Lies Pottel

Use of the Freund Clock Drawing Test within the Mini-Cog as a screening tool for cognitive impairment in elderly patients with or without cancer

OBJECTIVES We aimed to determine an optimal cut-off score for the Clock Drawing Test (CDT), scored by the scale of Freund, for efficient screening for cognitive impairment in elderly (cancer) patients within a Comprehensive Geriatric Assessment (CGA) and to compare the Freund CDT to the Mini-Cog. MATERIALS AND METHODS Data of 221 elderly (≥70years) patients, comprising of an OncoGeriatric (OG) and General Geriatric (GG) group, were retrospectively reviewed. All patients were evaluated with both the CDT and Mini Mental State Examination (MMSE) as the gold standard. Receiver Operating Characteristics (ROC) analysis was used to determine diagnostic performance. A pre-established algorithm was applied to retrieve Mini-Cog results through a combination of the CDT and the 3-Word Delayed Recall (3-WDR) test (included within MMSE). RESULTS Data of 105 OG and 116 GG patients were evaluated. Potential cognitive impairment (MMSE≤23) was detected in 29.5% and 65.8% of patients, respectively. The CDT showed good diagnostic accuracy in the OG (0.88±0.03) and GG (0.85±0.03) group, based on the area under the ROC curve (AUC±SE). CDT (cut-off≤4) provided good sensitivity (80.7%) and specificity (81.1%) in the OG group and excellent sensitivity (89.6%) and moderate specificity (51.3%) in the GG group. Addition of the 3-WDR test, to form the Mini-Cog, resulted in similar positive and negative predictive values for the OG group and higher negative predictive value for the GG group. CONCLUSION These data suggest that the Freund CDT, at the cut-off score of ≤4, is promising for use within a CGA. The Mini-Cog might be preferable in the GG population.

Omega-3 fatty acids: physiology, biological sources and potential applications in supportive cancer care

The impact of the Western diet on chronic diseases, such as cancer, has been well recognized. Dietary saturated and trans fatty acids have been found to play a negative role in obesity, heart disease, diabetes and cancer, while the beneficial health effects of n-3 polyunsaturated fatty acids (n-3 PUFAs) have become widely accepted. Despite the current knowledge, n-3 PUFA intake is still under recommended daily intake levels in Europe. As wild fish, currently still the major source of n-3 PUFA, are facing a decline, alternative sources such as marine and plant (both natural and transgenic) sources are being explored. In this review we aim to provide an overview of the current biological sources of n-3 PUFAs, their part in normal physiology, as well as their emerging application in supportive cancer care, and more specifically in cancer cachexia, therapy-related neurocognitive dysfunction and distress. In addition, we provide a brief summary of currently ongoing clinical trials examining potential beneficial effects of n-3 PUFAs in reducing cancer(therapy)-related side effects, and describe future research directions.

Validation of the Freund Clock Drawing Test as a screening tool to detect cognitive dysfunction in elderly cancer patients undergoing comprehensive geriatric assessment.

We aimed to validate the Freund Clock Drawing Test (CDT), with its predefined cutoff score of ≤4, as a screening tool to detect elderly cancer patients in need of a more in‐depth cognitive evaluation within a comprehensive geriatric assessment (CGA).

Integration of geriatric oncology in daily multidisciplinary cancer care: the time is now

M. LYCKE, MSC, Cancer Centre, General Hospital Groeninge, Kortrijk, L. POTTEL, MSC, PHD, Cancer Centre, General Hospital Groeninge, Kortrijk, T. BOTERBERG, MD, PHD, Department of Radiation Oncology, Ghent University Hospital, Ghent, L. KETELAARS, MSC, Department of Psycho-oncology, General Hospital Groeninge, Kortrijk, H. WILDIERS, MD, PHD, Department of General Medical Oncology & Leuven Cancer Institute, Leuven University Hospital, Leuven, Belgium, P. SCHOFIELD, DIPN, PGDIPED, RGN, PHD, Centre for Positive Ageing, University of Greenwich, London, D. WELLER, MBBS(ADEL), MPH, PHD, FRACGP, FRCGP, FAFPHM, FRCP(EDIN), Centre for Population Health Sciences, University of Edinburgh, Edinburgh, & P.R. DEBRUYNE, MD, PHD, MSC, FRCP(GLASG), FCP, Cancer Centre, General Hospital Groeninge, Kortrijk Belgium, & Centre for Positive Ageing, University of Greenwich, London, UK

Predictors of baseline cancer-related cognitive impairment in cancer patients scheduled for a curative treatment.

Recent research in the field of cancer‐related cognitive impairments (CRCI) has shown CRCI presentation prior to treatment initiation. Some have attributed these problems to worry and fatigue, whereas others have suggested an influence of age, IQ, and other psychosocial and medical factors.

Optimisation of pharmacy content in clinical cancer research protocols: Experience of the United Kingdom Chemotherapy and Pharmacy Advisory Service.

