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Safety and efficacy of electron beam radiation therapy for epithelial skin cancer in geriatric patients
S94
J O U RN A L OF GE R IAT RI C O N COL O G Y 3 ( 2 0 12 ) S3 3 –S 10 2
suggest that elderly patients with GB should not be excluded from intensive treatment modalities based only on their chronological age. References [1] Brandes AA, Franceschi E. Primary brain tumors in the elderly population. Current treatment options in neurology 2011; 13:427-435. doi:10.1016/j.jgo.2012.10.115
P115 Safety and efficacy of electron beam radiation therapy for epithelial skin cancer in geriatric patients G. Sokol⁎1,2,3, S. McIntyre3, L. Loftus1, G. Wright3. 1Moffitt Cancer Center, Tampa, Florida, USA, 2Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA, 3Florida Cancer Specialists, Tampa, Florida, USA Purpose of the Study: Radiation therapy is a well-recognized modality of treatment for squamous and basal cell cancers of the skin. The purpose of this study was to evaluate the response rate, cosmesis, and safety of electron beam radiation therapy in geriatric patients with non-melanoma skin cancers. Methods: One hundred and two patients with 332 separate epithelial skin cancers were treated definitively with superficial electron beam spray typically utilizing 6 MeV electrons to a depth dose of 90% utilizing topically applied bolus appropriate to the depth and size of the lesion. The ratio of squamous cell carcinomas to basal cell lesions was 1:3 with a small percentage of mixed basal and squamous cell components (~ 4%). The age range extended from ages 60–99 (average age 78, median age 75). Patients were treated with varying fractionation schedules depending on size and depth of invasion from 400 cGy in 12 fractions to 5000 cGy in 25 fractions. Tumor response was evaluated weekly during treatment, monthly after treatment for 2 visits, and every 4 months thereafter indeterminately. Cosmesis was graded on a 1–4 scale with 1 representing excellent cosmesis and 4 representing poor cosmesis. Patients were evaluated for complete or partial response at each visit. 331 of the lesions were stage T1–T3. One lesion was T4. Results: One hundred and one patients and 331 separate cancers sustained a complete response. A total of 3 patients subsequently failed with recurrent cancer in the treatment site. One of those patients had deep bone invasion (T4) and 2 patients sustained a geographical marginal recurrence. Cosmesis was excellent in 85% depending on initial presentation with respect to size, previous treatment or local tissue damage. Fifteen percent of responses were considered good with no unacceptable cosmetic results. There were no RTOG long term Grade 2 or above complications from treatment. Acute side effects consisted of moist desquamation and/or scabbing which consistently healed within 4–6 weeks or sooner. Conclusions: Electron beam spray radiation results in efficacy and safety comparable to any other form of treatment without the need for surgical intervention. There is no need for discontinuation of anticoagulants and minimal need for bandaging or other post treatment support. The treatment is generally painless, consumes less than 5 min for a treatment, and requires no significant skin or wound care. The only disadvantage is the number of visits required to complete treatment ranging from 10–25 depending on the size and depth of tumor involvement. This form of treatment for epithelial skin cancer represents an excellent noninvasive treatment for geriatric subjects. Surgery, postoperative wound care, suturing, cessation of anticoagulants and antibiotics are essentially unnecessary. X-ray irradiation is unnecessary, and electron beam treatment exposes only the treated area to irradiation. doi:10.1016/j.jgo.2012.10.116
Supportive care P116 The unmet supportive care needs and symptom burden in older breast cancer survivors in Singapore K.K.F. Cheng1, W.H. Wong2, L. Ge1, P. Khalechelvam1, C. Koh2. National University of Singapore, Singapore, 2National University Cancer Institute, Singapore 1
Background and Objectives: Experiencing late symptoms/side effects associated with cancer and its treatment is noted to be one of the most important aspects impeding the transition and can lead to multiple unmet needs for older breast cancer survivors. The current paper describes the prevalence and levels of perceived unmet supportive care needs, as well as the relationships between their unmet needs and symptom burden/quality of life of older breast cancer survivors. Methods: Subjects with breast cancer aged 50 or above and completed cancer treatment to 5 years were recruited from the National University Cancer Institute in Singapore. Measuring instruments included the Supportive Care Needs Survey (SCNS-34), Memorial Symptom