Immigrant Health and Changes to the Public-Charge Rule: Family Physicians' Response

As the US federal government pursues immigration reform, changes to the federal public-charge rule have triggered confusion and concerns among patients who are immigrants. Although federal judges temporarily blocked implementation, a decision by the Supreme Court in January 2020 allowed the proposed changes to take effect. These policy changes have resulted in many legal immigrants and their family members becoming more reluctant to apply for health insurance, food, housing, and other benefits for which they are qualified. This article summarizes the changes and exclusions. Family physicians can effectively respond to patient and immigrant community concerns about these changes by providing outreach education, access to primary health care, and referrals to legal and social services.

Association of pre-chemotherapy peripheral blood pro-inflammatory and coagulation factors with reduced relative dose intensity in women with breast cancer

Background

Chemotherapy decreases the risk of relapse and mortality in early-stage breast cancer (BC), but it comes with the risk of toxicity. Chemotherapy efficacy depends on relative dose intensity (RDI), and an RDI < 85% is associated with worse overall survival. The pro-inflammatory (interleukin (IL)-6, C-reactive protein (CRP)) and coagulation factors (D-dimer) serve as biomarkers of aging. The purpose of this study is to determine if these biomarkers are associated with reduced RDI in women with stage I–III BC.

Methods

This study enrolled women with stage I–III BC. Prior to adjuvant or neoadjuvant chemotherapy, peripheral blood was collected for biomarker measurement. Dose reductions and delays were captured and utilized to calculate the RDI delivered. Univariate and multivariate analyses were performed to describe the association between pre-chemotherapy IL-6, CRP, and D-dimer levels and an RDI < 85%, controlling for relevant tumor and patient factors (age, stage, receptor status, chemotherapy regimen, and pre-chemotherapy physical function and comorbidity).

Results

A total of 159 patients (mean age 58 years, range 30–81, SD 11.3) with stage I–III BC were enrolled. An RDI < 85% occurred in 22.6% (N = 36) of patients and was associated with higher pre-chemotherapy IL-6 (OR 1.14, 95% CI 1.04–1.25; p = 0.006) and D-dimer (OR 2.32, 95% CI 1.27–4.24; p = 0.006) levels, increased age (p = 0.001), increased number of comorbidities (p = 0.01), and decreased physical function by the Medical Outcomes Survey Activities of Daily Living (ADL) Scale (p = 0.009) in univariate analysis. A multivariate model, including two biomarkers (IL-6 and D-dimer), age, ADL, BC stage, and chemotherapy regimen, demonstrated a significant association between the increased biomarkers and reduced RDI < 85% (OR 2.54; p = 0.04).

Conclusions

Increased pre-chemotherapy biomarkers of aging (IL-6 and D-dimer) are associated with reduced RDI (<85%). Future studies are underway to validate these findings.

Trial registration

ClinicalTrials.gov, NCT01030250. Registered on 3 November 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13058-017-0895-5) contains supplementary material, which is available to authorized users.

Association of Pre-Chemotherapy Peripheral Blood Pro-Inflammatory and Coagulation Factors with Physical Function in Women with Breast Cancer

Breast cancer is a disease associated with aging. Before initiation of chemotherapy, an assessment of functional reserve is needed; however, simple performance assessment scores may not reflect the diverse nature of physical function and risk of toxicity among older adults. The focus of this article is on understanding the association between pre‐chemotherapy biomarkers (IL‐6, CRP, and D‐dimer) and measures of physical function.

Background.

Pro‐inflammatory and coagulation factors serve as biomarkers of aging and functional reserve. The purpose of this study was to determine if pro‐inflammatory (interleukin‐6 [IL‐6], C‐reactive protein [CRP]), and coagulation (D‐dimer) factors were associated with pre‐chemotherapy functional status in women with stage I–III breast cancer.

Patients and Methods.

