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P100 Observational survey of social isolation in older cancer patients
S54
Critical Reviews in Oncology/Hematology 72S1 (2009)
Method(s): We wanted to be interested in the oncologist’s reasoning. First of all by reviewing the current recommendations in cancer research for the treatment of old patient’s cancer and at those presenting an Alzheimer’s disease. Then by realizing an inquiry by questionnaire with the doctors setting in charge of the cancerous old patients, to understand what underlies their choices. Result(s): Several strong ideas take out answers: the old age and the Alzheimer’s disease seem to be the main obstacles to the access to diagnosis and oncologic treatment. And this for all the decision-makers, except the patients: doctors, nurses, paramedical team and families. The precision of the medical diagnosis for both chronic diseases and the knowledge of the life expectation are necessary to estimate profits and predictable unwanted effects of a treatment. The information of the patient, that of his(her) family and his(her) reliable person are also major criteria because they make possible the obtaining of the patient’s consent and the one of his(her) family. This obtaining is essential to make sure of a cooperation necessary for the care. A big part of the oncologic care is also based on the family, as mostly in Alzheimer’s disease. Modifications of the quality of life of the patient and his(her) caregiver is to be considered before treating or not, so it’s a criteria of decision. Modifications of the quality of life without treatment is also to be envisaged. The access to the specific oncogeriatric care is a criterion of selection in front of the decision, which often brings in the age as the brake. The anxiety of most of the doctors answering on any statutory limitation is striking, as well as the ethical concern to assure the best quality of care, according to the individual case of the patient, while being conscious of the problem of the cost. The utilitarist visions remain marginal. Conclusion(s): Studies are needed, which take into account the heterogeneousness of tumors and that of the old persons. The Alzheimer’s disease is a comorbidity among of the other one, which calls adaptations of treatment or not, according to its stage of evolution. Oncogeriatrics is a multidisciplinary individual medicine of future, which could be a good alternative to improve cancerologic care for the elderly and could protect old patients from decision-maker bias. P100 Observational survey of social isolation in older cancer patients J.M. Stokoe1 *, Z. Ali2 , A. Ring1,2 . 1 Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom, 2 Brighton and Sussex Medical School, Brighton, United Kingdom Purpose of the study: Social isolation has been shown to be an independent predictor of mortality in the geriatric population and to correlate with mortality following a diagnosis of breast cancer [1,2]. Degree of social support may be a particularly important factor in the management of older patients with cancer as it may help to mitigate against some of the physical and psychological impacts of diagnosis and treatment. The purpose of this study was to measure the degree of social isolation in outpatients attending our cancer centre, and to compare older and younger patients. Method: A survey was designed based on the questions used to construct the Berkman-Syme Social Networks Index (SNI). Questions included: marital status; number of close friends and relatives and frequency of contact; church membership and participation in group activities. Over a 5 week period all patients attending outpatients at the Sussex Cancer Centre (Brighton, UK) were invited to complete the survey. Patients completed the survey themselves and the responses were anonymous. The Chi-square test was used to analyse differences between those aged 70 or over, or less than 70. Results: Over a 5 week period, 250 completed questionnaires were returned. Of the respondents 76 (31%) were 70 years old or older, 71 (29%) were 60−69 years old and 102 (41%) were aged less than 60 years. One respondent did not give their date of birth. The proportion of patients who were unmarried, widowed or divorced was similar for older and younger patients (32% for those aged 70, vs 43% for those aged <70, p = 0.09). Older patients were more likely to report that they had no or only 1 or 2 close friends (24% vs 13%, p = 0.04).
10th SIOG Meeting, October 15–17, 2009, Berlin, Germany The proportion of patients who had no or only 1 or 2 close relatives was similar for older and younger patients (24% vs 22%, p = 0.84). Older patients were more likely to report that they saw no one, or only 1 or 2 of these contacts at least once per month, but this did not reach statistical significance (30% vs 21%, p = 0.11). Older patients were more likely to belong to a church or religious group (25% vs 12%, p = 0.03). The proportion of older and younger patients reporting that they did not belong to any social group was similar (57% vs 51%, P = 0.4). Conclusions: Early review of these results suggests that many of our patients experience social isolation. Older patients are more likely to have few or no friends, and there is also a non-significant trend for them to have less social contacts. Reference(s) [1] Berkman LF and Syme SL. American Journal of Epidemiology 1979;109:186– 204. [2] Kroenke CH et al. J Clin Oncol 2006;24: 1105–1111.
