Impact Of Patient Age Research Articles

The Impact of Patient Age on the Acceptability of Telemedicine in the Context of COVID-19

The objective of the study was to determine the extent to which patients from various age groups perceive telemedicine as a viable mode of healthcare delivery in the context of COVID-19. A RedCap survey was sent to patients in our OB/GYN outpatient clinics with in-person, telemedicine, re-scheduled or cancelled appointments between 3/11/20 to 5/11/20. Patients’ online responses were analyzed using a 5-point Likert scale. Statistical analysis was performed using Chi-Square and Fischer’s Exact Analysis with p < 0.05 considered significant. A total of 1083 patients completed the survey of whom 280 (25.9%) had a telemedicine appointment. Patients answered questions relating to their telemedicine visit. While older patients did encounter a higher proportion of technological difficulties (p<0.0001), younger patients, specifically those in the 25-34 age group, expressed greater dissatisfaction with their appointment being changed to telemedicine than older patients (p=0.02), and felt that telemedicine did not accomplish the same goals as an in-person visit (p=0.01). Nonetheless, all patients, regardless of age, were satisfied with the introduction to telemedicine (p=0.02) and the instructions provided to them prior to the visit (p=0.02). Connectivity issues seem to be the biggest obstacle to older patients particularly when there is absence of a reliable internet connection and a telemedicine-compatible device. Younger patients, though less satisfied, are more comfortable with new technology and with using telemedicine; they tend to experience less connectivity issues. Our focus going forward should be on finding ways to simplify the process, overcome the connectivity issues while addressing the main reasons leading to patient dissatisfaction.

Processed electroencephalography: impact of patient age and surgical position on intraoperative processed electroencephalogram monitoring of burst-suppression.

We previously reported that processed EEG underestimated the amount of burst suppression compared to off-line visual analysis. We performed a follow-up study to evaluate the reasons for the discordance. Forty-five patients were monitored intraoperatively with processed EEG. A computer algorithm was used to convert the SedLine® (machine)-generated burst suppression ratio into a raw duration of burst suppression. The reference standard was a precise off-line measurement by two neurologists. We measured other potential variables that may affect machine accuracy such as age, surgery position, and EEG artifacts. Overall, the median duration of bust suppression for all study subjects was 15.4min (Inter-quartile Range [IQR] = 1.0-20.1) for the machine vs. 16.1min (IQR = 0.3-19.7) for the neurologists' assessment; the 95% limits of agreement fall within -4.86 to 5.04s for individual 30-s epochs. EEG artifacts did not affect the concordance between the two methods. For patients in prone surgical position, the machine estimates had significantly lower overall sensitivity (0.86 vs. 0.97; p = 0.038) and significantly wider limits of agreement ([-4.24, 3.82] seconds vs. [-1.36, 1.13] seconds, p = 0.001) than patients in supine position. Machine readings for younger patients (age < 65years) had higher sensitivity (0.96 vs 0.92; p = 0.021) and specificity (0.99 vs 0.88; p = 0.007) for older patients. The duration of burst suppression estimated by the machine generally had good agreement compared with neurologists' estimation using a more precise off-line measurement. Factors that affected the concordance included patient age and position during surgery, but not EEG artifacts.

Impact of Intensified Conditioning and DLI for Relapsed/Refractory Acute Leukemia: Real-World Data from China Registry

