C112
Clinical outcomes in poor performance patients with advanced ovarian and primary peritoneal cancers
Laura Horsley, Charlie Gourley, Moira Stewart, Tzyvia Rye, Melanie Mackean
Edinburgh Cancer Centre, UK
Background
New patients, unwell, with advanced ovarian or primary peritoneal epithelial cancer (EOC) may respond dramatically to chemotherapy. The outcome for newly diagnosed performance status (PS) 3 patients is uncertain as such patients are typically excluded from clinical trials. We undertook a retrospective review over a 5-year period to determine the outcomes for these patients.
Method
Patients treated as an inpatient for their first cycle of chemotherapy (a surrogate for poor PS) for advanced EOC were identified from an electronic database. Information on stage, PS, chemotherapy, serum albumin, TPN, response, survival and mortality was extracted from case-notes and coded electronically.
Results
46 patients were identified as receiving inpatient chemotherapy between January 2002 and December 2006. 25(54%) were PS3; 16 (35%) were PS2 and 5(11%) PS 1. Twenty-one patients(46%) had attempted debulking with only 3 (7%) achieving no residual disease. Twenty patients(44%) were stage III and 25(54%) stage IV. Mean pre-treatment serum albumin was 27.6 (17-40) g/L. Total parenteral nutrition (TPN) was administered in 8 cases(17%). 45 patients received carboplatin given at AUC5 in 23 (50%); AUC6 in 18(39%), AUC7 in 4 (9%)cases. Five patients received additional taxol. Overall response rate was 59%. Median survival was 30 weeks (0.1-314 weeks) for whole group. Survival was significantly lower in PS3 patients compared to the remainder; median 17.7 vs 72.4 weeks (p=0.01). There was no statistically significant survival difference between those who had undergone surgery or TPN and those who had not. Nine(20%) patients died within 30-days of treatment. Number of co-morbidities was an independent prognostic factor for early death. (p=0.04) but age, PS, and serum albumin were not.
Conclusion
Patients requiring admission for their first cycle of chemotherapy, particularly those who are PS 3, have a significantly poorer outcome. Number of co-morbidities helps predict those patients likely to die within 30-days of treatment.
