- Email: [email protected]
P28 Follow-up and 6-months outcome of elderly cancer patients after initial onco-geriatric assessment
S28
Critical Reviews in Oncology/Hematology 72S1 (2009)
P26 A multidisciplinary onco-geriatric approach for the management of older patients with gynaecological cancer G. Colloca1 *, G. Gambassi1 , E. Foti2 , A.C. Testa2 , F. Cerullo1 , A. Ferrini1 , A. Luciani4 , R. Bernabei1 , G. Scambia2 , M. Cesari3 . 1 Department of Gerontology, Geriatrics and Psychiatry, 2 Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart, Rome, Italy, 3 Department of Aging and Geriatric Research; University of Florida-Institute on Aging, Gainesville, FL, USA, 4 Division of Medical Oncology, S Paolo Hospital, University of Milan, Italy Background: Older patients with cancer are less likely to be offered standard cancer treatments, partly because of their frailty and clinical complexity. The technology of comprehensive geriatric assessment (CGA) may help in identifying those frailer older patients at higher risk of complications and adverse drug reactions (ADRs) due to cancer treatment. Objective: Main aim of this project is to evaluate the effects of a multidisciplinary approach involving a geriatrician in combination to the standard oncological gynaecologist team in the assessment and management of older women with cancer. In particular, the study will explore whether the inclusion of a geriatrician in the management of older cancer patients may influence the treatment-related decisions (including the eligibility to standard surgical and/or therapeutical protocols, the treatment of comorbidities, and the prevention of ADRs). Design: A population-based study of cancer patients aged 65 years and older admitted to the Oncological Gynaecology Unit of the University Hospital “Agostino Gemelli” (Rome, Italy). The project is constituted by two phases: (1) a retrospective phase based on the analysis of data collected over the two years prior to the beginning of this study, and (2) a prospective two-year phase having the multidisciplinary team replacing the standard oncological gynaecologist team. Measurements: Functional status, body composition, cognition, comorbidity, incidence and severity of ADRs, nutritional status, social support, and one-year survival will be assessed. Every patient of the prospective phase will be evaluated by a geriatrician through CGA. Significance: This project represents one of the first studies aimed at demonstrating that a multidisciplinary approach combining oncologists and geriatricians expertises may provide significant benefits in the evaluation, management, and treatment of older cancer patients. It is expected that a higher number of older patients will benefit of standard oncological treatments, (potentially improving survival). The more comprehensive evaluation of the patients is also likely to contribute in improving their quality of life, and reduce the risk of ADRs. These beneficial effects will not only represent an important step forward to a better care for the patient, but may also significantly reduce health care-related expenditures. This study is supported by a grant awarded by the Swiss Bridge Foundation (Zurich, Switzerland) P27 Comprehensive Geriatric Assessment (CGA) at the Centro di Riferimento Oncologico, Aviano – National Cancer Institute – in treatment planning for senior adults with cancer: preliminary results L. Fratino *, D. Crivellari, A. Giacalone, J. Polesel, L. Tartuferi, P. Nigri, E. Vaccher, M. Spina, A. Bearz, M.G. Michieli, U. Tirelli. IRCCS Centro di Riferimento Oncologico, Aviano, Italy Purpose of the study: Elderly patients (EP, i.e., 70 years of age at cancer diagnosis) represents the predominant portion of cancer patients, but still few have access to optimal cancer treatments. CGA has been demonstrated to be an essential tool to plan cancer treatment in EP, and a milestone in screening processes and decision-making. In this presentation, we describe the preliminary results obtained through an Onco-geriatric program in our Institute in northern Italy. Method(s): Since February 2007, a multidisciplinary onco-geriatric Unit routinely evaluated EP with a new diagnosis of both solid and hematological cancer by means of CGA. According to CGA scales, EP was classified in three risk groups: FIT, UNFIT and Frail. Unfit EP were those with mild co-morbidity or mild disabled functionally; Frail EP were those aged >80 years or affected by severe co-morbidity and /or highly disabled. Fit EP were those who did not fall in UNFIT or FRAIL categories.