Background Patients with acute leukemia who become refractory to chemotherapy have poor prognosis, with limited therapeutic options. Intensified conditioning and DLI have shown improved survival and good tolerability in this patient cohort in clinical trials, but have never been tested in randomized trials and real world data are scarce. We aimed at analyzing the impact of clinical and treatment-related factors on transplant outcome in an unselected, population-based cohort.Methods Through the Chinese Blood and Marrow Transplantation Registry Group (CBMTRG), we identified 932 patients with refractory/relapsed acute leukemia receiving MSD or HID HCT during the period of 2003 to 2016. The median follow-up of survivors was 39 months.Results The 3-year leukemia free survival (LFS) rates were 40% for acute myeloid leukemia (AML) and 27% for acute lymphoblastic leukemia (ALL). In AML, LFS was not significantly improved with intensified conditioning alone (33% VS 41%, P=0.10), LFS was increased to 55% with the additional DLI (p=0.05, fig 1); In ALL, LFS was significantly improved with intensified conditioning alone (11% VS 30%, P=0.047), LFS was further increased to 51% with the additional DLI (p=0.004, fig 2). Multivariable analyses run separately in AML and ALL (Table). DLI was associated with a marked trend toward lower relapse, significantly lower NRM and higher LFS in AML and a significantly lower relapse and higher LFS in ALL in comparison to non-DLI, and no difference in ALL in terms of non-relapse mortality. Intensified conditioning was associated with a significantly lower relapse and higher LFS despite higher NRM in ALL in comparison to non-intensified conditioning; there was no impact of intensified conditioning in AML. In addition, HID was independently correlated with reduced relapse in both AML and ALL in comparison to MSD. Younger patient age was independently correlated with reduced NRM in both AML and ALL. Furthermore, in separate analyses in HID and MSD HCT, DLI had superior outcomes in both HID and MSD HCT while intensified conditioning only had influence on MSD outcomes; Similarly, the impact of patient age was only shown in MSD HCT. Besides, for AML patients with information on cytogenetics, poor cytogenetics resulted in higher relapse and lower LFS after MSD HCT in comparison to good or intermediate cytogenetics while there was no difference regarding cytogenetics in HID HCT.Conclusions These data suggest that both DLI and intensified conditioning improved outcomes and are valid options in the treatment of refractory/relapsed acute leukemia, with the role of DLI more prominent and more extensive. HID had more GVL effect than MSD in some circumstances. By a population-based approach (the largest for HID group) from the real-world data, we were able to provide novel data on transplant outcomes in refractory/relapsed acute leukemia, applicable to routine clinical practice outside the setting of clinical trials. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Evaluation of treatment-associated eye toxicity after irradiation in childhood and adolescence\u2014results from the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK)

PurposeThe aim of the study is to evaluate treatment-related acute and late eye toxicity associated with radiation therapy in childhood and adolescence as correlated with RT (radiotherapy) doses.MethodsFrom 2001 to 2016, a total of 1725 children and adolescents undergoing radiation therapy were prospectively documented in the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK). The RTOG/EORTC criteria were used to classify ocular acute and late effects. Uni- and multivariate analyses were carried out to evaluate the impact of patient age, pre-existing impairments, and radiation dose on ocular toxicity.ResultsOf all documented patients, 593 received dose to the eye and formed the basis of this analysis. In 435 patients, information on acute reaction was available and graded 1, 2, 3, and 4 in 49, 17, 0, and 2 patients, respectively. Information on late toxicity was available in 268 patients and graded 1, 2, 3, and 4 in 15, 11, 11, and 5 patients, respectively. The acute toxicity rate was significantly higher in children who received a maximum dose > 50 Gy to the eye (p < 0.001) and who had a pre-existing eye impairment (p < 0.001 in multivariate analysis). The development of late toxicity was significantly higher for patients experiencing acute toxicity and having received a radiation dose > 50 Gy.ConclusionAcute and late toxicity both correlate with high radiation dose to the eye (> 50 Gy) and acute toxicity additionally with pre-existing eye impairments.

Long-term effects of zonisamide in adult patients with intellectual disability.

