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A B S T R A C T S
may be related to the effects of treatments (endocrine
therapy and/or a ‘lack of’ surgery). Further work is required to
investigate this. The study is ongoing and is expanding into a
multi-centre one.
Disclosure of interest:
None declared
Keywords:
Comprehensive geriatric assessment, mood
assessment, older women, primary breast cancer
P035
ANDROGEN DEPRIVATION THERAPY AND THE RISK OF
PARKINSONISM IN OLDER MEN WITH PROSTATE CANCER
S. M. Alibhai
1,2,
*, R. Sutradhar
3
, J. Rangrej
3
, C. Marras
4
,
N. Fleshner
5
, J. W. Young
1
1
Medicine, University of Toronto,
2
Medicine, University Health
Network,
3
Institute for Clinical Evaluative Sciences,
4
Neurology,
5
Surgery, University Health Network, Toronto, Canada
Introduction:
Case reports and anecdotal experiences
suggest that some men develop parkinsonism after initiating
androgen-deprivation therapy (ADT) for the treatment of
prostate cancer, possibly due to neurophysiological effects of
changes in testosterone and/or estrogen.
Objectives:
To investigate whether ADT increases the risk
of parkinsonism in men with prostate cancer.
Methods:
Using linked administrative databases in
Ontario, Canada, men age 40 or older with prostate cancer on
continuous ADT for at least six months or who underwent
bilateral orchiectomy (n=38,931) were matched 1:1 with men
with prostate cancer who had never received ADT. Treated and
untreated groups were range-matched on age at index date and
year of diagnosis, and propensity-matched on comorbidities,
medications, cardiovascular risk factors, and socioeconomic
variables. A competing risks analysis was conducted where the
primary outcome was time to a new diagnosis of parkinsonism,
and time to death was a competing event.
Results:
The cohort had a mean age of 71.9 years and was
followed for a mean of 5.76 years. Under a competing risks
analysis, ADT use was not associated with an increased rate
of parkinsonism. Based on the results from the multivariable
cause-specific hazard regression model, the adjusted
relative rate of experiencing parkinsonism among ADT users
compared to non-users was 0.74 (95% confidence interval (CI)
0.67–0.83, p<0.0001).The adjusted relative rate of experiencing
the competing event of death among ADT users compared to
non-users was 1.33 (95% CI 1.30–1.36, p<0.0001). In both sets of
models increasing age was associated with an increasing risk
of parkinsonism. The 5-year incidence of parkinsonism was
1.03% in ADT users versus 1.56% in non-users.
Conclusion:
Contrary to our hypothesis, continuous ADT
use for at least 6 months in men with prostate cancer was not
associated with an increased risk of parkinsonism.
Disclosure of interest:
None declared
Keywords:
Androgen deprivation therapy, health services
research, parkinsonism, prostate cancer, toxicity
P036
CLINICAL AND TREATMENT FACTORS ASSOCIATED WITH
SURVIVAL AMONG WOMEN 70 YEARS AND OLDER WITH
EPITHELIAL OVARIAN CANCER
S. E. Robertson
1,
*, B. R. Khulpateea
1
, Y. Xiong
1
, K. O’Hara
2
,
M. Extermann
1
, H. S. Chon
1
1
Moffitt Cancer Center, Tampa, USA,
2
Hospital General
Universitario Gregorio Maranon, Madrid, Spain
Introduction:
Ovarian cancer is commonly diagnosed
in the 7
th
and 8
th
decades of life and yet elderly women are
underrepresented in clinical trials that guide physicians’
treatment decisions. As such, elderly patients frequently
receive suboptimal treatment regimens and suffer from
poorer outcomes.
Objectives:
We sought to examine factors associated with
differences in treatment and outcomes among older versus
younger patients with epithelial ovarian cancer.
Methods:
We performed a retrospective chart review of
323 patients with invasive epithelial ovarian cancer treated
at a single institution between January 1, 2001 and April 1,
2014. Patients were excluded from this review if they had a
prior personal history of cancer, had non-epithelial and/or
borderline histology, or if medical records were not available.
Clinical data obtained included disease characteristics
(disease stage, tumor histology and grade), baseline perfor-
mance measures (Karnofsky performance status (KPS), ECOG
Performance score, CIRS-G score, and CIRS-Severity Index),
treatment outcomes (surgical debulking status, type, timing
and number and completeness of chemotherapy regimens
given) and survival data.
Results:
Seventy-one patients (21.98%) were
70 years at
the time of cancer diagnosis. In a univariate analysis, study
subjects 70 years and older were significantly more likely to
have a tumor with serous histology, a higher CIRS-G score, a
higher CIRS-Severity Index,suboptimal surgical debulking,and
fewer total lines of chemotherapy given. Interestingly, ECOG
performance score and KPS were not significantly different
between the age groups. All variables significant to a level of p
0.1 in the univariate analysis were included in a multivariate
logistic regression analysis. In the multivariate analysis,
subjects
70 years were significantly more likely to have a
higher CIRS-Severity Index (OR 1.31, p=0.007), suboptimal
surgical debulking (OR 2.73, p = 0.03) and were less likely to
complete the recommended first line adjuvant chemotherapy
(OR 0.37, p=0.02). Survival analyses were performed and found
no difference in overall survival between the young and
elder age group (log-rank p=0.08). For the full cohort, factors
independently associated with decreased overall survival (OS)
in a multivariate cox proportional hazard model were higher
CIRS-G score (HR 1.22, p=0.001), suboptimal surgical debulking
(HR 2.36, p=0.0003) andmore total lines of chemotherapy given
(HR 1.10, p=0.008). Endometrioid histology was significantly
associated with improved OS (HR 0.28, p=0.03).
Conclusion:
We did not find a significant difference in
overall survival for patients 70 years or older as compared
to the younger cohort. Instead, survival was significantly
influenced by patient comorbidities as assessed by the CIRS-G
tool, surgical debulking status and total lines of chemotherapy