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H. Malhotra
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P1.11 - Poster Session/ Palliative and Supportive Care (ID 229)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.11-007 - To Determine Whether Psychosocial Factors Predict Depression among Older Indian Lung Cancer Patients (ID 3161)
09:30 - 09:30 | Author(s): H. Malhotra
- Abstract
Background:
Depression is extremely common in elderly lung cancer patients. However, it is extremely difficult to predict or develop predicting tools. There is some early studies suggesting using psychosocial factors. Unfortunately there appears to be no data from developing countries, more so from India. This is an attempt to initiate the process.
Methods:
Design: A descriptive correlational study. Setting: Multispeciality Hospitao Oncology OPD Sample: Indian Lung Cancer Patients with cancer aged 50–88 years. Methods: Fisher’s exact and Wilcoxon rank-sum tests were used to evaluate differences between patients who were possibly depressed (Geriatric Depression Scale) or not.Multivariate linear regression statistics were used to identify the psychosocial factors that predicted higher depression scores. Education and gender were included as covariates. Main Research Variables: Religiosity, emotional support, collectivism, perceived stigma, and depression.
Results:
Participants (N = 67) had a mean age of 65 years (SD = 8.4), and a majority were well-educated, insured, religiously affiliated, and currently in treatment. Participants who were in the lowest income category, not married, or male had higher depression scores. The multivariable model consisting of organized religion, emotional support, collectivism, education, and gender explained 52% (adjusted R2) of the variation in depression scores. Stigma became insignificant in the multivariable model
Conclusion:
Psychosocial factors are important predictors of depression. Emotional support and organized religious activities may represent protective factors against depression, whereas collectivism may increase their risk Implications for Management : Care providers need to be particularly aware of the potential psychological strain for patients with collectivist values, experienced stigma, disruptions in church attendance, and lack of emotional support. In addition, the treatment plans for these patients should ensure that family members are knowledgeable about cancer, its treatment, and side effects so they are empowered to meet support needs. Knowledge Translation: Among Indian Lung Cancer Patients patients with cancer, emotional support and reassurance from family and friends that they will not abandon them decreases the likelihood of depressive symptoms and minimizes the impact of stigmatizing responses, but the perception that the illness is placing a strain on the family increases the likelihood of such symptoms. Emotional support likely is a stronger predictor of depressive symptoms than religious service attendance
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P3.07 - Poster Session/ Small Cell Lung Cancer (ID 223)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.07-010 - Phase II Trial of Metronomic Temozolomide and Topotecan in Patients with Relapsed and/or Refractory Small Cell Lung Cancer (ID 2642)
09:30 - 09:30 | Author(s): H. Malhotra
- Abstract
Background:
The prognosis of recurrent or refractory small cell carcinoma of lung is poor with conventional therapies; one of the issues is the presence of brain metastasis. Topotecan is a topo-isomerase inhibitor with very good penetration to CNS system. The efficacy of topotecan in metronomic doses over a period of time is extremely well tolerated and effective. Topotecan is an approved drug for recurrent or refractory small cell carcinoma of lung. Temozolomide in metronomic dosing or in repeated small dosing can be an effective alternative to conventional dosing without the side-effects and has been shown to be effective in Neuro-endocrine tumors and Small Cell Carcinoma of Lung shows neuro-endocrine differentiation as well as the presence of unmethylated MGMT.
Methods:
This is a two arm Open Label Single Institute Phase II Study reviewed and approved by Institutional Review Board. Written Informed Consent was obtained from all patients. The study was conducted to find the safety and efficacy of this regime. All patients had recurrent small cell lung cancer that was sensitive or refractory to first line platinum therapy. Patients with brain mets were eligible. All patients had to have minimal functional reserves; had to be greater than the age of 18 years; Karnofsky scale > 60. Response evaluation by RECIST criteria Version 1.1 was used. Patients were treated with Topotecan 1mg per day along with Temozolomide 20mg in morning and in the evening, no food allowed 1hr before and 1hr after. The comparator arm was oral topotecan at standard dosage of 2.3mg/m[2] in Day 1 to Day 5. Patients were evaluated for toxicity every 3 weeks and for efficacy after every 12 weeks. There were 21 patients in each arm. Palliative medication and Best Supportive Care was offered to both the groups.
Results:
In the experimental arm vs comparator arm, response rate was as follows: · Complete response – 9.5% vs 0% · Partial response – 33.3% vs 23.8% · Stable disease in – 38.1% vs 28.6% Median Survival time was 38 weeks vs 25.9 weeks in the Intent to Treat population arm. (Log rank P=0.0104). Quality of Life had slower deterioration in patients with metronomic chemotherapy. Principal toxicities seen were mainly hematological toxicity in the standard arm 33% vs 4%; Grade IV thrombocytopenia in 7% vs 4%; Grade III/IV anemia in 25% vs 10%; Infection Grade III/IV in 16% vs 6%; Vomiting 6% vs 1%; Diarrhea 6% vs 0%; Dyspnea 9% vs 4%. Pain 6% vs 4%; Toxic death occurred in 6% in comparator arm.
Conclusion:
Metronomic Chemotherapy is associated with prolongation of survival and Quality of Life benefits in Relapsed Small Cell Lung Cancer.
