morbidities as well as susceptibility to the progressive accumulationof multiple chronic diseases, a decline in functional ability andcognitive functioning, and social problems. The importance ofdynamic interdisciplinary collaboration between oncology specialistsand geriatricians, and the incorporation of a geriatric assessment toevaluate the health status of elderly patients and patient/family-oriented approach into geriatric oncology practice have been wellestablished. In particular, oncology nursing specialists are at thefrontiers of the interdisciplinary geriatric oncology. However, thereremains limited empirical evidence to inform the treatment decisionand clinical care of elderly patient with cancer, and henceconsiderable variability in management of elderly patients withcancer could exist. Moving forward, the combination of geriatric,gerontology and oncology nursing science is critical to meet theever-increasing population of elderly and increased incidence ofcancer among the elderly. This paper provides an overview of thestate of the art of the research in geriatric oncology nursing,evaluates the need for sub-specialised care, and discusses specificresearch agenda for geriatric oncology assessment and nursing care.

Disclosure of Interest: None declared.

Keywords: None.

doi:10.1016/j.jgo.2014.06.009

S06SPECIFIC PROBLEMS IN SURGERY IN THE ELDERLYKok-Yang Tan1,*1Colorectal Service, Clinical Director of Geriatric Surgery Service, Singapore;Department of Surgery, Khoo Teck Puat Hospital, Singapore

The management of elderly surgical patients has to be at a higherlevel compared to a younger patient. Geriatric surgical patientsdemand multi-faceted, holistic care. Considerations should includethe physiological changes associated with ageing. Surgical manage-ment and planning for these patients must thus be holistic and allencompassing. It should be anticipatory of not only medical andsurgical problems that may arise but also address the psychosocialissue that may arise. The aim should not only be to reduce morbidityand mortality in this group of patients but also more importantly,their postoperative functional status should be addressed aggres-sively so as to preserve the independence of these patients. Indeed,in an elderly patient, failure to address all these issues may have anegative impact on the patients' outcomes. Treatment goals have tobe clear when the elderly are treated. Appropriate informed consentis important to ensure a satisfactory outcome for all sides.

Competing comorbidities, functional deficits and frailty in elderlysurgical patients demand a more coordinated multifaceted care inorder to achieve good outcomes. It is also beneficial to use geriatricpractice in elderly surgical patients. While most centres claim that allsurgical patients are managed in a multidisciplinary fashion, expertsfrom each discipline may still be working in their own silos. Onlywith a transdisciplinary approach can care for an elderly patient bedelivered in an optimal fashion that these complex patients demand.Only then can the real and practical outcome measure of functionalreturn be achieved.

Disclosure of Interest: None declared.

Keywords: Elderly, surgery, transdisciplinary.

doi:10.1016/j.jgo.2014.06.010

S07ADJUVANT CHEMOTHERAPY IN OLDER BREAST CANCER PATIENTS:HOW TO DECIDEHans Wildiers1,*1Department of General Medical Oncology, csir, KU Leuven, Belgium

The majority of older breast cancer patients probably do notbenefit much from adjuvant chemotherapy. The major challenge is toselect those older patients that do benefit from chemotherapy.

Four factors can be defined that determine together whetherchemotherapy will be beneficial in an individual patient. (i) Tumorextent including tumor size and nodal involvement is a well-establishedstrong prognostic factor in general, and the absolute benefit ofchemotherapy increases with higher tumor load. (ii) General healthstatus, as assessed by geriatric evaluation, is strongly associated withexpected life expectancy and tolerance of chemotherapy. A geriatricassessment is thus of paramount importance before deciding onadjuvant chemotherapy. Frail patients are likely to tolerate chemother-apy poorly and/or die from other causes in the following years, andgenerally do not benefit from adjuvant chemotherapy. (iii) Tumorbiology as indicated by breast cancer subtype predicts chemosensitivityand benefit from adjuvant chemotherapy. The indication for adjuvantchemotherapy in luminal A, B, triple negative and HER2 positive breastcancer will be discussed separately. (iiii) Last but not the least, patientsshould be involved as much as possible; estimated benefits of e.g. 10%absolute decrease in relapse rate might be valuable for 1 person but notfor another person. Studies show that the quality of provider commu-nication influences the choice of patients to receive chemotherapy.

