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P86 Are weekly CBCs (Complete Blood cell Counts) necessary for all elderly cancer patients undergoing chemotherapy?
Proffered papers, Posters phase consisted of a review of the global situation and exploratory interviews to elaborate guidelines for the semi-structured interviews used in a second phase. Result(s): The results present the general characteristic of the interviews and show how doctor’s differing perceptions of geriatric oncology can be an obstacle to everyday professional collaboration. The analysis start by an overview of the general perceptions of the geriatric oncology project: how the oncologists are faced with new uncertainties and geriatricians with new opportunities and constraints. It then shows various ways of taking the patient’s age into consideration: how age emerges as a new working rule, with the implicit competition between “young” and “elderly” patients and “elderly” and “geriatric” patients. Lastly, the survey analyze the misappreciation of the other’s role and the difference between care and cure perception. Conclusion(s): To conclude, it discusses two points. The first point concerns the interest to take in consideration the different medical specialities’ perception of elderly patient and the influence of those perceptions on the collaboration between cancer specialists and geriatricians. The second point suggests how the heterogeneity of perceptions could be a major impediment. In our point of view, taking this diversity into account may enable the leaders of the project, and those doctors who would like to engage to it, to envisage more open dialogue.
Supportive care P86 Are weekly CBCs (Complete Blood cell Counts) necessary for all elderly cancer patients undergoing chemotherapy? M.L.G. Janssen-Heijnen1,2 *, M. Extermann3 , I.E. Boler3 . 1 Eindhoven Cancer Registry, Department of Research, Eindhoven, The Netherlands, 2 Erasmus University Medical Centre, Department of Public Health, Rotterdam, The Netherlands, 3 Moffitt Cancer Center, Department of Senior Adult Oncology, University of South Florida, Tampa, Florida, USA Purpose of the study: For cancer patients receiving chemotherapy, weekly CBCs are common for early detection of grade 4 neutropenia. However, patients with normal blood cell counts during the first course of (some types of) chemotherapy might be very unlikely to experience grade 4 neutropenia in subsequent cycles. If this is the case, further weekly CBCs for this patient group might be avoided. Method(s): Prospective study using data of 223 patients (all tumour types, except leukemia) who were included in the CRASH (Chemotherapy Risk Assessment Score for High-age patients) trial between August 2003 and February 2007. Inclusion criteria were age 70+ and receiving any chemotherapy regimen (1st , 2nd , 3rd , or 4th line) in 7 cancer centers in the United States. Hematological toxicity was classified according to NCI Common Toxicity Criteria for Adverse Advents, version 3.0. MAX2-score was used as a measure for the toxicity of the chemotherapy regimen. Result(s): Sixty-two patients (28%) experienced grade 4 neutropenia during subsequent cycles of chemotherapy. This varied from 10% among those without neutropenia during the 1st cycle to 59% among those with grade 4 neutropenia during the 1st cycle. When we selected only patients who received chemotherapy with a MAX2-score lower than 0.20, only 4.6% of those without neutropenia during the first cycle experienced grade 4 neutropenia during subsequent cycles. Conclusion(s): Weekly CBC might be avoided in elderly cancer patients receiving chemotherapy with a MAX2-score lower than 0.20 and those without neutropenia during the 1st cycle. This low MAX2-score represents regimens such as Capecitabine, Carboplatin/pemetrexed, Gemcitabine, PEG-doxorubicin, weekly 5-FU/LV, Carboplatin/taxol weekly, Fludarabine, FOLFOX and Vinorelbine. Future prospective studies should confirm these results.