This study aimed to evaluate the tolerability and efficacy of zonisamide (ZNS) in adult patients with drug-resistant epilepsy and intellectual disability (ID) at our epilepsy centre. By conducting a monocentric, open-label observational study based on standardized seizure records we retrospectively assessed 87 patients (39 female, mean age 40.6±13.6, range 18-75years) with ID and drug-resistant epilepsy. Evaluation, including calculation of retention rate, was performed for the intervals 3-6, 9-12 and 21-24months after ZNS initiation. The Clinical Global Impressions Scale-Improvement (CGI-I) was used to detect qualitative changes in seizure severity and clinical status. Via regression analysis and the generalized estimating equations approach, we examined changes in body weight and impact of patient age also considering associations with other patient characteristics. The retention rate after 24months was 60%. 28% discontinued ZNS therapy due to increasing seizure frequency, lack of efficacy or adverse events (AEs). Sedation (38%), language impairment (19%), challenging behaviour (10%), mild rash (10%) and dizziness (10%) were the commonest AEs. The responder rate was 40%, eight patients (9%) became seizure free. We found CGI-I to be dose-dependent. Regarding changes in body weight, we observed no difference between patients continuing or withdrawing ZNS therapy and responders or non-responders. Though, we identified older age as a significant risk factor for weight loss. Zonisamide may provide a safe and efficient therapeutic option for patients with ID and drug-resistant epilepsy. However, weight status should be carefully monitored, especially in elderly patients.

The impact of patient age and procedure type on postoperative opioid use following ambulatory pediatric urologic procedures.

The aim of this study is to determine whether patient age and procedure type are associated with duration of opioid use in pediatric patients undergoing ambulatory urologic procedures. We retrospectively reviewed pediatric patients who underwent outpatient urologic procedures from 2013 to 2017. At postoperative visits, parents reported the number of days their child took opioid pain medication. Factors associated with duration of opioid use were evaluated using negative binomial regression models. 805 patients were included: 320 infants (39.8%), 430 children (53.4%), and 55 adolescents (6.8%). Overall mean length of opioid use was 1.7 (± 2.6) days. On average, infants used opioids for the shortest duration: 1.5 (± 2.3) days, followed by children: 1.7 (± 2.5) days, and adolescents: 3.1 (± 4.6) days. In adjusted models, adolescents used opioids for 85.2% longer (95% CI 13.1-161.8%; p < 0.001) than children and infants used opioids for 19.4% shorter duration (95% CI 0.4-34.7%; p = 0.05) than children. Each 1-year increase in age was associated with 6.1% increased duration of opioid use (95% CI 3.9-8.5%; p < 0.0001). Patients who underwent circumcision, hypospadias repair, and penile reconstruction took opioids for 75.9% (95% CI 42.6-117.1%; p < 0.001), 144.2% (95% CI 76.4-238.0%; p < 0.001), and 126.7% (95% CI 48.8-245.3%; p < 0.001) longer respectively than patients who underwent inguinal procedures. Increasing age, circumcision, hypospadias repair, and penile reconstruction are associated with increased duration of opioid use.

The Impact of Patient Age ≥80 Years on Postoperative Outcomes and Treatment Costs Following Pancreatic Surgery.

As life expectancy is increasing, elderly patients are evaluated more frequently for resection of benign or malignant pancreatic lesions. However, the impact of age on postoperative morbidity, mortality, and treatment costs in octogenarian patients (≥80 years) undergoing major pancreatic surgery needs further investigation. The clinicopathological data of patients who underwent pancreatic surgery between January 2015 and March 2019 in a major hepatopancreatobiliary center in Switzerland were assessed. Postoperative outcomes and hospital costs of octogenarians and younger patients were compared in univariate and multivariate regression analysis. During the study period, 346 patients underwent pancreatic resection. Pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, and other procedures were performed in 54%, 20%, 13%, and 13% of patients, respectively. The major postoperative morbidity rate and postoperative mortality rate were 25% and 3.5%, respectively. A total of 39 patients (11%) were ≥80 years old, and 307 patients were <80 years old. The majority of octogenarians suffered from ductal adenocarcinoma, whereas among younger patients, other indications for a pancreatic resection were predominant (ductal adenocarcinoma 64% vs. 41%, p = 0.006). Age ≥80 was associated with more frequent postoperative medical (pulmonary, cardiovascular) and surgical (high-grade pancreatic fistula, postoperative hemorrhage) complications. Postoperative mortality was significantly higher in octogenarians (15.4% vs. 2%, p < 0.0001). This finding may be explained by the higher rate of type C pancreatic fistula (13% vs. 5%), resulting more frequently in postoperative hemorrhage (18% vs. 5%, p = 0.002) among patients ≥80 years old. In the multivariate logistic regression analysis, patient age ≥80 years predicted postoperative mortality independently of the tumor entity and surgical technique (p = 0.013, OR 6.71, 95% CI [1.5–30.3]). Increased major postoperative morbidity was responsible for lower cost recovery in octogenarians (94% vs. 102%, p = 0.046). In conclusion, patient age ≥80 years is associated with increased postoperative medical and surgical morbidity after major pancreatic surgery leading to lower cost recovery and a lower chance for successful resuscitation in patients requiring revisional surgery for postoperative hemorrhage and/or pancreatic fistula. In octogenarian patients suffering from pancreatic tumors, careful selection, and thorough prehabilitation is crucial to achieve the best postoperative and long-term oncologic outcomes.

