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O.1 CGA in daily practice
Critical Reviews in Oncology/Hematology 64 (2007) S29–S34 www.elsevier.com/locate/critrevonc
Proffered papers O.1 Session II CGA in daily practice A. Bononi ∗ ,1 , G. Milena 1,2 , L. Stievano 1 , S. Baldan 3 , C. Barile 1 , D. Menon 1 , F. Pasini 1 . 1 Oncology Unit, 2 Pharmacology Section, 3 Geriatric Unit Rovigo General Hospital ULSS 18 Rovigo, Italy Introduction: It is becoming evident that selected elderly cancer patients may benefit from a Comprehensive Geriatric Assessment (CGA) and geriatric interventions. In daily practice, barriers to perform CGA, are time, costs, and each of well-defined procedure to interpret and apply for information. While Oncologists are interested prevalently in stage of the tumor, the size and spread of disease, Geriatricians look for signs of accelerated aging which increase vulnerability and mortality. We performed this study in the hope that geriatric assessment will improve treatments efficacy and tolerance through individualized treatment planning. Methods: Elderly (≥70 years) cancer patients were assigned to 3 different CGA categories, “Fit” “intermediate” and “frail”. The evaluation was done in the same day, first by the Geriatrician and then by the Oncologist. If needed, CGA was completed by a Molecular Biologist and Pharmacologist, a Psychologist for cognitive and depression evaluation and a Pharmacist for the pharmacological interactions. The tests employed were: ECOG performance status, MMSE, GDS, MNA(Mini-nutritional assessment), CIRS and CHARLSON. For analysis, the cohort of patients was divided in three groups: 70–75; 76–85; >85 years The time required to complete the CGA was 45 minutes Results: From June 2005 to December 2007, 216 consecutive patients, 97 M- 119 F, were evaluated, 49% were Frail, 37%Vulnerable 13%Fit. In the 70–75 years subgroup, most of patients was Fit (60%) and 17% frail, on the contrary in the range 76–85 years, the frailty increased to 60%. The fact that the distribution of vulnerability and frailty in the subgroup of this age was equivalent is particularly interesting. Regarding to32 the social conditions, the 35% of our patients live alone or with an old partner, 28% have cognitive impairment and 25% nutritional deficits. Very few patients have social supports (6%). In our patients co morbidities of 3–4 degree and the number of medications decrease with age. The treatment assigned by CGA categories is 60% supportive care, 20% oral chemotherapy in frail patients, oral 40% I.V 40% in Vulnerable and 57% chemotherapy(poly), 30% oral chemotherapy and only 3% supportive care in Fit patients. Conclusion: Our experience was extremely positive. The collaboration with other specialists in a multidisciplinary team was very gratifying. The tests are time consuming and this aspect probably needs some simplifications. This approach is important especially for patients aged 76–85 years because of the great number of frails (60%) in this group. Some doubt exist about a possible selection of elderly cancer patients before our evaluation.
O.2 Session IV A – 15.30–15.45 Acute myeloid leukemia (AML) in elderly patient: a two-center study on treatment outcome and therapy-related pharmacoeconomic analysis G. Giordano ∗ , G. Sticca, C. Di Falco, S. Storti. Hematoncology Division, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso, Italy Which is the best treatment for AML in elderly patients is still debated. Actually there are three main options: supportive treatment (ST), conventional chemotherapy (CC) and low dose chemotherapy (LDC). This is a retrospective nonrandomized study. A cost analysis on 17 patients hospitalization was performed. The monthly cost of hospitalisation or specific care was calculated dividing the global expense of hospitalisation or specific care in each group of treatment, for the sum of survival months of all patients in that group. 21 patients (12F/9M), median age 72 years (R 65–80), were treated as follows: 9 with CC, 9 with LDC, 3 with ST. 14 patients presented comorbidity, 13 had PS 0–1, 8 had secondary leukaemia and M2-M4 were the most represented FAB subtypes. The most frequent comorbidities were diabetes (7pts), second neoplasms (5pts) and ischemic cardiopathy (4pts). Global median survival for all patients, without regard for the treatment received, was 3 months (R 1–10). Median survival was 5 months for patients treated with CC, 5.5 for LDC and 1 for ST. Median hospitalisation was 1 month for ST (R 0.5–1), 2 months for CC (R 1–8) and 1 month for LDC (R 0.2–3). Monthly cost of hospitalisation was €5100 for ST, €3700 for CC and €1000 for LDC. The antibiotic expense was higher in ST (€2900/month vs €1100/month in CC and €300/month in LDC), but transfusion expense was higher in CC (€1200/month vs €900/month in ST vs €500/month in LDC). Chemotherapy expense was €500/month in CC vs €6/month in LDC. New drugs (Mylotarg and Glivec) increased significatively chemotherapy costs (€900/month vs €40/month) and hospitalisation expense (€4100/month vs €2300/month). Erythropoietin use didn’t reduce transfusional expense (€1200/month vs €700/month in patients without erythropoietin). G-CSF administration wasn’t effective in antibiotic expense reduction (€1800/month vs €1100/month without G-CSF). Supportive measures were higer in CC and ST (€1200/month) than in LDC (€200/month). In conclusion LDC seems to be an economic and effective therapeutic option especially if performed in outpatient setting.