10th SIOG Meeting, October 15–17, 2009, Berlin, Germany According to cancer type and risk groups, EP was stratified to receive specifically tailored treatments (e.g., clinical trials, standard treatment or best supportive care). Biochemical and immunological assessments were performed at baseline and during therapy. Toxicities data were also collected. Result(s): 334 EP were evaluated. Their median age was 76 years (range 70−90). Only 10% had a poor PS; 75% was affected by one or more co-morbidities that required daily treatment. The more frequent chronic recorded diseases were: respiratory (43%); metabolic (34%); cardiovascular (25%); and arthritis (22%). The median number of drugs chronically used was 2. The percentage distribution of EP by cancer type and risk group are described in the table. Cancer type
Fit
Unfit
Frail
GI (n = 81) Breast (n = 56) Lung (n = 69) RCC (n = 43) Haematological (n = 85)
30% 51% 31% 48% 26%
48% 21% 43% 44% 44%
22% 28% 26% 8% 30%
Among evaluated EP, 82% underwent site-specific treatment according to risk group. With regards to overall survival, a survival advantage for FIT/UNFIT EP (as compared to FRAIL ones) was noted in the first year after a diagnosis of hematological neoplasia. With regard to solid tumors (all types combined, breast cancer excluded) we found no difference in survival between frail and unfit and fit EP. All 56 EP with breast cancer were diagnosed in an early stage and underwent adjuvant treatment: none of them died during follow-up. Conclusion(s): Our experience showed that even in frail and unfit EP cancer treatment might be consider a safe and efficacious option. These preliminary results suggest that a better evaluation of the heterogeneity of EP by means of CGA allows us to identify the best treatment course and a tailored therapeutic program. P28 Follow-up and 6-months outcome of elderly cancer patients after initial onco-geriatric assessment M. Berle1 , P. Caillet1 , J. Vouriot1 , S. Krypciak1 , C. Delbaldo2 , S. Culine2 , E. Paillaud1 . 1. Department of Geriatry, Henri Mondor’s Hospital, Cr´eteil, France, 2 Department of Oncology, Henri Mondor’s Hospital, Cr´eteil, France Purpose of the study: To study the follow-up and 6-months outcome of elderly cancer patients (70 y) after a Comprehensive Geriatric Assessment (CGA) by a geriatric practitioner. Method(s): Retrospective and descriptive study of the evolution and the 6-months outcome during the treatment of 104 cancer patients after the initial CGA. Result(s): The average age was 80.2±5.4 years. Women outnumbered men (55.8 vs. 44.2%). The patients had gastrointestinal (78%), breast (12%) or other cancers (10%), most often with lymphatic node (42%) and/or metastatic (31%) development. Most of the patients (84%) belonged to Group III of Balducci-Extermann’s classification: “frail elderly“. The CGA influenced the initial cancer therapy in 32% of cases, including decisions of surgery, chemotherapy, hormonotherapy and therapeutic abstention. Surgical treatment (26%) was always performed and was accompanied by a post-operative complication in 37% of cases. Initially proposed chemotherapy determined (45%) was not feasible in 13% of cases. Usually performed in day hospital (68%), the chemotherapy protocol was amended or terminated in 28% and 15% of cases respectively, mainly because of its toxicity (65%). Radiotherapy (14%) and hormonotherapy (4%) were always possible, without modification or discontinuation of treatment protocol. During the 6 months follow-up, one hospitalization or more in short-stay unit was required for 39 patients (37%) and in rehabilitation unit for 26
Proffered papers, Posters
P29 Geriatric assessment in elderly cancer patients: geriatric syndromes and impact on treatment J. Vouriot1 , P. Caillet1 , M. Berle1 , S. Krypciak1 , C. Delbaldo2 , S. Culine2 , E. Paillaud1 . 