Impact of patient age on outcome after resection for hepatocellular carcinoma

There is little information on the impact of aging on liver resection of hepatocellular carcinoma (HCC). The aim of study was to evaluate the prognostic impact of the patient's age on the long-term survival after resection of HCC. The postoperative outcomes of the 291 elderly (≥ 70 years) and 340 younger (< 70 years) patients underwent curative liver resection for HCC were analyzed using multivariate and propensity-score matching. Risk score were calculated from the results of Cox regression analysis. The overall survival rate was significantly lower in the elderly group than that in the younger group (p = 0.01). Factors related to overall survival were vascular invasion (absent vs. present, HR 2.25; 95% CI 1.52-3.33, p = 0.0001), albumin level (< 3.0 vs. ≥ 3.0 g/dl, HR 2.23; 95% CI 1.31-3.79, p = 0.003), and number of tumors (solitary vs. multiple, HR 1.68; 95% CI 1.24-2.27, p = 0.001). The results of risk-score analysis with a Cox proportional-hazards model indicated that the proportion of poor-risk patients was significantly higher in the elderly than in the younger group. Propensity-score matching analysis yielded 234 pairs of patients. There were no significant differences in baseline profiles or risk scores between the two groups (p = 0.43). There were also no significant differences in the overall survival between the two groups (p = 0.23). Advanced age does not have a significant impact on the outcomes of patients after resection of HCC.

Likelihood of Proceeding to Allogeneic Hematopoietic Cell Transplantation in the United States after Search Activation in the National Registry: Impact of Patient Age, Disease, and Search Prognosis

The National Marrow Donor Program (NMDP) operates the Be The Match Registry to serve patients who require an allogeneic hematopoietic cell transplant (alloHCT). The factors that result in progression of an active donor search (ie, request for tissue typing or stem cell donation) to alloHCT are poorly understood. Some factors, such as differences in access by ethnic group, are known; however, deeper understanding of other patient and search factors is needed. Our study sought to identify the likelihood of patient progression from initiation of an active search for an unrelated adult donor/umbilical cord blood to transplant and to evaluate factors associated with proceeding to transplantation within 6 months. A retrospective cohort of US donor searches (ie, transplant center's first request of donor/cord blood unit testing; N=8816) of the Be The Match Registry from January to December 2016 was analyzed. An adult unrelated donor search prognosis score, which categorizes the prognosis of the donor search as good, fair, or poor based on the patient HLA type and race/ethnic group, was included. At 6 months, 3744 (42%) patients had received a transplant. White patients were more likely to receive a transplant (n=2590 of 5687, 45%) compared to black/African American patients (n=187 of 700, 27%; P < .001). In multivariate analysis, the adult unrelated donor search prognosis score was associated with proceeding to adult donor or cord blood transplant within 6 months across all patient populations. A poor search prognosis score had an odds ratio (OR) of 0.32 (95% confidence interval [CI], 0.26 to 0.39, P < .001), 0.22 (95% CI, 0.09 to 0.54, P=.001), 0.39 (95% CI, 0.23 to 0.65, P < .001), and 0.26 (95% CI, 0.14 to 0.45, P < .001) for adults with malignant disease, adults with nonmalignant disease, children with malignant disease, and children with nonmalignant disease, respectively. This study identified important factors in the likelihood of a patient proceeding to HCT and suggests areas for future intervention to reduce the barriers to transplant.