O.3 Session IV A – 15.30–15.45 Febrile neutropenia in elderly patient acute myeloid leukemia: monocentric pharmacoeconomic analysis G. Giordano ∗ , S. Piano, G. Farina, G. Sticca, C. Di Falco, S. Storti. Università Cattolica del Sacro Cuore, Campobasso, Italy More than 40% of patients with acute myelogenous leukemia (AML) are over 65 years old at the time of the diagnosis. Which is the
Proffered papers O.1 Session II CGA in daily practice A. Bononi ∗ ,1 , G. Milena 1,2 , L. Stievano 1 , S. Baldan 3 , C. Barile 1 , D. Menon 1 , F. Pasini 1 . 1 Oncology Unit, 2 Pharmacology Section, 3 Geriatric Unit Rovigo General Hospital ULSS 18 Rovigo, Italy Introduction: It is becoming evident that selected elderly cancer patients may benefit from a Comprehensive Geriatric Assessment (CGA) and geriatric interventions. In daily practice, barriers to perform CGA, are time, costs, and each of well-defined procedure to interpret and apply for information. While Oncologists are interested prevalently in stage of the tumor, the size and spread of disease, Geriatricians look for signs of accelerated aging which increase vulnerability and mortality. We performed this study in the hope that geriatric assessment will improve treatments efficacy and tolerance through individualized treatment planning. Methods: Elderly (≥70 years) cancer patients were assigned to 3 different CGA categories, “Fit” “intermediate” and “frail”. The evaluation was done in the same day, first by the Geriatrician and then by the Oncologist. If needed, CGA was completed by a Molecular Biologist and Pharmacologist, a Psychologist for cognitive and depression evaluation and a Pharmacist for the pharmacological interactions. The tests employed were: ECOG performance status, MMSE, GDS, MNA(Mini-nutritional assessment), CIRS and CHARLSON. For analysis, the cohort of patients was divided in three groups: 70–75; 76–85; >85 years The time required to complete the CGA was 45 minutes Results: From June 2005 to December 2007, 216 consecutive patients, 97 M- 119 F, were evaluated, 49% were Frail, 37%Vulnerable 13%Fit. In the 70–75 years subgroup, most of patients was Fit (60%) and 17% frail, on the contrary in the range 76–85 years, the frailty increased to 60%. The fact that the distribution of vulnerability and frailty in the subgroup of this age was equivalent is particularly interesting. Regarding to32 the social conditions, the 35% of our patients live alone or with an old partner, 28% have cognitive impairment and 25% nutritional deficits. Very few patients have social supports (6%). In our patients co morbidities of 3–4 degree and the number of medications decrease with age. The treatment assigned by CGA categories is 60% supportive care, 20% oral chemotherapy in frail patients, oral 40% I.V 40% in Vulnerable and 57% chemotherapy(poly), 30% oral chemotherapy and only 3% supportive care in Fit patients. Conclusion: Our experience was extremely positive. The collaboration with other specialists in a multidisciplinary team was very gratifying. The tests are time consuming and this aspect probably needs some simplifications. This approach is important especially for patients aged 76–85 years because of the great number of frails (60%) in this group. Some doubt exist about a possible selection of elderly cancer patients before our evaluation.
O.2 Session IV A – 15.30–15.45 Acute myeloid leukemia (AML) in elderly patient: a two-center study on treatment outcome and therapy-related pharmacoeconomic analysis G. Giordano ∗ , G. Sticca, C. Di Falco, S. Storti. Hematoncology Division, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Campobasso, Italy Which is the best treatment for AML in elderly patients is still debated. Actually there are three main options: supportive treatment (ST), conventional chemotherapy (CC) and low dose chemotherapy (LDC). This is a retrospective nonrandomized study. A cost analysis on 17 patients hospitalization was performed. The monthly cost of hospitalisation or specific care was calculated dividing the global expense of hospitalisation or specific care in each group of treatment, for the sum of survival months of all patients in that group. 21 patients (12F/9M), median age 72 years (R 65–80), were treated as follows: 9 with CC, 9 with LDC, 3 with ST. 14 patients presented comorbidity, 13 had PS 0–1, 8 had secondary leukaemia and M2-M4 were the most represented FAB subtypes. The most frequent comorbidities were diabetes (7pts), second neoplasms (5pts) and ischemic cardiopathy (4pts). Global median survival for all patients, without regard for the treatment received, was 3 months (R 1–10). Median survival was 5 months for patients treated with CC, 5.5 for LDC and 1 for ST. Median hospitalisation was 1 month for ST (R 0.5–1), 2 months for CC (R 1–8) and 1 month for LDC (R 0.2–3). Monthly cost of hospitalisation was €5100 for ST, €3700 for CC and €1000 for LDC. The antibiotic expense was higher in ST (€2900/month vs €1100/month in CC and €300/month in LDC), but transfusion expense was higher in CC (€1200/month vs €900/month in ST vs €500/month in LDC). Chemotherapy expense was €500/month in CC vs €6/month in LDC. New drugs (Mylotarg and Glivec) increased significatively chemotherapy costs (€900/month vs €40/month) and hospitalisation expense (€4100/month vs €2300/month). Erythropoietin use didn’t reduce transfusional expense (€1200/month vs €700/month in patients without erythropoietin). G-CSF administration wasn’t effective in antibiotic expense reduction (€1800/month vs €1100/month without G-CSF). Supportive measures were higer in CC and ST (€1200/month) than in LDC (€200/month). In conclusion LDC seems to be an economic and effective therapeutic option especially if performed in outpatient setting.
O.3 Session IV A – 15.30–15.45 Febrile neutropenia in elderly patient acute myeloid leukemia: monocentric pharmacoeconomic analysis G. Giordano ∗ , S. Piano, G. Farina, G. Sticca, C. Di Falco, S. Storti. Università Cattolica del Sacro Cuore, Campobasso, Italy More than 40% of patients with acute myelogenous leukemia (AML) are over 65 years old at the time of the diagnosis. Which is the