Disparity in use of supportive resources in elderly patients on chemotherapy for gastrointestinal malignancies: A single institution analysis.

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102 Background: Chemotherapy has clinical benefit for elderly patients with careful selection. Selection is based on ECOG Performance Status determination. Patients with ECOG PS of 0-2 are considered chemotherapy candidates whereas patients with PS > 3 are considered unlikely to benefit from it. Recommended tools such as a Comprehensive Geriatric Assessment (CGA) to help stratify patients further are not widely adopted. This study looks at disparity in use of supportive resources in patients > 65 years of age undergoing chemotherapy at the Virginia Commonwealth University (VCU) Hospital. Methods: We conducted a retrospective analysis for all patients 65 and above with gastrointestinal malignancies (gastroesophageal, colorectal, and pancreatic) treated between January 2005 and July 2016 that received chemotherapy in any setting. ECOG performance status at initiation of therapy was required. Data collected on receipt of supportive resources such as Physical Therapy (PT), Occupational Therapy (OT), Nutrition, Mental Health, Geriatrics and Palliative Care. Exact Pearson’s chi-square tests were used for comparison of services and ECOG PS, race, etc. Results: 226 patients met criteria. Majority of patients were male (56%), white (63%) and had advanced malignancies (80% Stage III/IV disease). Mean age was 72.2 (SD = 5.6). ECOG PS was ≤1 in 88% and ≥2 in the remainder. 61% of patients utilized at least one resource (Palliative care: 46%, Nutrition: 21%, Mental Health: 15%, PT: 13%). Patients with an ECOG PS 0 or 1 tended to use more services; nutrition statistically significant (p = 0.037). Racial disparities observed in receipt of PT (P = 0.002), mental health (P = 0.012), palliative care (P = 0.039) with white patients more likely to receive the service in each case. More white than non-white patients received services (66% vs. 55%, P = 0.067). Conclusions: ECOG PS 0 or 1 correlated with increased utilization as compared to less robust ECOG 2 patients; tools such as CGA for appropriate service allocation are needed. We identified racial disparity in the utilization of certain services and these need further exploration, including patters for referral of these services as a factor.