96 Impact of Patient Age, Presentation Time and Complaint on Door to EKG and Door to Balloon Times for ST-Elevation Myocardial Infarctions

96 Impact of Patient Age, Presentation Time and Complaint on Door to EKG and Door to Balloon Times for ST-Elevation Myocardial Infarctions

Distribution and impact of age in patients with implantable cardioverter-defibrillators regarding early complications and 1-year clinical outcome: results from the German Device Registry

Patients receiving implantable-cardioverter-defibrillators (ICD) in clinical practice are often older or younger than in clinical trials. Whether older patients benefit from ICD-therapy in a similar way as younger patients is under debate. The objective of this study was to provide real-world data regarding outcomes with respect to age in a large cohort in the German Device Registry. Within the registry data from 50 German centers were collected between January 2007 and February 2014. Our analysis included 3239 ICD patients representing a group of young (28%; group I: < 58years), intermediate aged (50%; group II: 58-74years), and elderly patients (22%; group III: 75-92years). Intergroup comparison of all groups was performed followed by individual comparison vs. group II serving as age-reference group. Procedure-related complications did not differ between all groups. Analysis of the primary endpoint, 1-year all-cause mortality, revealed an increased mortality in the elderly and a decreased mortality in the young cohort vs. the reference group II (group I 2.1%, group II 6.2%, group III 13.2%; p< 0.001). While all-cause rehospitalizations did not differ, we observed a difference in reported device revisions showing more device revisions required in younger patients (group I 8.9%, group II 6.8%, group III 4.0%; p= 0.001). One-year mortality was doubled in elderly ICD patients probably due to non-cardiac causes. These results further underpin the need for re-evaluating the primary prevention ICD indication in octo- and nonagenarians. Young patients show lower mortality rates but seem to bear higher risk of device-related complications, which highlights the need for improved measures to reduce device-related complications in the young.

Stable patients with schizophrenia switched to paliperidone palmitate 3-monthly formulation in a naturalistic setting: impact of patient age and disease duration on outcomes.

Background:Paliperidone palmitate 3-monthly (PP3M) is a second-generation, long-acting injectable antipsychotic formulation indicated for the maintenance treatment of adults with schizophrenia first stabilized with paliperidone palmitate 1-monthly (PP1M). This exploratory post hoc subgroup analysis of the 52-week, phase 3b REMISSIO study analysed outcomes according to patient age and disease duration in a naturalistic clinical setting.Methods:Outcomes of patients with schizophrenia were analysed according to age [<35 years (n = 123) versus ⩾35 years (n = 182)] and disease duration [⩽3 years (n = 72) versus >3 years (n = 233)]. The primary efficacy outcome was the proportion of patients achieving symptomatic remission according to the Andreasen criteria. Adverse events were monitored throughout the study.Results:At endpoint (last observation carried forward), 60.7% (95% CI: 51.4%, 69.4%) of younger patients and 54.1% of older patients (95% CI: 46.6%, 61.6%) achieved symptomatic remission. The proportions for patients with disease duration ⩽3 years and >3 years were similar: 57.8% (45.4%, 69.4%) versus 56.5% (49.8%, 62.9%). Functional remission was reached by 45.4% (36.2%, 54.8%) of patients aged <35 years and 36% (28.9%, 43.6%) of patients aged ⩾35 years with a similar pattern when analysed by disease duration. PP3M had a favourable safety profile and was generally well tolerated in both age groups.Conclusion:Patients with schizophrenia, previously stabilized on PP1M, may benefit from PP3M treatment with some additional potential improvements if started early in the disease course.Clinical trials.gov:NCT02713282

DISCORDANCE IN GOALS OF CARE BETWEEN PATIENTS WITH ADVANCED CANCER AND THEIR CAREGIVERS: DOES AGE PLAY A ROLE?

