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Factors associated with receipt of chemotherapy and causes of death for patients with colon cancer stage III
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
Results: To the best of our knowledge, no RCT has been published comparing full dose chemotherapy versus dose reduction in elderly patients with MCRC. Comparisons of different chemotherapy regimens in the elderly focusing on efficacy and toxicity have been described in several (phase II) studies. A review evaluating various chemotherapy regimens in elderly with CRC showed good efficacy of adjuvant chemotherapy in this population and prolongation of cancer free survival.[2] Furthermore, first line chemotherapy with capecitabine/ oxaliplatin has been shown to have similar efficacy as capecitabine/ irinotecan in patients aged over 70 years.[4] Overall, no evidence on age differences in efficacy of chemotherapy in MCRC patients was found. Benefits of irinotecan have been shown to be similar in elderly and younger patients when fluorouracil(FU)/folinic acid (FA) was compared with irinotecan plus FU/FA.[5] The CAIRO study applying three different regimens of first line systemic treatment showed no differences in survival comparing elderly with younger MCRC patients.[6] Inconsistent results on toxicity in elderly MCRC patients were published. Capecitabine was well tolerated in initial standard dose in MCRC patients over 70 years receiving first line treatment of capecitabine/oxaliplatin compared with oxaliplatin/5-fluorouracil/ leucovorin.[7] However, in the CAIRO study comparing capecitabine to capecitabine plus irinotecan, a higher incidence of toxicity was found in elderly treated with capecitabine only.[6] In a retrospective analysis, including elderly MCRC patients, dose reduction of adjuvant capecitabine/oxaliplatin was compared to full dose capecitabine/ oxaliplatin. No significant difference in GI-toxicity or hospitalization rate was found.[8] Conclusion: No RCT has been published focusing on dose reduction versus full dose chemotherapy in elderly MCRC patients. Overall, efficacy of chemotherapy in elderly MCRC patients is comparable to younger patients, however inclusion bias has to be considered excluding vulnerable elderly MCRC patients in trials. Studies on toxicity show inconsistent results. There are no data available to justify initial dose reduction or modification of treatment regimens in elderly patients with MCRC. Individual patient characteristics, like renal insufficiency, must always be taken into consideration. Studies comparing full dose chemotherapy versus reduced dose chemotherapy in elderly patients are needed.
References [1] Venderbosch S, Doornebal J, Teerenstra S, Lemmens W, Punt CJ, Koopman M. Outcome of first line systemic treatment in elderly compared to younger patients with metastatic colorectal cancer: a retrospective analysis of the CAIRO and CAIRO2 studies of the Dutch Colorectal Cancer Group (DCCG). Acta Oncol July 16 2012. [2] Saif MW, Lichtman SM. Chemotherapy options and outcomes in older adult patients with colorectal cancer. Crit Rev Oncol Hematol 2009 November;72(2):155–169. [3] Bastiaannet E, Liefers GJ, de Craen AJ, Kuppen PJ, van de Water W, Portielje JE, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat 2010 December;124(3):801–807. [4] Rosati G, Cordio S, Bordonaro R, Caputo G, Novello G, Reggiardo G, et al. Capecitabine in combination with oxaliplatin or irinotecan in elderly patients with advanced colorectal cancer: results of a randomized phase II study. Ann Oncol 2010 April;21(4):781–786. [5] Folprecht G, Seymour MT, Saltz L, Douillard JY, Hecker H, Stephens RJ, et al. Irinotecan/fluorouracil combination in first-line therapy of older and younger patients with metastatic colorectal
