Assessment of nutritional status and quality of life among cancer

abstracts

Annals of Oncology
(IRR) with ramucirumab, H1-antihistamines are recommended as premedication.
However, IRR is hardly observed in clinical practice in the ramucirumab regimen. The
H1-antihistamines have several side effects, such as drowsiness and dizziness, and the
use of H1-antihistamines might be restricted for the patients who need to drive a car or
for elderly patients. The aim of this study was to investigate the safety of ramucirumab
without H1-antihistamines as a premedication in patients with solid cancer.
Methods: We retrospectively reviewed the solid tumour patients who received ramucirumab, including regimen without H1-antihistamines at our institution between
2017 and 2019. The patients who received antiemetic steroid for cytotoxic chemotherapy was also included. The primary endpoint was the incidence of IRR during the infusion in the first cycle. The secondary endpoints were the incidence of IRR at any time
and other ramucirumab related adverse events.
Results: Of the 51 patients enrolled (median age, 69.5 years; range 41 - 83), 28 (55%)
were male. The origins of cancer were gastric cancer (n ¼ 22), lung cancer (n ¼ 26), and
colon cancer (n ¼ 3), respectively. Forty-two patients (82%) received ramucirumab in
combination with antiemetic steroid for cytotoxic chemotherapy, and nine patients
(18%) received ramucirumab monotherapy without steroid. No IRR was observed in
this study (IRR rate, 0%; 95% CI 0 - 0.69). Among the overall 272 infusions, there were
no events of IRRs or other ramucirumab related adverse events.
Conclusions: There was no IRRs without H1-antihistamines in our retrospective study.
Ramucirumab without H1-antihistamines as premedication would be a favourable
option for the patients who had trouble with the side effects of H1 antihistamine.
Legal entity responsible for the study: The authors.
Funding: Has not received any funding.
Disclosure: All authors have declared no conflicts of interest.

452P

Expression of erythropoietin receptor in patient with anemia related
chemotherapy and its correlation with absolute reticulocyte count

I. Wahid
Internal Medicine, Faculty of Medicine, Andalas University, Padang, Indonesia
Background: Cancer is the leading cause of death worldwide. In 2012, around 8,2 million deaths were caused by cancer.1 Chemotherapy in cancer patients is often accompanied by bone marrow aplasia which manifests as anemia. The choice of therapy for
anemia in cancer patients are blood transfusions. In addition, an ErythropoiesisStimulating Agent (ESA) can be added which can increase the production of erythrocytes in the bone marrow.17,18 Increased erythropoeisis process induced by ESA will
bind to Erythropoietin Receptor (EpoR) on the erythropoetic cell surface in the bone
marrow. In other hand, ESA therapy were still not giving a satisfied result and still lack
of data about expression of EpoR. Absolute reticulocyte count (ARC) is a marker of
erythrocyte production that is more accurate in distinguishing hypo or hyperproliferative anemia.
Methods: This study was an observational analytic, cross sectional study carried out at
the hematology specialty clinic, integrated oncology unit, Department of Internal
Medicine, Dr. M. Djamil Padang Hospital for 6 months. A sample of 30 patients who
met the inclusion and exclusion criteria. Initial screening for potential subjects was carried out, the research protocol was explained and informed consent was requested.
Results: There is a decrease of EpoR expression (8481,3365364,46 copies/uL) compared to normal value (34-3000 x 103 copies/uL). There is also a decrease of ARC
(27,9769,24 x109/L) compared to normal value (50-100 x109/L). Positive correlation
was found between EpoR expression and ARC. In the statistical test using the Pearson
test it was found that the correlation was significant (p < 0.05) with very strong gradations (r ¼ 0.819).
Conclusions: There is a decrease the average of EpoR expression in patient with anemia
related chemotherapy and significant positive correlation with a very strong gradation
between EpoR expression and ACR .
Legal entity responsible for the study: Division of Hematology and Medical
Oncology, Internal Medicine Department, Dr. M. Djamil General Hospital, Padang,
Indonesia.
Funding: Has not received any funding.
Disclosure: The author has declared no conflicts of interest.

