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A B S T R A C T S
S113
to be seen in the GO clinic for detailed assessment. Further
study will determine whether such an approach can be
implemented in other cancer sites at our institution and
whether the screening process can be refined further.
Disclosure of interest:
None declared
Keywords:
VES-13
P129
THE EFFECT OF COMPREHENSIVE GERIATRIC ASSESSMENT
ON TREATMENT DECISIONS AND MORTALITY AMONGST
OLDER PATIENTS TREATED FOR UPPER GASTROINTESTINAL
CANCER
R. Morris
1,
*, J. Pattinson
1
, A. Sims
1
, J. Brown
1
, A. Cowley
1
,
T. Masud
1
1
Health Care for Older People, Nottingham University Hospitals
NHS Trust, Nottingham, United Kingdom
Introduction:
Surgery remains the prime treatment
modality for successful treatment of upper gastro-intestinal
(UGI) cancer but the complex influences of advancing age,
multiple co-morbidities and frailty are often inadequately
accounted for in Multi-Disciplinary Team (MDT) decision-
making. Comprehensive Geriatric Assessment (CGA) in
cancer treatment is gaining prominence as a potential way of
informing such decisions and improving outcomes amongst
older patients.
Objectives:
This prospective cohort study in older adults
with Upper Gastro-intestinal (UGI) Cancer aimed to examine
the effect of CGA on Cancer Multi-Disciplinary Team (MDT)
decision-making and key outcomes.
Methods:
Consecutive patients (
70yrs) referred to the
UGI Cancer MDT were invited for assessment in a multi-
professional Geriatric Assessment Clinic. All patients were
assessed by geriatrician, nurse, occupational therapist, physio-
therapist, dietician and social worker. Planned interventions
were delivered and followed-up by the CGA team. Treatment
modality, surgical length of stay (los), unscheduled acute care
episodes and deaths were recorded and compared with a
historical control cohort.
Results:
139 CGA patients (65.5% male) were compared
with 140 (63.6% male) controls. Age, co-morbidities and
cancer diagnoses were similar in both groups. Significantly
more patients in the CGA group (38.1%) received potentially
curative surgical treatment than in the control group (21.4%)
(Chi-square=9.309; p=0.002). In those not treated surgically,
a greater proportion of the CGA group received palliative
treatment (39.5%) compared to controls (27.3%) (Chi-
Square=3.300; p=0.069). There was no significant difference
in total use of acute care between the two groups. Six-Month
mortality was significantly lower in the CGA group (28.1% vs
45.0%, Chi-square=8.632; p=0.003).
Conclusion:
CGA in UGI cancer assessment increases the
proportion of older patients receiving potentially curative
surgical treatment and active palliation. Six-month survival
was significantly greater in the CGA group. There was no
apparent cost in terms of increased overall use of acute care.
Disclosure of interest:
None declared
Keywords:
Comprehensive geriatric assessment, mortality,
treatment decisions
P130
MULTIMORBIDITY AND HEALTH OUTCOMES IN OLDER
ADULTS: A FOCUS ON CANCER SURVIVORS
D. F. Warner
1
, N. K. Schiltz
2
, K. C. Stange
3
, C. W. Given
4
,
C. Owusu
5
, N. A. Berger
5
, S. M. Koroukian
2,
*
1
Sociology, University of Nebraska, Lincoln,
2
Epidemiology and
Biostatistics,
3
Department of Family Medicine and Community
Health, Case Western Reserve University, Cleveland,
4
Department
of Family Medicine, Michigan State University, East Lansing,
5
Hematology/Oncology, University Hospitals of Cleveland,
Cleveland, USA
Introduction:
In the U.S., nearly 14.5 million individuals
with a history of cancer were alive as of January 1, 2014;
86% were 50 years of age or older [1]. Similar to the general
population, older cancer survivors (CS) are likely to present
with multimorbidity (MM), defined here as the co-occurrence
of chronic conditions, functional limitations, and geriatric
syndromes. Yet, little is known about CS’ MM profile, and
whether the association between CS and poor health
outcomes is due to differential MM.
Objectives:
This study has two objectives: 1) to characterize
CS’ MM profile; and 2) to evaluate the independent association
between CS status and health outcomes, including self-rated
fair/poor health, worse health in 2 years, and 2-year mortality.
We hypothesize that adjusting for MM and potential
confounders, CS status remains associated with worse health
outcomes.
Methods:
We used the 2010-2012 U.S. Health and Retire-
ment Study (HRS), a biennial survey of adults 50 years of
age or older. The HRS includes rich self-reported data on
socio-demographics; chronic conditions, including cancer
and years since diagnosis; functional limitations (e.g.,
limitations in mobility, strength), and geriatric syndromes
(e.g., poor cognitive functioning, severe pain). We constructed
a composite measure, MM0-MM3, reflecting the occurrence/
co-occurrence of chronic conditions (excluding cancer),
functional limitations, and geriatric syndromes, with MM0
indicating none of these conditions, and MM3 indicating the
co-occurrence of chronic conditions, functional limitations
and geriatric syndromes. Our main independent variable
was CS status, indicating the individual reported a (non-skin)
cancer diagnosis
2 years prior to the interview. In addition
to descriptive analyses, we conducted multivariable logistic
regression analyses to evaluate the association between CS
status and health outcomes, after adjusting for potential
confounders. We also examined whether the effect of CS
differed by years since diagnosis.
Results:
Our study population included 15,808 older adults;
11.8% were CS. The median age was 70.1 and 63.8 years among
CS and CFIs, respectively; 55.1% were women; and 21.3% were
non-white.Thirty one percent of CS and 21.1% of CFIs presented