46 / 154
S16
A B S T R A C T S
Often in these patients fatigue is one symptom within a
cluster of other symptoms such as anemia, depression and
sleep disorders that may contribute to the development
of cancer-related fatigue. Moreover, the elderly are often
affected by several co-morbidities (i.e., metabolic, endocrine
and cardiovascular disorders) which may cause fatigue.
The pathogenesis of cancer-related fatigue is not yet well
understood.
Each patient, especially if elderly, should be screened for
fatigue at their initial visit and during the routine subsequent
visits. Elderly patients are often reluctant to report fatigue
to their clinicians, mainly because they consider fatigue as
an unavoidable side effect. Therefore, health care providers
should help elderly patients to disclose and describe the
fatigue they are experiencing, its intensity and duration,
the factors that exacerbate or relieve fatigue and its impact
on functioning. An assessment tool may help patients to
talk about their fatigue. Unfortunately, no instruments have
been specifically developed for elderly cancer patients. The
most efficient way of recording fatigue is by using a simple
unidimensional severity scale such as a verbal rating scale
(none, mild, moderate and severe fatigue) or a numeric rating
scale (0–10 scale where 0 equals no fatigue and 10 equals the
worst imaginable fatigue). The Brief Fatigue Inventory which
has only nine items to measure, it is easy to use and could be
studied as measurement tool in elderly cancer patients.
MASCC is now elaborating guidelines on cancer-related
fatigue. Unfortunately, only few data are available on
elderly cancer patients. Therefore, I will try to adapt MASCC
guidelines concerning treatment of cancer-related fatigue to
elderly cancer patients.
Both pharmacological and not pharmacological interven-
tions will be presented. Education of the patient and physician
regarding this topic is necessary.
About 20 randomized placebo-controlled studies on
psychostimulants (methylphenidate, dexmethilphenidate,
dexamphetamine, modafinil and armodafinil) have been
published. No one carried out specifically in elderly cancer
patients. The results of these studies are contrasting and does
not permit us to drawn firm conclusions on the efficacy of
psychostimulants in the control of cancer-related fatigue.
The same is true for antidepressants which are efficacious
for depression but not against fatigue. The only efficacious
drug is dexamethasone that in a double-blind study in
terminal cancer patients reduced significantly the fatigue
with respect to placebo. Among the non-pharmacological
treatments physical exercise and psychosocial interventions
demonstrated some impact on the control of cancer-related
fatigue.
Disclosure of interest:
None declared
S51
COGNITIVE DYSFUNCTION: WHY DOES IT MATTER IN
OLDER PATIENTS WITH CANCER?
Siri Rostoft
Oslo university Hospital, Department of Geriatric Medicine, Oslo,
Norway
Aim:
To highlight why cognitive dysfunction is one of
the most important comorbidities to assess in older cancer
patients
Background:
The prevalence of cognitive dysfunction
and dementia increases with higher chronological age.
As the population of older patients with cancer increases,
professionals dealing with such patients need to develop
skills in recognizing, diagnosing, and dealing with cognitive
dysfunction.
Methods:
PubMed search of papers addressing cognitive
dysfunction in older patients with cancer as well as personal
clinical and research experience
Results:
Cognitive dysfunction and dementia influences
every part of the treatment trajectory for cancer patients
such as understanding information about the disease and
treatment options and contributing to the decision making,
and compliance both with the prescribed treatment and
warning signs of side effects. Additionally, both cognitive
impairment and dementia impacts life expectancy. The
risk of delirium during treatment is higher in patients with
preexisting cognitive impairment, and preventive strate-
gies should be put in place. In most cases, patients with
cognitive impairment need extensive supervision from
health personnel or caregivers during the course of the
cancer treatment. If cognitive impairment goes unnoticed by
the treating physician, the patient will be a higher risk of a
negative outcome.
Conclusion:
Doctors treating older patients with cancer
need to look actively for signs of cognitive impairment
because this comorbidity has immediate implications for
every step of the treatment trajectory.
Disclosure of interest:
None declared
S52
ARE GLIOBLASTOMA WELL TREATED IN THE ELDERLY?
Patrick Roth
University Hospital Zurich, Department of Neurology, Oslo, Norway
Approximately half of the patients diagnosed with
glioblastoma are 65 years or older and the incidence for
gliomas in the elderly population is rising for unknown
reasons. Glioblastoma, as the most frequent and most
malignant subtype, is associated with a particularly poor
prognosis. Various molecular markers have gained increasing
interest in the last years in patients suffering from glioma. In
the elderly, most gliomas display an unfavorable molecular
composition such as the absence of IDH mutations. The
available treatment options include surgery, radiation therapy
and alkylating chemotherapy, mainly with temozolomide.
Data presented at the ASCO meeting 2016 indicate that
temozolomide-based radiochemotherapy is superior to
radiotherapy alone in elderly glioblastoma patients. This
survival benefit is largely restricted to patients with tumors
harboring a methylation of the O6-methylguanine-DNA-
methyltransferase (MGMT) promoter. In patients who are
considered ineligible for combined treatment modality, post-