PO65TAILORING HIGH GRADE GLIOMA MANAGEMENT IN THE ELDERLY

Abstract

INTRODUCTION: With the increased effectiveness of the MDM more elderly patients with a radiological diagnosis of high grade glioma (HGG) are being discussed. Collaboration with local acute oncology, medical and palliative services allows avoiding unnecessary transportation of patients with poor performance status (PS). To achieve this we introduced a specialized supportive letter to empower local teams to explain the rationale for recommending palliative care alone for patients with poor PS with an offer of a neurooncology appointment if the patient/family requested. We are presenting a further review of our management strategies during the year 2014. METHOD: Retrospective analysis of the management of elderly patients aged >70 with HGG based on radiological findings or histological analysis, who were referred to the Neurosciences MDM in 2014. The following information was gathered from MDM database: age, WHOPS, type of treatment, histology results including MGMT status, overall survival(OS). And verbal feedback obtained about supportive letters. RESULTS: 47 patients(50% increase comparing with 2012). Median age 78 yrs, PS (0-2)in 17 patients and (3-4)in 30 patients. 13 patients underwent surgery (8 debulking, 5 biopsy). Only 5 patients (post-op) were suitable for subsequent oncological treatment (2 had TMZ alone). 31 patients received palliative care only (Mean OS 2.3 months). 22 patients were not seen by neuro-oncology team(8 letters sent to local teams with satisfactory feedback). CONCLUSION: Patients with PS 3-4 would benefit from effective communication between MDT and local teams. On the other hand patients with PS 0-2 would benefit from multidisciplinary assessment prior to surgical intervention.