S49 P87 The treatment of long-term co-morbidities in older patients with metastatic cancer J. Cashman1 *, J. Wright1 , A. Ring1,2 . 1 Brighton and Sussex Medical School, Brighton, United Kingdom, 2 Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom Purpose of the study: Patients diagnosed with metastatic cancer are rarely curable and are managed with the intention of prolonging life with the best possible quality. The majority of these patients are elderly and with increasing age the prevalence of co-morbidities such as ischaemic heart disease, hypertension and hypercholesterolaemia also increase. Therefore commonly older patients take medications to reduce the long-term risk of such cardiovascular problems. When older patients are diagnosed with metastatic cancer their life expectancy is significantly shortened and they are unlikely to derive benefit from agents used to treat long-term comorbidities. These medications may also be associated with negative effects, including adverse drug reactions, reduced compliance with anticancer and symptom control medication and side effects. The aim of the study was to determine whether older patients continue to take these medications after they have been diagnosed with metastatic cancer. Method(s): Between November 2008 and June 2009 patients over the age of 65 with metastatic cancer were recruited from oncology outpatient clinics at the Royal Sussex County Hospital and Eastbourne District General Hospital, UK. Eligible patients were identified by the oncology consultants and specialist registrars in outpatient clinics and were interviewed (by direct contact or telephone). Medical records were reviewed and the patient’s GP was contacted if necessary in order to ascertain current medication use, and where relevant the exact indication for the medication. Additional demographic and tumour/treatment history details were obtained from the medical records. Classes of medication of interest were prospectively defined; these were: anti-hypertensives, lipid lowering drugs, anti-platelet agents, anti-coagulants and bisphosphonates. Result(s): One hundred patients were recruited, with a median age of 73.5 years (range: 65−88); 52% were female. The primary cancer sites were: breast: 36%, prostate: 27%, colon: 14%, renal: 5%, non-small cell lung cancer: 4%, oesophageal: 4%, other 10%. The median performance status of the patients was 2. The median number of medications was 7 (range: 1−17). Eighty-one percent of patients were found to be taking one or more of the predefined medications for treatment of a long-term comorbidity, with 71% of patients taking anti-hypertensives and 33% taking lipid-lowering agents. Overall 52% of patients had side-effects attributable to these medications. Conclusion(s): The results of this study show that many patients with metastatic cancer continue to take drugs for primary and secondary prevention of co-morbidities for perceived long-term benefit. The benefits of these drugs are likely to be minimal and they have been found to be associated with side effects and inconvenience. Strategies need to be developed to address this in order to improve the care of these patients. P88 Geriatric palliative care interest group of the European Union Geriatric Medicine Society (EUGMS) S. Pautex1 *, V. Curiale2 , M. Pfisterer3 , L. Rexach4 , M. Ribbe5 , N. Van Den Noortgate6 . 1 Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, University Hospital Geneva, Switzerland, 2 Acute Care for Elders Unit, Department of Gerontology, Galliera Hospital, Genoa, Italy, 3 Klinik f¨ur Geriatrie, Evangelisches Krankenhaus Elisabethenstift, Darmstadt, Germany, 4 Coordinator of Palliative Care Unit, University Hospital Ram´on y Cajal Madrid, Spain, 5 VU University Medical Center, Amsterdam, the Netherlands, 6 Department of Geriatric Medicine, University Hospital Ghent, Belgium Purpose of the study: Populations are ageing at increasing rates. As more people live longer, new challenges are emerging. The dying trajectory of frail, older patients is quite different from this of younger patient often dying from cancer. The older patients often accumulate multiple chronic medical conditions and geriatric syndromes and present multiple, frequently unpredictable, exacerbations of their disease. To provide adequate palliative care to this population some specific skills are necessary.
Supportive care P86 Are weekly CBCs (Complete Blood cell Counts) necessary for all elderly cancer patients undergoing chemotherapy? M.L.G. Janssen-Heijnen1,2 *, M. Extermann3 , I.E. Boler3 . 1 Eindhoven Cancer Registry, Department of Research, Eindhoven, The Netherlands, 2 Erasmus University Medical Centre, Department of Public Health, Rotterdam, The Netherlands, 3 Moffitt Cancer Center, Department of Senior Adult Oncology, University of South Florida, Tampa, Florida, USA Purpose of the study: For cancer patients receiving chemotherapy, weekly CBCs are common for early detection of grade 4 neutropenia. However, patients with normal blood cell counts during the first course of (some types of) chemotherapy might be very unlikely to experience grade 4 neutropenia in subsequent cycles. If this is the case, further weekly CBCs for this patient group might be avoided. Method(s): Prospective study using data of 223 patients (all tumour types, except leukemia) who were included in the CRASH (Chemotherapy Risk Assessment Score for High-age patients) trial between August 2003 and February 2007. Inclusion criteria were age 70+ and receiving any chemotherapy regimen (1st , 2nd , 3rd , or 4th line) in 7 cancer centers in the United States. Hematological toxicity was classified according to NCI Common Toxicity Criteria for Adverse Advents, version 3.0. MAX2-score was used as a measure for the toxicity of the chemotherapy regimen. Result(s): Sixty-two patients (28%) experienced grade 4 neutropenia during subsequent cycles of chemotherapy. This varied from 10% among those without neutropenia during the 1st cycle to 59% among those with grade 4 neutropenia during the 1st cycle. When we selected only patients who received chemotherapy with a MAX2-score lower than 0.20, only 4.6% of those without neutropenia during the first cycle experienced grade 4 neutropenia during subsequent cycles. Conclusion(s): Weekly CBC might be avoided in elderly cancer patients receiving chemotherapy with a MAX2-score lower than 0.20 and those without neutropenia during the 1st cycle. This low MAX2-score represents regimens such as Capecitabine, Carboplatin/pemetrexed, Gemcitabine, PEG-doxorubicin, weekly 5-FU/LV, Carboplatin/taxol weekly, Fludarabine, FOLFOX and Vinorelbine. Future prospective studies should confirm these results.
