M. L. Gonzalez

Patient-reported outcomes for determining prognostic groups in veterans with stage IV solid tumors starting systemic therapy.

48 Background: A Recursive Partitioning Analysis (RPA) prognostic algorithm based on quality of life and symptoms predicted 4 groups with distinct median survivals in patients with metastatic solid tumors receiving chemotherapy (ASCO 2013, Abst 9567). We update our findings. METHODS The RPA algorithm is based upon Karnofsky performance status (KPS), Functional Assessment of Cancer Therapy (FACT) physical well-being (PWB) subscale, and Memorial Symptom Assessment Scale Short Form (MSAS-SF) physical symptom distress (PHYS) subscale. Starting in 2007, a convenience sample of Veterans who were prescribed systemic treatment for their cancer was enrolled in an IRB approved protocol, and completed quality of life (FACT- G) and symptom (MSAS SF) questionnaires at the first cycle of treatment. We analyzed records of patients with stage IV metastatic solid tumors enrolled through June 2013, and determined survival as of June 15, 2014. Analyses were performed with STATA 11.0. RESULTS There were 97 patients(pts). The median age was 64 yrs, range 27-88. Males comprised 95 (98%) pts. First line chemotherapy was given to 78 (80%) pts. The most common primary sites were lung cancer 33 (35%), prostate 17 (17%) and colon 11 (11%) pts. Median KPS was 90% range 40-100%, PWB median 23 (range 6-28), and MSAS SF median PHYS 0.76 (range 0-3.2). Overall median survival was 285 days (range 6-2,358) and 80 pts (82%) had died. There was 1 pt in group 1, 58 in group 2, 12 in group 3, and 23 in group 4. The patient in group 1 had uterine sarcoma. Median survival (days) by RPA group was 155 for group 1, 177 for group 2, 292 for group 3, and 674 for group 4 (p=.011). CONCLUSIONS These preliminary findings suggest that this algorithm is capable of dividing patients with metastatic solid tumor who are starting systemic therapy into prognostic groups. Further development is indicated.

Comparison of outcomes of patients with hepatocellular carcinoma (HCC) over 2 consecutive decades for a VA population.

e14536 Background: Hepatocellular carcinoma (HCC) incidence is increasing in the United States. We compared the outcome of HCC patients (pts) over two consecutive decades for a VA population. METHODS In an IRB-approved protocol, we reviewed the records of pts with diagnosis (dx) of HCC seen at a VA Medical Center from 1/1/1990 to 12/31/2009. Demographics, Vietnam era (V) status, stage, alpha-fetoprotein (AFP) level at dx, hepatitis B (HBV) and C (HCV), heavy alcohol use (E), tobacco use (T), BMI, diabetes (DM), ferritin (F) level, and treatment modalities were reviewed. Cox survival regression analysis and tests of proportions were performed. RESULTS All were men. There were 42 pts were from the first decade (d1) (1990 to 1999) and 72 pts from the 2nd decade (d1) (2000 to2009). The median (M) age at dx was 62.25 yo (35-87) for the whole population (W). Comparison of two decades is shown in the table. For the second decade, more variables were analyzed: M BMI of 70 pts was 25.3 (16.9-42.4). 34 pts (47.2%) were Caucasian, 33 pts (45.8%) African American, and 5 pts (7%) others. 25pts (34.7%) has DM, 57 (79%) E use, and 61 (84.7%) T use. Two pts (2.78%) received transplant, 4 (5.56%) resection, 16 (22%) local therapy (L), and 11 pts (15.3%) systemic therapy. In univariate survival analysis, age (p<0.004), stage (p<0.0001), AFP (p<0.0017), F (p<0.002), and V (p<0.0001) were significant predictors of survival. In multivariate survival analyses that included stage, AFP, F, and V for W, stage (p<0.019), AFP (p<0.0008), and F (p<0.035) were significant predictors. CONCLUSIONS The incidence of hepatocellular carcinoma increased at this medical center. Pts were diagnosed at an earlier stage and survival improved in 2nd decade. Stage, AFP, and ferritin levels were independent predictors of survival. [Table: see text].

Chronic lymphocytic leukemia (CLL) patients at a VA medical center: Comorbidity and survival.