453P

Body mass index did not correlate with short term overall survival in
breast cancers

J. Lee
Surgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
Background: Obesity is a risk factor for the development of new cases of breast cancer
and also affects survival in women who have already been diagnosed with breast cancer,
but in Asian women, these findings is not evident. We aimed to investigate the correlation between the body mass index (BMI) and overall survival of patients with a breast
cancer.
Methods: We conducted a retrospective observational study from a single institute
from January 2014 to December 2018. Among all 412 patients diagnosed and treated
with breast cancer, we categorized them as three groups (low weight: BMI < 18kg/m2,

Volume 30 | Supplement 9 | November 2019

normal: BMI < 25kg/m2, obesity: BMI 25kg/m2) and investigated overall survival
according to menopausal status and adjuvant endocrine therapy. We used a kaplanmeier analysis with log-rank test.
Results: Total 412 patients were enrolled. Mean duration of follow up was 33.3 months.
Obesity, normal BMI and low BMI was 120(29.1%), 202(49.0%), and 40 (9.7%)
patients, respectively. BMI was correlated with age, patients with obesity was 16% (28/
174) of women with less than 50 years, but 38.6% (92/238) of women with more than
50 years. Overall survival was not significantly different among groups (Obesity group:
95%, Normal group: 95.5%, low BMI: 97.5%, p ¼ 0.77, v2¼1.1). Women without adjuvant hormone therapy show lower overall survival, but it is not significant (Obesity
group: 87.7%, Normal group: 94.4%, low BMI: 90%, p ¼ 0.89, v2¼0.62). In women
with more than 50 years, low BMI was better than normal to obese women (p ¼ 0.89,
v2¼0.6).
Conclusions: Obesity is not major risk factor of overall survival in Korea, but in hormone receptor negative breast cancers, it correlated with early onset death or recurrence. Not only further studies need to lighten the relationship between obesity and
long-term survival, but also intervention to reduce BMI needs to know its effects on
breast cancer survival in Korea.
Legal entity responsible for the study: The author.
Funding: Has not received any funding.
Disclosure: The author has declared no conflicts of interest.

454P

Predictors of severity and comparison of CTCAE V3.0 vs V4.3 in
assessing chemotherapy induced extravasation injuries

S.S. Reddy1, S. Somayaji1, M. Krishna Murthy1, V.V. Maka2
Faculty of Pharmacy, Department of Pharmacy Practice, M. S. Ramaiah University of
Applied Sciences, Bangalore, India, 2Department of Medical Oncology, M. S. Ramaiah
Medical College and Hospitals, Bangalore, India

1

Background: Extravasation is an important Adverse Event in chemotherapy, which is
evaluated using CTCAE (Common Terminology Criteria for Adverse Events) grading
scale. This study focuses on predicting risk factors and comparing CTCAE v3.0 and 4.3
in assessing chemotherapy-induced extravasation.
Methods: An observational study was conducted in medical oncology wards of a tertiary care hospital among adult patients receiving parenteral chemotherapy. European
society of medical oncology – European oncology nursing society (ESMO-EONS)
guidelines was used to classify chemotherapeutic agents. Significant risk factors were
determined using binary logistic analysis. Spearman’s rank correlation coefficient and
Wilcoxon’s sign rank test was applied to evaluate the difference between CTCAE v3.0
and v4.3.
Results: A total of 46 patients were enrolled in the study. According to CTCAE v4.3,
amongst the 46 patients who experienced extravasation 30 presented with Grade II and
the rest 16 with Grade III severity. Patients aged above 60 years showed significance
(OR: 2.236, p ¼ 0.007), and females were prone to severe extravasation injury (OR:
2.713, p ¼ 0.010). Ambulation was found to be a major risk factor (OR: 4.66,
p ¼ 0.001). Patients with comorbidities had higher chances of getting severe extravasation (OR: 3.009, p ¼ 0.029) and irritants were found to be predominant in worsening it
(OR: 2.24, p ¼ 0.007). The Spearman’s rank correlation coefficient established a good
association in EV grades between both versions of CTCAE (rho¼0.877, p ¼ 0.000).