Prior to chemotherapy initiation in patients with stage I–III breast cancer, the following was captured: IL‐6, CRP, D‐dimer blood levels, and physical function measures including activities of daily living (ADL, subscale of Medical Outcomes Study Physical Health); instrumental activities of daily living (IADL, subscale of the Older Americans Resources and Services Program); Timed Up and Go (TUG); physician‐rated Karnofsky Performance Status (KPS); and self‐rated KPS. The association of these biomarkers with physical function measures was evaluated.

Results.

One hundred sixty patients (mean age 58.3 years, range 30–81 years) with stage I–III breast cancer (stages I [n = 34; 21.5%], II [n = 88; 55.7%], III [n = 36; 22.8%]) were enrolled. The group with poorest physical function (defined by ADL <70, IADL <14, and TUG ≥10 seconds) had higher levels of IL‐6 (p = .05), D‐dimer (p = .0004), and CRP (p = .05). There was no significant association between these biomarkers and KPS. Patients with at least two biomarkers in the highest quartile were more likely to have poorer physical function (odds ration [OR] 18.75, p < .001). In multivariate analysis adjusting for age, stage, number of comorbidities, and body mass index, the association remained (OR 14.6, p = .002).

Conclusion.

Pre‐chemotherapy biomarkers of aging are associated with poorer physical function among patients with breast cancer across the aging spectrum. The Oncologist 2017;22:1189–1196

Implications for Practice.

Commonly used physical function assessment tools may not reflect the diverse nature of physical function and risk for chemotherapy toxicity, particularly in older adults. No laboratory test reflects functional reserve. Pro‐inflammatory and coagulation factors, such as IL‐6, CRP, and D‐dimer, can serve as biomarkers of aging and physical function; however, few studies have evaluated their utility in patients with cancer. This study was designed to understand the association between pre‐chemotherapy biomarkers and physical function in women with early stage breast cancer undergoing adjuvant chemotherapy. Results indicate that elevated pre‐chemotherapy levels in two of the three peripheral biomarkers are associated with the poorest physical function among patients with breast cancer across the aging spectrum.

Association between renal function and chemotherapy-related toxicity in older adults with cancer

PURPOSE

To evaluate the association between renal function (RF) and chemotherapy-related toxicity (CRT) in older adults with cancer and to compare the effect of different RF formulas and body weight measurements on this association.

METHODS

This is a secondary analysis of data from a prospective multicenter study of patients ≥ age 65 who were starting a new chemotherapy regimen. RF was estimated with 4 formulas (modified Jelliffe [Jelliffe], Cockcroft-Gault [CG], Wright, and Modification of Diet in Renal Disease [MDRD]), using actual, ideal and adjusted body weights for 492 patients. The association between baseline RF and grade 3-5 CRT was evaluated by unconditional logistic regression.

RESULTS

As a continuous variable, decreased creatinine clearance (CrCl) calculated by CG with actual body weight was associated with increased odds of CRT (OR 1.12, P<0.01; 95% CI 1.04-1.20) indicating that on average for every 10mL/min decrease in CrCl the odds of CRT increased by 12%. Very low RF (in the lowest 10%) with all formulas (CG, Jelliffe, Wright and MDRD) was associated with increased odds for CRT. This association is independent of the type of chemotherapy received (those requiring dose adjustment for renal function vs not). Neither primary dose reduction nor chemotherapy duration was associated with CRT. Serum creatinine alone was not associated with increased odds of CRT (OR 0.67, P=0.15).

CONCLUSIONS

Decreased RF is associated with increased odds of CRT and should be considered when assessing risk of CRT in older adults with cancer. Serum creatinine alone is not adequate for risk assessment.