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cancer: combined analysis of 2,691 patients in randomized controlled trials. J Clin Oncol March 20 2008;26(9):1443–1451. [6] Venderbosch S, Doornebal J, Teerenstra S, Lemmens W, Punt CJ, Koopman M. Outcome of first line systemic treatment in elderly compared to younger patients with metastatic colorectal cancer: a retrospective analysis of the CAIRO and CAIRO2 studies of the Dutch Colorectal Cancer Group (DCCG). Acta Oncol July 16 2012. [7] Feliu J, Salud A, Escudero P, Lopez-Gomez L, Bolanos M, Galan A, et al. XELOX (capecitabine plus oxaliplatin) as first-line treatment for elderly patients over 70 years of age with advanced colorectal cancer. Br J Cancer April 10 2006;94(7):969–975. [8] Baird R, Biondo A, Chhaya V, McLachlan J, Karpathakis A, Rahman S, et al. Toxicity associated with capecitabine plus oxaliplatin in colorectal cancer before and after an institutional policy of capecitabine dose reduction. Br J Cancer January 4 2011;104(1):43–50. doi:10.1016/j.jgo.2012.10.030
P30 Factors associated with receipt of chemotherapy and causes of death for patients with colon cancer stage III C.B.M. van den Broek⁎1, E. Bastiaannet1,2, A.J.M. de Craen2, C. Puylaert1, C.J.H. van de Velde1, J.E.A. Portielje3, G.J. Liefers1. 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands, 2Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands, 3Department of Clinical Oncology, HAGA Hospital, The Hague, The Netherlands Purpose: Since 1997, the Dutch guidelines recommend to treat all stage III colon cancer patients with adjuvant chemotherapy, regardless of age. Despite the improvement in survival and recurrence rates shown by several studies, a large proportion of patients are not treated adherent to this guideline. The percentage of patients not receiving adjuvant chemotherapy increases with age. In the present study factors associated with receiving adjuvant chemotherapy were studied as well as causes of death for this population. Methods: All patients with stage III colon cancer diagnosed between 2000 and 2009 in two hospitals in the mid-western part of The Netherlands were included. Age at time of surgery was divided into four groups. The number of comorbidities and the Charlson Comorbidity score per person were assessed. Characteristics were compared between the groups using chi-squared test. Univariate and multivariable logistic regression was performed to assess independent factors associated with adjuvant chemotherapy. Results: A total of 336 patients were included in this study. Half of the patients were treated with adjuvant chemotherapy (50.6%), and the other 49.4% of patients did not receive adjuvant chemotherapy after surgery. The multivariable logistic regression with the best model fit, which included age, gender, polypharmacy, and civil status, showed that both age and polypharmacy remained significantly associated with receiving chemotherapy (both p b 0.001). There were no differences in recurrences between patients with and without chemotherapy (p = 0.06). Fewer patients died due to the consequences of the primary tumour when they did not receive chemotherapy (31.0% versus 71.2%, p b 0.001). Patients who did not receive additional chemotherapy had more complications after surgery (57.8% versus 18.8%, p b 0.001), and more often died of other causes (14.5% versus 8.5%, p b 0.001). Furthermore 31.9% of the patients who did not receive adjuvant chemotherapy died within 1 year, while 4.7% of the patients who received adjuvant chemotherapy died within 1 year.