Cancer is considered a family disease as the caregivers (CG’s) role extends beyond providing care as they can also help facilitate treatment decisions. While much has been reported in the literature about patient (PT) goals of care (GoC), little is known about discordance between PT and CG GoC and the impact of PT age. The variables of interest were PT and CG identified GoC using a 100-point visual analog scale (VAS) with anchors of quality of life (0) and survival (100). Discordance was defined as a > 40 point difference on the VAS. The GoC data reported here were those obtained at enrollment and prior to subject’s death. A sample of 235 PTs and CGs of PTs diagnosed with advanced cancers were included in the study. Mean age for the PTs was 64.7 (SD=10.5, range =21-88) with 54% being > 65. At enrollment, 28.7% of the PT-CG pairs of those PTs 65 years (X2 (1)=1.06, p=.304). At death, 61.8% (X2 (1)=31.04 <.001, Φ=.49) with discord at enrollment had discord at death. For patients who were older, 66.7% who had discord at enrollment also had discord at death and for patients

P1.12-08 The Impact of Patient Age and Socioeconomic Factors on Clinical Outcomes in Small Cell Lung Cancer (SCLC): A National Study

SCLC represents one of the most aggressive cancers with limited treatment options. Chemotherapy with or without radiation therapy remain the backbone treatment for this challenging disease. The impact of age and other socioeconomic factors on treatment modalities and clinical outcomes remain largely unknown. This study investigates the demographic, clinical, socioeconomic, and treatment modalities in each age group and the impact of patients’ age on survival. The National Cancer Database with NSCLC incident cases between 2004-2014 was used. Clinical factors including Charlson-Deyo comorbidity score, TNM staging, tumor histology, and type of treatment, demographic features, socioeconomic status and overall survival (OS) were analyzed by age of diagnosis, accounting for multivariate factors in NCDB. A total of 214,096 SCLC patients were included in the analysis. Median age at diagnosis was 67 years old (y/o). OS including all stages is 10.97 months for <60 y/o; 9.43 months for 60-69 y/o; 7.20 months for 70-79 y/o and 3.42 months for ≥80 y/o respectively (p<0.0001). The impact of age on survival is more prominent in stage I, II and III patients than those in stage IV patients. Patients ≥80 y/o are associated with significant smaller tumor size (41 mm vs 50 mm, p<0.0001) and more stage I cancer at diagnosis (3.8% vs 6.9%, p<0.0001) compared to patients <60 y/o respectively. Patients ≥ 80 y/o are associated with high income, high education and Pacific geographic region. Hispanics, Asians, females, and patients younger than 60 y/o are independently associated with improved OS. Despite comparable comorbidity, patients with ≥80 y/o are treated differently and received much less aggressive therapy including radiation therapy and/or chemotherapy at each stage (p<0.0001). The overall survival of SCLC is significantly impacted by patient’s age and socioeconomic factors. In particular, elderly patients are associated with significantly smaller tumor size, more stage I at diagnosis, however, they are under-treated and have worse survival compared to younger patients.

Physical and Psychological Effectiveness of Cardiac Rehabilitation: Age Is Not a Limiting Factor!