References[1] Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I,

Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M,Aapro M, Audisio R: Management of elderly patients with breastcancer: updated recommendations of the International Society ofGeriatric Oncology (SIOG) and European Society of Breast CancerSpecialists (EUSOMA). Lancet Oncol. 2012 Apr; 13(4):e148-60.

[2] Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G,Bernard-Marty C, Hurria A, Extermann M, Girre V, Brain E,Audisio RA, Bartelink H, Barton M, Giordano SH, Muss H, AaproM. Management of breast cancer in elderly individuals: Recom-mendations of the International Society of Geriatric Oncology(SIOG). Lancet Oncol 2007; 8(12): 1101-15.

Disclosure of Interest: None declared.

Keywords: breast cancer, adjuvant chemotherapy.

doi:10.1016/j.jgo.2014.06.011

S08CARDIAC TOXICITY IN BREAST CANCERVivianne Shih1,*1Department of Pharmacy, National Cancer Centre, Singapore

As we strive to achieve improved treatment outcomes withbreast cancer therapy, the complications arising from treatmentcannot be neglected. Cancer survivors should not need to sufferfrom treatment associated complications such as heart failure thatwould contribute to increased healthcare costs and reducepatients' health related quality of life. Cardiotoxicity can rangefrom acute and early toxicity such as electrographic abnormalities,arrhythmias, decline in left ventricular ejection fraction to chronicand late onset toxicity such as congestive heart failure that may

SIOG APAC 2014 Invited Speakers Abstract submission S3

only arise years after cancer treatment. It is one of the lesscommon adverse effect that has been reported with conventionalchemotherapy such as anthracyclines but targeted therapies suchas anti-human epidermal growth factor receptor-2 (HER2), such astrastuzumab have not been spared either.

Approximately 20% of breast cancer tumours overexpress HER2and this subgroup has been reported to be more aggressive and isassociated with poorer treatment prognosis. Trastuzumab is ahumanised monoclonal antibody that targets the extracellulardomain of HER2 receptor. It has been used to treat HER2 positivebreast cancer in both metastatic and adjuvant settings but its efficacyhas been limited with the occurrence of cardiotoxicity. Compared toanthracyclines, cardiotoxicity arising from targeted therapy differssuch as in terms of clinical presentation, risk factors and treatment.

With newer drugs such as pertuzumab and ado-trastuzumabemtansine, for the treatment of HER2-positive breast cancer andpotentially the use of dual HER2 targeted therapy, cardiotoxicityremains a true concern that requires careful surveillance. Hence, inrecent years, the area of cardio-oncology is rapidly gaining interestamong clinicians. Further research is warranted to aid clinicians inbetter preventive and surveillance measures for cardiotoxicity associ-ated with breast cancer therapy. Prompt treatment can then berendered if required andhopefully avoiding serious, long term sequelae.

At the end of the session, participants should be able to

• List the common chemotherapy and/or targeted therapies that cancause cardiotoxicity.

• Distinguish cardiotoxicity arising from conventional chemotherapyand targeted agents.

• Discuss the appropriate preventive, monitoring and treatment ofcardiotoxicity caused by drugs used in cancer therapy.

Disclosure of Interest: None declared.

Keywords: Cardiotoxicity, anthracyclines, HER2 therapy.

doi:10.1016/j.jgo.2014.06.012

S09COMMUNICATING TREATMENT OPTIONS TO OLDER PATIENTS:CHALLENGES AND OPPORTUNITIESArti Hurria, MDDepartment of Medical Oncology and Therapeutics Research, City ofHope National Medical Center, Duarte, California, USA

A key component of care of older patients is the recognition thatchronologic age alone cannot guide the management of an older adultwith cancer. Treatment decisions must also take into account anindividual’s functional status, cognition, the risks and benefits of therapy,and patient preference (which can be influenced by socioeconomicfactors such as finances, spirituality, culture, and social support). High-quality cancer care should be evidence-based and patient-centered.

