ESMO Supporter 2018

Displaying One Session

Hall B3 - Room 21 Poster Discussion session
Date
20.10.2018
Time
09:30 - 10:30
Location
Hall B3 - Room 21
Chairs
  • Dorothy Keefe (Adelaide, AU)
  • Florian Strasser (St. Gallen, CH)
Poster Discussion session - Supportive and palliative care 1 Poster Discussion session

1683PD - Factors that influence oncology nutrition efficacy in breast cancer patients under antiestrogenic treatment

Presentation Number
1683PD
Lecture Time
09:30 - 09:30
Speakers
  • Diana V. Artene (Bucharest, RO)
Location
Hall B3 - Room 21, ICM München, Munich, Germany
Date
20.10.2018
Time
09:30 - 10:30

Abstract

Background

Many breast cancer patients gain weight during treatment increasing recurrence, metastasis and mortality risks. The diagnosis overthrows patients’ lifestyle aggravating sedentariness and any pre-existing weight gain causes like insulin and leptin resistance, sleep disturbances and hedonic eating.

Methods

To test the efficacy of an at-home oncology nutrition intervention meant to stop weight gain during antiestrogenic treatment we proposed a diet based on foods naturally high in proteins, omega-3 fatty acids, calcium, probiotics and prebiotics. 331 patients were randomly assigned to the control group, with no oncology nutrition advice besides the physician recommendation to avoid weight gain. 283 patients were randomly assigned to the intervention group and asked to follow the proposed diet. We measured weight and body composition and we compared results at 24 months between intervention and control groups. Then we analysed the results based on the administered oncology treatment type and patients’ age, comorbidities, lifestyle characteristics.

Results

At 24 months, patients within the intervention group reached a modest but statistically significant weight loss and fat loss with no sarcopenia (2.44kg weight loss, 2.37% subcutaneous fat loss, 0.65% visceral fat loss, 1,24% muscle mass increase), while those in the control group maintained weight, increased fat and lost muscle (0.35kg weight loss, 0.34% subcutaneous fat increase, 0.4% visceral fat increase, 0.42 muscle mass decrease). Efficacy was influenced by: age – 31-40 yo patients having worse results than 41-50 yo patients and than 51-80 yo patients; AET type – patients on letrozole having best results; de novo thyroidal disease – lowered fat loss; depression – lowered fat loss; statins – when co-administrated throughout exemestane treatment – lowered fat loss; sleep disturbances – increased sarcopenia. Efficacy was not influenced by: chemotherapy or radiotherapy administration, type of surgery, cardiovascular disease, smoking or by the dieting history.

Conclusions

Oncology nutrition interventions can counteract sarcopenic obesity during antiestrogenic treatment, but the efficacy of the intervention can be influenced by patients’ age and comorbidities.

Legal entity responsible for the study

Carol Davila Medicine University.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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Poster Discussion session - Supportive and palliative care 1 Poster Discussion session

1684PD_PR - Physical activity (PA) and patterns of quality of life (QOL) after adjuvant chemotherapy (CT) for breast cancer (BC)

Presentation Number
1684PD_PR
Lecture Time
09:30 - 09:30
Speakers
  • Antonio Di Meglio (Villejuif, FR)
Location
Hall B3 - Room 21, ICM München, Munich, Germany
Date
20.10.2018
Time
09:30 - 10:30

Abstract

Background

We aimed to describe longitudinal patterns of QOL and the interplay between PA and risk of QOL deterioration among BC patients (pts).

Methods

We used a French prospective longitudinal clinical study (CANTO, NCT01993498) to identify 2525 stage I-III BC pts treated with adjuvant CT from 2012-14. PA exposure (GPAQ 16) and QOL (EORTC QLQ C30/B23) were reported by pts before CT, and at 3-6 and 12 months after CT. Pts with levels of PA ≥10 MET-hours/week were considered physically active (as per WHO recommendations on PA). Poor QOL was defined by functional scores <60 and symptoms scores ≥40 (Giesinger, 2016). We used multivariate mixed models to assess patterns of QOL and group based trajectory models to identify clusters of pts with poor QOL and associated risk factors, adjusting for PA as time dependent covariate.

