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Febrile neutropenia in adjuvant and neoadjuvant chemotherapy for breast cancer: a retrospective study in routine clinical practice from a single institution
S170
Abstracts
Proffered Papers, Sunday 29 January 2017
Results: A Grounded Theory of the way melanoma patients and carers maintained their normal activities and roles was developed. This involved the process of re-thinking aspects of daily life while understanding what melanoma meant to them. Patients and carers experienced changes in terms of their roles, routines and relationships. Roles were maintained where possible but modified to avoid sun exposure. Routines included sun protection measures, self-examination and attending hospital for surveillance. The nature of a relationship determined how much information was shared or whether it was hidden. Relationships with HCPs were seen as different to personal relationships with information still central. HCPs, particularly CNS formed relationships with patients and actively sought to change aspects of patients’ and carers’ routines, such as sun protection. They also engaged in activities to maintain patients’ roles. Patients, carers and HCPs identified similar key time points with diagnosis being the most important. Conclusions: Through a deeper understanding of the experience of melanoma patients and their carers, healthcare professionals can develop individualised care and contribute to positive experiences. Developing a therapeutic relationship from diagnosis is key to this. No conflict of interest. 1824 POSTER Febrile neutropenia in adjuvant and neoadjuvant chemotherapy for breast cancer: a retrospective study in routine clinical practice from a single institution J. Bacrie1 , M. Laurans1 , P. Iorio1 , E. Fourme2 , J.Y. Pierga3 , A. Bethune ´ Volters1 , B. Benzidane1 , L. Bozec3 , F. Lerebours3 , C. Dubot3 , 2 1 3 O. Bensaoula , D. Lefeuvre . Curie Institute, chemotherapy outpatient clinic, Saint Cloud, France; 2 Curie Institute, Department of statistics, Saint Cloud, France; 3 Curie Institute, Department of medical oncology, Saint Cloud, France Background: Febrile neutropenia (FN) is one of the most critical and frequent side effect of chemotherapy. Despite many existing guidelines based on the use of granulocyte colony stimulating factor (G-CSF), FN still arises and cripples the quality of life and treatment of many patients. The purpose of this study was to assess in a routine clinical practice the incidence and the management of FN in chemotherapy regimen for early breast cancer. Material and Methods: Every patient treated for primary breast cancer by chemotherapy in 2014 in the Institut Curie − Hopital ˆ Rene´ Huguenin, was included retrospectively. The incidence rate of FN and their management were reported. Factors associated with FN were studied with a Poisson regression with robust error variance. Results: 524 patients received either neoadjuvant chemotherapy (N = 130) or adjuvant (N = 394). Most patients (80%) were treated with a combination of 5-Fluorouracil, Epirubicin, and Cyclophosphamide (FEC100 3 cycles) followed by Docetaxel 100mg/m2 (3 cycles). 18% of patients received a primary prophylaxis (PP) for FN with G-CSF using pegfilgrastim in 64% of cases. 74% of patients over 70 years received a PP. Overall, the incidence rate of FN was 17%. Less than 5% of patients who received the PP suffered from FN. Recurrent FN after secondary prophylaxis occured in 9% of patients. 47% of FN occurred after the first cycle and 30% after the fourth one, which correspond to Docetaxel +/− Trastuzumab. FEC100 chemotherapy regimen was associated with a relative risk of FN of 2.2 (p = 0.03). Among comorbidities, auto-immune or inflammatory diseases were associated with a higher risk of FN (RR: 2.56; p = 0.02). There was no significant difference between adjuvant and neoadjuvant chemotherapy regarding FN. Management of FN was ambulatory in 72% of cases. Ambulatory patients with FN were treated mainly with the combination of amoxicillin-clavulanic acid and ciprofloxacin. Dose reduction or chemotherapy regimen modification were necessary in 25% of patients after FN. No toxic death was reported. N (%) Febrile neutropenia Ambulatory patients Hospitalized patients in Institut Curie Hospitalized elsewhere No antibiotics Oral amoxicillin–clavulanic acid + ciprofloxacin Oral monoantibiotic Tazocillin Secondary prophylaxy G-CSF Chemotherapy regimen modification Dose reduction