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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: Overall, factors associated with chemotherapy for stage III colon cancer were polypharmacy and increasing age. Additionally, more patients died within one year when receiving no chemotherapy, probably due to their worse physical status. As a result, when those patients died within the first postoperative year, they not only mainly died from the surgical complications and the primary tumour, but also due to other causes, such as heart failure. doi:10.1016/j.jgo.2012.10.031
Epidemiology P31 Cancer in elderly patients (CEP) in Tunisia: Retrospective study about 243 patients collected from 2002 to 2007 M.M. Ayadi⁎, G.E.F. Noubbigh, S. Ben Nasr, H. Boudabous, R. Bahloul, M. Afrit, S. Laabidi, H. Boussen. Medical Oncology Department of Abderrahmen Mami's Hospital, Ariana, Tunisia Purpose of the study: To report the epidemiologic, clinical, extension, treatment and results of CEP in a Tunisian population from a department of medical oncology. Methods: We collected retrospectively from 2002 to 2007 cases of CEP (N70 years) within a recruitment of a medical oncology department in Tunisia. We analyzed the following data: age, sex, delay to diagnosis (DD), site, histologic type, stage, co-morbidities, treatment and evolution. Results: These CEP represented 16.7% of the 1507 patients treated for cancer during this period. Mean age was 77.7 +/− 4.21 years (70 to 86), SR 0.93, DD 7.8 +/− 5.28 months (1 to 48), while lung (49 cases), digestive (46 cases) and breast cancer (29 cases) represented the most frequent anatomic sites as well as co-morbidities in 75 cases. 11 patients (4.5%) developed metachronous second cancers and 40 pts (16.4%) have initial metastases at diagnosis. Treatment included chemotherapy in 148 pts (61.3%), surgery in 85 pts (34%) and radiotherapy in 40 pts (17%). Median survival was 24 months. Conclusion: CEP represented more than 15% of patients treated for cancer in a Tunisian series, this age group represented around 6% according to Tunisian population data about 10,732,900 inhabitants in July 2011. CEP are characterized by late diagnosis/consultation, frequent co-morbidities, locally advanced and/or metastatic cases and probably less aggressive treatment compared to younger patients. doi:10.1016/j.jgo.2012.10.032
P32 Surrogate and medical information desired by elderly cancer patients P. Caillet⁎1,2, G. Varnier1, E. Liuu1, C. Tournigand3, H. Vincent4, C. Lazarovici4, E. Paillaud1,2 for the ELCAPA Study Group† 1 Department of Internal Medicine and Geriatrics, Geriatric Oncology Clinic, AP-HP, Henri-Mondor Hospital, Créteil, France, 2Paris Est Créteil University (UPEC), LIC EA 4393, Créteil, France, 3Department of Medical Oncology, AP-HP, Henri-Mondor Hospital, Créteil, France, 4Department of Geriatrics, AP-HP, Paul-Brousse Hospital, Villejuif, France †The ELCAPA Study Group was composed of three oncologists (S. Culine, C. Tournigand, and M. Chaubet), one radiotherapist (JL Lagrange), five geriatricians (P. Caillet, M. Laurent, E. Liuu, E. Paillaud and H. Vincent), two epidemiologists (F. Canouï-Poitrine and S. Bastuji-Garin), one pharmacist (M. Carvahlo-Verlinde), one bio-statistician (A. Le Thuaut), one medical doctor of clinical research (N. Reynald) and one assistant of clinical research associate (N. Boudjema).
Introduction: The notion of surrogate is well established for many years in the Anglo-Saxon countries. In France, this notion introduced by law in 2002 remains unclear in patients, particularly in elderly patients. Moreover, very few studies have focused on the medical information that elderly patients with cancer wanted to receive about their disease. Purpose: The purpose of this study was twofold: 1/ whether elderly patients with cancer were aware of the surrogate concept; and 2/ specify the level and quality of information that older patients with cancer wanted to receive or had received about their disease. Materials and methods: Prospective study conducted in the oncogeriatric consultation, after the diagnosis announcement, in patients aged 70 and over, with solid malignancies, using a binary response questionnaire (yes or no), and open and short responses. Results: Population (N = 141), median age 79.5 years (70 to 94 years), consisted mostly of women (53.9%, n = 76). Mostly patients were living at home (97.8%, n = 137/140), alone in 46.4% of cases (n = 65/140), and had close children in 76.9% of cases (n = 90/117). Patients were independent for basic activities of daily living (ADL N 5/6) in 94.3% of cases (n = 133) and instrumental ADLs (IADL N 12/14) in 84.4% of cases (n = 119). Patients showed no cognitive impairment in 82% of cases (n = 100). At the time of the study, only 