH score before the chemo and event after (not more than 1 month later) according NCI-ctc version 3.0 toxicity table as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events or geriatrics health problems. CRASH points for Toxicity of chemotherapy regime were established using the chemotox table values and regimens that were not listed were scored by analogy. Results: 37/41 included pts were evaluable (exclusion 4 pts: missing data), mean age 81.8 years (72 to 93 years), 53% (22/41) were older than 80 years. Sex ratio was 0.85. Histological subtypes: 17 DLCB, 7 follicular lymphoma, 5 mantle cells lymphoma and 8 others. Chemotherapy was rituximab associated with anthracycline for 33 pts (ZEM n = 11, mini CHOP n = 1), or with non anthracycline regimen as bendamustine n = 3, VP16-Holoxan n = 1, COP-Aracytine n = 2, others n = 19. CRASH score was low or int-low in 10 pts, int-hight or hight in 27 pts. Focus on hematologic risk factor it was low or int-low in 13 patients, inthight or hight in 24 patients. Focus on NON-hematologic risk factor it was low or int-low in 15 patients, int-hight or hight in 22 patients. Focus on event after the treatment, severe toxicity (Grade 3 and more or severe geriatrics problems) was observed in 14 patients. Conclusion: CRASH score is often high in those ONHL. Adverse effects after chemotherapy existed but are less frequently (maybe because of the adapted chimio regime). We observed hematological toxicity and non-hematological toxicity with geriatrics problems. It suggests frailty and risk of toxicity for those ONHL. Those results have to be confirmed into a prospective multicentric study network in the hope to prevent side effects and chemotoxicity by supportive care and more frequent geriatric assessment and specific cares. Disclosure of Interest: None Declared
Keywords: Lymphoma, Nutrition doi:10.1016/j.jgo.2013.09.082
Keywords: Haematological, Lymphoma doi:10.1016/j.jgo.2013.09.083
Track 2 - Haem malignancies in the elderly Lymphoma in the elderly P079 Crash score in the older french non Hodgkin lymphoma receiving chemotherapy, feasability S. Trarieux-Signol1,*, J.B. Fargeas1, J. Abraham1, A. Olivrie1, M.A. Picat2, N. Signol1, A. Jaccard1, D. Bordessoule1. 1Hématologie; 2Gériatrie, CHU LIMOGES, Limoges, France Introduction: The incidence of non Hodgkin lymphoma (NHL) in pts older than 70 years is increasing during the last decade. Geriatric assessment objectives that older adults with NHL (ONHL) vary considerably in terms of performance status, comorbidities and functional reserve. The usual chemosensivity of NHL leads to prescription of a toxic anthracycline chemotherapy in association with rituximab in B NHL. Comprehensive geriatric assessment (CGA) is the best way to identify the functional problems and disabilities of older patients with the aim of providing care and arranging longer-term follow-up. Objectives: In some variety of cancer the CRASH score distinguished the individual risk of severe toxicity from chemotherapy and it could be interesting to study the predictive value of this score in a French ONHL general population. The aim of this study was to establish the interest of the use in a non-selective population of consecutive ONHL pts. Methods: We conducted a retrospective, multicentric study on consecutive NHL pts treated by chemotherapy from june 2010 to march 2013. Inclusion criteria were 70 years old and over pts with a histologically proved diagnosis of NHL according to the guideline of
Track 2 - Haem malignancies in the elderly Lymphoma in the elderly P080 Association between geriatric depression scale-15 and social support in older lymphoma patients in Brazil D.B. Ferreira1,*, L.L. Luz1, L.M. Santiago2, A.P.D.A. Sales3, J.F.S. da Silva3, I.E. Mattos1. 1Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation; 2Federal University of Rio de Janeiro, Rio de Janeiro; 3Federal University of Mato Grosso do Sul, Campo Grande, Brazil Introduction: In Brazil, the incidence rates of Non-Hodgkin’s Lymphoma are increasing in both genders. Cancer treatment causes physical, psychological and social repercussions in these patients. Studies indicated that social support could be an indicator of the social environment in which the patient is inserted and that the psychological changes that may occur could be represented by depression, one of the most important changes identified in these individuals. Objectives: To analyse the relationship between GDS-15 and social support scores in elder patients with Non-Hodgkin’s Lymphoma. Methods: This is a correlation study with preliminary data from a cross-sectional study currently being developed in a cancer referral hospital in Rio de Janeiro, Brazil. The study includes patients undergoing treatment for Non-Hodgkin Lymphoma, between March/June, 2013. Participants were interviewed using a
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2013 SIOG Poster Abstracts
