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the trajectory of symptom scores and performance status during the last months of life, an important issue is missed. More than 80% of patients with advanced cancer can develop delirium in the last days before death, and delirium is present in 26% to 44% of patients at the time of admission to an acute care hospital or palliative care unit. 2 If a patient is cognitively impaired, or for other reasons cannot participate in the symptom assessment, the Edmonton Symptom Assessment System (ESAS) is completed by the caregiver or professional. In that case, the subjective symptom scales (depression, anxiety, tiredness, and well-being) are left blank. 3 Seow et al states, "Scores were reported by the patient (ESAS) or provider (PPS [Palliative Performance Scale]) during visits to the cancer center or the home." If all of the ESAS were completed by the patient, we can deduce that a number of patients with delirium had to be excluded. It would be interesting to know if screening for delirium was performed, what tool was used, and how many patients were excluded for this reason.

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11509 Background: Older patients have increased risk of toxicity from chemotherapy. The purpose of this study was to analyse predictive factors for developing grade 3-5 toxicity in older patients treated with chemotherapy. Methods: This prospective multicenter study included 500 cancer patients ≥ 70 years between Feb 2014 and Jun 2018. A prechemotherapy assessment including sociodemographics, tumor/treatment variables, laboratory test results, and geriatric assessment variables (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status) was performed. Logistic regression was used to examine the association between these factors and the development of grade 3-5 toxicity. Results: Mean age of the patients was 77 years (70-92), ECOG PS 0/1/2: 25%/63%/12%. 223 (45%) had a primary dose reduction.167 (33%) patients developed grade 3-5 toxicity (28% grade 3, 5% grade 4, 1% grade 5). Univariate analysis found a higher risk of grade 3-5 toxicity in patients with creatinine clearance ≤ 60 mL/min, IADL ≤7, VES13 ≥ 6, and the administration of standard chemotherapy doses. In multivariable analysis, only the chemotherapy dose (odds ratio [OR] 1.179; 95% confidence interval [CI] 1.215–2.655) and creatinine clearance (odds ratio [OR] 0.989; 95% confidence interval [CI] 0.981–0.997) were independently associated with toxicity. Conclusions: Renal function and chemotherapy dose were significant predictors of grade 3-5 toxicity among older patients treated with chemotherapy.

Mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumor of the gastrointestinal tract that consists of a dual adenocarcinomatous and neuroendocrine differentiation. Frequently only one component is identified, leading to incomplete diagnosis and suboptimal treatment. This kind of tumors therefore constitutes a diagnostic challenge. They represent a minority of gastrointestinal neoplasms, being more frequent in the stomach, gallbladder and pancreas. Only a hundred cases have been described in the colon, and specifically only 6 cases in the transverse colon have been published in the English literature.