1 Department of Geriatry, Henri Mondor’s Hospital, Cr´eteil, France, 2 Department of Oncology, Henri Mondor’s Hospital, Cr´eteil, France Purpose of the study: To study the population of elderly cancer patients (70 y) evaluated by Comprehensive Geriatric Assessment (CGA), to identify the proposed recommendations of care and to measure the impact on the cancer treatment. Method(s): Prospective descriptive study of 201 cancer patients, assessed by a CGA conducted at the request of Oncologists (January 2007 – September 2008). Result(s): In our population, the average age was 80.6±5.7 y and women outnumbered men (58 vs. 42%). Most CGAs were carried out during a hospitalization (61%). Digestive cancers were the most frequent ones (68%), followed by breast cancer (11%) and haemopathies (9%). The general status was clinically impaired in 50% of the patients, but only half of them had an ECOG status 2. Sixty percent of patients were in pain (with or without connection with cancer) at the time of the evaluation. The patients had on average 4.7±2.4 comorbidities. The polymedication related to 71% of them. The CGA showed an inappropriate social environment in 17% of cases, dependency for 1 or more ADL in 34%, a risk of fall in 50%, malnutrition for 66%, a cognitive impairment in 25% and a depressive syndrome in 35%. The subjects had on average 1.8±1.4 geriatric syndromes. The majority of patients (78%) were classified in Group III of the BalducciExtermann’s classification “frail elderly”. At the end of the CGA, the geriatric practitioner implemented or recommended a social management in 36% of cases, kinesitherapy in 31%, nutritional cares in 68%, a psychological follow-up in 40% and a consultation for memory in 10%. The CGA influenced the initial proposed oncological therapy in 32% of cases and non-oncological treatment in 33%. The geriatric practitioner’s opinions and the oncologist’s one about the therapeutic management finally chosen agreed in 96.5% of cases. Conclusion(s): Thanks to its exhaustivity, CGA revealed a high incidence of geriatric frailty factors in our population, in particular malnutrition, which allowed the implementation of corrective actions. CGA had a significant impact on the medical decision because it affected the cancer treatment in one third of cases. P30 The Jules Bordet Onco-Geriatric Pilot Unit: one-year report C. Bernard-Marty1 *, M. Diaz1 , J.P. Praet2 , M. Moreau1 , F. Cardoso1 , D. De Valeriola1 , M.J. Piccart1 . 1 Jules Bordet Institute, Brussels, Belgium, 2 Saint Pierre Hospital, Brussels, Belgium Purpose of the study: While the elderly comprise the largest age group of patients seen by oncologists, a major deficiency of cancer treatment in the older population is the lack of evidence basis for clinical decision-making. A survey performed at the Jules Bordet Institute showed that 30% of the hospitalized patients are aged 70 years old and more. An Onco-Geriatric Pilot Unit dedicated to these patients was created, with the intent to provide a pluridisciplinary management. Method(s): Between April 2008 and March 2009, 248 patients (27% males and 73% females) with solid tumors were hospitalized in the Unit to benefit from concomitant oncological and geriatric intervention. Details of their
social (origin, destination, presence of caregiver), functional (PS, ADL, IADL), physical (comorbidities, number of medication, renal function), nutritional (MNA), and mental (MMSE, GDS) status were assessed. Result(s): Among these 248 cancer patients, 175 (52.7%) were aged 70 years old and more. Within these elderly patients, the median age was 77.9 (range 70−93, IQR 73.6–84.1), unexpectedly lower than planned mainly because of the lack of established rule limiting the patients’ age at entry and of the novelty of the Unit); nevertheless, the mean age curve evolved favorably with time (see figure below). The most frequent tumor sites were breast (33.9%), colorectal (10.3%), skin (9.2%) and ovarian (7.1%). The median duration of hospitalization was 4 days (range 1−40, IQR 2−9). Twenty-six percent of patients had an impaired renal function (GFR <60 ml/min). Median Albumin was 3.6 g/dl (range 2.5−5, IQR 3.3−4.1). Conclusion(s): This innovative inpatient Unit dedicated to elderly patients still needs improvement but gives important data on this understudied population. Characteristics of the patients and results of the geriatric assessment will be available.
0.6
Proportion
patients (25%), outside the strict framework of the anticancer treatment, mainly due to the cancer evolution and/or the loss of autonomy. The mortality rate of the overall population was 30.8% at 6 months. Conclusion(s): The majority of patients belonged to the BalducciExtermann’s group III, “frail elderly“. In our study, half of cases treated by chemotherapy presented tolerance issues requiring either adjustment or discontinuation of treatment. Finally, in our population, half of the patients required one hospitalization at least, for a reason other than the cancer treatment.