structured questionnaire containing sociodemographic and clinical variables and underwent a Comprehensive Geriatric Assessment (CGA). For measuring social support, we used the instrument Medical Outcomes Survey Social Support (MOS-SS), translated and validated in Brazil. The geriatric depression scale 15 (GDS-15) was used to assess symptoms of depression. Data was analysed with Pearson’s correlation coefficient, considering as statistically significant p ≤ 0.05. Results: Seventy-six elders were evaluated and 50% were male. Mean age of participants was 68.22 (±6:42) years. When evaluating the correlation between GDS-15 results and the dimensions of social support, it was observed that all of them showed statistically significant inverse correlations. This indicates that individuals with high social support scores tend to have low GDS scores, or no symptoms of depression. The stronger correlations were observed between depression and dimensions of information support (r = -0.36, p b 0.001), affective support (r = -0.45, p b 0.001) and social interaction (r = -0.41, p b 0.001). Conclusion: The measurement of social support in older patients may be a useful tool for identifying those who need more frequent attention due to the greater likelihood of developing depressive symptoms during treatment. Thus, these findings point to the importance of providing multi-professional and individualized care for elders with cancer. Disclosure of Interest: None Declared
the average scores of material support (p = 0.021), of emotional support (p = 0.047) and of information support (p = 0.005) were higher in the male group. Mean differences in the other dimensions did not reach statistical significance. Conclusion: The observed differences in social support dimensions between men and women with Non-Hodgkin’s lymphoma show that gender-related factors could influence treatment results. Thus, the importance to include the evaluation of social support in a comprehensive assessment of older patients with cancer. This could be a useful tool to identify patients in need of more specific attention from the multidisciplinary team.
Disclosure of Interest: None Declared
Keywords: Epidemiology, Lymphoma
doi:10.1016/j.jgo.2013.09.085
Track 2 - Haem malignancies in the elderly Lymphoma in the elderly P082 DLBCL in elderly: A single centre experience from north India A.H. Nehra*, A. Vora, A. Pandey, R. Naithani, A. Gupta. Max Cancer Centre, Max Super Speciality Hospital, New Delhi, India
Keywords: Epidemiology, Lymphoma, Networks doi:10.1016/j.jgo.2013.09.084
Track 2 - Haem malignancies in the elderly Lymphoma in the elderly P081 Differences in social support in elders with non-Hodgkin’s lymphoma in Brazil D.B. Ferreira1,*, L.L. Luz1, L.M. Santiago2, G.M. Rodrigues1, J.S.B. Santos1, I.E. Mattos1. 1Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation; 2Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Introduction: Social support is considered an indicator of quality of life in cancer patients. The oncological treatment of patients with NonHodgkin’s lymphoma causes physical, psychological and social repercussions. However, there are few studies about differences in social support between men and women. Objectives: To evaluate if there are differences in social support reported by elderly male and female with Non-Hodgkin's lymphoma. Methods: This study analyses preliminary data of a cross-sectional study that is being developed with Non-Hodgkin lymphoma patients in a cancer referral hospital in Rio de Janeiro, Brazil. Patients were interviewed using a structured questionnaire containing sociodemographic and clinical variables and underwent a Comprehensive Geriatric Assessment (CGA). For this analysis, we compared social support scores of each dimension between elder men and women that were undergoing treatment between March/June, 2013. Social support was measured with the instrument of the Medical Outcomes Social Support Survey (MOS-SS), translated and validated in Brazil. This instrument assesses five dimensions of social support: material, emotional, informational, affective, and positive social interaction. For data analysis, we used the nonparametric Mann-Whitney statistical test, considering as statistically significant p ≤ 0.05. Results: We evaluated 76 elderly, 50% of them were female. Mean age of participants was 68.22 (±6:42) years. In comparing each dimension of social support in the two groups, it was observed that
Introduction: Elderly DLBCL is treated on similar lines of younger counterpart. Objectives: To evaluate efficacy and safety of curative chemotherapy in elderly NHL. Methods: We evaluated our charts to see demographic profile of all patients above 65 years at our centre, diagnosed with DLBCL, their treatment profile, dose intensity, efficacy, toxicity of 1 st line chemotherapy followed by radiotherapy. Results: Total 36 patients could be identified fitting into our inclusion criteria. Male:female ratio = 1:1; age wise distribution: N65: 36; N70: 23; N75: 8; N80 years: 4. All patients were biopsy proven, CD 20 positive NHL. nodal vs extranodal distribution was: 30:6. One patient on repeat biopsy review was mantle cell lymphoma and two were SLL. Rest all 33 were DLBCL. All patients were adequately staged with PET/bone marrow (13 patients refused bone marrow assuming PET was adequate to rule out bone marrow). Prechemo work up was complete in all patients. 