Selected Lactobacillus strains isolated from sugary and milk kefir reduce Salmonella infection of epithelial cells in vitro

The isolation of potentially probiotic strains and the subsequent study of their properties are very important steps to gain insight in the health benefits ascribed to sugary and milk kefir. The aim of the present study was to characterise fifteen Lactobacillus strains isolated from these beverages by determining some surface properties and their ability to antagonise enterocyte cell damage after Salmonella infection in vitro. Lactobacillus surface properties were determined by hydrophobicity, autoaggregation, and coaggregation assays with Salmonella. In addition, lactobacilli adhesion to Caco-2/TC-7 cells and the effect on Salmonella invasion were evaluated. Finally, the disassembly of F-actin cytoskeleton on intestinal epithelial cells was assayed in vitro when Salmonella infection was performed in the presence of selected Lactobacillus strains. Ten out of the 15 strains showed a high adhesion capacity to Caco-2/TC-7 cells. Most of the strains were hydrophilic and non-autoaggregating. Strains isolated from sugary kefir were non-coaggregating with Salmonella, while strains Lactobacillus paracasei CIDCA 83120, 83121, 83123, 83124, 8339, 83102 isolated from milk kefir were able to coaggregate after 1 h. L. paracasei CIDCA 8339 and Lactobacillus kefiri CIDCA 83102 were able to diminish Salmonella invasion to the enterocytes. An antagonistic effect on cytoskeleton disruption elicited by the pathogen was also demonstrated. Our results suggest that both strains isolated from milk kefir could be considered as appropriate probiotic candidates.

Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer

PURPOSE

Older adults are at increased risk for chemotherapy toxicity, and standard oncology assessment measures cannot identify those at risk. A predictive model for chemotherapy toxicity was developed (N = 500) that consisted of geriatric assessment questions and other clinical variables. This study aims to externally validate this model in an independent cohort (N = 250).

PATIENTS AND METHODS

Patients age ≥ 65 years with a solid tumor, fluent in English, and who were scheduled to receive a new chemotherapy regimen were recruited from eight institutions. Risk of chemotherapy toxicity was calculated (low, medium, or high risk) on the basis of the prediction model before the start of chemotherapy. Chemotherapy-related toxicity was captured (grade 3 [hospitalization indicated], grade 4 [life threatening], and grade 5 [treatment-related death]). Validation of the prediction model was performed by calculating the area under the receiver-operating characteristic curve.

RESULTS

The study sample (N = 250) had a mean age of 73 years (range, 65 to 94 [standard deviation, 5.8]). More than one half of patients (58%) experienced grade ≥ 3 toxicity. Risk of toxicity increased with increasing risk score (36.7% low, 62.4% medium, 70.2% high risk; P < .001). The area under the curve of the receiver-operating characteristic curve was 0.65 (95% CI, 0.58 to 0.71), which was not statistically different from the development cohort (0.72; 95% CI, 0.68 to 0.77; P = .09). There was no association between Karnofsky Performance Status and chemotherapy toxicity (P = .25).

CONCLUSION

This study externally validated a chemotherapy toxicity predictive model for older adults with cancer. This predictive model should be considered when discussing the risks and benefits of chemotherapy with older adults.

Platys: From Position to Place-Oriented Mobile Computing

The Platys project focuses on developing a high-level, semantic notion of location called place. A place, unlike a geospatial position, derives its meaning from a user’s actions and interactions in addition to the physical location where they occur. Our aim is to enable the construction of a large variety of applications that take advantage of place to render relevant content and functionality and thus, improve user experience. We consider elements of context that are particularly related to mobile computing. The main problems we have addressed to realize our place-oriented mobile computing vision, are representing places, recognizing places, engineering place-aware applications. We describe the approaches we have developed for addressing these problems and related subproblems. A key element of our work is the use of collaborative information sharing where users’ devices share and integrate knowledge about places. Our place ontology facilitates such collaboration. Declarative privacy policies allow users to specify contextual features under which they prefer to share or not share their information.

Abstract P6-08-34: p16INK4a expression and chemotherapy toxicity in women with early stage breast cancer

Background: Increased expression of p16INK4a, a molecular marker of aging, is a hallmark of increased cellular senescence in most mammalian tissues. In human peripheral blood T-lymphocytes, expression of p16INK4a increases 10-fold between 20 and 80 years of age (Liu et al, Aging Cell, 2009). We hypothesized that higher "molecular age," as evidenced by increased T-cell expression of p16INK4a at the time of initiation of breast cancer (BC) chemotherapy (CRx), predicts increased treatment-related toxicity.