P101 The family burden of elderly cancer patient. Preliminary results A. Giacalone *, L. Fratino, J. Polesel, R. Talamini, M. Berretta, D. Crivellari, E. Vaccher, M. Rupolo, A. Lleshi, P. Nigri, U. Tirelli. National Cancer Institute, Aviano (PN), Italy Purpose of the study: Family strain, perceived by the members involved in caring for patients affected by cancer, has important impact and consequences on the life of the family and on the patients too. The purpose of this study is to explore the prevalence of and to identify the caregivingrelated problems experienced by the caregivers of senior cancer patients. Method(s): We asked the caregivers – identified by the patients themselves at recruitment – to fill in the FSQ (Family Strain Questionnaire) and a socio-demographical questionnaire. Patients characteristics and type of cancer were also collected. Result(s): From January to June 2009, 28 caregivers (21 females, mean age 52; and 7 males, mean age 42) completed the questionnaires. Education (years of schooling 12) was good for 64% of them; 75% was married and 50% lived with the patient or in the same building. Working status was as follows: 46.4% employees; 21.4% independent work; 7.1% other; 25.1% not employed. Degree of relationship was near for 75% of caregivers. Elderly patients (16 males and 12 females, mean age 77.2 years) were mostly affected by breast (8 pts) or prostate (5pts) or hematological (4pts) cancer; the average time from diagnosis was 44 months (range 0–218). Depressive symptoms were present in 7/28 (25%) patients. Caregivers perceived a mean subjective emotional burden (EB) score (referring to the perceptions of anxiety, helplessness, anger and psychophysiologic disturbances due to the patient’s illness) of 5.1; a problem in social involvement (SI) score (referring to the difficulty in approaching and maintaining social relationships and interests and time for self) of 2.6; a need for knowledge about the disease (NK) score (referring to the need to know as much as possible about the illness and its management) of 2.5; a satisfaction with family relationships (FR) score of 2.6; and a thoughts about death (TD) score (referring to the sense of loss or anticipated loss for the death of patient) of 2.1. The only significant gender-related differences were found between NK (p = 0.04) and FR (p = 0.02). We also founded significant gender-related difference for the item “able to talk with patient about disease” (p = 0.05). Conclusion(s): Care giving strain seems to be related to gender rather than to age. Our preliminary data show that females are more involved in the care of elderly patient, and this results in limitations on daily life that increase emotional distress. Moreover, females are more worried about psychological well-being of elderly patient and better inclined to talk with their beloved about the cancer disease than male caregivers.
Critical Reviews in Oncology/Hematology 72S1 (2009)
Method(s): We wanted to be interested in the oncologist’s reasoning. First of all by reviewing the current recommendations in cancer research for the treatment of old patient’s cancer and at those presenting an Alzheimer’s disease. Then by realizing an inquiry by questionnaire with the doctors setting in charge of the cancerous old patients, to understand what underlies their choices. Result(s): Several strong ideas take out answers: the old age and the Alzheimer’s disease seem to be the main obstacles to the access to diagnosis and oncologic treatment. And this for all the decision-makers, except the patients: doctors, nurses, paramedical team and families. The precision of the medical diagnosis for both chronic diseases and the knowledge of the life expectation are necessary to estimate profits and predictable unwanted effects of a treatment. The information of the patient, that of his(her) family and his(her) reliable person are also major criteria because they make possible the obtaining of the patient’s consent and the one of his(her) family. This obtaining is essential to make sure of a cooperation necessary for the care. A big part of the oncologic care is also based on the family, as mostly in Alzheimer’s disease. Modifications of the quality of life of the patient and his(her) caregiver is to be considered before treating or not, so it’s a criteria of decision. Modifications of the quality of life without treatment is also to be envisaged. The access to the specific oncogeriatric care is a criterion of selection in front of the decision, which often brings in the age as the brake. The anxiety of most of the doctors answering on any statutory limitation is striking, as well as the ethical concern to assure the best quality of care, according to the individual case of the patient, while being conscious of the problem of the cost. The utilitarist visions remain marginal. Conclusion(s): Studies are needed, which take into account the heterogeneousness of tumors and that of the old persons. The Alzheimer’s disease is a comorbidity among of the other one, which calls adaptations of treatment or not, according to its stage of evolution. Oncogeriatrics is a multidisciplinary individual medicine of future, which could be a good alternative to improve cancerologic care for the elderly and could protect old patients from decision-maker bias. P100 Observational survey of social isolation in older cancer patients J.M. Stokoe1 *, Z. Ali2 , A. Ring1,2 . 1 Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom, 2 Brighton and Sussex Medical School, Brighton, United Kingdom Purpose of the study: Social isolation has been shown to be an independent predictor of mortality in the geriatric population and to correlate with mortality following a diagnosis of breast cancer [1,2]. Degree of social support may be a particularly important factor in the management of older patients with cancer as it may help to mitigate against some of the physical and psychological impacts of diagnosis and treatment. The purpose of this study was to measure the degree of social isolation in outpatients attending our cancer centre, and to compare older and younger patients. Method: A survey was designed based on the questions used to construct the Berkman-Syme Social Networks Index (SNI). Questions included: marital status; number of close friends and relatives and frequency of contact; church membership and participation in group activities. Over a 5 week period all patients attending outpatients at the Sussex Cancer Centre (Brighton, UK) were invited to complete the survey. Patients completed the survey themselves and the responses were anonymous. The Chi-square test was used to analyse differences between those aged 70 or over, or less than 70. Results: Over a 5 week period, 250 completed questionnaires were returned. Of the respondents 76 (31%) were 70 years old or older, 71 (29%) were 60−69 years old and 102 (41%) were aged less than 60 years. One respondent did not give their date of birth. The proportion of patients who were unmarried, widowed or divorced was similar for older and younger patients (32% for those aged 70, vs 43% for those aged <70, p = 0.09). Older patients were more likely to report that they had no or only 1 or 2 close friends (24% vs 13%, p = 0.04).