6602 Background: To determine whether co morbidity indices predict survival in chronic lymphocytic leukemia (CLL) patients (pts). METHODS In an IRB-approved protocol, we reviewed the records of 107 pts diagnosed with CLL at a VA Medical Center from January 2001 to May 2010. Records were reviewed for demographic, clinical, pathological data. ECOG PS, Veteran status (V-Vietnam) treatment status and survival were tabulated. Comorbidity was assessed using Charlson Comorbidity Index (CCI), The Kaplan-Feinstein Index (KFI), the Cumulative Illness Rating Scale (CIRS) and the VA comorbidity Index. We preformed Cox regression analysis to determine predictors of survival. RESULTS There were 107 pts with a median (M) age of 72 yo (48-94). The M hemoglobin(Hgb) was 13.6 g/dl (7.3-16.7), M WBC 15.4 K/cmm (2.8-289), M platelets 201 K/cmm (50-1077), M blood urea nitrogen (BUN) 19 mg/dL (1-88), M creatinine (Cr) 1.1 mg/dl (0.4-3.6), M lactate dehydrogenase (LDH) 177 IU/L (105-1635), M beta 2-microglobulin 2.3 mg/dl (0.9-8.9) and M BMI 28.7 kg/m2 (15.06-43.1). Early stage pts numbered 94 (88%). The M CCI was 4 (0.8-8.7), M KFI 1 (0-3), M CIRS 15 3 (1-6), M CIRS 16 7 (1-14), M CIRS 17 2 (1-4.5), M VA comorbidity 3 (0-8).106 pts had a PS 0-2. By immunophenotyping 42 ptswere CD38/ ZAP-70 positive. 65 pts (75 %) non-V, 30 (28%) V. The M survival was 1290 days (4-6715). In univariate analysis age (P<0.01), stage (p< 0.03), BMI (P 0.05) beta 2-microglobulin (p< 0.0001), Hgb (p<0.005), WBC (p<0.0004), BUN (p<0.0006), Cr (p<0.0002), LDH (p<0.0033,), second malignancy (P<0.0436) and V (p<0.04) were significant predictors of survival. In the multivariate analysis, B2-Microglobulin was the only significant independent predictor of survival (p < 0.0172). Comorbidity indices were not predictors of survival. CONCLUSIONS Co morbidity indices were not able to able predict survival in this group as many patients were early stage pts with good performance status.

Myelodysplastic syndrome (MDS) patients at a VA medical center: Comorbidity and survival.

6611 Background: To determine whether co morbidity indices predict survival in myelodysplastic syndrome (MDS) patients. Methods: In an IRB approved protocol, we reviewed the records of patients (pts) diagnosed with MDS at a VA Medical Center from June 1998 to December 2009. Records were reviewed for demographic, clinical and pathological data, ECOG PS, Erythropoietin use and response, transfusion dependency, International Prognostic Scoring System (IPSS), total number of treatments and survival. Cox survival regression analysis was performed. Comorbidity was assessed with three co morbidity indices, the Charlson Comorbidity Index (CMI), the Kaplan-Feinstein Index (KFI) and the Cumulative Illness Rating Scale (CIRS). Results: There were 81 analyzable pts with a median (M) age of 74.5 (47-94). The M hemoglobin was 9.5 g/dl (4.3-16.9), M WBC 5.05 K/cmm (1.2-100), M platelets 158.5 K/cmm (10-1346), M albumin 3.9 g/dL (0-5), M ferritin 378 ng/mL (0-7750), M LDH 188 IU/L (0-2426). The M CMI was 2 (0-8), M KFI 2...

Processes as predictors of outcomes of EOL care at a VA medical center

20646 Background: The objective of the study is to find quality indicators that predict outcomes of EOL care. Methods: Items from performance measures proposed by Earle et al (Int J Qual Health Care 2005;17:505) were used to develop multivariate logistic regression models for the outcomes 1) whether a patient enters into Hospice, 2) dies in an acute care institution, and 3) is admitted into the ICU within one month of death. We analyzed data from a cohort of veteran patients. Process variables included the type of underlying disease, whether pain or symptom medications were administered, whether psychological support was given, and whether patients were admitted to the MICU. Analyses were done with SAS. Conclusions: Supportive care measures, such as pain and symptom medications are associated with increased likelihood of entering Hospice, and support counseling increases the likelihood of dying in an acute care institution and being admitted to the ICU within the last month of life. These findings should ...