Assessment Scale (MSAS), and Medical Outcomes Study Short Form Health Survey version 2.0 (SF-12). Results: Among the subjects who participated in the survey, the mean age was 58.7 years (SD 5.8; range 50–74). Half were diagnosed with stage II breast cancer (50%). The mean time of last cancer treatment was 25.6 months (SD 17.4; range 1–60). Majority had undergone mastectomy (n= 66; 60%), 47 (42.7%) treated with chemo-radiotherapy, and 75 (68.2%) receiving hormonal therapy. Subjects reported the greatest unmet need in Health Care System/ Information needs (24.9 ± 13.8; score range 0–100, with higher scores representing high levels of unmet needs), followed by Patient Care Support needs (16.8± 12.0), and Psychological needs (13.0 ± 14.6). Of the ten highest frequencies of moderate-to-high unmet needs items, five were related to the Health Care System/Information domain, and four were related to the Psychological needs domain. The most prevalent reported symptoms were lack of energy (45.5%), numbness/tingling in hands/feet (44.5%), and pain (36.4%) (Table 1). The most frequent, severe and distressing symptom was numbness/tingling in hands/feet. The PSYCH and PHYS subscales, Global Distress Index (GDI), and Total MSAS scores were 0.45 ± 0.6, 0.29 ± 0.3, 0.53 ± 0.5, 0.31±0.3, respectively, (score range 0–4, with higher scores representing high subscale score). Those reporting high levels of PSYCH score reported greater unmet Psychological needs (r=0.64, pb 0.01). Significant strong correlations were noted between PHYS, GDI and TMSAS scores, and unmet Physical/Daily Living needs (r=0.74–0.76, pb 0.01). The SF-12 Physical Composite Score (PCS) and Mental Composite Score (MCS) were 49.8 ± 9.1 and 53.6 ± 10.8, respectively, (score range 0–100, with lower scores representing poor quality of life). Significant moderate negative correlation was noted between PCS score and unmet Physical/Daily Living needs (r = − 0.41, p b 0.05). The unmet Psychological needs was correlated significantly with the MCS score (r = − 0.62, p b 0.01). Conclusion: Our data suggest that older breast cancer survivors continue to experience severe and distressing physical and psychological symptoms. Also older breast cancer survivors have many unmet needs across a range of domains. Result from this study suggests that older survivors with unmet needs had poor quality of life. Hence, regular assessment of symptoms and unmet needs is essential for good cancer survivorship care.
doi:10.1016/j.jgo.2012.10.117
J O U RN A L OF GE R IAT RI C O N COL O G Y 3 ( 2 0 12 ) S3 3 –S 10 2
suggest that elderly patients with GB should not be excluded from intensive treatment modalities based only on their chronological age. References [1] Brandes AA, Franceschi E. Primary brain tumors in the elderly population. Current treatment options in neurology 2011; 13:427-435. doi:10.1016/j.jgo.2012.10.115
P115 Safety and efficacy of electron beam radiation therapy for epithelial skin cancer in geriatric patients G. Sokol⁎1,2,3, S. McIntyre3, L. Loftus1, G. Wright3. 1Moffitt Cancer Center, Tampa, Florida, USA, 2Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA, 3Florida Cancer Specialists, Tampa, Florida, USA Purpose of the Study: Radiation therapy is a well-recognized modality of treatment for squamous and basal cell cancers of the skin. The purpose of this study was to evaluate the response rate, cosmesis, and safety of electron beam radiation therapy in geriatric patients with non-melanoma skin cancers. Methods: One hundred and two patients with 332 separate epithelial skin cancers were treated definitively with superficial electron beam spray typically utilizing 6 MeV electrons to a depth dose of 90% utilizing topically applied bolus appropriate to the depth and size of the lesion. The ratio of squamous cell carcinomas to basal cell lesions was 1:3 with a small percentage of mixed basal and squamous cell components (~ 4%). The age range extended from ages 60–99 (average age 78, median age 75). Patients were treated with varying fractionation schedules depending on size and depth of invasion from 400 cGy in 12 fractions to 5000 cGy in 25 fractions. Tumor response was evaluated weekly during treatment, monthly after treatment for 2 visits, and every 4 months thereafter indeterminately. Cosmesis was graded on a 1–4 scale with 1 representing excellent cosmesis and 4 representing poor cosmesis. Patients were evaluated for complete or partial response at each visit. 