BackgroundThere is little data regarding the impact of patient age on the physical and psychological effectiveness of cardiac rehabilitation (CR). The aim of the present study was therefore to compare the effects of an exercise-based CR program on physical and psychological parameters in young, old, and very old patients. We also aimed to identify the features that best predicted CR outcome. MethodsA total of 733 patients were divided into 3 subgroups: YOUNG (< 65 years old), OLD (between 65 and 80 years old), and VERY OLD (≥ 80 years old). Physical variables such as peak workload and estimated peak VO2 as well as psychological variables such as scores of anxiety and depression were evaluated for all patients before and after CR. ResultsPerformance in all tests and scores for all questionnaires were significantly improved in all patients (P < 0.05). Age was significantly correlated with all the initial values (P < 0.05) but not with post-CR values. In addition, lower initial values of peak workload were associated with larger post-CR improvements irrespective of age. However, higher pre-CR anxiety and depression scores were associated with greater post-CR increases in physical performance in YOUNG and OLD patients, respectively. ConclusionsCR induced significant improvements of physical and psychological parameters for all patient groups. More interestingly, our results suggest that patients with the greatest physical impairments at baseline would benefit the most from CR, whatever their age. However, the value of initial mental state as a predictor of post-CR improvement depends on the age of the patient.

PO503 Impact of Patient Age and Gender On Primary Care Physician Adherence to National Guidelines For Common CVD

PO503 Impact of Patient Age and Gender On Primary Care Physician Adherence to National Guidelines For Common CVD

P1.15-18 The Impact of Patient Age on Clinical Outcomes in NSCLC: A National Study

P1.15-18 The Impact of Patient Age on Clinical Outcomes in NSCLC: A National Study

Impact of Patient Age on Molecular Alterations of Left-Sided Colorectal Tumors.

The incidence of colorectal cancer (CRC) in younger patients is rising, mostly due to tumors in the descending colon and rectum. Therefore, we aimed to explore the molecular differences of left-sided CRC between younger (≤45 years) and older patients (≥65). In total, 1,126 CRC tumor samples from the splenic flexure to (and including) the rectum were examined by next-generation sequencing (NGS), immunohistochemistry, and in situ hybridization. Microsatellite instability (MSI) and tumor mutational burden (TMB) were assessed by NGS. Younger patients (n = 350), when compared with older patients (n = 776), showed higher mutation rates in genes associated with cancer-predisposing syndromes (e.g., Lynch syndrome), such as MSH6 (4.8% vs. 1.2%, p = .005), MSH2 (2.7% vs. 0.0%, p = .004), POLE (1.6% vs. 0.0%, p = .008), NF1 (5.9% vs. 0.5%, p < .001), SMAD4 (14.3% vs. 8.3%, p = .024), and BRCA2 (3.7% vs. 0.5%, p = .002). Genes involved in histone modification were also significantly more mutated: KDM5C (1.9% vs. 0%, p = .036), KMT2A (1.1% vs. 0%, p = .033), KMT2C (1.6% vs. 0%, p = .031), KMT2D (3.8% vs. 0.7%, p = .005), and SETD2 (3.2% vs. 0.9%, p = .039). Finally, TMB-high (9.7% vs. 2.8%, p < .001) and MSI-high (MSI-H; 8.1% vs. 1.9%, p = .009) were more frequent in younger patients. Our findings highlight the importance of genetic counseling and screening in younger CRC patients. MSI-H and TMB-high tumors could benefit from immune-checkpoint inhibitors, now approved for the treatment of MSI-H/deficient mismatch repair metastatic CRC patients. Finally, histone modifiers could serve as a new promising therapeutic target. With confirmatory studies, these results may influence our approach to younger adults with CRC. The increasing rate of colorectal cancers (CRC), primarily distal tumors, among young adults poses a global health issue. This study investigates the molecular differences between younger (≤45 years old) and older (≥65) adults with left-sided CRCs. Younger patients more frequently harbor mutations in genes associated with cancer-predisposing syndromes. Higher rates of microsatellite instability-high and tumor mutational burden-high tumors occur in younger patients, who could benefit from immune-checkpoint inhibitors. Finally, histone modifiers are more frequently mutated in younger patients and could serve as a new promising therapeutic target. This study provides new insights into mutations that may guide development of novel tailored therapy in younger CRC patients.

Impact of Patient Age and Histological Type on Radioactive Iodine Avidity of Recurrent Lesions of Differentiated Thyroid Carcinoma.