Wilcoxon’s Rank test revealed a significant difference between the two. (p ¼ 0.0003).
Conclusions: The severity of EV depends on early identification of symptoms, patient
related factors and nature of drug. This information is pivotal to work towards a scenario of better-prevented and managed events of EV. The updated versions of CTCAE
(v4.3 and v5) are better fit to use for accurate scoring of severity.
Legal entity responsible for the study: All Authors.
Funding: Has not received any funding.
Disclosure: All authors have declared no conflicts of interest.

455P

Assessment of nutritional status and quality of life among cancer
patients undergoing chemotherapy

S. Prathima1, M. Murthy1, V.V. Maka2, P.R. Paibhavi1, H. Reddy3, S. Vungarala1
Pharmacy Practice, M. S. Ramaiah University of Applied Sciences, Bangalore, India,
2
Department of Medical Oncology, M. S. Ramaiah Medical College and Hospitals,
Bangalore, India, 3Pharm D, MS Ramaiah Memorial Hospital, Bangalore, India

1

Background: Nutritional status and proper dietary intake have a vital role in cancer
prognosis and progression. Alterations in metabolic system due to chemotherapy and
cancer can lead to high prevalence of malnutrition. It can be attributable to cancer,
therapy effect and decreased food intake. Malnutrition has negative impact on patients
treatment, side effects, immunity, Quality of life (QOL) and prolonged hospital stay
and expense. Our study aims to assess the nutritional status, timely intervention and
QOL in cancer patients undergoing chemotherapy.
Methods: A prospective hospital-based multidisciplinary interventional study was conducted in 97 patients with known histological malignancies who had received chemotherapy as inpatients in oncology wards at Ramaiah hospital in Bangalore for a period

doi:10.1093/annonc/mdz434 | ix149


abstracts
of six months. Detailed interview of patients and their care-takers were analysed in
structured formats. Malnutrition and QOL were assessed using PG-SGA scale and
EORTC QLQ C-30 questionnaire respectively. QOL was assessed at the beginning and
at the end of the chemotherapy whereas PG-SGA scale was done for all the cycles and
dietary intervention was given to patients who were moderately and severely malnourished. Follow up was done for all the patients till the end of the therapy.
Results: Out of 97 patients 61% were females and 36% were males. During the chemotherapy third cycle 19.5% patients were found to be well nourished (stage A) 63% were
moderately malnourished (stage B) and 17.5% were severely malnourished (stage C).
After the chemotherapy sixth cycle 60% were in stage A and 34% were in stage B and
6% were in stage C. Qol was also assessed and the total score before and after the chemotherapy was found to be 54.2 þ 11.46 and 46.16 þ 9.77 respectively Whereas 23% of
the patients showed higher score (9.8 ỵ 3.6) in physical domain before the treatment
and at the end of the treatment the score increased (22 ỵ 4.1). Emotional domain
before treatment (5.9 ỵ 2.5) and after treatment (5.3 ỵ 2.3) social (3.6 ỵ 1.4 and
3.5 ỵ 1.4) cognitive (2.04 ỵ 0.31 and 2.04 þ 0.30) and role (5.9 þ 1.5 and 3.9 þ 1.4).
Conclusions: Pre-emptive assessment of nutritional status and prompt dietary guidance and intervention can improve patient’s nutritional status and QOL.
Legal entity responsible for the study: Sri Prathima.
Funding: Has not received any funding.
Disclosure: All authors have declared no conflicts of interest.

456P

Use of gamma irradiated bone allografts in treatment of various bone
tumours

A.N. Mishra1, S. Kapoor2, S.M. Mishra3, Y. Mishra4
Surgical Oncology, Gandhi Medical College, Bhopal, Madhya Pradesh, India,
2

Orthopaedics, ISIC, New Delhi, India, 3Pharmacy, Barkatullah University, Bhopal,
Madhya Pradesh, India, 4Internal Medicine, Peoples College of Cedical Sciences, Bhopal,
India