91 (17) 66 (72) 6 (7) 19 (21) 5 (5) 50 (55) 12 (13) 19 (21) 86 (93) 6 (7) 16 (18)
Conclusion: Incidence rate of FN induced by adjuvant/neoadjuvant chemotherapy in early breast cancer is higher in routine clinical practice than in clinical trials. Prevention and management of FN in order to safeguard patient’s safety and quality of life are a major issue for both medical oncologists and supportive care physicians. Primary prophylaxis in patients at risk (elderly, comorbid patients) especially with FEC regimen is the key stone in managing this side effect. No conflict of interest. 1825 POSTER DISCUSSION Changes in cognitive impairment in ovarian cancer patients receiving chemotherapy; a pilot study M. Szabo1 , N. Heller2 , M. Gallanagh2 , F. Nussey2 , C. Gourley2 , M. Mackean2 . 1 Western general hospital, Oncology, Edinburgh, United Kingdom; 2 Western General Hospital, Edinburgh Cancer Centre, Edinburgh, United Kingdom Background: Post-chemotherapy cognitive impairment (PCCI) is a poorly understood side-effect reported by some chemotherapy patients with a potentially severe impact on everyday life. In the elderly cancer patient, cognitive disorders are often underdiagnosed. Ovarian cancer patients can benefit from chemotherapy even in the over 80 population. The effects of chemotherapy on general cognitive function have not previously been reported for ovarian cancer. The purpose of this pilot study was to investigate cognitive function in patients with ovarian cancer and the effects of chemotherapy on this. Method: In this prospective audit, we used the validated Addenbrookes Cognitive Examination (ACE) version III. It assesses six key abilities of cognition with high specificity and sensitivity. Normative data for the UK suggest a cutoff score of 88−82 to predict dementia. Age-related deviation of the norm is minimal. Consecutive patients with ovarian cancer commencing any new line of chemotherapy were included. ACE was performed on each patient twice − on day 1 of their first treatment and at clinic upon completion of chemotherapy. Two versions of the test were used to avoid recognition. The results of the individual assessments were compared to investigate the effect of chemotherapy on cognition. Results: 17 patients with ovarian cancer consented. Median age was 67 (range 50−86) 6 patients were chemonaive, 9 received single agent chemotherapy (5 only platinum). 15 had repeat ACE after chemotherapy: one patient (in whom clinically relevant dementia was suspected) withdrew her consent; another patient died from progressive disease. Results are shown in the table. Seven (41%) patients initially scored below the normative cut-off for cognitive impairment which was previously formally undiagnosed, with a trend amongst previously treated patients (2/6 (33.3%) in chemonaive vs 5/11 (45.5%) in prior chemo). There was no significant age-related difference (mean ACE score 87 vs 86 for age <65 vs 65 yrs). A mean increase of 1.46 in ACE scores after chemotherapy was found. Subjectively all but one patient felt that treatment had negatively impacted on their cognition. Patient
Age
Line of chemo
1st ACE Pre chemo
2nd ACE Post chemo
Difference
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Mean
62 66 71 78 71 68 75 50 86 65 62 64 73 57 66 68 66 67.5
4 1 2 1 2 3 4 3 2 1 1 1 3 2 1 2 2 2.6
73 95 88 82 89 79 82 80 76 77 87 99 89 100 83 92 97 87
82 97 82 86 88 died 83 93 withdrew 77 85 99 90 100 85 92 96 89
+9 +2 −6 +4 −1 +1 +13 0 −2 0 +1 0 +2 0 −1 1.46
Conclusion: 7 out of 17 patients had undiagnosed cognitive impairment prior to starting chemotherapy for ovarian cancer. During chemotherapy most patients felt their cognitive function deteriorated, yet this could not be confirmed using ACE III. Selective testing of individual cognitive abilities in chemonaive patients may be more successful in understanding PCCI. No conflict of interest.