16 patients received RCHOP, 2 patients RCEOP, 9 patients RCVP, 2 patients RMVP, 4 patients R + bendamustin; 2 patients R alone. 31 patients could receive full dose (2patients 10% adriamycin less) of intended chemotherapy dose. No patients had any extra toxicity beyond expected. No mortality on treatment was reported. Response evaluation was done on clinical examination and PET. 60% of patients achieved metabolic CR post chemotherapy. Long term follow up is being evaluated and will be presented during conference. Conclusion: Elderly DLBCL could be treated with curative intent irrespective of age. Almost 50%of patients could achieve full dose intensity of RCHOP. More than half achieved metabolic CR. No treatment related mortality can be because of appropriate patient selection or small number. Disclosure of Interest: None Declared Keyword: Epidemiology doi:10.1016/j.jgo.2013.09.086
Methods: These are preliminary results of a cross-sectional study that is being developed in a cancer referral hospital in Rio de Janeiro, Brazil. Patients were interviewed with a structured questionnaire containing sociodemographic and clinical variables and a Multidimensional Geriatric Assessment, covering various domains, including nutrition. A descriptive analysis of the study population was performed with measures of central tendency and frequency distributions. To verify the presence of statistically significant differences between strata of independent variables, the statistical tests chi-square and Fisher's exact were used, considering a significance level of 5%. Results: This analysis included 78 elders, whose mean age was 68.79 (±6.71) years. Men constituted more than half of the sample (40; 51.3%) and most of the individuals were married (46, 59.0%) or widowed (14, 17.9%). Regarding education, 32 (41.0%) had lower education and only 9 (11.5%) subjects had a college degree. We identified a high proportion of individuals with severe comorbidity (62, 79.5%, based on the number of categories affected -CIRSG) and 15 (19.2%) subjects with depressive symptoms, based on GDS. As for functionality, 12 (15.4%) individuals were dependent in basic activities of daily living (ADL) and 37 (47.4%) in instrumental activities of daily living (IADL). Average weight of the sample was 71.39 (±13.29) kg (48 kg - 105 kg), mean height of 1.67 (±0.15) m (1.48 m - 2.70 m) and Body Mass Index average was 21.50 (±3.62) kg/m 2 (kg/m2 16.20 31.40 kg/m 2). The prevalence of adequate nutritional status was 43.6%, with 43.6% of patients at nutritional risk and 12.8% with malnutrition. Stratified analysis showed that 67.6% of those who were at nutritional risk or malnourished had 70 years or over, 71.1% were women, 73.0% were dependent in IADL, 83% in ADL and 80% had depressive symptoms. Conclusion: We identified nutritional risk or malnutrition in 56.4% of the patients. The majority of the individuals with nutritional problems also had deficiencies in other health domains, which points to the importance of a multidisciplinary team for the care of older cancer patients. Disclosure of Interest: None Declared
S59
OMS whatever the disease staging. Therapy has been chosen in a collaborative multidisciplinary discussion and care has been organized in the multicentric regional network of a local hospital in Limousin, HEMATOLIM. It was first line chemotherapy or not. Pts had geriatric assessment according to the SIOG recommendations for CGA. We describe CRASH score before the chemo and event after (not more than 1 month later) according NCI-ctc version 3.0 toxicity table as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events or geriatrics health problems. CRASH points for Toxicity of chemotherapy regime were established using the chemotox table values and regimens that were not listed were scored by analogy. Results: 37/41 included pts were evaluable (exclusion 4 pts: missing data), mean age 81.8 years (72 to 93 years), 53% (22/41) were older than 80 years. Sex ratio was 0.85. Histological subtypes: 17 DLCB, 7 follicular lymphoma, 5 mantle cells lymphoma and 8 others. Chemotherapy was rituximab associated with anthracycline for 33 pts (ZEM n = 11, mini CHOP n = 1), or with non anthracycline regimen as bendamustine n = 3, VP16-Holoxan n = 1, COP-Aracytine n = 2, others n = 19. CRASH score was low or int-low in 10 pts, int-hight or hight in 27 pts. Focus on hematologic risk factor it was low or int-low in 13 patients, inthight or hight in 24 patients. Focus on NON-hematologic risk factor it was low or int-low in 15 patients, int-hight or hight in 22 patients. Focus on event after the treatment, severe toxicity (Grade 3 and more or severe geriatrics problems) was observed in 14 patients. Conclusion: CRASH score is often high in those ONHL. Adverse effects after chemotherapy existed but are less frequently (maybe because of the adapted chimio regime). We observed hematological toxicity and non-hematological toxicity with geriatrics problems. It suggests frailty and risk of toxicity for those ONHL. Those results have to be confirmed into a prospective multicentric study network in the hope to prevent side effects and chemotoxicity by supportive care and more frequent geriatric assessment and specific cares. Disclosure of Interest: None Declared
