Tumori Journal Abstract Book - October 2020 - 189

T - Miscellanea

189

T25

T26

Survival of patients with obesity
and cancer: A systematic review
and meta-analysis

Integration between geriatric
oncology and palliative care:
a single center experience for
elderly cancer patients (pts)

Petrelli F.1, Ghidini A.2, Cortellini A.3, Indini A.4, Tomasello G.5,
Ghidini M.4, Nigro O.6, Salati M.7, Dottorini L.8, Iaculli A.8,
Varricchio A.1, Costanzo A.1, Rampulla V.1, Bossi A.1, Barni S.1,
Zaniboni A.9
ASST Bergamo Ovest, Treviglio; 2Casa di Cura Igea, Milano; 3San Salvatore
Hospital, L'Aquila, Italy; Department of Biotechnology and Applied Clinical
Sciences, L'Aquila; 4Fondazione IRCCS Ca' Granda Ospedale Maggiore
Policlinico, Milano; 5ASST Grande Ospedale Metropolitano Niguarda, Milano;
6
ASST Sette Laghi, Ospedale di Circolo, Varese; 7University Hospital of
Modena, Modena Cancer Centre, Modena; 8ASST Bergamo Est, Seriate;
9
Fondazione Poliambulanza, Brescia

Liguigli W.1, Cengarle R.1, Rimanti A.1, Catania G.1, Faglioni L.1,
Zanardi Di Pietro I.1, Iridile C.1, Ravelli A.1, Rigotti L.1, Cantore M.1
1

Ospedale Carlo Poma, Mantova

Background: Obesity is associated with an increased risk
of many cancers and of overall mortality for non-cancer
causes. In last years, various studies suggested an obesity
paradox that represents the better prognosis of obese cancer patients compared to non-obese patients. We performed
a systematic review and meta-analysis to assess the association between obesity and outcome after a diagnosis of
cancer and to found eventual setting of obesity paradox in
the published literature
Material and Methods: PubMed, the Cochrane Library,
and EMBASE were searched from inception to January
2020, for studies reporting survival of patients with obesity and cancer. The primary outcome of the study refers to
overall survival (OS). Secondary endpoints were cancerspecific survival (CSS) and progression- or disease-free
survival (PFS or RFS).
Results: Overall survival and relapse associated with obesity in patients with cancer were evaluated among
n=6,320,365 participants (n=203 studies). Overall, association of obesity and cancer was associated with an
increased mortality (hazard ratio [HR] =1.14, 95% confidence interval [CI]: 1.09-1.19; P<.01) and CSS (HR=1.17,
95%CI 1.12-1.23; P<.01). Patients were also at increased
risk for relapse (HR=1.13, 95%CI 1.07-1.19; P<.01).
Obese with lung cancer, renal cell carcinoma and melanoma had instead a better prognosis than non-obese and
satisfied the criteria of obesity paradox.
Conclusions: Most of obese patients with cancer have a
reduced survival and an increased risk of relapse. In lung
cancer, renal cell carcinoma and melanoma obesity was
paradoxically protective in terms of outcome. More intensive follow up, adequate dosing of oncological treatments,
calories intake restrictions, physical activity and monitoring of obesity-related complications are effective measures for reducing mortality in these subjects. The
mechanism underlying obesity paradox is probably linked
to an enhanced performance of immune cells confined in
adipose tissue.

Background: Comprehensive Geriatric Assessment
(CGA) is utilized to plan the social and health care of
elderly and to complete the diagnostic-therapeutic choice
of oncologist also considering early integration with palliative care.
Material (patients) and methods: Cancer pts hospitalized aged ⩾ 70 years were screened by G8 questionnaire
to define if necessary CGA. CGA identified: fit, unfit and
frail pts. Unfit and frail pts were discussed in multidisciplinary meetings to decide the most appropriate strategy.
Results: From Febraury 2019 to April 2020, we evaluated
95 pts (60% male, 40% female; median age: 78). All pts
were screened by G8: 2% were not at risk and 98% were at
risk. Pts at risk, evaluated by CGA resulted: 3 fit, 45 unfit
and 45 frail. 3 fit pts received standard medical or surgical
therapy. 41 unfit pts (91%) received personalized care and
4 pts got worse quickly and died. Median age was 76,
median score IADL/ADL (Instrumental/Activities Daily
Living) was 5, median daily drugs taken was 6 and the
median number of geriatric syndromes was 1.3.
Malnutrition was present in 31% and MMSE (Mini Mental
State Examination) was normal in 62%. Among these 45
pts 32 died with a median survival of 120 days (pts alive
had a median follow-up of 145 days) 14 at home, 13 in
hospice and 5 during hospitalization.
Among 45 frail pts, 3 received personalized care and 42
received Best Supportive Care. Median age was 81,
median score IADL/ADL was 2, median daily drugs taken
was 7 and the median number of geriatric syndromes was
2. Malnutrition was present in 55%, MMSE was normal in
22% but was not possible to evaluate 13 ones for poor general medical condition. Among these 45 pts 40 died with a
median survival of 36 days: 12 at home, 24 in hospice, and
4 during hospitalization.
In both subgroups main comorbidities were: cardiac
(55%), renal (21%), pulmonary (16%), dementia and
depression (13%) and comorbidity index of CIRS
(Cumulative Illness Rating Scale) was similar.
Conclusions: Unfit pts have a better functional, cognitive
and nutritional status than frail pts. Early integration between
geriatric oncology and palliative care represents the possibility to create a personalized care pathway and to avoid unnecessary diagnostic pathway especially for frail pts.

Tumori Journal Abstract Book - October 2020

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