Abstracts
Proffered Papers, Sunday 29 January 2017
Results: A Grounded Theory of the way melanoma patients and carers maintained their normal activities and roles was developed. This involved the process of re-thinking aspects of daily life while understanding what melanoma meant to them. Patients and carers experienced changes in terms of their roles, routines and relationships. Roles were maintained where possible but modified to avoid sun exposure. Routines included sun protection measures, self-examination and attending hospital for surveillance. The nature of a relationship determined how much information was shared or whether it was hidden. Relationships with HCPs were seen as different to personal relationships with information still central. HCPs, particularly CNS formed relationships with patients and actively sought to change aspects of patients’ and carers’ routines, such as sun protection. They also engaged in activities to maintain patients’ roles. Patients, carers and HCPs identified similar key time points with diagnosis being the most important. Conclusions: Through a deeper understanding of the experience of melanoma patients and their carers, healthcare professionals can develop individualised care and contribute to positive experiences. Developing a therapeutic relationship from diagnosis is key to this. No conflict of interest. 1824 POSTER Febrile neutropenia in adjuvant and neoadjuvant chemotherapy for breast cancer: a retrospective study in routine clinical practice from a single institution J. Bacrie1 , M. Laurans1 , P. Iorio1 , E. Fourme2 , J.Y. Pierga3 , A. Bethune ´ Volters1 , B. Benzidane1 , L. Bozec3 , F. Lerebours3 , C. Dubot3 , 2 1 3 O. Bensaoula , D. Lefeuvre . Curie Institute, chemotherapy outpatient clinic, Saint Cloud, France; 2 Curie Institute, Department of statistics, Saint Cloud, France; 3 Curie Institute, Department of medical oncology, Saint Cloud, France Background: Febrile neutropenia (FN) is one of the most critical and frequent side effect of chemotherapy. Despite many existing guidelines based on the use of granulocyte colony stimulating factor (G-CSF), FN still arises and cripples the quality of life and treatment of many patients. The purpose of this study was to assess in a routine clinical practice the incidence and the management of FN in chemotherapy regimen for early breast cancer. Material and Methods: Every patient treated for primary breast cancer by chemotherapy in 2014 in the Institut Curie − Hopital ˆ Rene´ Huguenin, was included retrospectively. The incidence rate of FN and their management were reported. Factors associated with FN were studied with a Poisson regression with robust error variance. Results: 524 patients received either neoadjuvant chemotherapy (N = 130) or adjuvant (N = 394). Most patients (80%) were treated with a combination of 5-Fluorouracil, Epirubicin, and Cyclophosphamide (FEC100 3 cycles) followed by Docetaxel 100mg/m2 (3 cycles). 18% of patients received a primary prophylaxis (PP) for FN with G-CSF using pegfilgrastim in 64% of cases. 74% of patients over 70 years received a PP. Overall, the incidence rate of FN was 17%. Less than 5% of patients who received the PP suffered from FN. Recurrent FN after secondary prophylaxis occured in 9% of patients. 47% of FN occurred after the first cycle and 30% after the fourth one, which correspond to Docetaxel +/− Trastuzumab. FEC100 chemotherapy regimen was associated with a relative risk of FN of 2.2 (p = 0.03). Among comorbidities, auto-immune or inflammatory diseases were associated with a higher risk of FN (RR: 2.56; p = 0.02). There was no significant difference between adjuvant and neoadjuvant chemotherapy regarding FN. Management of FN was ambulatory in 72% of cases. Ambulatory patients with FN were treated mainly with the combination of amoxicillin-clavulanic acid and ciprofloxacin. Dose reduction or chemotherapy regimen modification were necessary in 25% of patients after FN. No toxic death was reported. N (%) Febrile neutropenia Ambulatory patients Hospitalized patients in Institut Curie Hospitalized elsewhere No antibiotics Oral amoxicillin–clavulanic acid + ciprofloxacin Oral monoantibiotic Tazocillin Secondary prophylaxy G-CSF Chemotherapy regimen modification Dose reduction