Age is a prognostic factor for recurrent differentiated thyroid carcinoma (DTC) and may be related to radioactive iodine (RAI) nonavidity. Indications for molecular-targeted drugs (MTDs) are currently limited to RAI-refractory DTC. Demonstrating refractoriness to RAI, mainly indicated by RAI nonavidity, may be a barrier to the introduction of MTDs for elderly patients. The present study was conducted to evaluate the impact of age and histological type on the RAI avidity of recurrent lesions of DTC. Two hundred fifty-eight patients (189 patients with classic papillary thyroid carcinoma [cPTC], 8 patients with follicular variant of papillary thyroid carcinoma, and 61 patients with follicular thyroid carcinoma), who underwent their first RAI whole-body scanning for recurrent DTC at our institution between 2004 and 2013, were retrospectively studied. Radioactive iodine uptake was determined by visible uptake by metastatic lesion(s) in a diagnostic RAI-whole-body scan. The prevalence of RAI-avid lung metastases in cPTC indicated a significant, inverse correlation with age (<55 years, 36.2%; ≥55 years, 3%; P < 0.001). By contrast, for follicular thyroid carcinoma, the prevalence of RAI avidity was not influenced by age. Similar tendencies were observed for lymph node metastases. Radioactive iodine avidity by metastatic lesions of cPTC in elderly patients, especially those older than 55 years, was seldom demonstrated. Adherence to a strategy of restricting MTD administration after confirmation of RAI refractoriness should be revisited for elderly patients. A strategy of omitting RAI treatment should be taken into account when considering age and histological type.

The impact of patient age on toxicity and efficacy of immunotherapy agents.

e15116 Background: Little data exists for the use of immune checkpoint inhibitors (ICI) in patients ≥80y old. Ageing is associated with immunosenescence, which may impact the efficacy and toxicity of immune-based therapies. Here we provide efficacy and immune related adverse event (irAE) data for patients ≥80y old and younger patient cohorts treated in routine clinical practice at 3 UK Cancer Centres: Guy’s and St Thomas’ NHS Foundation Trust, Oxford University Hospitals NHS Foundation Trust and University Hospitals of Leicester NHS Trust. Methods: Melanoma, renal cell carcinoma (RCC), non-small cell lung cancer (NSCLC) and urothelial carcinoma (UC) patients treated with ICIs between March 2016 – August 2018 were identified, and divided into five age-defined cohorts: &lt; 50y, 50-59y, 60-69y, 70-79y, ≥80y. Median progression free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method with data censored on 5th February 2018. Frequency and severity of five common irAEs were determined: hepatitis, endocrinopathies, immune-related gastrointestinal, skin and rheumatological. Results: 386 patients aged 22 – 98y (median 67y) received single-agent nivolumab (21%), pembrolizumab (62%), ipilimumab (10%) or combination ipilimumab and nivolumab (7%). 12% of patients were aged &lt; 50y, 18% were 50-59y, 29% were 60-69y, 28% were 70-79y and 13% were ≥80y. Response rates (partial + complete response) were similar across all age groups (53% &lt; 50y, 29% 50-59y, 48% 60-69y, 43% 70-79y and 47% ≥80y). Median PFS was 10.6, 10.3, 10.0, 5.8 and 19.7 months and OS was not reached, not reached, 29.0, 18.3, and 20.9 months for patients &lt; 50y, 50-59y, 60-69y, 70-79y and ≥80y, respectively. The rate of any grade irAEs was lowest in patients ≥80y (59%), and highest in patients &lt; 50y (92%). Grade 3-5 irAEs were also less frequent in patients ≥80y (10%) than those &lt; 50y and 60-69y (both 18%). Conclusions: Of 386 patients 13% were ≥80y with response rates comparable to younger patient cohorts and rates of irAEs lower than younger patient cohorts in this retrospective analysis of a heterogenous patient population. Our data suggests that ICIs are well-tolerated and efficacious in elderly patients and that age alone should not preclude ICI use.