Background Team-based and timely integrated palliative care is a gold standard of care in oncology, but issues concerning its optimal organization remain. Palliative Care in Day-Hospital (PCDH) could be one of the most efficient service model of palliative care to deliver interdisciplinary and multidimensional care addressing the complex supportive care needs of patients with advanced cancer. We hypothesize that, compared to conventional outpatient palliative care, PCDH allows the clinical benefits of palliative care to be enhanced. Methods/design This study is a multicentre parallel group trial with stratified randomization. Patient management in PCDH will be compared to conventional outpatient palliative care. The inclusion criteria are advanced cancer patients referred to a palliative care team with an estimated life expectancy of more than 2 months and less than 1 year. The primary endpoint is health-related quality of life with deterioration-free survival based on the EORTC QLQ-C30 questionnaire. The secondary objectives are the following: increase in patient satisfaction with care using the EORTC PATSAT-C33 and OUT-PATSAT7 questionnaires, better understanding of the prognosis using the PTPQ questionnaire and advance care planning; decrease in the need for supportive care among relatives using the SCNS-P&C-F questionnaire, and reduction in end-of-life care aggressiveness. Patients will complete one to five questionnaires on a tablet before each monthly visit over 6 months and will be followed for 1 year. A qualitative study will take place, aiming to understand the specificity of palliative care management in PCDH. Cost-effectiveness, cost-utility and, an additional economic evaluation based on capability approach will be conducted from a societal point of view. Discussion The first strength of this study is that it combines the main relevant outcomes assessing integrated palliative care; patient quality of life and satisfaction; discussion of the prognosis and advance care planning, family well-being and end-of-life care aggressiveness. The second strength of the study is that it is a mixed-method study associating a qualitative analysis of the specificity of PCDH organization, with a medical-economic study to analyse the cost of care. Trial registration Name of the registry: IDRCB 2019-A03116–51 Trial registration number:NCT04604873 Date of registration: October 27, 2020 URL of trial registry record

e18326 Background: Supportive care in cancer (SCC) may create a financial burden, compared to a standard cancer department. In 2011, a specific SCC inpatient unit was developed in an academic hospital, based on a multidisciplinary approach in order to anticipate patient’s disability and limit emergency hospitalization. Assess the cost effectiveness of the SCC unit expenses and benefits compared to Medical (MO) and Gastro-Intestinal (GI) oncology departments. Methods: Data were analyzed over a six year period (2011-2016). Cost of hospital stays and cost per year were calculated based on the hospital’s standard cost accounting method. Hospital benefits were calculated as the difference between total incomes and total expenses (cost and Diagnosis Related Group tariffs for the stay) and results were compared (period available for comparison 2011 to 2014). Results: Total costs for the hospital, primarily due to staff expenses, were lower for the SCC unit compared to MO and GI in 2011 and 2014, as well as the daily cost per stay (DCS). Benefit per year was also higher for the SCC unit permitting it, to benefit financially compared to the two other oncology units (Table). Incomes reimbursed by the National Health system for SCC unit were 1,632,601 euros in 2015 and 2,096,285 euros in 2016 with a total of 357 and 408 patients admitted in the 8 bed SCC unit in 2015 and 2016 respectively. Conclusions: The SCC unit was less expensive to operate compared to our other oncology units. Our results suggest that its development permitted the oncology department to enhance its quality of care without any additional expenses. [Table: see text]

The management of older patients with breast cancer, a public health issue, remains a highly topical subject. Among this heterogeneous population, only few studies have focused on outcomes of older women treated with exclusive radiation therapy for localized BC. This retrospective study provides data concerning the efficacy and safety of exclusive RT, as well as the impact of comorbidities according to the Charlson Comorbidity Index on survival in this subset of women not suitable for surgery or who have refused it. This analysis demonstrates that this treatment is well-tolerated; however, the prognosis is strongly impacted by age and comorbidities. K E Y W O R D Sbreast cancer, comorbidities, older women, radiation therapy | 977 CAO et Al.

Introduction: This study aimed to assess the efficacy, tolerance and impact of comorbidities on outcomes in older women treated by exclusive radiation therapy (RT) for non-metastatic breast cancer (BC). Material and methods: We studied retrospectively female patients older 70 years at diagnosis, treated by exclusive RT for their BC between 2003 and 2013 in our Department. We analysed overall survival (OS), progression free survival (PFS), and specific survival (SS). Comorbidities were evaluated with the Charlson Comorbidity Index (CCI), and toxicities with the CCTCAE v3.0. Results: Between 2003 and 2013, there were 978 patients older than 70 treated for BC in our Hospital, and 817 received RT. Hypofractionated RT was delivered in 90.2% of patients. Of them, 66 patients underwent exclusive RT after refusal of surgery. The median age was 84.8 [71.3-91.7]. The median follow-up was 51.9 months [0.5- 99]. OS, SS and PFS at 5 years were 65.5% CI 95% [54.1-79.3], 86.3% CI 95% [77.2-96.4]), and 58.4% CI 95% [46.9-72.7], respectively. Five-year OS was statistically different according to age younger or older than 85 years: 72.9% CI 95% [58.4-91.1] and 57.1%, IC 95% [40.8-79.8], (p = 0.0026). Similar results were found for 5-year PFS: 64.5% CI 95% [49.5-84.1] and 51.6% CI 95% [35.8-74.5] (p = 0.014). The 5-year OS was also statistically different according to CCI score, respectively 70.8% CI 95% [57.0-87.9] and 59.8% CI 95 % [42.4-84.3] (p = 0.039) for a score of 0 or ≥ 1. Median CCI score was 1. There were 10.6% of the patients who experienced no toxicities; there were 59% who presented grade 1 and 2 radiodermatitis. Late toxicities were mainly fibrosis, observed in 39.4% of the patients, mostly of grade 1 and 2.Conclusion: Exclusive radiation therapy for non-metastatic BC in older women is feasible and well tolerated when adapted techniques are used, but the prognostic is strongly impacted by age and comorbidities. Citation Format: Lorraine Waechter, Kim Cao, Matthieu Carton, Youlia Kirova, Alain Fourquet. Outcomes of exclusive radiation therapy for breast cancer in older women according to age and comorbidity status: An observational retrospective study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-12.

10120 Background: The PROCHE [Programme for optimisation of the chemotherapy network] initiative is an innovative oncology-monitoring program designed to reduce patient waiting time and chemotherapy wastage, ultimately improving patient care. Methods: Primary objective was to evaluate the incidence of nausea reported by grade (NCI-CTC AE: from 0 to 4) from 2008 to 2016. Association was quantified using Mantel-Haenszel khi2 and exact p-values. Secondary objective compared the 2009-2016 patients with the control patients of 2008 period. Results: Between Oct 2008 and Oct 2016, 3012 patients participated in the program, representing 36 803 questionnaires completed over the whole period. Nausea was, clinically and statistically, significantly improved during the whole follow-up period with a decrease of grade 3-4 from 0.6% to 0.08% and a decrease of grade 1-2 from 29.3% to 8.2%. The already adapted nausea management in 2008 with 70% of questionnaires reported no nausea improved to 92% in 2016, with a 10% improvement the year after program initiation. As MASCC propose to change guidelines with an improvement above 10%, such an organization may impact new recommendations. Conclusions: Anticipating anti-cancer treatment adaptation and prevention, following guidelines and using adapted antiemetics, explain these positive results. The PROCHE initiative improves chemotherapy induced nausea. [Table: see text]