91 (17) 66 (72) 6 (7) 19 (21) 5 (5) 50 (55) 12 (13) 19 (21) 86 (93) 6 (7) 16 (18)
Conclusion: Incidence rate of FN induced by adjuvant/neoadjuvant chemotherapy in early breast cancer is higher in routine clinical practice than in clinical trials. Prevention and management of FN in order to safeguard patient’s safety and quality of life are a major issue for both medical oncologists and supportive care physicians. Primary prophylaxis in patients at risk (elderly, comorbid patients) especially with FEC regimen is the key stone in managing this side effect. No conflict of interest. 1825 POSTER DISCUSSION Changes in cognitive impairment in ovarian cancer patients receiving chemotherapy; a pilot study M. Szabo1 , N. Heller2 , M. Gallanagh2 , F. Nussey2 , C. Gourley2 , M. Mackean2 . 1 Western general hospital, Oncology, Edinburgh, United Kingdom; 2 Western General Hospital, Edinburgh Cancer Centre, Edinburgh, United Kingdom Background: Post-chemotherapy cognitive impairment (PCCI) is a poorly understood side-effect reported by some chemotherapy patients with a potentially severe impact on everyday life. In the elderly cancer patient, cognitive disorders are often underdiagnosed. Ovarian cancer patients can benefit from chemotherapy even in the over 80 population. The effects of chemotherapy on general cognitive function have not previously been reported for ovarian cancer. The purpose of this pilot study was to investigate cognitive function in patients with ovarian cancer and the effects of chemotherapy on this. Method: In this prospective audit, we used the validated Addenbrookes Cognitive Examination (ACE) version III. It assesses six key abilities of cognition with high specificity and sensitivity. Normative data for the UK suggest a cutoff score of 88−82 to predict dementia. Age-related deviation of the norm is minimal. Consecutive patients with ovarian cancer commencing any new line of chemotherapy were included. ACE was performed on each patient twice − on day 1 of their first treatment and at clinic upon completion of chemotherapy. Two versions of the test were used to avoid recognition. The results of the individual assessments were compared to investigate the effect of chemotherapy on cognition. Results: 17 patients with ovarian cancer consented. Median age was 67 (range 50−86) 6 patients were chemonaive, 9 received single agent chemotherapy (5 only platinum). 15 had repeat ACE after chemotherapy: one patient (in whom clinically relevant dementia was suspected) withdrew her consent; another patient died from progressive disease. Results are shown in the table. Seven (41%) patients initially scored below the normative cut-off for cognitive impairment which was previously formally undiagnosed, with a trend amongst previously treated patients (2/6 (33.3%) in chemonaive vs 5/11 (45.5%) in prior chemo). There was no significant age-related difference (mean ACE score 87 vs 86 for age <65 vs 65 yrs). A mean increase of 1.46 in ACE scores after chemotherapy was found. Subjectively all but one patient felt that treatment had negatively impacted on their cognition. Patient
Age
Line of chemo
1st ACE Pre chemo
2nd ACE Post chemo
Difference
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Mean
62 66 71 78 71 68 75 50 86 65 62 64 73 57 66 68 66 67.5
4 1 2 1 2 3 4 3 2 1 1 1 3 2 1 2 2 2.6
73 95 88 82 89 79 82 80 76 77 87 99 89 100 83 92 97 87
82 97 82 86 88 died 83 93 withdrew 77 85 99 90 100 85 92 96 89
+9 +2 −6 +4 −1 +1 +13 0 −2 0 +1 0 +2 0 −1 1.46
Conclusion: 7 out of 17 patients had undiagnosed cognitive impairment prior to starting chemotherapy for ovarian cancer. During chemotherapy most patients felt their cognitive function deteriorated, yet this could not be confirmed using ACE III. Selective testing of individual cognitive abilities in chemonaive patients may be more successful in understanding PCCI. No conflict of interest.