4.9% of patients (n = 7/141) had officially designated a surrogate. While 50.4% (n = 71) of patients thought they knew what a surrogate was, only 29.4% (n = 20) proposed an exact definition. Among these patients (n = 20), the spouse and children were each identified in 40% of cases (n = 8), with an official designation in 58.3% of cases (n = 7/12). After completing the questionnaire, 46.3% of patients (n = 63/136) have appointed a surrogate. In the event of an inability to decide for themselves, patients wanted the medical decisions taken by a family member in 81.6% of cases (n = 115) and by their general practitioner in 6.4% of cases (n = 9). In the event that a family member was designated to make medical decisions, it was children in 52.2% of cases (n = 60) and spouse in 35.7% of cases (n = 41). In the event that their health was critical, patients wanted to know the truth in 89.3% of cases (n = 125/140). In this case, they wanted the physician to inform the person of their choice in 69.6% of cases (n = 87/125) or inform this person themselves in 21.6% of cases (n = 27). Regarding the quality of medical information already received on the malignancy, patients felt that medical information received was adequate in 73.8% of cases (n = 93) and clear in 82.5% of cases (n = 104). In total, 85.7% of patients were satisfied or somewhat satisfied with the quality and quantity of information received. Conclusion: In our population, elderly cancer patients knew the surrogate definition in less than 30% of cases, and only 5% had formally designated a surrogate. In the event of a critical health condition, patients wanted to know the truth in almost 90% of cases. Patients were mostly satisfied with the information they had previously received about their cancer. doi:10.1016/j.jgo.2012.10.033
P33 Predictors of cancer treatment failures in elderly: Results from the ELCAPA-03 cohort study M. Laurent1,2, E. Paillaud1,2, J.L. Lagrange3, M. Carvahlo-Verlinde4, P. Caillet1,2, A. Le Thuaut2,5,6, E. Liuu1, H. Vincent7, C. Tournigand8, S. Culine9, F. Canouï-Poitrine⁎2,5 for the ELCAPA Study Group† 1 Department of Internal Medicine and Geriatrics, Geriatric Oncology Clinic, AP-HP, Henri-Mondor Hospital, Créteil, France, 2Paris Est Créteil University (UPEC), LIC EA 4393, Créteil, France, 3Department of
Results: To the best of our knowledge, no RCT has been published comparing full dose chemotherapy versus dose reduction in elderly patients with MCRC. Comparisons of different chemotherapy regimens in the elderly focusing on efficacy and toxicity have been described in several (phase II) studies. A review evaluating various chemotherapy regimens in elderly with CRC showed good efficacy of adjuvant chemotherapy in this population and prolongation of cancer free survival.[2] Furthermore, first line chemotherapy with capecitabine/ oxaliplatin has been shown to have similar efficacy as capecitabine/ irinotecan in patients aged over 70 years.[4] Overall, no evidence on age differences in efficacy of chemotherapy in MCRC patients was found. Benefits of irinotecan have been shown to be similar in elderly and younger patients when fluorouracil(FU)/folinic acid (FA) was compared with irinotecan plus FU/FA.[5] The CAIRO study applying three different regimens of first line systemic treatment showed no differences in survival comparing elderly with younger MCRC patients.[6] Inconsistent results on toxicity in elderly MCRC patients were published. Capecitabine was well tolerated in initial standard dose in MCRC patients over 70 years receiving first line treatment of capecitabine/oxaliplatin compared with oxaliplatin/5-fluorouracil/ leucovorin.[7] However, in the CAIRO study comparing capecitabine to capecitabine plus irinotecan, a higher incidence of toxicity was found in elderly treated with capecitabine only.[6] In a retrospective analysis, including elderly MCRC patients, dose reduction of adjuvant capecitabine/oxaliplatin was compared to full dose capecitabine/ oxaliplatin. No significant difference in GI-toxicity or hospitalization rate was found.[8] Conclusion: No RCT has been published focusing on dose reduction versus full dose chemotherapy in elderly MCRC patients. Overall, efficacy of chemotherapy in elderly MCRC patients is comparable to younger patients, however inclusion bias has to be considered excluding vulnerable elderly MCRC patients in trials. Studies on toxicity show inconsistent results. There are no data available to justify initial dose reduction or modification of treatment regimens in elderly patients with MCRC. Individual patient characteristics, like renal insufficiency, must always be taken into consideration. Studies comparing full dose chemotherapy versus reduced dose chemotherapy in elderly patients are needed.
