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Large Age, Socioeconomic and Hospital-Dependent Variation in Administration of Chemotherapy for Stage IV NSCLC
S20
2013 SIOG Oral Abstracts
Table 1 Nutritional status
Major complicationsOR (95% CI; p-value)
Mildly impaired Moderately or severely impaired
3.80 (1.76-8.22; 0.001) 3.43 (1.16-10.11; 0.026)
Image:
Methods: All patients diagnosed with primary NSCLC stage IV from 2001 to 2010 in the area of the Eindhoven Cancer Registry (n = 4,091) were included. Univariable and multivariable logistic regression analyses and Cox regression analyses were performed to evaluate chemotherapy use and survival, respectively. Results: Overall, 44% of the patients received chemotherapy, which increased from 30% in 2001 to 50% in 2010. Higher rates were found among younger patients (multivariable odds ratio (OR≤ 64_vs_ ≥ 75_years) 1.9 (95%CI:1.6-2.2), in higher socioeconomic status (ORhigh_vs_low 1.7 (95%CI:1.4-2.1)), patients without comorbidity (OR0_vs_ ≥ 2 1.6 (95%CI:1.3-1.9)), patients diagnosed in more recent years (OR2010_vs_2001–2003 1.9 (95%CI:1.5-2.4)), having adenocarcinoma (ORsquamous_vs_adenocarcinoma 0.8 (95%CI:0.6-1.0)), and specific site of metastasis (ORcompared_to_brain ranging from 1.2 in adrenal gland to 1.4 in other sites). Also a large hospital variation was observed, up to OR 2.0 (95%CI:1.5-2.7). Survival did not improve over time (median 19 weeks). One-year survival rates were 31% (median 35 weeks) for patients receiving chemotherapy and 8% for those not receiving chemotherapy (median 10 weeks). Prognostic factors were receipt of chemotherapy (hazard ratio (HR) 0.4 (95%CI: 0.4-0.5)), histology (HRother_vs_adenocarcinoma 1.1 (1.0-1.2)) and location of metastasis (HRcompared_to_brain ranging from 1.2 for lymph nodes to 1.7 for liver). Conclusion: Despite increasing administration rates of chemotherapy, survival rates remained unchanged on a population basis. The administration of chemotherapy was affected by hospital of diagnosis, patient related (age, comorbidity and socioeconomic status) and tumour related (histology, location of metastasis) factors.The role of both patient and doctor preferences in the administration of chemotherapy remains to be explored. Identifying patients who benefit from chemotherapy should become a key issue.
Figure 1.
Disclosure of Interest: None Declared These results emphasize the need for more research on the influence of pre-operative optimization of nutritional status on post-operative outcome in onco-geriatric patients.
Keywords: Lung doi:10.1016/j.jgo.2013.09.199
Disclosure of Interest: None Declared Keywords: Clinical trials, Longevity, Nutrition
doi:10.1016/j.jgo.2013.09.198
Track 1 - Solid Tumours in the Elderly Lung cancer in eldery patients O7 Large Age, Socioeconomic and Hospital-Dependent Variation in Administration of Chemotherapy for Stage IV NSCLC M. Aarts1,⁎, B. van den Borne2, B. Biesma3, J. Kloover4, J. Aerts5,6, V. Lemmens1,7. 1Research, Comprehensive Cancer Centre South, 2Pulmonary Diseases, Catharina Hospital, Eindhoven, 3Pulmonary Diseases, Jeroen Bosch Hospital, 's-Hertogenbosch, 4Respiratory Diseases and Tuberculosis, Elisabeth Hospital, Tilburg, 5Pulmonary diseases, Erasmus Medical Center, Rotterdam, 6Respiratory Diseases and Tuberculosis, Amphia, Breda, 7Public Health, Erasmus Medical Center, Rotterdam, Netherlands Introduction: Meta-analyses reported that administration of chemotherapy in addition to best supportive care was found to improve survival in patients with metastasised non-small cell lung cancer (NSCLC). To our knowledge, limited data are available on the prescription rates of chemotherapy for patients with metastasised NSCLC. Objectives: The objective of this study was to investigate which factors were associated with the administration of chemotherapy for patients with stage IV NSCLC, and their relation to survival at a population-based level.