The discussion regarding treatment options involves balancing thebenefits of specific therapies with the possibility for increasedtreatment-related toxicity potentially exacerbated by physiologicaldecline or comorbidities that often co-exist in the older population.The number of older adults with cancer is increasing,1 but older adultsremain underrepresented on cancer clinical trials.2-4 Furthermore,studies often exclude older adults with comorbid medical conditionsor organ dysfunction. In order to prepare for the challenges that willresult from the aging of the world’s population, it is important toincrease the breadth and depth of data obtained from cancer clinicaltrials.5 Efforts should be made to match the characteristics of the studypopulation to that of patients with the disease (i.e., enroll older patientsand individuals with multiple comorbid conditions onto clinical trials).

In addition, clinical oncology trials should capture a more detailedcharacterization of the study population through evaluation tools suchas a comprehensive geriatric assessment (CGA),6 which can assess theunique needs of older adults with cancer and identify those who aremost at risk for treatment-related adverse side effects.7

Among older adults, cancer is often only one of multiple coexistinghealth conditions. Physical, cognitive, or emotional issues only add tothe complexity of their care needs. The goals of cancer care may bedifferent for older adults. The typical goals of cancer care can bedramatically influenced by the health and social issues experienced byolder adults, with an emphasis on quality of life playing a critical role inwhich treatments they arewilling to accept. In fact, the effects of cancertherapies on physical or cognitive function could be just as important, ifnot more important, to older patients than response or survival.8 It isalso important to take into account the need for caregiver supportduring and after therapy, since many individuals caring for olderpatients with cancer are often older adults themselves.

Olderpatientswith cancer shouldbe supported throughout thedecisionmaking process so that they can understand their options and be able toselect a treatment that fits their overall goals, values, and preferences.

Disclosure of interest: Dr. Hurria has received research supportfrom Celgene Corporation and GlaxoSmithKline, and has served as aconsultant for GTx, Inc. and Seattle Genetics.

Keywords: cancer; older patient; therapeutic management; geriatricassessment; clinical trials

References[1] Smith BD, Smith GL, Hurria A, et al. Future of cancer incidence

in the United States: burdens upon an aging, changing nation. JClin Oncol 2009;27:2758–2765.

[2] Talarico L, Chen G, Pazdur R, et al. Enrollment of elderlypatients in clinical trials for cancer drug registration: a 7-yearexperience by the US Food and Drug Administration. J Clin Oncol2004;22:4626–4631.

[3] Hutchins LF, Unger JM, Crowley JJ, et al. Underrepresentation ofpatients 65 years of age or older in cancer-treatment trials. NEngl J Med 1999;341:2061–2067.

[4] Scher KS, Hurria A, Peterson BL, et al. Under-representation ofolder adults in cancer registration trials: known problem, littleprogress. J Clin Oncol 2012;30:2036–2038.

[5] Levit LA, Balogh E, Nass SJ, et al. Delivering high-quality cancercare : charting a new course for a system in crisis. Washington,D.C. The National Academies Press; 2013.

[6] Hurria A, Gupta S, Zauderer M, et al. Developing a cancer-specificgeriatric assessment: a feasibility study.Cancer 2005;104:1998–2005.

[7] Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapytoxicity in older adults with cancer: a prospective multicenterstudy. J Clin Oncol 2011;29:3457–3465.

[8] Fried TR, Bradley EH, Towle VR, et al. Understanding the treatmentpreferences of seriously ill patients.NEngl JMed2002;346:1061–1066.

doi:10.1016/j.jgo.2014.06.013

S10DO ELDERLY PATIENTS BENEFIT FROM ENROLLMENT INTOPHASE I TRIALSDavid Tai1,*1Division of Medical Oncology, National Cancer Center Singapore,Singapore

Background: Despite the significant burden of cancer in the olderpopulation, their outcomes in the context of phase I studies havebeen poorly studied. We evaluated the clinical characteristics and

SIOG APAC 2014 Invited Speakers Abstract submissionS4