References [1] Venderbosch S, Doornebal J, Teerenstra S, Lemmens W, Punt CJ, Koopman M. Outcome of first line systemic treatment in elderly compared to younger patients with metastatic colorectal cancer: a retrospective analysis of the CAIRO and CAIRO2 studies of the Dutch Colorectal Cancer Group (DCCG). Acta Oncol July 16 2012. [2] Saif MW, Lichtman SM. Chemotherapy options and outcomes in older adult patients with colorectal cancer. Crit Rev Oncol Hematol 2009 November;72(2):155–169. [3] Bastiaannet E, Liefers GJ, de Craen AJ, Kuppen PJ, van de Water W, Portielje JE, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat 2010 December;124(3):801–807. [4] Rosati G, Cordio S, Bordonaro R, Caputo G, Novello G, Reggiardo G, et al. Capecitabine in combination with oxaliplatin or irinotecan in elderly patients with advanced colorectal cancer: results of a randomized phase II study. Ann Oncol 2010 April;21(4):781–786. [5] Folprecht G, Seymour MT, Saltz L, Douillard JY, Hecker H, Stephens RJ, et al. Irinotecan/fluorouracil combination in first-line therapy of older and younger patients with metastatic colorectal
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cancer: combined analysis of 2,691 patients in randomized controlled trials. J Clin Oncol March 20 2008;26(9):1443–1451. [6] Venderbosch S, Doornebal J, Teerenstra S, Lemmens W, Punt CJ, Koopman M. Outcome of first line systemic treatment in elderly compared to younger patients with metastatic colorectal cancer: a retrospective analysis of the CAIRO and CAIRO2 studies of the Dutch Colorectal Cancer Group (DCCG). Acta Oncol July 16 2012. [7] Feliu J, Salud A, Escudero P, Lopez-Gomez L, Bolanos M, Galan A, et al. XELOX (capecitabine plus oxaliplatin) as first-line treatment for elderly patients over 70 years of age with advanced colorectal cancer. Br J Cancer April 10 2006;94(7):969–975. [8] Baird R, Biondo A, Chhaya V, McLachlan J, Karpathakis A, Rahman S, et al. Toxicity associated with capecitabine plus oxaliplatin in colorectal cancer before and after an institutional policy of capecitabine dose reduction. Br J Cancer January 4 2011;104(1):43–50. doi:10.1016/j.jgo.2012.10.030
P30 Factors associated with receipt of chemotherapy and causes of death for patients with colon cancer stage III C.B.M. van den Broek⁎1, E. Bastiaannet1,2, A.J.M. de Craen2, C. Puylaert1, C.J.H. van de Velde1, J.E.A. Portielje3, G.J. Liefers1. 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands, 2Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands, 3Department of Clinical Oncology, HAGA Hospital, The Hague, The Netherlands Purpose: Since 1997, the Dutch guidelines recommend to treat all stage III colon cancer patients with adjuvant chemotherapy, regardless of age. Despite the improvement in survival and recurrence rates shown by several studies, a large proportion of patients are not treated adherent to this guideline. The percentage of patients not receiving adjuvant chemotherapy increases with age. In the present study factors associated with receiving adjuvant chemotherapy were studied as well as causes of death for this population. Methods: All patients with stage III colon cancer diagnosed between 2000 and 2009 in two hospitals in the mid-western part of The Netherlands were included. Age at time of surgery was divided into four groups. The number of comorbidities and the Charlson Comorbidity score per person were assessed. Characteristics were compared between the groups using chi-squared test. Univariate and multivariable logistic regression was performed to assess independent factors associated with adjuvant chemotherapy. Results: A total of 336 patients were included in this study. Half of the patients were treated with adjuvant chemotherapy (50.6%), and the other 49.4% of patients did not receive adjuvant chemotherapy after surgery. The multivariable logistic regression with the best model fit, which included age, gender, polypharmacy, and civil status, showed that both age and polypharmacy remained significantly associated with receiving chemotherapy (both p b 0.001). There were no differences in recurrences between patients with and without chemotherapy (p = 0.06). Fewer patients died due to the consequences of the primary tumour when they did not receive chemotherapy (31.0% versus 71.2%, p b 0.001). Patients who did not receive additional chemotherapy had more complications after surgery (57.8% versus 18.8%, p b 0.001), and more often died of other causes (14.5% versus 8.5%, p b 0.001). Furthermore 31.9% of the patients who did not receive adjuvant chemotherapy died within 1 year, while 4.7% of the patients who received adjuvant chemotherapy died within 1 year.