Results

Mean age (Standard Deviation, SD) was 52 y (11). 57%, 62% and 63% pts were physically active before CT, 3-6 and 12 months after CT, respectively. QOL scores before CT were higher among physically active vs inactive pts, including (mean [SD]): global health status (GHS) (69 [1.4] vs 65 [1.4]), physical (90 [1.1] vs 87 [1.1]) and emotional function (65 [1.9] vs 62 [1.9]) (all adjusted p<.05). QOL significantly worsened after CT, but scores remained higher among active pts (p<.001). A cluster of 33% pts had high and persistent risk of poor GHS: associated factors included comorbidities vs no (adjusted odds ratio 1.4 [95% Confidence Interval 1.1-1.9]), low income vs high (1.6 [1.2-2.0]), smoking vs no (1.3 [1.1-1.6]), mastectomy vs partial surgery (1.2 [1.1-1.6]). A significant interaction between recommended levels of PA and risk of poor GHS was observed (p<.001). Consistent with GHS, we found clusters of pts with high risk of poor QOL across physical, emotional and multiple other QOL domains, with similar risk factors and significant interactions with recommended levels of PA.

Conclusions

Among this large cohort of BC survivors, QOL significantly worsened after CT. We were able to group pts following distinct longitudinal patterns of QOL and to identify clinical, socio-economical, and treatment risk factors for poor QOL, including PA behavior. Interventional strategies that also promote PA may help prevent QOL deterioration after CT.

Clinical trial identification

NCT01993498

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Poster Discussion session - Supportive and palliative care 1 Poster Discussion session

1685PD - Effects of 6-month exercise training on quality of life in pancreatic cancer patients: results from a randomized controlled trial

Presentation Number
1685PD
Lecture Time
09:30 - 09:30
Speakers
  • Karen Steindorf (Heidelberg, DE)
Location
Hall B3 - Room 21, ICM München, Munich, Germany
Date
20.10.2018
Time
09:30 - 10:30

Abstract

Background

Given the poor prognosis and high symptom burden of pancreatic cancer, preservation of quality of life (QoL), physical functioning and minimization of adverse treatment effects are important treatment goals in pancreatic cancer patients. Even though exercise has proven to provide health benefits, including improvements in QoL, in patients with various cancer types, studies are rare for more aggressive cancer types like pancreatic cancer. Therefore, we conducted a randomized controlled trial to assess the efficacy of a 6-month resistance training (RT) on QoL in pancreatic cancer patients.

Methods

Sixty-five pancreatic cancer patients, mostly stage IIb after tumor resection and during chemotherapy, were assigned to one of two progressive RT groups (supervised or home-based) or to usual care for 6 months. The primary outcome, the physical functioning subscale of the EORTC QLQ-C30, and other QoL-related outcomes were assessed before the intervention, after 3 and 6 months.

Results

Forty-seven patients (mean age: 60.5 years, 53.2% males) completed the intervention period. After 6 months, no between-group differences were observed. However, after 3 months, intention-to-treat analyses showed significant between-group mean differences (MD) in favor for the pooled RT group for physical functioning (MD = 12.0; p = 0.010), as well as for overall QoL (MD = 12.5; p = 0.014), and several other secondary outcomes (cognitive functioning, insomnia, physical fatigue, and reduced activity). Both modes of delivery, supervised and home-based resistance-training, showed similar effects. Overall mean training adherence rate was 66.5%, with a steady decrease over the 6-month intervention period.

Conclusions

This was the first randomized controlled RT intervention trial in pancreatic cancer patients. The findings showed clinically relevant improvements in QoL after 3 but not 6 months. Given the severity of pancreatic cancer and the importance of maintaining QoL, patients should be timely advised to perform exercise. Future research needs to focus on prolonging the positive mid-term effects, possibly through improving training adherence.

Clinical trial identification

NCT01977066.

Legal entity responsible for the study

German Cancer Research Center.

Funding

German Cancer Aid (Foundation).

Disclosure

All authors have declared no conflicts of interest.

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Poster Discussion session - Supportive and palliative care 1 Poster Discussion session

1513PD - A prospective study examining cachexia predictors in patients with incurable cancer.

Presentation Number
1513PD
Lecture Time
09:30 - 09:30
Speakers
  • Ola Magne Vagnildhaug (Trondheim, NO)
Location
Hall B3 - Room 21, ICM München, Munich, Germany
Date
20.10.2018
Time
09:30 - 10:30

Abstract

Background

A predictive model of cachexia development would help identify those at greatest risk for early therapeutic intervention. The aims of this study were to identify predictors of cachexia development and to use these to create and evaluate the accuracy of a predictive model.

