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objective of this study was to examine temporal trends in
opioid prescribing among cancer patients with different
pain severity.
Material and Methods
Approach: Our study cohort comprised of Ontario residents
≥18 years with a history of cancer who were eligible for
the government’s paid pharmacare program and who had
a pain assessment using the Edmonton Symptom
Assessment Scale (ESAS). Use of ESAS is the result of a
population-based provincial initiative to screen
ambulatory cancer patients for 9 common cancer
symptoms. For each year between 2007 and 2013, we
used the date of an individual’s highest pain score as the
index date to calculate annual opioid prescription rates
for claims within -30 days to +7 days of the index date. We
evaluated prescriptions for drugs for neuropathic pain as
a secondary outcome.
Results
Results: During the study period, individuals meeting the
cohort inclusion criteria increased over 7-fold with 12,066
individuals aged 18-64 years and 43,715 individuals aged
³65 years eligible in 2013. Over time, changes in the
distribution of patients across cancer types and pain
scores were observed. For example, for those aged 18-64,
33% of patients had pain 7-10 in 2007 decreasing to 22%
with pain 7-10 in 2013. Similarly, for those aged ≥65, 21%
had pain 7-10 in 2007 decreasing to 11% in 2013. In both
age groups, opioids were prescribed most frequently for
those with pain 7-10 and least frequently for those with
no pain. Among 18-64 year olds with pain 7-10, opioid
prescription rates decreased from 46% in 2007 to 38% in
2013 (p<0.05). The respective values for those ³65 years
were 61% to 39% (p<0.05). Prescriptions for drugs for
neuropathic pain increased modestly.
Conclusion
Conclusion: Over time, pain assessment among cancer
patients has increased. However, the proportion with pain
who receive an opioid prescription has decreased. This
finding may be due to increased detection of non-cancer
related pain, but may also be the result of increased
scrutiny of opioid prescribing and policy changes intended
to decrease prescribing in non-cancer patients.
EP-1388 Clinical features of bone metastases and
their importance for radiotherapy
N. Bychkova
1
, E. Khmelevsky
1
1
Gertzen Moscow Research Oncological Institute,
Radiotherapy Department, Moscow, Russian Federation
Purpose or Objective
To study the features of bone metastases according to
different primary tumors and their importance for
radiotherapy
Material and Methods
We analyzed 680 cases of symptomatic bone metastases
included in the randomized controlled trial and treated
with EBRT. The primary breast tumors were diagnosed in
426 (62,6%), prostate in 57 (8,4%), lung in 57 (8,4%), renal
in 47 (6,9%), colon in 18 (2,6%), bladder in 11 (1,6%) and
other tumors in 64 (9,5%) cases. Patient selection criteria
for radiotherapy were pain, risk of pathological
fracture/malignant spinal cord compression, increasing
neurologic dysfunction. Irradiation of one anatomical area
was applied («block concept»). Treatment schedules
included 2, 3 and 4 fractions of 6,5Gy and standard
treatment schedule with 23 fractions of 2 Gy.
Results
The average follow-up period was 70 months. Pain
intensity before treatment was significantly higher for
bone metastases of prostate and lung cancer compared to
breast cancer (p<0,01) and for the men in general
(p<0,001 for non-prostate cases). Average relative lesion
length in irradiation’s areas was significantly lower for
renal cancer – 1,8 (for the three-level scale) and
significantly higher for prostate cancer – 2,28 (p=0,017).
The risk of pathological fracture was the lowest only for
prostate cancer metastases – 0,21 compared to 0,46 for
breast cancer lesions (p=0,0002). Overall effectiveness of
EBRT was 96,1%. Complete response rate (CRR) was
observed in 59,1% of cases. CRR correlated with the level
of total dose. CRR was significantly higher for bone
metastases of breast cancer compared to lung and renal
cancer (63,6% as opposed to 40,4% and 28,3%, р<0,02) and
for melanoma metastases (75%) compared to renal cancer
(p=0,036). It is interesting, that bone metastases of
melanoma and soft-tissue sarcomas were one of the most
radiosensitive. In the multifactorial analysis MANOVA
tumor primary site and pain intensity before radiotherapy
were the only independent prognostic factors of the
effectiveness of radiotherapy.
Conclusion
Tumor primary site is a clinical predictor of
radiosensitivity of bone metastases, it significantly affect
the CRR. Revealed features of bone lesions according to
different primary tumors allow to develop individual
treatment programs with a view to high efficiency and
ease of realization.
EP-1389 Superficial hyperthermia with radiotherapy:
toxicity and outcome of 62 metastatic lesions
G. Cattari
1
, A.G. Di Dia
2
, M. Gatti
1
, E. Delmastro
1
, E.
Garibaldi
1
, G. Belli
1
, A. Salatino
1
, P. Gabriele
1
1
FPO-IRCCS Candiolo, Radiotherapy, Candiolo- Turin,
Italy
2
FPO-IRCCS Candiolo, Medical Physic, Candiolo- Turin,
Italy
Purpose or Objective
The purpose of this study is to evaluate the safety,
feasibility and toxicity of radiotherapy-hyperthermia (RT-
HT) in the treatment of superficial recurrent and
metastatic tumors in this setting of patients
Material and Methods
Thirty-nine patients (mean age 69 years; range: 49-93)
with
histologically
confirmed
superficial
recurrent/metastatic tumours were treated: 19 breast, 10
head & neck, 2 malignant melanoma, 4 sarcomas, 1
uterine, 1 hepatocarcinoma and 2 pancreatic carcinoma.
The total number of treated lesions was 62. The mean
Karnofsky Index value is 75.
Pre-treated patients (70%)
received a previous mean RT dose of 50 Gy. Patients
underwent RT treatment using 3D-conformal RT (16/39) or
Helical Tomotherapy (23/39). External beam RT was
delivered in 5-27 fractions of 1.7-5 Gy to a total dose of
20-57.5 Gy (mean external dose: 39 Gy). Hyperthermia
(HT) treatment is performed with a double
electromagnetic superficial applicators operating at the
frequency of 434 MHz. HT session was delivered
once/twice weekly during the period of RT , 1-2 hours
after RT [mean value: 5; range: 1-9 sessions]. Average,
maximum and minimum temperature parameters were
recorded during HT treatment. The treatment goal was to
reach 40- 42°C in > 90% (T90) of measured points for a
duration of 60 minutes. Acute and late toxicity was
evaluated according to the CTCAE criteria. Local control
was assessed after the end of the treatment on the basis
of the RECIST Criteria
Results
During HT treatment the median temperature [range]
reached was 40.5 °C [39 – 42.9°C]. Five patients
interrupted the treatment: 2 pts (5%) for G3 toxicity,
2 (5%) for poor compliance and 1 (2.5%) for clinical
progression disease. Two pts (5%) had acute cutaneous
toxicity ≥ G3 at 1 month. Four patients had toxicity > G2
at 3 months, three patients had > G2 at 6 months and only
one patients at 12 months. No patients showed toxicity ≥