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A B S T R A C T S
S119
Methods:
Patients were over 70 years of age with a
diagnosis of cancer, deemed fit for radical RT after assessment
by Consultant radiation oncologist. Pre-treatment, the EFS
questionnaire was carried out with each patient. Post-
treatment, the incidence and severity (CTCAE V3.0 grading) of
all adverse events were recorded.
Results:
From January 2013 to August 2015, 67 patients
took part in the study, 63 eligible for inclusion. Aged 70–95yrs,
(Mean= 75.8).
Primary oncological diagnosis: prostate (34%/n=21), breast
(22%/n=14), (14%/ n=9), upper GI (8%/n=5), lung (6%/n=4),
rectal (5%/n=3), gynaecological (3%/n=2). Non metastatic
disease (96.8%/n=61).
EFS scores ranged from 0-9, (mean=4). ‘Not frail’ (70%/n=44),
‘Vulnerable’ (19%/n=12) and ‘Mild frailty’ (11%/n=7) categories.
No patients in the mod-severe frailty categories.
Patient outcomes: multiple (2+) Grade 1 or 2 toxicities
seen in 76% (n=48). Grade 3 or 4 toxicities recorded in 29%
(n=18). Multiple grade 3 or 4 toxicities in4.7% (n=3). Unplanned
breaks in treatment were necessary in 3%/n=2. 22%/n=14 were
admitted for treatment. By target site patients with upper
GI, lung, gynaecological or malignancies had a high rate of
toxicity/admission.
There was no statistical correlation between EFS score
and the presence of Grade 3/4 toxicities/admission. Medium
positive correlation between age and EFS existed, with older
age associated with a higher EFS (rho=.41, n= 63, p.001).
Medium positive correlation between grade 3/4 toxicity and
RT dose, with higher RT dose associated with grade 3+ toxicity
(rho=.35, n= 63, p.005)
Conclusion:
This study showed that neither EFS score, age
nor ECOG performance status were predictive of RT toxicity.
There was no greater incidence of breaks in treatment or
admissions in the older or frailer groups. However, there was
a higher rate of toxicity/admission in certain target sites than
would be expected in the general population. This study was
limited by its small study size and also that patients referred
were of good performance status. Whilst no statistically
significant correlation could be found between frailty and RT
toxicities, this study does highlight the potential for further
investigation in specific radiotherapy sites in the older
population.
Disclosure of interest:
None declared
Keywords:
Edmonton Frail Scale, geriatric assessment
P139
TRAINING MEDICAL ONCOLOGISTS TO ADDRESS THE
NEEDS OF AGING CANCER PATIENTS
T. Hsu
1,
*, W. Dale
2
, A. Gajra
3
, H. M. Holmes
4
, E. R. Kessler
5
,
R. Maggiore
6
, A. Magnuson
7
, I. Parker
8
, A. Hurria
9
1
The Ottawa Hospital Cancer Centre, Ottawa, Canada,
2
University
of Chicago Medical Center, Chicago,
3
Upstate Cancer Center,
Syracuse,
4
University of Texas Health Science Center at Houston,
Houston,
5
University of Colorado School of Medicine, Aurora,
6
Oregon Health and Science University, Portland,
7
University
of Rochester Medical Center, Rochester,
8
ElderCare Mediation
Solutions, La Jolla,
9
City of Hope National Comprehensive Cancer
Center, Duarte, USA
Introduction:
Older adults comprise 60% of newly
diagnosed cancer cases and 70% of all cancer deaths.There are
insufficient geriatricians to care for all older adults. Therefore
all oncologists need a basic knowledge of geriatric issues to
better meet the needs of older cancer patients. Unfortunately,
up to 2/3 of oncology trainees report never receiving training
on the needs of older patients with cancer and there is no
formal consensus about what geriatric oncology competencies
a medical oncology trainee should possess.
Objectives:
The objective of this study was to identify
a minimal set of competencies medical oncology trainees
should possess in geriatric oncology.
Methods:
A modified Delphi survey of experts in geriatric
oncology and oncology medical education in North America
was conducted. Geriatric oncology experts were identified
through the Cancer and Aging Research Group membership.
Program directors of North American oncology training
programs were contacted. Snowball sampling was used to
identify further oncology education experts. Invitations to
potential experts continued until 15-20 experts from each
category agreed to participate.
Potential geriatric oncology competencies were identified
through a review of existing studies and of the American
Society of Clinical Oncology and European Society of Medical
Oncology core oncology curriculum. Experts were asked
to categorize when the proposed competencies should
be attained: on completion of internal medicine training,
oncology training, or geriatric oncology training. Results were
fed back to the experts who were asked to re-classify the
competencies in subsequent rounds. Consensus was obtained
if 2/3 of the experts agreed on the stage of training at which
the competency should be attained.
Results:
Thirty-three experts in geriatric oncology (n=18)
and oncology education (n=15) participated in the Delphi.
Respondents were trained in oncology (73%) and geriatrics
(36%), or both (19%); 52% were in practice for 5-10 years and
26% for
20 years. Most respondents (55%) spend <5 h/week
involved in oncology education while 23% spend 5-10 h/week.
An initial list of 46 potential competencies were identified
by the investigators spanning 6 domains (aging and cancer
interface; prescribing systemic therapies in older adults;
geriatric assessment; geriatric oncology knowledge base;
geriatric syndromes; psychosocial needs and survivorship).
Respondents suggested 22 additional competencies, which
were incorporated the Delphi. Following two rounds of
ranking, 46% (n=36) of proposed competencies were ranked
as appropriate for oncology trainees to obtain. Strongest
consensus (
90% agreement) was for the following
competencies:
- Describe biological and psychosocial changes that occur
with aging and their implications regarding cancer and
cancer care
- Recognize the heterogeneity of aging in older adults with
cancer
- Describe factors that may impact an older person’s
preferences with respect to cancer therapy