2138P - Time toxicity of palliative chemotherapy in a geriatric oncology population

Background

Older adults with cancer undergoing cytotoxic chemotherapy (CTx) are at increased risk of treatment-associated toxicity. Data supporting the efficacy of systemic anticancer therapy (SACT) in this patient population are sometimes limited. The concept of time toxicity has emerged to describe the time commitments and opportunity cost involved in undertaking SACT, particularly when the magnitude of clinical benefit is expected to be modest.

Methods

We conducted a retrospective review of patients attending the multidisciplinary Geriatric Oncology Assessment and Liaison (GOAL) clinic of University Hospital Waterford, Ireland over a 3.5-year period. We included patients for whom an initial or subsequent line of palliative CTx was commenced in the last 6 months of life. We recorded ambulatory physical healthcare contact days related to the delivery of CTx as well as treatment-related inpatient admissions as a measure of time toxicity.

Results

Of 304 patients assessed, 64 patients commenced SACT with palliative intent. A total of 26 patients met inclusion criteria for the study. The median age of patients was 78 (67-86). At initial GOAL clinic review, 15 patients (58%) had an ECOG performance status of 1, and 10 patients (38%) had a performance status of 2. Most patients received single agent cytotoxic CTx (17/26; 65%) and 85% of patients received only 1 line of treatment. 23 patients (88%) required hospital admission during treatment and 11 patients (42%) required more than one admission. 5 patients (19%) were admitted due to treatment-associated toxicity. The median number of physical healthcare contact days related to CTx (including hospital admissions directly due to treatment toxicity) was 14 (5-37). Median survival from initiation of CTx was 119 days (15-170). 9 patients (35%) received treatment in the last month of life.

Conclusions

High rates of hospitalisation were noted in our study, reflecting the challenges in delivering CTx to an older adult population. Physical healthcare contact days represented a substantial proportion of days alive from commencing systemic treatment. Consideration of the time toxicity of CTx in this population may help to better align palliative-intent treatment with patient goals.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.