Methods: Patients (pts) with early breast cancer scheduled to receive neoadjuvant (NA) or adjuvant (Adj) chemotherapy (CRx) had p16INK4a evaluation performed prior to treatment. Expression of p16INK4a mRNA in CD3+ T-lymphocytes was determined using TaqMan real time quantitative reverse transcription polymerase chain reaction. Grade 3 and 4 (G3/4) hematologic (H) and non-hematologic (NH) toxicities (NCI CTCAE version 4) were assessed during and within 4 weeks of completion of CRx. Wilcoxon Rank Sum tests compared p16INK4a between groups.

Results: 93 pts with Stage I-III BC and complete toxicity data during and within 4 weeks after completion of CRx have been accrued. Median age (range) was 52 (25-76). 48 (52%) of pts were hormone receptor (HR) positive, 21 (23%) HER-2 positive, and 24 (26%) triple-negative. 39 (42%) received NA and 54 (58%) received Adj CRx. 57 pts (61%) received an anthracycline containing combination and 21 (23%) cyclophosphamide/docetaxel (TC). 85 pts (91%) received pegfilgrastim. Overall, 69 pts (74%) had a G3/4 toxicity during or ≤4 wks of CRx, 54% NH and 40% H. 22 pts (24%) were hospitalized for CRx related toxicity and 11 (12%) of these admissions were for neutropenic fever (NF). 23 (25%) reported G3/4 fatigue during CRx and had significantly higher p16INK4a values at baseline than those without fatigue (p=0.03). There was no significant association of baseline p16INK4a and other NH or H toxicity or hospitalization in this cohort.

Conclusion: In this small sample of pts treated with anthracycline and non-anthracycline containing NA and Adj CRx regimens, there was a significant association of baseline p16INK4a and G3/4 fatigue. The heterogeneity of treatment and use of pegfilgrastim in almost all pts limits the power of this study to find significant relationships between p16INK4a and other toxicities. The cohort for this study is being expanded to further explore p16INK4a as a predictor for G3/4 toxicity.

Support: Breast Cancer Treatment Foundation, New York, NY; University Cancer Research Fund, University of North Carolina, Chapel Hill.

Citation Format: Hyman Muss, Allison Deal, Arti Hurria, Natalia Mitin, Chad Torrice, Krishnamurthy Janakiraman, Trevor Jolly, Grant Williams, Shani Alston, Jerard West, Laura Zavala, Vani Katheria, Norman Sharpless. p16INK4a expression and chemotherapy toxicity in women with early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-08-34.

Abstract P6-01-07: Association of baseline pro-inflammatory (IL-6, CRP) and coagulation (D-dimer) markers with baseline functional status in women with breast cancer (BC) undergoing chemotherapy