Methods

A secondary analysis of an international, prospective, observational multicentre study was conducted. Patients with incurable cancer and without cachexia, who attended a palliative care unit were amenable to the analysis. Cachexia was defined as weight loss (WL) >5% (6 months) or WL > 2% and body mass index<20kg/m2. Disease related, demographic and patient reported markers were evaluated as possible predictors with Cox analysis. The predictor “cancer type” was divided into high risk (pancreatic or gastric cancer), low risk (sarcoma, breast or hematologic cancer) or neutral risk (all others). A classification and regression tree analysis was used to create a model based on optimal combinations and cut-offs of significant predictors for cachexia development, and accuracy was evaluated with receiver operating characteristic curve analysis.

Results

628 patients, 57% female, were included in the analysis. Median (IQR) age was 65 (17) years and Karnofsky performance status 70 (10). Median (IQR) follow-up was 109 (108) days, and 159 (25%) patients developed cachexia. Initial WL, cancer type, appetite and chronic obstructive pulmonary disease were significant predictors (p ≤ 0.04). A four-level model was created with each level carrying an increasing risk of cachexia development. Level 1-patients (WL < 3%, low risk cancer type and no or little appetite loss) had a relative hazard ratio (RHR) of 0.27 of cachexia development, while level 4-patients (WL 3-5%) had a RHR of 4.9. Accuracy of cachexia predictions at 3 months was 76%, and a risk level ≥3 (1-3% WL and neutral risk cancer type OR < 3% weight loss and high risk cancer type) yielded a sensitivity of 46% and a specificity of 90% of cachexia development.

Conclusions

Important predictors of cachexia have been identified and used to construct a predictive model of cancer cachexia. Patients with a risk level ≥3 have a high risk of cachexia development, and should be targeted for therapeutic intervention.

Legal entity responsible for the study

European Palliative Care Research Centre, NTNU-Norwegian University of Science and Technology.

Funding

The European Palliative Care Research Centre, funded by Helsinn, The Norwegian Cancer Society, Joint Research Council at NTNU.

Disclosure

F. Strasser: Punctual advisorships (boards, expert meetings): Danone, Grünenthal, Helsinn, ISIS Global, Mundipharma, Novartis, Novelpharm, Obexia, Ono Pharmaceutical, Psioxus Therapeutics, PrIME Oncology, Sunstone Captial, Vifor; Unrestricted industry grants for clinical research: Celgene, Fresenius, Helsinn; Participation in a clinical cachexia trial lead by Novartis. All financial support was given to the institution. B. Laird: Honoraria: Helsinn. All other authors have declared no conflicts of interest.

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Poster Discussion session - Supportive and palliative care 1 Poster Discussion session

Invited Discussant 1683PD, 1684PD, 1685PD and 1513PD

Lecture Time
09:30 - 09:50
Speakers
  • Dorothy Keefe (Adelaide, AU)
Location
Hall B3 - Room 21, ICM München, Munich, Germany
Date
20.10.2018
Time
09:30 - 10:30
Poster Discussion session - Supportive and palliative care 1 Poster Discussion session

Q&A led by Discussant

Lecture Time
09:50 - 10:00
Location
Hall B3 - Room 21, ICM München, Munich, Germany
Date
20.10.2018
Time
09:30 - 10:30
Poster Discussion session - Supportive and palliative care 1 Poster Discussion session

1514PD - Timing of palliative care referral before and after a cluster randomized controlled trial (RCT) of early palliative care

Presentation Number
1514PD
Lecture Time
10:00 - 10:00
Speakers
  • David Hausner (Toronto, CA)
Location
Hall B3 - Room 21, ICM München, Munich, Germany
Date
20.10.2018
Time
09:30 - 10:30

Abstract

Background

Between December 2006 and February 2011, our cancer center undertook an RCT of early palliative care in patients with lung, gastrointestinal (GI), genitourinary (GU), breast, and gynecological (Gyne) cancers. The trial showed benefits in quality of life favoring early palliative care (at clinical prognosis 6-24 months) over standard care. We hypothesized that there would be an increase in earlier referrals to the oncology palliative care clinic (OPCC) following the RCT.

Methods

Administrative databases were reviewed for 2 groups of patients: Group 1 (before RCT) was seen in the OPCC June-October 2006; Group 2 (following RCT) seen May 2015 - April 2016. Death dates were retrieved in January 2018. Data have been collected for 337/407 patients in Group 1 and 387/1007 in Group 2. Timing of referral was categorized as early (>6 months from referral to death) and late (≤6 months from referral to death). Using chi-square tests for categorical predictors and t-tests for continuous predictors, we compared distributions and means between groups 1 and 2 for demographics, primary tumor site, referring service and referral reason (pain & symptom management [PSM], palliative planning [PP], PSM together with PP [PSM+PP], other).