331 of the lesions were stage T1–T3. One lesion was T4. Results: One hundred and one patients and 331 separate cancers sustained a complete response. A total of 3 patients subsequently failed with recurrent cancer in the treatment site. One of those patients had deep bone invasion (T4) and 2 patients sustained a geographical marginal recurrence. Cosmesis was excellent in 85% depending on initial presentation with respect to size, previous treatment or local tissue damage. Fifteen percent of responses were considered good with no unacceptable cosmetic results. There were no RTOG long term Grade 2 or above complications from treatment. Acute side effects consisted of moist desquamation and/or scabbing which consistently healed within 4–6 weeks or sooner. Conclusions: Electron beam spray radiation results in efficacy and safety comparable to any other form of treatment without the need for surgical intervention. There is no need for discontinuation of anticoagulants and minimal need for bandaging or other post treatment support. The treatment is generally painless, consumes less than 5 min for a treatment, and requires no significant skin or wound care. The only disadvantage is the number of visits required to complete treatment ranging from 10–25 depending on the size and depth of tumor involvement. This form of treatment for epithelial skin cancer represents an excellent noninvasive treatment for geriatric subjects. Surgery, postoperative wound care, suturing, cessation of anticoagulants and antibiotics are essentially unnecessary. X-ray irradiation is unnecessary, and electron beam treatment exposes only the treated area to irradiation. doi:10.1016/j.jgo.2012.10.116
Supportive care P116 The unmet supportive care needs and symptom burden in older breast cancer survivors in Singapore K.K.F. Cheng1, W.H. Wong2, L. Ge1, P. Khalechelvam1, C. Koh2. National University of Singapore, Singapore, 2National University Cancer Institute, Singapore 1
Background and Objectives: Experiencing late symptoms/side effects associated with cancer and its treatment is noted to be one of the most important aspects impeding the transition and can lead to multiple unmet needs for older breast cancer survivors. The current paper describes the prevalence and levels of perceived unmet supportive care needs, as well as the relationships between their unmet needs and symptom burden/quality of life of older breast cancer survivors. Methods: Subjects with breast cancer aged 50 or above and completed cancer treatment to 5 years were recruited from the National University Cancer Institute in Singapore. Measuring instruments included the Supportive Care Needs Survey (SCNS-34), Memorial Symptom Assessment Scale (MSAS), and Medical Outcomes Study Short Form Health Survey version 2.0 (SF-12). Results: Among the subjects who participated in the survey, the mean age was 58.7 years (SD 5.8; range 50–74). Half were diagnosed with stage II breast cancer (50%). The mean time of last cancer treatment was 25.6 months (SD 17.4; range 1–60). Majority had undergone mastectomy (n= 66; 60%), 47 (42.7%) treated with chemo-radiotherapy, and 75 (68.2%) receiving hormonal therapy. Subjects reported the greatest unmet need in Health Care System/ Information needs (24.9 ± 13.8; score range 0–100, with higher scores representing high levels of unmet needs), followed by Patient Care Support needs (16.8± 12.0), and Psychological needs (13.0 ± 14.6). Of the ten highest frequencies of moderate-to-high unmet needs items, five were related to the Health Care System/Information domain, and four were related to the Psychological needs domain. The most prevalent reported symptoms were lack of energy (45.5%), numbness/tingling in hands/feet (44.5%), and pain (36.4%) (Table 1). The most frequent, severe and distressing symptom was numbness/tingling in hands/feet. The PSYCH and PHYS subscales, Global Distress Index (GDI), and Total MSAS scores were 0.45 ± 0.6, 0.29 ± 0.3, 0.53 ± 0.5, 0.31±0.3, respectively, (score range 0–4, with higher scores representing high subscale score). Those reporting high levels of PSYCH score reported greater unmet Psychological needs (r=0.64, pb 0.01). Significant strong correlations were noted between PHYS, GDI and TMSAS scores, and unmet Physical/Daily Living needs (r=0.74–0.76, pb 0.01). The SF-12 Physical Composite Score (PCS) and Mental Composite Score (MCS) were 49.8 ± 9.1 and 53.6 ± 10.8, respectively, (score range 0–100, with lower scores representing poor quality of life). Significant moderate negative correlation was noted between PCS score and unmet Physical/Daily Living needs (r = − 0.41, p b 0.05). The unmet Psychological needs was correlated significantly with the MCS score (r = − 0.62, p b 0.01). Conclusion: Our data suggest that older breast cancer survivors continue to experience severe and distressing physical and psychological symptoms. Also older breast cancer survivors have many unmet needs across a range of domains. Result from this study suggests that older survivors with unmet needs had poor quality of life. Hence, regular assessment of symptoms and unmet needs is essential for good cancer survivorship care.
doi:10.1016/j.jgo.2012.10.117