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A B S T R A C T S
Objectives:
The primary objective was to describe the use
of Tevagrastim
®
in either primary or secondary prophylaxis.
Descriptive statistics were used to describe tumor type and
FN risk level (as defined by EORTC guidelines).
Methods:
The TULIP study is a multicenter, observational,
prospective cohort study. The study involved 112 French
oncologists and was conducted in cancer patients aged 65 and
above, undergoing CT supported by prophylactic treatment
with Tevagrastim
®
. Patients were followed according to
routine medical practice from Tevagrastim
®
initiation until
the end of the CT or after a maximum of 6 cycles.
Results:
From January 2014 to May 2015, 1119 evaluable
patients were documented in the study (mean age 73.9 ±
6.2 years, 52.6% Men). The majority was suffering from solid
tumor (72.9%) with ECOG 0-1 for 79.7% of them. Among
patients with identified febrile neutropenia risk (n=510), 66%
had a overall risk
20%, and 34% <20%. Through all CT cycles,
no differences were observed across age categories ([65-74],
[75-85] or
85) with regards to dose, duration of filgrastim
treatment and time to first injection. For 70.1% of patients
filgrastim was administered during CT first cycle and 83.5%
received primary prophylaxis (PP).The median time between
CT start and filgrastim administration was 4 days.The median
duration of filgrastim treatment was 3 and 5 days respectively
for the 7 day-cycle and 14/21/28 day-cycles. Dose reductions
and CT delays were less frequent in patients receiving PP (4.8%
and 7.1% respectively) than secondary prophylaxis (9.2% and
13.3% respectively). CT dose reductions frequency (5.5%) and
delays (8%) due to neutropenia was also low regardless of the
patient age. Less than 2% of patients (18 patients) experienced
at least one adverse event related to Tevagrastim
®
or for
which relatedness have not been reported, 9 patients (0.8%)
experienced a serious adverse reaction.
Conclusion:
This study in elderly patients shows no
difference in therapeutic care according to age category.
Tevagrastim
®
use was consistent with French Market
Authorization terms. Few CT dose reductions and delays were
observed. Safety data were consistent with the known safety
profile.
Disclosure of interest:
I. Krakrowski Consultant for: Teva,
J.-L. Mouysset Grant/Research Support from: Teva, D. Burlacu
Grant/Research Support from: Teva Santé for Tulip Study, K.
Benabed Grant/Research Support from: Teva, M. Hacini Grant/
Research Support from: Teva, A. El Weshi Grant/Research
Support from: Teva, P. Janoray Grant/Research Support from:
Teva, R. Diab Grant/Research Support from: Teva, Sandoz,
Hospira, D. Badinand Grant/Research Support from: Teva, M.
Gardner Grant/Research Support from: Teva, N. Sakek Grant/
Research Support from: Teva, Hospira, E. Fabre Grant/Research
Support from: Teva, Patient inclusion inTulip Study, N. Jovenin
Grant/Research Support from: Teva, Hospira, Leo, Sandoz,
Amgen, Eisai, Consultant for: Hospira, Leo, Eisai, S. Corbinais
Grant/Research Support from: Teva, K. Laribi Grant/Research
Support from: Amgen, Novartis, Roche, Hospira, Janssen-
Cilag, Teva, Mundi Pharma, Novartis
Keywords:
Chemotherapy-induced neutropenia, elderly
patients, filgrastim, primary prophylaxis, secondary
prophylaxis
P056
CHEMOTHERAPY AND HEALTH CARE UTILISATION NEAR
THE END OF LIFE IN PATIENTS WITH LUNG CANCER
K. J. Schulkes
1,
*, I. C. van Walree
2
, L. J. van Elden
1
,
D. ten Bokkel Huinink
3
, M. E. Hamaker
2
1
Pulmonology,
2
Geriatric Medicine,
3
Internal Medicine,
Diakonessenhuis Utrecht, Utrecht, Netherlands
Introduction:
The quality of medical care delivered to
cancer patients near the end of life is of significant concern.
Previous studies have defined several areas suggestive of
aggressive cancer treatment as potentially representing poor
quality care, including use of chemotherapy very near death,
use of treatment resulting in high rates of emergency room
(ER) visits, hospitalization or intensive care units stays for
terminal patients and underuse of hospice services. In this
time of increasingly sophisticated anti-cancer treatments and
subsequently mounting health care costs, judicious use of
treatment options and tailor-made care will be of paramount
importance.
Objectives:
A first step in improving the quality of care
provided at the end of life for patients diagnosed and treated
for cancer, is to become aware of our own treatment practices.
Therefore, the primary objective of the current analysis is to
examine the use of chemotherapy in the last three months
before death among lung cancer patients. Secondary outcome
measures were hospital admissions, ICU admissions and ER
visits in the last three months prior to death for patients with
pulmonary malignancies.
Methods:
Patients were selected from the hospital
administration database including all patients deceased and
treated with chemotherapy for lung cancer between Febuary
2011 and August 2015 at the Diakonessenhuis, Utrecht,
the Netherlands. The patient characteristics, the use of
chemotherapy and hospital visits were exctracted from the
medical files.
Results:
A total of 256 deceased patients who had been
treated with chemotherapy for lung cancer (median age 65.8,
range 22.3–85.6 years) were included. Of these, 180 (66%)
patients were treated for NSCLC and 66 (34%) patients for
SCLC. For 110 patients (43%) chemotherapy was given in the
last three months prior to death (CT+) and for 146 patients
(57%) no chemotherapy was administrered in the last three
months prior to death (CT–). Of the CT+ patients, 32% (n=35)
died in the hospital compared to 19% (n=27) of the CT– patients
(p<0.05). For 85% (n=93) of the CT+ patients unplanned
hospital admissions were made in these last three months,
in comparison to 56% (n=82) of the CT– patients(p<0.05). Visits
to the ER in their last three months were made in 78% (n=86)
for CT+ patients in comparison to 56% (n=84) for CT– patients
(p<0.05).
Conclusion:
43% of the patients deceased with lung cancer
and treated with chemotherapy received chemotherapeutic
treatment in the last three months prior to death. Healthcare
consumption in the last three months prior to death is high
for all lung cancer patients. However, we found that the rate of
hospital admissions, ER admissions and the chance of dying
in the hospital, are all significantly higher in patients who
recived chemotherapy in the last three months prior to death.