10th SIOG Meeting, October 15–17, 2009, Berlin, Germany The proportion of patients who had no or only 1 or 2 close relatives was similar for older and younger patients (24% vs 22%, p = 0.84). Older patients were more likely to report that they saw no one, or only 1 or 2 of these contacts at least once per month, but this did not reach statistical significance (30% vs 21%, p = 0.11). Older patients were more likely to belong to a church or religious group (25% vs 12%, p = 0.03). The proportion of older and younger patients reporting that they did not belong to any social group was similar (57% vs 51%, P = 0.4). Conclusions: Early review of these results suggests that many of our patients experience social isolation. Older patients are more likely to have few or no friends, and there is also a non-significant trend for them to have less social contacts. Reference(s) [1] Berkman LF and Syme SL. American Journal of Epidemiology 1979;109:186– 204. [2] Kroenke CH et al. J Clin Oncol 2006;24: 1105–1111.
P101 The family burden of elderly cancer patient. Preliminary results A. Giacalone *, L. Fratino, J. Polesel, R. Talamini, M. Berretta, D. Crivellari, E. Vaccher, M. Rupolo, A. Lleshi, P. Nigri, U. Tirelli. National Cancer Institute, Aviano (PN), Italy Purpose of the study: Family strain, perceived by the members involved in caring for patients affected by cancer, has important impact and consequences on the life of the family and on the patients too. The purpose of this study is to explore the prevalence of and to identify the caregivingrelated problems experienced by the caregivers of senior cancer patients. Method(s): We asked the caregivers – identified by the patients themselves at recruitment – to fill in the FSQ (Family Strain Questionnaire) and a socio-demographical questionnaire. Patients characteristics and type of cancer were also collected. Result(s): From January to June 2009, 28 caregivers (21 females, mean age 52; and 7 males, mean age 42) completed the questionnaires. Education (years of schooling 12) was good for 64% of them; 75% was married and 50% lived with the patient or in the same building. Working status was as follows: 46.4% employees; 21.4% independent work; 7.1% other; 25.1% not employed. Degree of relationship was near for 75% of caregivers. Elderly patients (16 males and 12 females, mean age 77.2 years) were mostly affected by breast (8 pts) or prostate (5pts) or hematological (4pts) cancer; the average time from diagnosis was 44 months (range 0–218). Depressive symptoms were present in 7/28 (25%) patients. Caregivers perceived a mean subjective emotional burden (EB) score (referring to the perceptions of anxiety, helplessness, anger and psychophysiologic disturbances due to the patient’s illness) of 5.1; a problem in social involvement (SI) score (referring to the difficulty in approaching and maintaining social relationships and interests and time for self) of 2.6; a need for knowledge about the disease (NK) score (referring to the need to know as much as possible about the illness and its management) of 2.5; a satisfaction with family relationships (FR) score of 2.6; and a thoughts about death (TD) score (referring to the sense of loss or anticipated loss for the death of patient) of 2.1. The only significant gender-related differences were found between NK (p = 0.04) and FR (p = 0.02). We also founded significant gender-related difference for the item “able to talk with patient about disease” (p = 0.05). Conclusion(s): Care giving strain seems to be related to gender rather than to age. Our preliminary data show that females are more involved in the care of elderly patient, and this results in limitations on daily life that increase emotional distress. Moreover, females are more worried about psychological well-being of elderly patient and better inclined to talk with their beloved about the cancer disease than male caregivers.