S29
0.5
0.4 T1
T2
T3
T4
Trimester (04/2008 to 03/2009)
Proportion of patients aged 70 year old and more hospitalized in the OncoGeriatric Pilot Unit (04/2008−03/2009).
P31 The impact of a Comprehensive Geriatric Assessment (CGA) on medical oncology treatment decisions for elderly patients with cancer A.M. Horgan *, N.B. Leighl, S.M.H. Alibhai. Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada Purpose of the study: More than half of new cancer diagnoses occur in the elderly. A comprehensive geriatric assessment (CGA) has been suggested as a potential aid for developing treatment plans for older cancer patients, but its value remains uncertain. The aim of this pilot study is to determine the impact of a CGA on therapeutic decisions in elderly patients with cancer. Method(s): A pilot geriatric oncology clinic was established in Princess Margaret Hospital in January 2009. Patients 70 years, with a new diagnosis of gastrointestinal or lung cancer, were assessed by a medical oncologist and a treatment plan made, as per standard practice. Patients then underwent consultation in the geriatric oncology clinic. This consultation included a CGA utilizing validated measures of functional status, social support, co-morbidity, mood, and cognition. The initial treatment decision was reassessed by the primary medical oncologist with the benefit of these findings. Result(s): 14 patients (7 men, 7 women), with a median age of 78 years have been enrolled to date. Cancer diagnoses included gastroesophageal (3), colorectal (4), hepatocellular (2) and lung (3) cancer. Disease was locally advanced and metastatic in 9 and 5 patients, respectively. Only 5 patients were offered standard therapy at initial oncology assessment, with a modified approach recommended for 4 patients. The treatment plan was undecided at the time of referral in 5 patients. The majority had an ECOG PS of 0−1 (n = 8) or 2 (n = 5). No patient had significant cognitive deficits on mini - mental state examination, with a median score of 29/30. One patient was dependent for 1 basic activity of daily living and 5 were dependent for 1 instrumental activities of daily living. The average number of medications per patient was 6. The majority of patients had low (n = 5) or moderate (n = 6) co-morbidity using the Charlson comorbidity index.
Critical Reviews in Oncology/Hematology 72S1 (2009)
P26 A multidisciplinary onco-geriatric approach for the management of older patients with gynaecological cancer G. Colloca1 *, G. Gambassi1 , E. Foti2 , A.C. Testa2 , F. Cerullo1 , A. Ferrini1 , A. Luciani4 , R. Bernabei1 , G. Scambia2 , M. Cesari3 . 1 Department of Gerontology, Geriatrics and Psychiatry, 2 Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart, Rome, Italy, 3 Department of Aging and Geriatric Research; University of Florida-Institute on Aging, Gainesville, FL, USA, 4 Division of Medical Oncology, S Paolo Hospital, University of Milan, Italy Background: Older patients with cancer are less likely to be offered standard cancer treatments, partly because of their frailty and clinical complexity. The technology of comprehensive geriatric assessment (CGA) may help in identifying those frailer older patients at higher risk of complications and adverse drug reactions (ADRs) due to cancer treatment. Objective: Main aim of this project is to evaluate the effects of a multidisciplinary approach involving a geriatrician in combination to the standard oncological gynaecologist team in the assessment and management of older women with cancer. In particular, the study will explore whether the inclusion of a geriatrician in the management of older cancer patients may influence the treatment-related decisions (including the eligibility to standard surgical and/or therapeutical protocols, the treatment of comorbidities, and the prevention of ADRs). Design: A population-based study of cancer patients aged 65 years and older admitted to the Oncological Gynaecology Unit of the University Hospital “Agostino Gemelli” (Rome, Italy). The project is constituted by two phases: (1) a retrospective phase based on the analysis of data collected over the two years prior to the beginning of this study, and (2) a prospective two-year phase having the multidisciplinary team replacing the standard oncological gynaecologist team. Measurements: Functional status, body composition, cognition, comorbidity, incidence and severity of ADRs, nutritional status, social support, and one-year survival will be