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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: Overall, factors associated with chemotherapy for stage III colon cancer were polypharmacy and increasing age. Additionally, more patients died within one year when receiving no chemotherapy, probably due to their worse physical status. As a result, when those patients died within the first postoperative year, they not only mainly died from the surgical complications and the primary tumour, but also due to other causes, such as heart failure. doi:10.1016/j.jgo.2012.10.031
Epidemiology P31 Cancer in elderly patients (CEP) in Tunisia: Retrospective study about 243 patients collected from 2002 to 2007 M.M. Ayadi⁎, G.E.F. Noubbigh, S. Ben Nasr, H. Boudabous, R. Bahloul, M. Afrit, S. Laabidi, H. Boussen. Medical Oncology Department of Abderrahmen Mami's Hospital, Ariana, Tunisia Purpose of the study: To report the epidemiologic, clinical, extension, treatment and results of CEP in a Tunisian population from a department of medical oncology. Methods: We collected retrospectively from 2002 to 2007 cases of CEP (N70 years) within a recruitment of a medical oncology department in Tunisia. We analyzed the following data: age, sex, delay to diagnosis (DD), site, histologic type, stage, co-morbidities, treatment and evolution. Results: These CEP represented 16.7% of the 1507 patients treated for cancer during this period. Mean age was 77.7 +/− 4.21 years (70 to 86), SR 0.93, DD 7.8 +/− 5.28 months (1 to 48), while lung (49 cases), digestive (46 cases) and breast cancer (29 cases) represented the most frequent anatomic sites as well as co-morbidities in 75 cases. 11 patients (4.5%) developed metachronous second cancers and 40 pts (16.4%) have initial metastases at diagnosis. Treatment included chemotherapy in 148 pts (61.3%), surgery in 85 pts (34%) and radiotherapy in 40 pts (17%). Median survival was 24 months. Conclusion: CEP represented more than 15% of patients treated for cancer in a Tunisian series, this age group represented around 6% according to Tunisian population data about 10,732,900 inhabitants in July 2011. CEP are characterized by late diagnosis/consultation, frequent co-morbidities, locally advanced and/or metastatic cases and probably less aggressive treatment compared to younger patients. doi:10.1016/j.jgo.2012.10.032
P32 Surrogate and medical information desired by elderly cancer patients P. Caillet⁎1,2, G. Varnier1, E. Liuu1, C. Tournigand3, H. Vincent4, C. Lazarovici4, E. Paillaud1,2 for the ELCAPA Study Group† 1 Department of Internal Medicine and Geriatrics, Geriatric Oncology Clinic, AP-HP, Henri-Mondor Hospital, Créteil, France, 2Paris Est Créteil University (UPEC), LIC EA 4393, Créteil, France, 3Department of Medical Oncology, AP-HP, Henri-Mondor Hospital, Créteil, France, 4Department of Geriatrics, AP-HP, Paul-Brousse Hospital, Villejuif, France †The ELCAPA Study Group was composed of three oncologists (S. Culine, C. Tournigand, and M. Chaubet), one radiotherapist (JL Lagrange), five geriatricians (P. Caillet, M. Laurent, E. Liuu, E. Paillaud and H. Vincent), two epidemiologists (F. Canouï-Poitrine and S. Bastuji-Garin), one pharmacist (M. Carvahlo-Verlinde), one bio-statistician (A. Le Thuaut), one medical doctor of clinical research (N. Reynald) and one assistant of clinical research associate (N. Boudjema).