Keywords: Lymphoma, Nutrition doi:10.1016/j.jgo.2013.09.082
Keywords: Haematological, Lymphoma doi:10.1016/j.jgo.2013.09.083
Track 2 - Haem malignancies in the elderly Lymphoma in the elderly P079 Crash score in the older french non Hodgkin lymphoma receiving chemotherapy, feasability S. Trarieux-Signol1,*, J.B. Fargeas1, J. Abraham1, A. Olivrie1, M.A. Picat2, N. Signol1, A. Jaccard1, D. Bordessoule1. 1Hématologie; 2Gériatrie, CHU LIMOGES, Limoges, France Introduction: The incidence of non Hodgkin lymphoma (NHL) in pts older than 70 years is increasing during the last decade. Geriatric assessment objectives that older adults with NHL (ONHL) vary considerably in terms of performance status, comorbidities and functional reserve. The usual chemosensivity of NHL leads to prescription of a toxic anthracycline chemotherapy in association with rituximab in B NHL. Comprehensive geriatric assessment (CGA) is the best way to identify the functional problems and disabilities of older patients with the aim of providing care and arranging longer-term follow-up. Objectives: In some variety of cancer the CRASH score distinguished the individual risk of severe toxicity from chemotherapy and it could be interesting to study the predictive value of this score in a French ONHL general population. The aim of this study was to establish the interest of the use in a non-selective population of consecutive ONHL pts. Methods: We conducted a retrospective, multicentric study on consecutive NHL pts treated by chemotherapy from june 2010 to march 2013. Inclusion criteria were 70 years old and over pts with a histologically proved diagnosis of NHL according to the guideline of
Track 2 - Haem malignancies in the elderly Lymphoma in the elderly P080 Association between geriatric depression scale-15 and social support in older lymphoma patients in Brazil D.B. Ferreira1,*, L.L. Luz1, L.M. Santiago2, A.P.D.A. Sales3, J.F.S. da Silva3, I.E. Mattos1. 1Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation; 2Federal University of Rio de Janeiro, Rio de Janeiro; 3Federal University of Mato Grosso do Sul, Campo Grande, Brazil Introduction: In Brazil, the incidence rates of Non-Hodgkin’s Lymphoma are increasing in both genders. Cancer treatment causes physical, psychological and social repercussions in these patients. Studies indicated that social support could be an indicator of the social environment in which the patient is inserted and that the psychological changes that may occur could be represented by depression, one of the most important changes identified in these individuals. Objectives: To analyse the relationship between GDS-15 and social support scores in elder patients with Non-Hodgkin’s Lymphoma. Methods: This is a correlation study with preliminary data from a cross-sectional study currently being developed in a cancer referral hospital in Rio de Janeiro, Brazil. The study includes patients undergoing treatment for Non-Hodgkin Lymphoma, between March/June, 2013. Participants were interviewed using a
S60
2013 SIOG Poster Abstracts
structured questionnaire containing sociodemographic and clinical variables and underwent a Comprehensive Geriatric Assessment (CGA). For measuring social support, we used the instrument Medical Outcomes Survey Social Support (MOS-SS), translated and validated in Brazil. The geriatric depression scale 15 (GDS-15) was used to assess symptoms of depression. Data was analysed with Pearson’s correlation coefficient, considering as statistically significant p ≤ 0.05. Results: Seventy-six elders were evaluated and 50% were male. Mean age of participants was 68.22 (±6:42) years. When evaluating the correlation between GDS-15 results and the dimensions of social support, it was observed that all of them showed statistically significant inverse correlations. This indicates that individuals with high social support scores tend to have low GDS scores, or no symptoms of depression. The stronger correlations were observed between depression and dimensions of information support (r = -0.36, p b 0.001), affective support (r = -0.45, p b 0.001) and social interaction (r = -0.41, p b 0.001). Conclusion: The measurement of social support in older patients may be a useful tool for identifying those who need more frequent attention due to the greater likelihood of developing depressive symptoms during treatment. Thus, these findings point to the importance of providing multi-professional and individualized care for elders with cancer. Disclosure of Interest: None Declared
the average scores of material support (p = 0.021), of emotional support (p = 0.047) and of information support (p = 0.005) were higher in the male group. Mean differences in the other dimensions did not reach statistical significance. Conclusion: The observed differences in social support dimensions between men and women with Non-Hodgkin’s lymphoma show that gender-related factors could influence treatment results. Thus, the importance to include the evaluation of social support in a comprehensive assessment of older patients with cancer. This could be a useful tool to identify patients in need of more specific attention from the multidisciplinary team.