assessed. Every patient of the prospective phase will be evaluated by a geriatrician through CGA. Significance: This project represents one of the first studies aimed at demonstrating that a multidisciplinary approach combining oncologists and geriatricians expertises may provide significant benefits in the evaluation, management, and treatment of older cancer patients. It is expected that a higher number of older patients will benefit of standard oncological treatments, (potentially improving survival). The more comprehensive evaluation of the patients is also likely to contribute in improving their quality of life, and reduce the risk of ADRs. These beneficial effects will not only represent an important step forward to a better care for the patient, but may also significantly reduce health care-related expenditures. This study is supported by a grant awarded by the Swiss Bridge Foundation (Zurich, Switzerland) P27 Comprehensive Geriatric Assessment (CGA) at the Centro di Riferimento Oncologico, Aviano – National Cancer Institute – in treatment planning for senior adults with cancer: preliminary results L. Fratino *, D. Crivellari, A. Giacalone, J. Polesel, L. Tartuferi, P. Nigri, E. Vaccher, M. Spina, A. Bearz, M.G. Michieli, U. Tirelli. IRCCS Centro di Riferimento Oncologico, Aviano, Italy Purpose of the study: Elderly patients (EP, i.e., 70 years of age at cancer diagnosis) represents the predominant portion of cancer patients, but still few have access to optimal cancer treatments. CGA has been demonstrated to be an essential tool to plan cancer treatment in EP, and a milestone in screening processes and decision-making. In this presentation, we describe the preliminary results obtained through an Onco-geriatric program in our Institute in northern Italy. Method(s): Since February 2007, a multidisciplinary onco-geriatric Unit routinely evaluated EP with a new diagnosis of both solid and hematological cancer by means of CGA. According to CGA scales, EP was classified in three risk groups: FIT, UNFIT and Frail. Unfit EP were those with mild co-morbidity or mild disabled functionally; Frail EP were those aged >80 years or affected by severe co-morbidity and /or highly disabled. Fit EP were those who did not fall in UNFIT or FRAIL categories.
10th SIOG Meeting, October 15–17, 2009, Berlin, Germany According to cancer type and risk groups, EP was stratified to receive specifically tailored treatments (e.g., clinical trials, standard treatment or best supportive care). Biochemical and immunological assessments were performed at baseline and during therapy. Toxicities data were also collected. Result(s): 334 EP were evaluated. Their median age was 76 years (range 70−90). Only 10% had a poor PS; 75% was affected by one or more co-morbidities that required daily treatment. The more frequent chronic recorded diseases were: respiratory (43%); metabolic (34%); cardiovascular (25%); and arthritis (22%). The median number of drugs chronically used was 2. The percentage distribution of EP by cancer type and risk group are described in the table. Cancer type
Fit
Unfit
Frail
GI (n = 81) Breast (n = 56) Lung (n = 69) RCC (n = 43) Haematological (n = 85)
30% 51% 31% 48% 26%
48% 21% 43% 44% 44%
22% 28% 26% 8% 30%
Among evaluated EP, 82% underwent site-specific treatment according to risk group. With regards to overall survival, a survival advantage for FIT/UNFIT EP (as compared to FRAIL ones) was noted in the first year after a diagnosis of hematological neoplasia. With regard to solid tumors (all types combined, breast cancer excluded) we found no difference in survival between frail and unfit and fit EP. All 56 EP with breast cancer were diagnosed in an early stage and underwent adjuvant treatment: none of them died during follow-up. Conclusion(s): Our experience showed that even in frail and unfit EP cancer treatment might be consider a safe and efficacious option. These preliminary results suggest that a better evaluation of the heterogeneity of EP by means of CGA allows us to identify the best treatment course and a tailored therapeutic program. P28 Follow-up and 6-months outcome of elderly cancer patients after initial onco-geriatric assessment M. Berle1 , P. Caillet1 , J. Vouriot1 , S. Krypciak1 , C. Delbaldo2 , S. Culine2 , E. Paillaud1 . 