Introduction: The notion of surrogate is well established for many years in the Anglo-Saxon countries. In France, this notion introduced by law in 2002 remains unclear in patients, particularly in elderly patients. Moreover, very few studies have focused on the medical information that elderly patients with cancer wanted to receive about their disease. Purpose: The purpose of this study was twofold: 1/ whether elderly patients with cancer were aware of the surrogate concept; and 2/ specify the level and quality of information that older patients with cancer wanted to receive or had received about their disease. Materials and methods: Prospective study conducted in the oncogeriatric consultation, after the diagnosis announcement, in patients aged 70 and over, with solid malignancies, using a binary response questionnaire (yes or no), and open and short responses. Results: Population (N = 141), median age 79.5 years (70 to 94 years), consisted mostly of women (53.9%, n = 76). Mostly patients were living at home (97.8%, n = 137/140), alone in 46.4% of cases (n = 65/140), and had close children in 76.9% of cases (n = 90/117). Patients were independent for basic activities of daily living (ADL N 5/6) in 94.3% of cases (n = 133) and instrumental ADLs (IADL N 12/14) in 84.4% of cases (n = 119). Patients showed no cognitive impairment in 82% of cases (n = 100). At the time of the study, only 4.9% of patients (n = 7/141) had officially designated a surrogate. While 50.4% (n = 71) of patients thought they knew what a surrogate was, only 29.4% (n = 20) proposed an exact definition. Among these patients (n = 20), the spouse and children were each identified in 40% of cases (n = 8), with an official designation in 58.3% of cases (n = 7/12). After completing the questionnaire, 46.3% of patients (n = 63/136) have appointed a surrogate. In the event of an inability to decide for themselves, patients wanted the medical decisions taken by a family member in 81.6% of cases (n = 115) and by their general practitioner in 6.4% of cases (n = 9). In the event that a family member was designated to make medical decisions, it was children in 52.2% of cases (n = 60) and spouse in 35.7% of cases (n = 41). In the event that their health was critical, patients wanted to know the truth in 89.3% of cases (n = 125/140). In this case, they wanted the physician to inform the person of their choice in 69.6% of cases (n = 87/125) or inform this person themselves in 21.6% of cases (n = 27). Regarding the quality of medical information already received on the malignancy, patients felt that medical information received was adequate in 73.8% of cases (n = 93) and clear in 82.5% of cases (n = 104). In total, 85.7% of patients were satisfied or somewhat satisfied with the quality and quantity of information received. Conclusion: In our population, elderly cancer patients knew the surrogate definition in less than 30% of cases, and only 5% had formally designated a surrogate. In the event of a critical health condition, patients wanted to know the truth in almost 90% of cases. Patients were mostly satisfied with the information they had previously received about their cancer. doi:10.1016/j.jgo.2012.10.033
P33 Predictors of cancer treatment failures in elderly: Results from the ELCAPA-03 cohort study M. Laurent1,2, E. Paillaud1,2, J.L. Lagrange3, M. Carvahlo-Verlinde4, P. Caillet1,2, A. Le Thuaut2,5,6, E. Liuu1, H. Vincent7, C. Tournigand8, S. Culine9, F. Canouï-Poitrine⁎2,5 for the ELCAPA Study Group† 1 Department of Internal Medicine and Geriatrics, Geriatric Oncology Clinic, AP-HP, Henri-Mondor Hospital, Créteil, France, 2Paris Est Créteil University (UPEC), LIC EA 4393, Créteil, France, 3Department of