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A B S T R A C T S
has been described in women with breast cancer and an
increasing number of other malignancies.
Objectives:
To study neurocognitive profile in older cancer
patients in a geriatric clinic
Methods:
We conducted a retrospective cohort analysis,
of older adult patients evaluated at the Program for Healthy
Aging at MD Anderson Cancer Center from January 1, 2013
through March 31, 2015. Cognitive assessment was conducted
through personal and family interview, andMontreal cognitive
assessment (MoCA). Education and occupational history,
history of strokes, concussions and family history of dementia
and other risk factors were evaluated. Functional, physical,
nutritional, medication, social support, and comorbidity
assessment were conducted. Mood inventory was completed
using the personal health questionnaire (PHQ-9). Imaging
with computerized tomography and evaluation for potentially
reversible factors were appraised.
Results:
One hundred and ninety two patients underwent
geriatric assessment, age range 65–90 years. Mean age 78.3 ±
6.6 years. One hundred and twenty one cases had some degree
of neurocognitive deficit, with 64 patients (33.3%) presenting
major neurocognitive deficit (dementia), and 57 cases, minor
neurocognitive deficit (mild cognitive impairment -MCI)
(29.7%). Early stage dementia was evidenced in 35 cases
(54.7%), moderate stage in 24 (42.1%), and severe stage in
5 cases (7.8%). Although the prevalence of dementia was
similar to population estimates, MCI prevalence (29.7%) was
significantly higher comparing to MCI prevalence in the
general population for aged 70-79 years (5.8%), and there was
considerable underdiagnoses of cognitive impairment
Conclusion:
Neurocognitive deficits (MCI and dementia)
are common in older adults with solid tumors and
hematologic malignancies. Identification and management of
these conditions is of great relevance in the course of cancer
therapy.
Disclosure of interest:
None declared
Keywords:
Geriatric assessment, neurocognitive deficits
P050
RESCUE GCS-F USE AS A MARKER OF SAFETY OF ANTI-
CANCER TREATMENTS IN GERIATRIC PATIENTS IN
REGIONAL AND RURAL SOUTH AUSTRALIA
D. M. Poprawski
1,
*, M. Buxton
2
1
Cancer Services, Country Health South Australia, Elizabeth Vale
SA 5112,
2
Pharmacy, Country Health South Australia, Mt Gambier,
Australia
Introduction:
South Eastern (SE) South Australia (SA) has
a robust cancer service providing multidisciplinary medical
oncology care with visiting oncologist, nurse practitioner,
cancer care coordinator, and a team of chemotherapy nurses/
pharmacists. The regional and rural (R&R) cancer service is a
new concept in bringing care closer to home due to tyranny
of distance, trying to overcome the inequity of cancer care
access, and to drive cancer care outcome towardsmetropolitan
outcome gold-standards [1].
Oncogeriatric care is complex in oncological services, and
often is questioned as to its safety. There is an increasing
body of data [2], that while the geriatric population is having a
higher need for supportive care while undergoing anti-cancer
therapies, this can be safely administered in an outpatient
and community setting.
Febrile neutropenia is one of complications of anti-cancer
treatments, sometimes requiring stimulation of stem cells to
provide neutrophils via rescue doses of filgastrim (GCS-F) [3].
The need for rescue GCS-F can be seen as an indirect marker
of safety of anti-cancer provision in oncogeriatric pracice.
Objectives:
To review the use of GCS-F administration as
rescue medication in geriatric patients undergoing anti-
cancer treatments in SA’s regional and rural area, when
presenting with febrile neutropenia.
Methods:
A retrospective clinical review of GCS-F use in
SE SA took place. All GCS-F usage was recorded by Pharmacy,
thus provided an easy pathway for finding patients. A period
between 1 May 2015 - 30 April 2016 was reviewed by checking
Pharmacy records, and casenotes for both Emergency
Department and Inpatient stay.
Results:
SE
SA provides care to medical oncology patients,
with 2015 showing a 995 clinic consultations. Between 1 May
2015 - 30 April 2016, there were 919 verified protocols for
anti-cancer therapy, which included hormonal, supportive,
chemotherapy/targeted and immunotherapy protocols. This
includes multiple therapies for a single patient being used.
483 protocols of the 919 total were for patients who made
the geriatric category of
65 yrs. The majority were in 2
groups: 65-69 years and 75-79 years, although all groups were
represented.
Over 12 months, there were 19 occasions for GCS-F
dispensing from pharmacy. This was for a total of 13 patients,
of which 6 (46%) were
65 years, or 9 presentations for GCS-F
dispensing. There were 9 (61%) medical oncology patients,
and 3 (23%) were
65 years. Others were 3 (23%) hematology
patients treated inmetropolitanhospitals, 1 (7%) with probably
myelodysplastic syndrome, and 2 (15%) renal patients.
Looking at the aim of this study, the GCS-F rescue therapy
administered to medical oncology patients amounted to
only 0.4% of total therapies given, and 0.8% of all geriatric
treatments administered.
Conclusion:
Geriatric population can safely receive anti-
cancer treatments in regional and rural area of SA. While
there is a risk of myelosuppression, the management of febrile
neutropenia requiring rescue GCS-F administration is rare.
References
:
[1] Fox P, Boyce A. Cancer Health Inequality Persists in Regional
and Remote Australia. MJA 2014;201(8):445-6.
[2] Balducci L, Carreca I. Supportive Care in the Older Cancer
Patient. Crit Rev Onol Hematol 2003;48(Suppl):S65-70.
[3] Australian Working Group. The Consensus Guidelines in
Management of Febrile Neutropenia in Cancer Patients.
Intern Med J 2011;41(Suppl.1):75-129.
Disclosure of interest:
None declared
Keywords:
Anticancer treatment, GCS-F/filgastrim, geriatric
patient, safety