Background: Pro-inflammatory and coagulation factors such as IL-6, CRP and D-dimer serve as biomarkers for aging. The utility of these markers as biologic correlates of physical function in patients with BC is not known. This study was performed to determine if baseline serum markers of inflammation (IL-6, CRP) and coagulation (D-dimer) correlate with baseline functional status in women with stage I-III BC requiring chemotherapy (chemo). Methods: This is a prospective longitudinal study that enrolled 153 women across all age groups with BC who had pre-chemotherapy peripheral blood captured for IL-6, CRP, and D-dimer and a baseline assessment of the following functional status measures: activities of daily living (Medical Outcomes Study [MOS] Physical Health); instrumental activities of daily living (IADL); self-rated Karnofsky performance status (KPS); physician-rated KPS; number of falls in last 6 months; and Timed Up and Go (TUG). Peripheral blood samples were collected for measurement of IL-6, CRP and D-dimer. Quantitative IL-6 and CRP levels were obtained using NOVEX® immunoassay (Invitrogen) and D-dimer levels were measured with Nanopia®D-dimer(Sekisui). Univariate analyses were performed to describe correlations of these three biomarkers and 6 measures of physical function. Results: 153 patients (mean age of 57.5 y, range 30-81 y) with stage I- III BC (Stages I [n=35; 23%], II [n=82; 54%], III [n=36; 24%]) were enrolled. Chemo regimens include: doxorubicin+cyclophosphamide/ paclitaxel(AC-T: 44%), docetaxel/cyclophosphamide (TC: 35%), docetaxel/carboplatin/trastuzumab (TCH: 7%) and other regimen(14%). Scores for the physical function measures are as follow: MOS (median 89, range 0-100); IADL (median 14, range 4-14); self-rated KPS (median 90, range 60-100); physician-rated KPS (median 100, range 80-100); TUG (median 9 seconds, range 5-18). Serum biomarkers measurements and distributions are listed in table 1. There were associations between decreased physical function by IADL and increased IL-6 (p&lt;0.01); decreased MOS and increased D-dimer (p&lt;0.01); increased number of falls and increased CRP (p=0.02) and D-dimer (p=0.04); increased TUG and increased IL-6 (p&lt;0.01), CRP (p&lt;0.01) and D-dimer (p=0.06) (Table 2). Physician and patient-rated KPS did not correlate with IL-6, CRP and D-dimer level. Conclusions: Baseline measures of inflammation and coagulation correlate with physical function measures among patients with breast cancer. Future analyses evaluating the association between aging biomarkers and measures of physical function with subsequent risk of chemotherapy toxicity is underway.

Table 1. Serum biomarkers measurement at baseline prior to initiation of chemotherapyBiomarkerMeanStandard DeviationMedianRangeIL-6 (pg/ml)4.35.13.00-48.0CRP(µg/ml)5.77.92.80.1-48.4D-dimer(µg/ml)0.70.60.60.1-3.3

Table 2. Univariate analysis of measures of physical functions versus biomarkersVariablesSpearman Coefficientp valueMOS vs D-dimer-0.21&lt;0.01IADL vs IL-6-0.27&lt;0.01No. of falls vs D-dimer0.160.04No. of falls vs CRP0.190.02TUG vs D-dimer0.150.06TUG vs IL-60.26&lt;0.01TUG vs CRP0.23&lt;0.01

Citation Format: Yuan Yuan, Nilesh Vora, Tao Feng, Joanne Mortimer, Thehang Luu, George Somlo, Joseph Chao, Vivi Tran, Shu Mi, Tim Synold, James Waisman, Laura Zavala, Vani Katheria, Arti Hurria. Association of baseline pro-inflammatory (IL-6, CRP) and coagulation (D-dimer) markers with baseline functional status in women with breast cancer (BC) undergoing chemotherapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-01-07.

The relationship between age, anxiety, and depression in older adults with cancer

OBJECTIVE

In older men with prostate cancer, aging is associated with reduced anxiety and increased depression. The purpose of this study was to examine the association among age, anxiety, and depression in a cohort of older adults receiving chemotherapy.

METHODS

This is a secondary analysis of a prospective longitudinal study investigating chemotherapy toxicity in older adults with cancer. Baseline data (pre-chemotherapy) included: age, sociodemographics, tumor and treatment factors, functional status, comorbidities, psychological state (measured by the Hospital Anxiety and Depression Scale), and social support. Univariate and multiple regression analyses were conducted to test the relationship between age, anxiety, and depression.

RESULTS

The average age of the 500 patients (56% females) was 73.1. The majority had late stage disease: 22% Stage III and 61% stage IV. Clinically significant depression was reported in 12.6%. Clinically significant anxiety was reported in 20.9%. In univariate analyses, there was no association between anxiety and age, or depression and age. In multivariable analyses, older age (p=0.05) was associated with decreased anxiety, as well as lack of social support (p<0.01) and increased number of comorbidities (p<0.01). In multivariable analysis, depression was associated with lack of social support (p<0.01), increased number of comorbidities (p<0.01), and advanced stage (p<0.01).

CONCLUSIONS

This study supports previous research that anxiety decreases with age in older adults with cancer. However, depression remained constant with increasing age. Greater resources and attention to identifying and treating the psychological sequelae of cancer in older adults are warranted.

