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S76
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
P-165
Oncogeriatrics: multidisciplinary management
Q. Cohen
1
, P. Bocquet
1
, A. Sebaux
1
, J.-L. Novella
2
, A.-A. Zulfiqar
1
1
CHU Reims, Reims, France;
2
France
Objectives:
Incidence of colon cancer is increasing in the elderly.
Taking oncogeriatric load is thus essential.
Methods:
We illustrate this problem through a clinical case.
Results:
A 78-year-old patient was hospitalized for asthenia and
weight loss (6 kg in one year) associated with a regenerative
normocytic anemia, to 9.9 g / dl, with an inflammatory syndrome
without infectious point (CRP 78mg / L). An indurated and
painful mass, on palpation, was discovered in the right iliac
fossa, with free lymph nodes. Abdominal CT scan, colonoscopy
with biopsies and anatomopathology results revealed a caecal
adenocarcinoma, accompanied by mesenteric lymphadenopathy
with liver metastases. Bilateral pulmonary embolism is also
detected. The tumor is classified pT3aN2M1. This patient had
a medical history including many cardiovascular problems like
double bypass for ST+ coronary syndrome, pacemaker for
atrioventricular block, and a left internal carotid stenosis
>
80%.
A Geriatric Evaluation was realized: Charlson Index at 14, Balducci
2, questionnaire G8 at 4/17, Mini Mental State: 19/30. mini Geriatric
Depression Scale at 2/4, BMI 20 kg/m
2
, Mini Nutritional Assessment
at 10 kg/m
2
. Thus, a surgical treatment was decided, but in
condition to the anesthetic assessment (the patient was ASA 3)
and vascular assessment (left carotid stenosis severe more than
80% at ultrasound carotid Doppler). Unfortunately, the patient died
before the surgical management.
Conclusions:
This case illustrates the whole point of oncogeriatric
assessment, which provides clinicians with essential data to support
cancer in the elderly and their long-term monitoring.
P-166
Frailty status of elderly cancer patients in the Central Denmark
Region
M. Ørum
1
, K. Jensen
2
, P. Meldgaard
3
, E.M. Damsgaard
4
1
Geriatric Department Aarhus University Hospital, Aarhus C,
Denmark;
2
Oncology department Aarhus University Hospital,
Aarhus C, Denmark;
3
Oncology Department, Aarhus university
Hospital, Aarhus C, Denmark;
4
Department of Geriatrics, Aarhus
University Hospital, Aarhus C, Denmark
Objectives:
Comorbidity, mental illness, physical impairment and
cognitive problems are more prevalent in elderly patients than
younger. This means that elderly cancer patients are more
vulnerable in physiological, psychological and social respects. The
objective of this study is to describe the overall health status of
elderly (70 years+) cancer patients with lung cancer (LC), cancer of
the head and neck (HN), cancer of the upper gastrointestinal tract
(UGI), and colorectal cancer CRC) using Comprehensive Geriatric
Assessment (CGA) and the Balducci frailty criteria.
Methods:
From January the 8th to April the 16th 2015 154 elderly
cancer patients were referred to the Oncology Outpatient Clinic at
Aarhus University Hospital, Denmark for treatment. They were also
referred for oncogeriatric assessment. All patients were evaluated
regarding comorbidity (CIRS-G), Mental health (GDS-15), cognitive
status (MMSE), nutritional status (MNA), and functional status
(Barthel-100 and FAQ IADL). The patients were divided into fit,
vulnerable or frail. The oncogeriatric evaluation took place prior to
start of the cancer treatment.
Results:
154 patients were referred for oncogeriatric evaluation.
53% were females, Mean age 76.7 years (71.3–82.1). LC 44%, HN
11%, UGI 12%, CRC 33%. 95% lived independently, 3% in sheltered
housing and 2% in nursing homes. 128 patients underwent CGA.
13% were considered fit, 35% vulnerable, and 52% were frail.
Conclusion:
More than half of elderly cancer patients referred to
cancer treatment at Aarhus University Hospital is considered frail
prior to the beginning of the treatment.
Delirium
P-167
Delirium in elderly patients undergoing intraabdominal cancer
surgery
–
associated factors and consequences
K. Alexander
1
, A. Shahrokni
1
, B. Korc-Grodzicki
1
1
Memorial Sloan Kettering Cancer Center, New York, United States of
America
Objectives:
To identify factors associated with the development of
delirium following intraabdominal cancer surgery and associated
consequences.
Methods:
This is a retrospective analysis of older cancer patients
(age ≥75 years) with intra abdominal malignancies (hepatobiliary,
gastric, colorectal, urologic, or gynecologic) who presented to the
Geriatrics clinic at Memorial Sloan Kettering Cancer Center for
preoperative evaluation between October 2010 and December 2012.
Sociodemographic features, pre-operative geriatric assessment and
hospitalization characteristics were collected and analyzed. For
continuous and categorical variables, t-test and Chi-square test
were applied respectively.
Results:
592 patients (age ≥75 years) undergoing intraabdominal
cancer surgery were analyzed. 79 (13.3%) patients developed
delirium whereas 513 (86.7%) did not have documented delirium.
Factors that were associated with postoperative delirium were
a history of falls in the past year (P = 0.001), preoperative IADL
dependency (P = 0.015) and a lower preoperative Mini Cog score
(P
<
0.001). Patients who developed delirium were more likely to
have a longer length of stay (P
<
0.001) and require skilled services
at discharge (P
<
0.001). Six-month survival was significantly lower
in patients who developed postoperative delirium (p = 0.018).
Conclusions:
Development of postoperative delirium in elderly
cancer patients is associated with a number of variables.
Recognizing these factors early on, prior to surgery could help
identify patients at high risk for developing delirium. Addressing
the modifiable variables and implementing protocols to prevent
delirium in these high risk patients may help reduce the length of
hospital stay, requirement of skilled care at discharge and provide
a better survival outcome for these patients.
P-168
Timing is of key importance in determining the association
between S100B and delirium
S. Beishuizen
Academical Medical Centre, Amsterdam, Netherlands
Objectives:
Elevated levels of S100B, a marker of brain damage,
have been found in serum of delirious patients. S100B measured
in serum can also originate from extra-neuronal sources and is
elevated after trauma, surgery and during inflammation. S100B
levels in cerebrospinal fluid (CSF) are more likely to reflect cerebral
origin. We compared S100B levels in CSF of patients with and
without delirium.
Methods:
We conducted a prospective cohort study at the surgery
department of a teaching hospital in The Netherlands. Patients aged
65 years and older who were admitted for hip fracture surgery
under spinal anesthesia were included. Delirium was diagnosed
using the Diagnostic and Statistical Manual of Mental Disorders,
IV edition (DMS-IV-R). We measured S100B levels in CSF obtained
prior to the administration of spinal anesthetics.
Results:
Sixty-six patients, aged 65–97 years, were included. Fifteen
patients (22.7%) developed delirium during admission. There was