Results

Early referrals to OPCC increased from 105/337 (31%) to 180/387 (47%) (p < 0.001). For women, early referrals increased from 33% to 51%, and for men from 30% to 42%. Although there was no change in the timeliness of referrals for PSM alone, earlier referrals increased significantly among patients referred for PSM+PP, and those referred for PP. Early referrals increased among medical oncologists from 32% (65/206) to 48% (118/244) (p < 0.001) but not among radiation oncologists (29% [23/80] to 40% [28/70], p = 0.17). Early referrals tended to increase for all tumor site groups except head and neck, with significant increases among patients with GI cancers (25% [22/87] to 48% [50/104], p = 0.001), and Gyne cancers (23% [8/35] to 58% [32/55], p = 0.001).

Conclusions

Following an RCT supporting early palliative care for patients with advanced cancer, oncologists referred patients substantially earlier to an outpatient palliative care clinic.

Legal entity responsible for the study

Camilla Zimmermann.

Funding

Canadian Institutes of Health Research.

Disclosure

All authors have declared no conflicts of interest.

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Poster Discussion session - Supportive and palliative care 1 Poster Discussion session

1515PD - Randomized clinical trial of an individualized intervention promotes cancer patients’ prognostic awareness and reduces CPR received in the last month

Presentation Number
1515PD
Lecture Time
10:00 - 10:00
Speakers
  • Chen H. Chen (Taipei city, TW)
Location
Hall B3 - Room 21, ICM München, Munich, Germany
Date
20.10.2018
Time
09:30 - 10:30

Abstract

Background

Half of advanced cancer patients do not have accurate prognostic awareness (PA). However, few randomized clinical trials (RCTs) have focused on facilitating these patients’ PA to reduce their life-sustaining treatments (LSTs) at end of life.

Methods

A blinded RCT was conducted for terminally ill cancer patients with internal validity enhanced by concealing arm allocation, blinding participants and data collectors, and ensuring treatment fidelity. The experimental-arm received an interactive intervention tailored to their readiness for prognostic information. The control-arm received a sham symptom-management educational treatment. Effectiveness of the intervention in facilitating accurate PA and reducing LSTs received was evaluated by intention-to-treat analysis using multivariate logistic regression, specifically by modeling “arm by time proximity to death” with the generalized estimating equation and “arm by accurate PA” interactions, respectively.

Results

Participants (N = 460) were randomly assigned 1:1 to experimental and control arms, each with 215 participants in the final sample. With reference to 151-180 days before death, the experimental-arm had significantly higher odds of accurate PA than the control-arm 61-90, 91-120, and 121-150 days before death (AOR [95% CI]: 1.94 [1.10-3.40], 1.89 [1.06-3.36], and 1.98 [1.19-3.28], respectively) but not 1-60 days before death. Experimental-arm participants with accurate PA were significantly less likely than control-arm participants without accurate PA to receive cardiopulmonary resuscitation (CPR) (0.16 [0.03-0.73]), but not less likely to receive other LSTs (including intensive care unit care and mechanical ventilation) in their last month.

Conclusions

Our intervention facilitated participants’ accurate PA early in their terminal-illness trajectory, thereby reducing their risk of receiving CPR in their last month and avoiding suffering from futile LSTs.

Clinical trial identification

NCT01912846.

Legal entity responsible for the study

Chang Gung University.

Funding

National Health Research Institutes (NHRI-EX106-10208PI), Ministry of Science and Technology (MOST 104-2314-B-182-027-MY3), Chang Gung Memorial Hospital (BMRP888).

Disclosure

All authors have declared no conflicts of interest.

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Poster Discussion session - Supportive and palliative care 1 Poster Discussion session

Invited Discussant 1514PD and 1515PD

Lecture Time
10:00 - 10:15
Speakers
  • Florian Strasser (St. Gallen, CH)
Location
Hall B3 - Room 21, ICM München, Munich, Germany
Date
20.10.2018
Time
09:30 - 10:30
Poster Discussion session - Supportive and palliative care 1 Poster Discussion session

Q&A led by Discussant

Lecture Time
10:15 - 10:25
Location
Hall B3 - Room 21, ICM München, Munich, Germany
Date
20.10.2018
Time
09:30 - 10:30