Polypharmacy and potentially inappropriate medication use in older adults with cancer undergoing chemotherapy: effect on chemotherapy-related toxicity and hospitalization during treatment

OBJECTIVES

To evaluate the prevalence of polypharmacy and potentially inappropriate medication (PIM) use and the association between these and chemotherapy-related adverse events in older adults with cancer undergoing chemotherapy.

DESIGN

Secondary analysis of prospectively collected data.

SETTING

Outpatient oncology clinics in seven academic medical centers.

PARTICIPANTS

Adults aged 65 and older with cancer undergoing chemotherapy.

MEASUREMENTS

Measures included number of daily medications (polypharmacy); PIM use based on three indices (Beers, Zhan, and Drugs to Avoid in the Elderly criteria), and use of six "high risk" medication classes for adverse drug events (anticoagulants, antiplatelet agents, opioids, insulin, oral hypoglycemics, antiarrhythmics). Using multivariate logistic regression, the relations were evaluated between these criteria and Grade 3 to 5 chemotherapy-related toxicity and between these criteria and hospitalization during chemotherapy.

RESULTS

Participants (N=500; mean age 73, 61% Stage IV disease) took a mean of 5±4 daily medications (range 0-23). PIM use was common (up to 29% according to Beers criteria). No association was found between number of daily medications (reference 0-3 medications) and toxicity (4-9 medications, odds ratio (OR)=1.34, 95% confidence interval (CI)=0.92-1.97; ≥10 medications, OR=0.82, 95% CI=0.45-1.49) or hospitalization (≥4 medications, OR=1.34, 95% CI=0.82-2.18, P=.24). There was also no association between PIM use and toxicity (P=.93) or hospitalization (P=.98). No medication class was associated with either outcome.

CONCLUSIONS

Polypharmacy and PIM use were common but were not associated with chemotherapy-related toxicity or hospitalization in older adults with cancer.

Anemia and functional disability in older adults with cancer

9109

Background: While anemia is associated with functional disability in older adults in general, this relationship has not been well characterized in older adults with cancer. We sought to examine the association between anemia and functional disability and to identify other factors associated with functional disability in patients (pts) age ≥65 with cancer. Methods: We conducted a secondary analysis of a multi-center prospective study of 500 pts ≥ age 65 that identified predictors of chemotherapy (chemo) toxicity (Hurria et al, JCO, 2011). The primary outcome of this analysis was functional disability, defined as need for assistance with ≥1 instrumental activities of daily living. Data collected prior to initiation of a new chemo regimen included: age, tumor/treatment variables, labs [including hemoglobin (Hb)], and geriatric assessment (functional status, comorbidity, social support, psychological, cognitive, and nutritional status). Anemia (World Health Organization criteria) was defined as Hb <12g/dl (women) and Hb <13g/dl (men). Bivariate analysis and logistic regression were used to examine the association between functional disability, anemia, and other pre-treatment variables. Results: Among 500 pts [median age 72 years (range 65-91), 56% female, 61% stage IV], the prevalence of functional disability and anemia was 43% and 51%, respectively. The mean Hb was 11.7g/dl and 12.6g/dl among pts with and without functional disability. Pts with anemia were more likely to report functional disability (53% vs. 46%, p<0.01). On multivariate analysis, factors associated with functional disability included anemia [Odds Ratio (OR)= 2.06, 95% confidence interval (CI)= 1.39-3.05], increased age (OR= 1.04, 95% CI = 1.00-1.07), increased comorbidity (OR= 1.23, 95% CI = 1.09-1.39), advanced stage (OR= 1.85, 95% CI = 1.22-2.80), and unintentional weight loss (OR= 2.02, 95% CI = 1.37-3.00). Conclusions: Anemia was highly prevalent and was associated with functional disability. Prospective studies that further examine the relationship between anemia and functional disability and randomized-controlled trials that evaluate the correction of anemia as a modifiable strategy to improve functional status in older pts with cancer are warranted.

