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M.F. Fanelli
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P2.11 - Poster Session/ Palliative and Supportive Care (ID 230)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.11-007 - Geriatric Oncology and Lung Cancer: Comprehensive Geriatric Assessment (CGA) Aspects Related to Outcomes and Important End-Points (ID 492)
09:30 - 09:30 | Author(s): M.F. Fanelli
- Abstract
Background:
Interdisciplinary oncology approach for geriatric patients (pts) is essential to improve health care, in the global era of populational aging. A possible way to implement that is to use CGA and interventions directed by its findings. Lung cancer (LC) treatment is a good scenario to present the importance of CGA, since its pts are usually old and with multiple comorbidities.
Methods:
LC pts with 70+ years old were found in our cohort of more than 600 pts, evaluated from Jan/12-Dez/12, the period of implementation of CGA in the Geriatric Oncology Unit of A. C. Camargo Cancer Center, a tertiary cancer care institution in Sao Paulo-SP, Brazil. Important geriatric data were extracted to evaluate those pts, to exemplify the importance of a coordinated interdisciplinary treatment plan with better chances of improving favorable clinical end-points. CGA assessments included scales of: activities of daily living/ADL (basic: Katz; instrumental: Lawton), mini-nutritional assessment, depression (geriatric depression scale/GDS), comorbidities and polypharmacy. Fit pts received mainly full treatment; frail/borderline pts, mainly modified tx and/or specific supportive care.
Results:
Eighty pts with LC were part of a subgroup of the major cohort. Most relevant data at first visit are show in the table below. All pts were assessed with CGA by at least one nurse, before medical oncology evaluation - sometimes, by a psychologist as well. Table 1. Relevant CGA data and elderly with lung cancer (n=80).
* Some subjects may have variable not available. In addition, selected comorbidity count ranged 0-5 (median 2); polipharmacy 0-6 (median 5). Seventeen pts were in follow-up only (21%); 48 (60%) pts were under chemotherapy (isolated or combined with other therapies). Even though CGA domains were altered in around 60% of them, the planned treatment could be offered to 57 (71%) pts. Longer survival probability, in the series, was predicted by performance status (ECOG), BADL (Katz) and mini-nutritional assessment.Variable Categories or values Age Median (range) 75 (70-88) n (%)* Sex Male/Female 44/36 55/45 ECOG/PS 0-1/2-3 53/23 63/29 Histology Adeno/SCC/Small cel 42/17/8 53/21/10 BADL KATZ = A 60 75 Altered KATZ 20 25 IADL Lawton = 27 27 34 Altered Lawton 53 60 GDS Normal (0-4) 43 54 Altered (≥4) 17 21 Not available (na) 20 25 Nutrition Undernourished ( < 8) 15 19 Under risk (8-11) 24 30 Normal (12-14) 24 30 na 17 21
Conclusion:
CGA is gaining increasing importance in geriatric oncology. In the present LC subgroup cohort, even though in a small case series, it shows that many pts are vulnerable or even frail; however, interdisciplinary evaluation and multimodal treatment could be offered, without major complications. Limitations include missing data in any domain of CGA, for example. All efforts to better study and define CGA and help to implement interdisciplinary interventions may be utile to improve elderly quality of life and survival in LC care.
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-034 - Long-Term Survival in Metastatic Non-Small Cell Lung Cancer: Predictive Clinical Factors (ID 330)
09:30 - 09:30 | Author(s): M.F. Fanelli
- Abstract
Background:
While most patients with non-small cell lung cancer (NSCLC) stage IV, presents an unfavorable prognosis, a small proportion presents median overall survival beyond 2 years. The aim of this study is to identify clinical factors associated with long-term survival (LTS) in patients metastatic NSCLC.
Methods:
Single-center, retrospective study performed from the selection of patients in electronic medical records with a diagnosis of NSCLC, metastatic at diagnosis, and treated at AC Camargo Cancer Center in Brazil, from January / 2007 to June / 2014. We compared the group of patients who survived more than two years, the long-term survivors (LTS), to that survived less than two years, the short-term survival (STS), regarding the clinical characteristics and treatments performed. Using the chi-square test (categorical variable), and T test (continuous variables), for univariate analysis and by binary logistic regression model for multivariate analyzes, adopting the significance level P < 0.05
Results:
From 292 patients with stage IV NSCLC, there were 46 (15.7%) patients who survived beyond 2 years, and the remaining 246 patients who survived less than two years, we selected a control group of 46 patients. In the LTS group, the median overall survival (OS) was 39.7 months, and five-year-survival was 10.8%, while in the control group median OS was 9.2 months. In the univariate analysis related to clinical factors, the LTS was associated with female gender (P: 0.03); not smoking (P: 0.013); ≤ 2 metastatic sites (P: 0.02); ECOG of 0-1 (P: 0.01); absence of extra-thoracic metastasis (P: 0.001); absence of liver metastasis (P: 0.004) absence of bone metastasis (P: 0.001); absence of weight loss (P: 0.03); absence of decreased appetite (P: 0.001); and the presence of activating mutation in the EGFR gene (0.024). In univariate analysis regarding factors related to treatment, the LTS was associated with: two or more systemic treatment lines (P: 0.001); partial or complete response in first-line chemotherapy (p = 0.0001); use of tyrosine-kinase inhibitor (p = 0.0001); and maintenance chemotherapy (P: 0.012). In multivariate analysis of clinical factors, were considered long predictors of survival: two or fewer metastatic sites (OR: 7.1; P: 0.008) and ECOG 0-1 (OR: 12.2 P: 0.024). There was a trend for female gender (OR: 3.1 P: 0.057).
Conclusion:
We conclude that, in our sample, patients with stage IV NSCLC who have ECOG 0-1 and oligometastatic disease (≤ 2 sites) are more likely to long-term survival.