Track 2 - Haem malignancies in the elderly Haematological cancer in elderly patients O8 Discriminative Power of VES-13 and G8 for Detecting Geriatric Impairments in Elderly Patients with a Haematological Malignancy M.E. Hamaker1,⁎, M. Mitrovic2, R. Stauder2. 1Geriatric Medicine, Diakonessenhuis, Zeist, Netherlands, 2Haematology, Innsbruck University Hospital, Innsbruck, Austria Introduction: In oncology, geriatric assessments are used to detect disabilities and comorbid conditions that potentially contribute to an older patient’s vulnerability predisposing to poor outcome and treatment complications. However, such assessments are time-consuming, leading cancer specialists to search for a screening tool that will separate fit older cancer patients, able to receive standard cancer treatment, from vulnerable patients that should subsequently receive a full assessment to guide tailoring of their treatment regimen. Data and recommendations on the use of geriatric assessment in treatment algorithms for elderly patients with a haematological malignancy are rare. In particular, studies analysing the discriminative power of screening tools in this population are lacking, Objectives: To assess the sensitivity and specificity of the VES-13 and G8 screening tools for detecting geriatric impairments in elderly patients with a haematological malignancy. Methods: A consecutive cohort of patients aged 60 years and older newly diagnosed with a haematological malignancy received a geriatric assessment including the following domains: cognition (MMSE, cut-off ≤24), mood (GDS, cut-off ≥10), ADL (Barthel, cut-off ≥1 impairment),
2013 SIOG Oral Abstracts
Table 1 Nutritional status
Major complicationsOR (95% CI; p-value)
Mildly impaired Moderately or severely impaired
3.80 (1.76-8.22; 0.001) 3.43 (1.16-10.11; 0.026)
Image:
Methods: All patients diagnosed with primary NSCLC stage IV from 2001 to 2010 in the area of the Eindhoven Cancer Registry (n = 4,091) were included. Univariable and multivariable logistic regression analyses and Cox regression analyses were performed to evaluate chemotherapy use and survival, respectively. Results: Overall, 44% of the patients received chemotherapy, which increased from 30% in 2001 to 50% in 2010. Higher rates were found among younger patients (multivariable odds ratio (OR≤ 64_vs_ ≥ 75_years) 1.9 (95%CI:1.6-2.2), in higher socioeconomic status (ORhigh_vs_low 1.7 (95%CI:1.4-2.1)), patients without comorbidity (OR0_vs_ ≥ 2 1.6 (95%CI:1.3-1.9)), patients diagnosed in more recent years (OR2010_vs_2001–2003 1.9 (95%CI:1.5-2.4)), having adenocarcinoma (ORsquamous_vs_adenocarcinoma 0.8 (95%CI:0.6-1.0)), and specific site of metastasis (ORcompared_to_brain ranging from 1.2 in adrenal gland to 1.4 in other sites). Also a large hospital variation was observed, up to OR 2.0 (95%CI:1.5-2.7). Survival did not improve over time (median 19 weeks). One-year survival rates were 31% (median 35 weeks) for patients receiving chemotherapy and 8% for those not receiving chemotherapy (median 10 weeks). Prognostic factors were receipt of chemotherapy (hazard ratio (HR) 0.4 (95%CI: 0.4-0.5)), histology (HRother_vs_adenocarcinoma 1.1 (1.0-1.2)) and location of metastasis (HRcompared_to_brain ranging from 1.2 for lymph nodes to 1.7 for liver). Conclusion: Despite increasing administration rates of chemotherapy, survival rates remained unchanged on a population basis. The administration of chemotherapy was affected by hospital of diagnosis, patient related (age, comorbidity and socioeconomic status) and tumour related (histology, location of metastasis) factors.The role of both patient and doctor preferences in the administration of chemotherapy remains to be explored. Identifying patients who benefit from chemotherapy should become a key issue.
Figure 1.
Disclosure of Interest: None Declared These results emphasize the need for more research on the influence of pre-operative optimization of nutritional status on post-operative outcome in onco-geriatric patients.
Keywords: Lung doi:10.1016/j.jgo.2013.09.199
Disclosure of Interest: None Declared Keywords: Clinical trials, Longevity, Nutrition
doi:10.1016/j.jgo.2013.09.198
Track 1 - Solid Tumours in the Elderly Lung cancer in eldery patients O7 Large Age, Socioeconomic and Hospital-Dependent Variation in Administration of Chemotherapy for Stage IV NSCLC M. Aarts1,⁎, B. van den Borne2, B. Biesma3, J. Kloover4, J. Aerts5,6, V. Lemmens1,7. 1Research, Comprehensive Cancer Centre South, 2Pulmonary Diseases, Catharina Hospital, Eindhoven, 3Pulmonary Diseases, Jeroen Bosch Hospital, 's-Hertogenbosch, 4Respiratory Diseases and Tuberculosis, Elisabeth Hospital, Tilburg, 5Pulmonary diseases, Erasmus Medical Center, Rotterdam, 6Respiratory Diseases and Tuberculosis, Amphia, Breda, 7Public Health, Erasmus Medical Center, Rotterdam, Netherlands Introduction: Meta-analyses reported that administration of chemotherapy in addition to best supportive care was found to improve survival in patients with metastasised non-small cell lung cancer (NSCLC). To our knowledge, limited data are available on the prescription rates of chemotherapy for patients with metastasised NSCLC. Objectives: The objective of this study was to investigate which factors were associated with the administration of chemotherapy for patients with stage IV NSCLC, and their relation to survival at a population-based level.
Track 2 - Haem malignancies in the elderly Haematological cancer in elderly patients O8 Discriminative Power of VES-13 and G8 for Detecting Geriatric Impairments in Elderly Patients with a Haematological Malignancy M.E. Hamaker1,⁎, M. Mitrovic2, R. Stauder2. 1Geriatric Medicine, Diakonessenhuis, Zeist, Netherlands, 2Haematology, Innsbruck University Hospital, Innsbruck, Austria Introduction: In oncology, geriatric assessments are used to detect disabilities and comorbid conditions that potentially contribute to an older patient’s vulnerability predisposing to poor outcome and treatment complications. However, such assessments are time-consuming, leading cancer specialists to search for a screening tool that will separate fit older cancer patients, able to receive standard cancer treatment, from vulnerable patients that should subsequently receive a full assessment to guide tailoring of their treatment regimen. Data and recommendations on the use of geriatric assessment in treatment algorithms for elderly patients with a haematological malignancy are rare. In particular, studies analysing the discriminative power of screening tools in this population are lacking, Objectives: To assess the sensitivity and specificity of the VES-13 and G8 screening tools for detecting geriatric impairments in elderly patients with a haematological malignancy. Methods: A consecutive cohort of patients aged 60 years and older newly diagnosed with a haematological malignancy received a geriatric assessment including the following domains: cognition (MMSE, cut-off ≤24), mood (GDS, cut-off ≥10), ADL (Barthel, cut-off ≥1 impairment),