Factors associated with life expectancy (LE) < 3 months (mo) among older adults receiving palliative chemotherapy (chemo)

9034

Background: Optimal treatment decision-making for older adults with advanced cancer requires a better understanding of risk factors associated with limited LE. Our objective was to evaluate the factors associated with LE< 3mo among patients (pts) age > 65 who were beginning a new chemo regimen. Methods: We conducted a secondary analysis of a multi-site cohort study of pts ≥65 years receiving chemo (Hurria et al, JCO 2011). This analysis included only pts receiving palliative chemo. Bivariate analysis and multivariate logistic regression were utilized to identify factors associated with LE < 3 mo including: sociodemographics, labs [hemoglobin (Hb), albumin, liver function, creatinine clearance], and geriatric assessment (GA) variables (functional status, social support, comorbidity, psychological, cognitive, and nutritional status). Results: Among 290 pts (median age 72 [range 65-91], 52% female) with advanced cancer (gastrointestinal 28%, lung 31%, breast/gyn 22%, other 19%), 13.4% died within 3 mo of chemo initiation. In bivariate analysis, pts with LE < 3mo were more likely (p<0.05 for each variable) to have lower albumin and Hb, unintentional weight loss, and poorer physical function [defined as need for assistance with instrumental activities of daily living (IADL), lower score on Medical Outcomes Survey (MOS) Physical Health, MD-rated and patient-rated Karnofsky performance status (KPS), and MOS Social Activity score]. Measures of functional status were highly correlated with one another and therefore one functional status measure (in addition to measures significant in bivariate analysis) was included in each multivariate logistic regression. In multivariate analyses, (controlling for age, comorbidity, and line of chemo) poorer physical function (as evaluated by need for assistance with IADLs, MOS Physical <70, or MD-rated KPS <70) and unintentional weight loss were independently associated with LE<3mo (p<0.05). Conclusions: Among older pts with advanced cancer who were prescribed a new chemo regimen for palliative intent, physical function measures (as evaluated by geriatric assessment and MD report) and unintentional weight loss were associated with LE < 3months.

The relationship among age, anxiety, and depression in older adults with cancer

9123

Background: Depression and anxiety are common psychological sequelae of cancer, resulting in decreased adherence to treatment regimens and longer hospital stays. In men with prostate cancer, aging is associated with reduced anxiety and increased depression. The overall goal of this study was to examine the association among age, anxiety, and depression in a cohort of older adults receiving chemotherapy (chemo). Methods: This is a secondary analysis of a prospective longitudinal study investigating chemotherapy toxicity in older adults with cancer. Eligibility included: age > 65, diagnosis of cancer, and scheduled to receive a new chemo regimen. Baseline data (pre-chemotherapy) included: age, sociodemographics, tumor and treatment factors (including tumor type and stage), geriatric assessment parameters (functional status, comorbidities, psychological state, nutritional status, social support). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Univariate and multiple regression analyses were conducted to test the relationship between age, anxiety, and depression. Results: The average age of the 500 patients (56% females) was 73.1 (range 65-91, SD+6.18) with 5% Stage I, 12% Stage II, 22% Stage III and 61% stage IV. Mean depression and anxiety scores were: 3.6+3.17; 4.7+3.60. Clinically significant depression was reported in 12.6% (n=62). Clinically significant anxiety was reported in 20.9% (n=103). In univariate analyses, there was no association between anxiety and age, or depression and age. In multivariable analyses, older age (beta= -0.07, p = 0.05) was associated with decreased anxiety, as well as lack of social support (p < 0.01) and increased number of comorbidities (p < 0.01). In multivariable analysis, depression was associated with lack of social support (p < 0.01), increased number of comorbidities (p < 0.01), and advanced stage (p < 0.01). Conclusions: This study supports previous research that anxiety decreases with age in older adults with cancer. However, depression remained constant with increasing age. Greater resources and attention to identifying and treating the psychological sequelae of cancer in older adults are warranted.