Background Clarity and accuracy of the pharmacy aspects of cancer clinical trial protocols is essential. Inconsistencies and ambiguities in such protocols have the potential to delay research and jeopardise both patient safety and collection of credible data. The Chemotherapy and Pharmacy Advisory Service was established by the UK National Cancer Research Network, currently known as National Institute for Health Research Clinical Research Network, to improve the quality of pharmacy-related content in cancer clinical research protocols. This article reports the scope of Chemotherapy and Pharmacy Advisory Service, its methodology of mandated protocol review and pharmacy-related guidance initiatives and its current impact. Methods Over a 6-year period (2008–2013) since the inception of Chemotherapy and Pharmacy Advisory Service, cancer clinical trial protocols were reviewed by the service, prior to implementation at clinical trial sites. A customised Review Checklist was developed and used by a panel of experts to standardise the review process and report back queries and inconsistencies to chief investigators. Based on common queries, a Standard Protocol Template comprising specific guidance on drug-related content and a Pharmacy Manual Template were developed. In addition, a guidance framework was established to address ‘ad hoc’ pharmacy-related queries. The most common remarks made at protocol review have been summarised and categorised through retrospective analysis. In order to evaluate the impact of the service, chief investigators were asked to respond to queries made at protocol review and make appropriate changes to their protocols. Responses from chief investigators have been collated and acceptance rates determined. Results A total of 176 protocols were reviewed. The median number of remarks per protocol was 26, of which 20 were deemed clinically relevant and mainly concerned the drug regimen, support medication, frequency and type of monitoring and drug supply aspects. Further analysis revealed that 62% of chief investigators responded to the review. All responses were positive with an overall acceptance rate of 89% of the proposed protocol changes. Conclusion Review of pharmacy content of cancer clinical trial protocols is feasible and exposes many undetected clinically relevant issues that could hinder efficient trial conduct. Our service audit revealed that the majority of suggestions were effectively incorporated in the final protocols. The refinement of existing and development of new pharmacy-related guidance documents by Chemotherapy and Pharmacy Advisory Service might aid in better and safer clinical research.

The distress thermometer predicts subjective, but not objective, cognitive complaints six months after treatment initiation in cancer patients

ABSTRACT Objectives: Research has indicated that cancer-related cognitive impairments (CRCI) may be influenced by psychosocial factors such as distress, worry and fatigue. Therefore, we aimed to validate the distress thermometer (DT) as a screening tool to detect CRCI six months post-treatment-initiation in a group of general cancer patients. Methods: Patients (≥18 years, n = 125) with a histologically confirmed diagnosis of a solid cancer or hematological malignancy, scheduled for a curative treatment, were evaluated at baseline (T0) and six months post-treatment-initiation (T1) for CRCI by a neuropsychological assessment, including patient-reported outcome measures (PROMs). Assessed cognitive domains included premorbid intelligence, attention, processing speed, flexibility, verbal and visual episodic memory and verbal fluency. PROMs entailed distress (DT, cut-off ≥4, range 0–10), anxiety and depression, fatigue (FACIT-fatigue scale) and subjective cognitive complaints. Results: At T0, 60.4% of patients showed a DT score of ≥4, whereas 50% met this criterion at T1. According to the definition of the International Cognition and Cancer Task Force, 25.5% and 28.3% of patients presented with a CRCI at T0 and T1, respectively. When evaluating the DT as a screening tool for CRCI at T1, data showed an inverse relationship between the DT and CRCI. ROC-curve analysis revealed an AUC <0.5. ROC-curve analyses evaluating the DT and FACIT-fatigue scale as screening tools for subjective cognitive complaints showed an AUC ± SE of, respectively, 0.642 ± 0.067 and 0.794 ± 0.057. Conclusions: The DT at T0 cannot be used to screen for objective CRCI at T1, but both the DT and FACIT-fatigue scale at T0 showed potential as screening tools for subjective cognitive complaints at T1.

1408PTHE UNITED KINGDOM (UK) NATIONAL CANCER RESEARCH NETWORK (NCRN) CHEMOTHERAPY AND PHARMACY ADVISORY SERVICE (CPAS): SERVICE DEVELOPMENT AND QUALITY CONTROL EXPERIENCE OF PHARMACY ASPECTS IN CLINICAL RESEARCH PROTOCOLS

ABSTRACT Aim: The Chemotherapy and Pharmacy Advisory Service (CPAS) was established in 2007 by the UK National Cancer Research Network (NCRN) to improve the quality of pharmacy-related issues in clinical research protocols. We report the scope and methodology of the CPAS, and its impact on the quality of clinical research protocols. Methods: All clinical research protocols were independently reviewed by a minimum of three health professionals including at least one oncology pharmacist, using a customised protocol review checklist (assessing 12 areas of clinical oncology/pharmacy). A collated review was subsequently drafted by the CPAS pharmacy advisor and returned to the chief investigators. A working party performed a systematic review of all protocol reviews conducted by CPAS during the 6-year period since its inception (2008-2013) and categorised the remarks. A service evaluation audit was conducted to check response rate and acceptance rate of the proposed changes with chief investigators. Results: During the 6 year systematic review period a total of 176 clinical research protocols were reviewed. The median number of remarks per protocol was 26 of which 20 were deemed clinically relevant. The majority of clinically relevant remarks concerned the drug regimen, guidelines concerning support medication, frequency and type of monitoring and drug supply aspects. Further analysis of the 176 protocols reviewed revealed that 62% of chief investigators responded to the review. All responses were positive with an overall acceptance rate of 89% of the proposed protocol changes. Conclusions: Review of pharmacy aspects regarding clinical cancer research protocols is feasible and reveals many undetected clinically relevant issues that could hinder efficient trial conduct. Our service audit revealed that the very large majority of suggestions were effectively incorporated in the final protocols. Disclosure: All authors have declared no conflicts of interest.