1. Department of Geriatry, Henri Mondor’s Hospital, Cr´eteil, France, 2 Department of Oncology, Henri Mondor’s Hospital, Cr´eteil, France Purpose of the study: To study the follow-up and 6-months outcome of elderly cancer patients (70 y) after a Comprehensive Geriatric Assessment (CGA) by a geriatric practitioner. Method(s): Retrospective and descriptive study of the evolution and the 6-months outcome during the treatment of 104 cancer patients after the initial CGA. Result(s): The average age was 80.2±5.4 years. Women outnumbered men (55.8 vs. 44.2%). The patients had gastrointestinal (78%), breast (12%) or other cancers (10%), most often with lymphatic node (42%) and/or metastatic (31%) development. Most of the patients (84%) belonged to Group III of Balducci-Extermann’s classification: “frail elderly“. The CGA influenced the initial cancer therapy in 32% of cases, including decisions of surgery, chemotherapy, hormonotherapy and therapeutic abstention. Surgical treatment (26%) was always performed and was accompanied by a post-operative complication in 37% of cases. Initially proposed chemotherapy determined (45%) was not feasible in 13% of cases. Usually performed in day hospital (68%), the chemotherapy protocol was amended or terminated in 28% and 15% of cases respectively, mainly because of its toxicity (65%). Radiotherapy (14%) and hormonotherapy (4%) were always possible, without modification or discontinuation of treatment protocol. During the 6 months follow-up, one hospitalization or more in short-stay unit was required for 39 patients (37%) and in rehabilitation unit for 26
Proffered papers, Posters
P29 Geriatric assessment in elderly cancer patients: geriatric syndromes and impact on treatment J. Vouriot1 , P. Caillet1 , M. Berle1 , S. Krypciak1 , C. Delbaldo2 , S. Culine2 , E. Paillaud1 . 1 Department of Geriatry, Henri Mondor’s Hospital, Cr´eteil, France, 2 Department of Oncology, Henri Mondor’s Hospital, Cr´eteil, France Purpose of the study: To study the population of elderly cancer patients (70 y) evaluated by Comprehensive Geriatric Assessment (CGA), to identify the proposed recommendations of care and to measure the impact on the cancer treatment. Method(s): Prospective descriptive study of 201 cancer patients, assessed by a CGA conducted at the request of Oncologists (January 2007 – September 2008). Result(s): In our population, the average age was 80.6±5.7 y and women outnumbered men (58 vs. 42%). Most CGAs were carried out during a hospitalization (61%). Digestive cancers were the most frequent ones (68%), followed by breast cancer (11%) and haemopathies (9%). The general status was clinically impaired in 50% of the patients, but only half of them had an ECOG status 2. Sixty percent of patients were in pain (with or without connection with cancer) at the time of the evaluation. The patients had on average 4.7±2.4 comorbidities. The polymedication related to 71% of them. The CGA showed an inappropriate social environment in 17% of cases, dependency for 1 or more ADL in 34%, a risk of fall in 50%, malnutrition for 66%, a cognitive impairment in 25% and a depressive syndrome in 35%. The subjects had on average 1.8±1.4 geriatric syndromes. The majority of patients (78%) were classified in Group III of the BalducciExtermann’s classification “frail elderly”. At the end of the CGA, the geriatric practitioner implemented or recommended a social management in 36% of cases, kinesitherapy in 31%, nutritional cares in 68%, a psychological follow-up in 40% and a consultation for memory in 10%. The CGA influenced the initial proposed oncological therapy in 32% of cases and non-oncological treatment in 33%. The geriatric practitioner’s opinions and the oncologist’s one about the therapeutic management finally chosen agreed in 96.5% of cases. Conclusion(s): Thanks to its exhaustivity, CGA revealed a high incidence of geriatric frailty factors in our population, in particular malnutrition, which allowed the implementation of corrective actions. CGA had a significant impact on the medical decision because it affected the cancer treatment in one third of cases. P30 The Jules Bordet Onco-Geriatric Pilot Unit: one-year report C. Bernard-Marty1 *, M. Diaz1 , J.P. Praet2 , M. Moreau1 , F. Cardoso1 , D. De Valeriola1 , M.J. Piccart1 . 1 Jules Bordet Institute, Brussels, Belgium, 2 Saint Pierre Hospital, Brussels, Belgium Purpose of the study: While the elderly comprise the largest age group of patients seen by oncologists, a major deficiency of cancer treatment in the older population is the lack of evidence basis for clinical decision-making. A survey performed at the Jules Bordet Institute showed that 30% of the hospitalized patients are aged 70 years old and more. An Onco-Geriatric Pilot Unit dedicated to these patients was created, with the intent to provide a pluridisciplinary management. Method(s): Between April 2008 and March 2009, 248 patients (27% males and 73% females) with solid tumors were hospitalized in the Unit to benefit from concomitant oncological and geriatric intervention. Details of their