1

Background: Osteogenic augmentation is required in various orthopaedic conditions.
Defects caused by removal of malignant or local bone tumours requires reconstructive
surgeries to restore skeletal continuity and bone grafts to fill bone defects. Different
modalities which can help to increase osteogenesis include autografts, allografts and
synthetic bone graft substitutes. Autograft is the gold standard, provides osteogenic,
osteoinductive and osteoconductive properties but has limitations of requirement for
additional incisions, poor bone quality in elderly patients, increases operation time,
causes donor site pain and morbidity and likely permanent residual disability and limited amount. Autograft is the gold standard but is available in limited amount and morbidities associated with it. Bone graft substitutes are costly, limited in quantity and
don’t integrate with host bone. Bone allografts are a good option, but not widely used
in India and there are sparse reports in literature from developing countries. Our study
signifies use of gamma irradiated deep freezed bone allografts in treatment of various
bone tumours.
Methods: It’s a prospective descriptive study. Strict inclusion and exclusion criteria, as
per standard guidelines of American and European Association of Tissue Banking,
were followed. We have a in-house facility of gamma irradiated deep freezed bone
allografts available in hospital. 20 patients with giant cell tumours of proximal tibia,
proximal ulna and distal radius, aneurysmal bone cysts of proximal humerus and distal
radius, etc were operated during one year and followed up for atleast 24 weeks thereafter . Sloof's Criteria was used for assessing osteointegration of grafts.
Results: Allografts have not only accepted well but defects have healed and bone integration is at various stages. Only one patient got infected (5%). 19 out of 20 patients
(95 %) in our study group had either attained or at various stages of osteointegration
and healing.
Conclusions: We conclude that deep freezed bone allografts is a viable option in
patients with large bone defects after resection of bone tumours, thus give satisfactory
surgical outcome, with no serious side effects.

Legal entity responsible for the study: The authors.
Funding: Has not received any funding.
Disclosure: All authors have declared no conflicts of interest.

ix150 | Supportive care

Annals of Oncology
457P

The prevalence of vitamin D deficiency in Thai cancer patients, its
dynamics and association with cancer survival

C. Ngokngarm1, C. Bandidwattanawong2
Medicine, Vajira Hospital Centre, Bangkok, Thailand, 2Medicine, Bangkok Metropolitan
Administration Medical School and Vajira Hospital, Pathumwan, Thailand
1

Background: Vitamin D deficiency is associated with various kinds of cancer.
Moreover, vitamin D level possibly has an inverse relationship with cancer mortality.
The data on vitamin D status among Thai cancer patients and its association with cancer survival are scarce. Objectives: The primary outcome was to determine the prevalence of vitamin D deficiency among unselected Thai cancer patients. The secondary
outcomes were to explore the effect of cancer treatment upon vitamin D status, the
independent predictive factor(s) of vitamin D deficiency among cancer patients and its
potential independent factor of cancer survival.
Methods: There were 106 consecutive cancer patients participated in this prospective
descriptive study conducted at Division of Medical Oncology. Vitamin D (25(OH) D)
levels were collected before and after cancer treatment. Demographic data, vitamin D
status, and treatment outcomes were collected and analysed.
Results: There were 106 consecutive cancer patients participated in this study.
Determination of vitamin D status after cancer treatment were obtained in 76 patients.
The investigators found that almost all of the cancer patients had vitamin D deficiency

(102 of 106, 96.2%). Determination of vitamin D status after cancer treatment were
obtained in 76 patients. The investigators did not demonstrate the significant change of
vitamin D level (mean change ¼ -1.46 (95% C.I., -3.33-0.41), p ¼ 0.124) when the
blood samples were collected before and after cancer treatment. Therefore, cancer treatment was unlikely to affect the vitamin D status. There was a trend towards inverse relationship between the BMI and vitamin D level. At the median follow-up time of 254.5
days (IQR 220-297), the investigators revealed that low BSA (BSA < 1.5 m2), PS 2 at
presentation was the independent predictive factors of survival, according to the multivariate analysis.
Conclusions: Nearly all Thai cancer patients have vitamin D deficiency. Cancer treatment does not affect the vitamin D status. Low serum vitamin D level does not affect
survival outcome.
Legal entity responsible for the study: Chavapon Ngokngarm/Vajira hospital,
Thailand.
Funding: Medical Research Fund of Faculty Medicine Vajira Hospital,
Navamindradhiraj University.
Disclosure: All authors have declared no conflicts of interest.

Volume 30 | Supplement 9 | November 2019