Assessment of nutritional status and quality of life among cancer

Among all 412 patients diagnosed and treated with breast cancer, we categorized them as three groups low weight: BMI < 18kg/m2, normal: BMI < 25kg/m2, obesity: BMI25kg/m2 and investigate

(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

ramu-cirumab, including regimen without H1-antihistamines at our institution between

2017 and 2019 The patients who received antiemetic steroid for cytotoxic

chemother-apy was also included The primary endpoint was the incidence of IRR during the

infu-sion 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 (n¼ 22), lung cancer (n ¼ 26), and

colon cancer (n¼ 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

mil-lion deaths were caused by cancer.1Chemotherapy in cancer patients is often

accompa-nied by bone marrow aplasia which manifests as anemia The choice of therapy for

anemia in cancer patients are blood transfusions In addition, an

Erythropoiesis-Stimulating Agent (ESA) can be added which can increase the production of

erythro-cytes in the bone marrow.17,18Increased 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

hyperprolifera-tive 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

car-ried out, the research protocol was explained and informed consent was requested

Results: There is a decrease of EpoR expression (8481,3365364,46 copies/uL)

com-pared to normal value (34-3000 x 103copies/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

grada-tions (r¼ 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

correla-tion 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,

normal: BMI < 25kg/m2, obesity: BMI25kg/m2) and investigated overall survival according to menopausal status and adjuvant endocrine therapy We used a kaplan-meier 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%, p¼ 0.77, v2¼1.1) Women without adju-vant hormone therapy show lower overall survival, but it is not significant (Obesity group: 87.7%, Normal group: 94.4%, low BMI: 90%, p¼ 0.89, v2¼0.62) In women with more than 50 years, low BMI was better than normal to obese women (p¼ 0.89,

v2¼0.6)

Conclusions: Obesity is not major risk factor of overall survival in Korea, but in hor-mone receptor negative breast cancers, it correlated with early onset death or recur-rence 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 1

Faculty of Pharmacy, Department of 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

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 terti-ary 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, p¼ 0.007), and females were prone to severe extravasation injury (OR: 2.713, p¼ 0.010) Ambulation was found to be a major risk factor (OR: 4.66, p¼ 0.001) Patients with comorbidities had higher chances of getting severe extravasa-tion (OR: 3.009, p¼ 0.029) and irritants were found to be predominant in worsening it (OR: 2.24, p¼ 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 (p¼ 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 sce-nario 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

1

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 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 con-ducted in 97 patients with known histological malignancies who had received chemo-therapy as inpatients in oncology wards at Ramaiah hospital in Bangalore for a period

Volume 30 | Supplement 9 | November 2019 doi:10.1093/annonc/mdz434 | ix149

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

malnour-ished 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

chemo-therapy 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

che-motherapy was found to be 54.2þ 11.46 and 46.16 þ 9.77 respectively Whereas 23% of

the patients showed higher score (9.8þ 3.6) in physical domain before the treatment

and at the end of the treatment the score increased (22þ 4.1) Emotional domain

before treatment (5.9þ 2.5) and after treatment (5.3 þ 2.3) social (3.6 þ 1.4 and

3.5þ 1.4) cognitive (2.04 þ 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

guid-ance 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 1

Surgical Oncology, Gandhi Medical College, Bhopal, Madhya Pradesh, India,

2

Orthopaedics, ISIC, New Delhi, India,3

Pharmacy, Barkatullah University, Bhopal, Madhya Pradesh, India,4

Internal Medicine, Peoples College of Cedical Sciences, Bhopal, India

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

lim-ited amount Autograft is the gold standard but is available in limlim-ited amount and

mor-bidities 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

there-after Sloof&#39;s Criteria was used for assessing osteointegration of grafts

Results: Allografts have not only accepted well but defects have healed and bone

inte-gration 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

457P The prevalence of vitamin D deficiency in Thai cancer patients, its dynamics and association with cancer survival

C Ngokngarm1

, C Bandidwattanawong2 1

Medicine, Vajira Hospital Centre, Bangkok, Thailand,2

Medicine, Bangkok Metropolitan Administration Medical School and Vajira Hospital, Pathumwan, Thailand

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 can-cer survival are scarce Objectives: The primary outcome was to determine the preva-lence 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 change¼ -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 treat-ment was unlikely to affect the vitamin D status There was a trend towards inverse rela-tionship 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 multi-variate analysis

Conclusions: Nearly all Thai cancer patients have vitamin D deficiency Cancer treat-ment 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

ix150 | Supportive care Volume 30 | Supplement 9 | November 2019