S49 P87 The treatment of long-term co-morbidities in older patients with metastatic cancer J. Cashman1 *, J. Wright1 , A. Ring1,2 . 1 Brighton and Sussex Medical School, Brighton, United Kingdom, 2 Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom Purpose of the study: Patients diagnosed with metastatic cancer are rarely curable and are managed with the intention of prolonging life with the best possible quality. The majority of these patients are elderly and with increasing age the prevalence of co-morbidities such as ischaemic heart disease, hypertension and hypercholesterolaemia also increase. Therefore commonly older patients take medications to reduce the long-term risk of such cardiovascular problems. When older patients are diagnosed with metastatic cancer their life expectancy is significantly shortened and they are unlikely to derive benefit from agents used to treat long-term comorbidities. These medications may also be associated with negative effects, including adverse drug reactions, reduced compliance with anticancer and symptom control medication and side effects. The aim of the study was to determine whether older patients continue to take these medications after they have been diagnosed with metastatic cancer. Method(s): Between November 2008 and June 2009 patients over the age of 65 with metastatic cancer were recruited from oncology outpatient clinics at the Royal Sussex County Hospital and Eastbourne District General Hospital, UK. Eligible patients were identified by the oncology consultants and specialist registrars in outpatient clinics and were interviewed (by direct contact or telephone). Medical records were reviewed and the patient’s GP was contacted if necessary in order to ascertain current medication use, and where relevant the exact indication for the medication. Additional demographic and tumour/treatment history details were obtained from the medical records. Classes of medication of interest were prospectively defined; these were: anti-hypertensives, lipid lowering drugs, anti-platelet agents, anti-coagulants and bisphosphonates. Result(s): One hundred patients were recruited, with a median age of 73.5 years (range: 65−88); 52% were female. The primary cancer sites were: breast: 36%, prostate: 27%, colon: 14%, renal: 5%, non-small cell lung cancer: 4%, oesophageal: 4%, other 10%. The median performance status of the patients was 2. The median number of medications was 7 (range: 1−17). Eighty-one percent of patients were found to be taking one or more of the predefined medications for treatment of a long-term comorbidity, with 71% of patients taking anti-hypertensives and 33% taking lipid-lowering agents. Overall 52% of patients had side-effects attributable to these medications. Conclusion(s): The results of this study show that many patients with metastatic cancer continue to take drugs for primary and secondary prevention of co-morbidities for perceived long-term benefit. The benefits of these drugs are likely to be minimal and they have been found to be associated with side effects and inconvenience. Strategies need to be developed to address this in order to improve the care of these patients. P88 Geriatric palliative care interest group of the European Union Geriatric Medicine Society (EUGMS) S. Pautex1 *, V. Curiale2 , M. Pfisterer3 , L. Rexach4 , M. Ribbe5 , N. Van Den Noortgate6 . 1 Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, University Hospital Geneva, Switzerland, 2 Acute Care for Elders Unit, Department of Gerontology, Galliera Hospital, Genoa, Italy, 3 Klinik f¨ur Geriatrie, Evangelisches Krankenhaus Elisabethenstift, Darmstadt, Germany, 4 Coordinator of Palliative Care Unit, University Hospital Ram´on y Cajal Madrid, Spain, 5 VU University Medical Center, Amsterdam, the Netherlands, 6 Department of Geriatric Medicine, University Hospital Ghent, Belgium Purpose of the study: Populations are ageing at increasing rates. As more people live longer, new challenges are emerging. The dying trajectory of frail, older patients is quite different from this of younger patient often dying from cancer. The older patients often accumulate multiple chronic medical conditions and geriatric syndromes and present multiple, frequently unpredictable, exacerbations of their disease. To provide adequate palliative care to this population some specific skills are necessary.