social (origin, destination, presence of caregiver), functional (PS, ADL, IADL), physical (comorbidities, number of medication, renal function), nutritional (MNA), and mental (MMSE, GDS) status were assessed. Result(s): Among these 248 cancer patients, 175 (52.7%) were aged 70 years old and more. Within these elderly patients, the median age was 77.9 (range 70−93, IQR 73.6–84.1), unexpectedly lower than planned mainly because of the lack of established rule limiting the patients’ age at entry and of the novelty of the Unit); nevertheless, the mean age curve evolved favorably with time (see figure below). The most frequent tumor sites were breast (33.9%), colorectal (10.3%), skin (9.2%) and ovarian (7.1%). The median duration of hospitalization was 4 days (range 1−40, IQR 2−9). Twenty-six percent of patients had an impaired renal function (GFR <60 ml/min). Median Albumin was 3.6 g/dl (range 2.5−5, IQR 3.3−4.1). Conclusion(s): This innovative inpatient Unit dedicated to elderly patients still needs improvement but gives important data on this understudied population. Characteristics of the patients and results of the geriatric assessment will be available.
0.6
Proportion
patients (25%), outside the strict framework of the anticancer treatment, mainly due to the cancer evolution and/or the loss of autonomy. The mortality rate of the overall population was 30.8% at 6 months. Conclusion(s): The majority of patients belonged to the BalducciExtermann’s group III, “frail elderly“. In our study, half of cases treated by chemotherapy presented tolerance issues requiring either adjustment or discontinuation of treatment. Finally, in our population, half of the patients required one hospitalization at least, for a reason other than the cancer treatment.
S29
0.5
0.4 T1
T2
T3
T4
Trimester (04/2008 to 03/2009)
Proportion of patients aged 70 year old and more hospitalized in the OncoGeriatric Pilot Unit (04/2008−03/2009).
P31 The impact of a Comprehensive Geriatric Assessment (CGA) on medical oncology treatment decisions for elderly patients with cancer A.M. Horgan *, N.B. Leighl, S.M.H. Alibhai. Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada Purpose of the study: More than half of new cancer diagnoses occur in the elderly. A comprehensive geriatric assessment (CGA) has been suggested as a potential aid for developing treatment plans for older cancer patients, but its value remains uncertain. The aim of this pilot study is to determine the impact of a CGA on therapeutic decisions in elderly patients with cancer. Method(s): A pilot geriatric oncology clinic was established in Princess Margaret Hospital in January 2009. Patients 70 years, with a new diagnosis of gastrointestinal or lung cancer, were assessed by a medical oncologist and a treatment plan made, as per standard practice. Patients then underwent consultation in the geriatric oncology clinic. This consultation included a CGA utilizing validated measures of functional status, social support, co-morbidity, mood, and cognition. The initial treatment decision was reassessed by the primary medical oncologist with the benefit of these findings. Result(s): 14 patients (7 men, 7 women), with a median age of 78 years have been enrolled to date. Cancer diagnoses included gastroesophageal (3), colorectal (4), hepatocellular (2) and lung (3) cancer. Disease was locally advanced and metastatic in 9 and 5 patients, respectively. Only 5 patients were offered standard therapy at initial oncology assessment, with a modified approach recommended for 4 patients. The treatment plan was undecided at the time of referral in 5 patients. The majority had an ECOG PS of 0−1 (n = 8) or 2 (n = 5). No patient had significant cognitive deficits on mini - mental state examination, with a median score of 29/30. One patient was dependent for 1 basic activity of daily living and 5 were dependent for 1 instrumental activities of daily living. The average number of medications per patient was 6. The majority of patients had low (n = 5) or moderate (n = 6) co-morbidity using the Charlson comorbidity index.