Disclosure of Interest: None Declared
Keywords: Epidemiology, Lymphoma
doi:10.1016/j.jgo.2013.09.085
Track 2 - Haem malignancies in the elderly Lymphoma in the elderly P082 DLBCL in elderly: A single centre experience from north India A.H. Nehra*, A. Vora, A. Pandey, R. Naithani, A. Gupta. Max Cancer Centre, Max Super Speciality Hospital, New Delhi, India
Keywords: Epidemiology, Lymphoma, Networks doi:10.1016/j.jgo.2013.09.084
Track 2 - Haem malignancies in the elderly Lymphoma in the elderly P081 Differences in social support in elders with non-Hodgkin’s lymphoma in Brazil D.B. Ferreira1,*, L.L. Luz1, L.M. Santiago2, G.M. Rodrigues1, J.S.B. Santos1, I.E. Mattos1. 1Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation; 2Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Introduction: Social support is considered an indicator of quality of life in cancer patients. The oncological treatment of patients with NonHodgkin’s lymphoma causes physical, psychological and social repercussions. However, there are few studies about differences in social support between men and women. Objectives: To evaluate if there are differences in social support reported by elderly male and female with Non-Hodgkin's lymphoma. Methods: This study analyses preliminary data of a cross-sectional study that is being developed with Non-Hodgkin lymphoma patients in a cancer referral hospital in Rio de Janeiro, Brazil. Patients were interviewed using a structured questionnaire containing sociodemographic and clinical variables and underwent a Comprehensive Geriatric Assessment (CGA). For this analysis, we compared social support scores of each dimension between elder men and women that were undergoing treatment between March/June, 2013. Social support was measured with the instrument of the Medical Outcomes Social Support Survey (MOS-SS), translated and validated in Brazil. This instrument assesses five dimensions of social support: material, emotional, informational, affective, and positive social interaction. For data analysis, we used the nonparametric Mann-Whitney statistical test, considering as statistically significant p ≤ 0.05. Results: We evaluated 76 elderly, 50% of them were female. Mean age of participants was 68.22 (±6:42) years. In comparing each dimension of social support in the two groups, it was observed that
Introduction: Elderly DLBCL is treated on similar lines of younger counterpart. Objectives: To evaluate efficacy and safety of curative chemotherapy in elderly NHL. Methods: We evaluated our charts to see demographic profile of all patients above 65 years at our centre, diagnosed with DLBCL, their treatment profile, dose intensity, efficacy, toxicity of 1 st line chemotherapy followed by radiotherapy. Results: Total 36 patients could be identified fitting into our inclusion criteria. Male:female ratio = 1:1; age wise distribution: N65: 36; N70: 23; N75: 8; N80 years: 4. All patients were biopsy proven, CD 20 positive NHL. nodal vs extranodal distribution was: 30:6. One patient on repeat biopsy review was mantle cell lymphoma and two were SLL. Rest all 33 were DLBCL. All patients were adequately staged with PET/bone marrow (13 patients refused bone marrow assuming PET was adequate to rule out bone marrow). Prechemo work up was complete in all patients. 16 patients received RCHOP, 2 patients RCEOP, 9 patients RCVP, 2 patients RMVP, 4 patients R + bendamustin; 2 patients R alone. 31 patients could receive full dose (2patients 10% adriamycin less) of intended chemotherapy dose. No patients had any extra toxicity beyond expected. No mortality on treatment was reported. Response evaluation was done on clinical examination and PET. 60% of patients achieved metabolic CR post chemotherapy. Long term follow up is being evaluated and will be presented during conference. Conclusion: Elderly DLBCL could be treated with curative intent irrespective of age. Almost 50%of patients could achieve full dose intensity of RCHOP. More than half achieved metabolic CR. No treatment related mortality can be because of appropriate patient selection or small number. Disclosure of Interest: None Declared Keyword: Epidemiology doi:10.1016/j.jgo.2013.09.086