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A B S T R A C T S
S97
for: MSO, Merck, TEVA, E. Fiedler: None declared, U. Mueller-
Werdan: None declared, D. Vordermark Consultant for: Roche,
Boehringer, Sqibb
Keywords:
elderly cancer patients, geriatric assessment,
HRQOL, transsectoral care
P103
EVALUATION OF TWO ONCO-GERIATRIC SCORE SYSTEMS
FOR PREDICTION OF THERAPY-ASSOCIATED TOXICITY IN
ELDERLY CANCER PATIENTS
I. Ortland
1,
*, M. T. Mendel
1
, M. Kowar
2
, Y.-D. Ko
3
, A. H. Jacobs
2
,
U. Jaehde
1
1
Institute of Pharmacy, Clinical Pharmacy, University of Bonn,
2
Department of Geriatrics and Neurology,
3
Department of Oncology
and Hematology, Johanniter Hospital Bonn, Bonn, Germany
Introduction:
Decisions on the treatment of elderly
cancer patients are particularly challenging due to high
inter-individual variability of co-morbidity and frailty, as
well as age-associated physiological alterations. Therefore,
a tool for supporting and guiding individual onco-geriatric
benefit-risk assessments could be valuable in the treatment
of these patients. Two promising score systems for predicting
chemotherapy-associated toxicity in elderly cancer patients
were recently developed. However, they have not been broadly
used in clinical routine so far.
Objectives:
We aim at profoundly assessing both published
onco-geriatric score systems for future clinical use. First, our
goal was to assess the feasibility and potential of the two score
systems in a pilot study. Our next step will be the comparison
of both scores regarding their predictive performance of
therapy risks.
Methods:
The two possible tools for toxicity prediction in
elderly cancer patients are the CARG score (Cancer and Ageing
Research Group [1]) and the CRASH score (Chemotherapy
Risk Assessment Scale for High-Age Patients [2]). They
combine different geriatric and oncological parameters
(for instance functional abilities or treatment modalities)
and stratify patients into different risk categories regarding
chemotherapy-related toxicity. In the pilot study we recruited
cancer patients
70 years and performed the CARG and
CRASH score before starting systemic cancer treatment.
The feasibility and potential of the two score systems were
assessed by comparing the score results with each other
as well as the physicians’ therapy decisions with the score
results. Furthermore, the necessary time for patient interviews
was evaluated and patient-reported symptoms were analyzed
for toxicity evaluation (PRO-CTCAE [3]).
Results:
In the pilot study we recruited 20 elderly cancer
patients. The results of both scores differed from the
physician’s assessment by predicting a higher chemotherapy-
associated toxicity (CRASH Combined Score 10% vs CARG 15%
vs Physicians 90% of patients in the low toxicity risk prediction
category). Moreover, the results revealed a discrepancy in risk
predictions between the two score systems. Additionally, the
analysis indicated that the interview of the CARG score can
be performed much faster than the one of the CRASH score
(mean 3.3 min vs 27.1 min). The correlation between patient-
reported toxicity and the scores’ or physicians’ predictions
remains to be further analyzed on a larger scale.
Conclusion:
The pilot study indicates the feasibility and
potential of an onco-geriatric assessment to improve cancer
therapy in the elderly. However, the results also clearly
demonstrate the importance of further evaluating which
one of the score systems predicts chemotherapy-associated
toxicity better. In the future, the score with higher predictive
performance may be implemented in clinical routine for
improving onco-geriatric therapy decisions or may serve as a
stratification tool in clinical studies.
References:
[1] Hurria A et al. Predicting chemotherapy toxicity in older
adults with cancer: a prospective multicenter study. J Clin
Oncol 2011; 29:3457-65.
[2] Extermann M et al. Predicting the risk of chemotherapy
toxicity in older patients: the Chemotherapy Risk Assess-
ment Scale for High-Age Patients (CRASH) Score. Cancer
2012; 118:3377-86.
[3] Basch E et al. Use of patient-reported outcomes to improve
the predictive accuracy of clinician-reported adverse
events. J Natl Cancer Inst 2011; 103:1808-1810.
Disclosure of interest:
None declared
Keywords:
Chemotherapy toxicity, Geriatric assessment
P104
FOUR MODELS OF FRAILTY IN COLORECTAL CANCER
PATIENTS QUALIFIED FOR ELECTIVE SURGERY
J. Kenig
1,
*, A. Papier
1
, P. Walega
1
, O. Urszula
1
, W. Nowak
1
1
3rd Department of General Surgery, Jagiellonian University
Medical College, Krakow, Poland
Introduction:
There are many definitions of frailty in
the literature. At present, there are two principal models of
it: the phenotype model described by Fried et al. (PF) and
the models based on the Geriatric Assessment (GA) such
as: the Cumulative Deficit Model (CDM), the Pre-operative
Assessment of Cancer in the Elderly (PACE) dedicated to
surgical patients and the Balducci-criteria. However, the best
assessment model is still debatable.
Objectives:
Therefore, the aim of this prospective study
was to compare four models of frailty, in the same population
of surgical patients with colorectal cancer and to evaluate its
accuracy in predicting postoperative 30-day outcome.
Methods:
Between January 2013 and December 2015,
consecutive patients over 70 years of age with colorectal
cancer requiring elective surgery under general anesthesia
were enrolled into the study, whichwas conducted at a tertiary
referral hospital. Patients who had peritoneal carcinomatosis
and only explorative laparoscopy/laparotomy were excluded
from further analysis. Two patients refused to participate in
the study. Four patients were excluded due to incomplete
data.