Rosaleen Lannon

055Point Prevalence of Malignancy in a Geriatric Medicine Inpatient Cohort

Background: With Ireland’s ageing demographics and increasing risk factor prevalence, the incidence of cancer is expected to double by 2040 [1]. This will lead to a fourfold increase in its prevalence, presenting an important challenge for the provision of optimal cancer care to older persons. We set out to evaluate the point prevalence of current and prior diagnosis of malignancy in a specialised geriatric medicine inpatient population of an acute hospital. Methods: Data was extracted by reviewing the electronic patient record and paper chart of each patient under the care of the geriatric medicine service on a single week day. Information regarding demographics, current and prior cancer diagnosis and treatment was recorded. Results: On the day of data collection, there were 154 inpatients under the care of our geriatric service. The median age was 83 years; 71 (46.1%) were male. The prevalence of current diagnosis of cancers excluding non-melanoma skin cancer was 12.34% while the prevalence of previous cancer diagnosis was 16.23%. The commonest current cancer diagnoses were that of female breast (n = 3), lung (n = 2), colorectal (n = 2), mouth & pharynx (n = 2), multiple myeloma (n = 2) and others (n = 8). Twelve had had surgery or were undergoing treatment during this hospitalisation. Six were being managed conservatively. Of those that received treatment, 4 were treated with surgery alone and 3 were on hormonal therapy. Conclusion: Geriatric oncology is an increasingly recognised and evolving subspecialty. Our findings highlight the prevalence of current and prior malignancy in a geriatric medicine inpatient cohort and support the need for further interspecialty training, opportunities for shared learning and the potential for increased integration of clinical services in the future. Reference 1. National Cancer Registry. Cancer projections for Ireland 2015–2040. Cork: National Cancer Registry, 2014.

155Adherence and Persistence to Teriparatide Treatment

Background: Osteoporosis increases the risk of fracture and associated morbidity and mortality. Efficacy of anti-osteoporotic treatment is based on drug potency and adherence and persistence. Teriparatide (TPTD) is the first anabolic agent developed for the treatment of osteoporosis and can significantly reduce the incidence of vertebral fractures. We evaluated adherence and persistence to TPTD treatment in patients with severe osteoporosis in a specialised Bone Health Service. Methods: A cross-sectional and retrospective longitudinal study was performed of all patients in our clinic with severe osteoporosis treated with TPTD from 2004 to 2016. Results: 597 patients commenced TPTD from 2004 to 2016: 90% female, mean age 70 years (range 30–99); 225 (38%) had vertebral fractures; 136 (23%) had Colles fractures; and 75 (13%) had a hip fracture. 106 patients (18%) are currently on treatment. 491 (82%) are no longer on treatment with 367 (75%) having completed 18 months or more of treatment. 122 patients (25%) stopped treatment before 18 months. Of these, the mean length of time on treatment was 195 days. Reasons for prematurely stopping included self-discontinued 19 (16%), side effects 62 (51%), death from any cause 8 (7%), incidental cancer diagnosis 4 (3%), lost to follow up 8 (7%) and other 21 (17%). Most side effects experienced were mild and included rash 4 (6%), palpitations 4 (6%), headaches 6 (10%), fatigue 7 (11%), nausea 11 (18%), dizziness 12 (19%) and generalised/ joint pain 29 (47%). However a small number reported night sweats 1 (2%), UTI/kidney stones 3 (5%) and weight loss 1 (2%). Conclusion: In our study adherence and persistence with TPTD was higher than that reported with oral antiresorptive treatments. The major factor that reduced adherence and persistence was tolerability. These findings are important, as high adherence and persistence with therapy is necessary to ensure an optimal therapeutic outcome.