S14INFECTIOUS COMPLICATIONS IN PATIENTS WITH CLLVicki Morrison1

1Hem/Onc & Inf Dis, University of Minnesota, VAMC, Minneapolis, MN,United States

Abstract: Infectious complications continue to be a major cause ofmorbidity and mortality in patients with chronic lymphocyticleukemia (CLL). The pathogenesis of infections in these patients ismultifactorial, related to inherent immune defects and therapy-relatedimmunosuppression. Hypogammaglobulinemia is an important pre-disposing factor for infection in all patients. The use of the purineanalogs as fludarabine, and monoclonal antibodies as rituximab andalemtuzumab, has introduced a new spectrum of infectious complica-tions caused by pathogens as Pneumocystis, Listeria, mycobacteria,herpesviruses Candida, and Aspergillus, related to the cellular immunesuppression induced by these agents. In this discussion, we will focuson the pathogenesis and risk factors for infections in patients with CLL,the spectrum of infectious complications, and preventive approachesto infection in these patients, utilizing antimicrobial and immuno-globulin prophylaxis and vaccination strategies.

Disclosure of interest: None declared

Keywords: None

doi:10.1016/j.jgo.2014.09.015

S15SOCIAL AND CULTURAL DETERMINANTS OF HEALTH IN ELDERLYCANCER PATIENTSLea Baider11Onkology, Hadassah University Hospital, Jerusalem2Clinical Oncology and Radiotherapy, AssutaMedical Center, Tel-Aviv, Israel

Abstract: Health policies, social and economical resources varysubstantially between cultures, societies and family norms of behavior.

The illness appraisal and psychological behavior of the elderlypatients diagnosed with cancer are determined by their familyculture and their ecological environment.

Presentations will focus on factors as level of education, socialcohesion, religious beliefs, norms of behavior, cultural perception ofillness, as fundamental determinants of illness and health in theelderly patient.

Disclosure of interest: None declared

Keywords: None

doi:10.1016/j.jgo.2014.09.016

S16SOCIAL AND CULTURAL DETERMINANTS OF HEALTH IN ELDERLYCANCER PATIENTSAntonella Surbone11Department of Medicine, New York University Medical School, 550 FirstAvenue, BCD 516, New York, NY 10016, USA

Abstract: Studies in the U.S. and other Western countries indicatethat socio-economic status (SES), gender, age and culture arepredictors of access to and outcome of good cancer care. In Westernsocieties, the elderly are seen through the prism of ageism, a socio-

cultural distorted way of undervaluing older people when they ceaseto be productive. This in turn leads to social isolation, poverty and poorhealth in many elderly, for whom access to cancer care is especiallydifficult, and survival and QoL are worse than in adult patients.

Elderly patients with cancer are often underdiagnosed orundertreated on the biased assumption of their intrinsic fragilityand lack of autonomy and compliance. By contrast, fragility is aspecific medical syndrome affecting a limited number of elderlypeople. Elderly cancer patients cope efficiently with their illness and,when not mentally incapacitated, are capable of fully autonomousdecision-making. Yet many of them are not informed aboutscreening or standard or experimental treatments as adult patients.Receiving less accurate information hinders elderly cancer patients'ability to make informed decision about their care. As clinicians, wetherefore need to learn and foster non-discriminatory practices incommunication and care in geriatric oncology.

Disclosure of interest: None declared

Keywords: None

doi:10.1016/j.jgo.2014.09.017

S17COPING STYLES IN ELDERLY PATIENTSJoachim Weis11Psychooncology, Klinik für Tumorbiologie Klinik für OnkologischeRehabilitation, Freiburg, Germany

Abstract: The majority of cancer diagnoses around the worldoccurs in older adults. It is estimated that more than half of cancersurvivors are N65 years of age and that this segment of the populationwill continue to expand. The knowledge on how patients cope withcancer has increased within the last three decades. A lot ofpsychological theories have been developed to understand andexplain patient’s behavior, emotions and cognitions. But we have onlylittle knowledge if elder patients show different copings patterns.Coping is understood as a complex process influenced bymany factorslike personality, stress appraisal etc. as well as social factors like socialsupport, social network etc. Even the cultural background of thepatient may influence the individual ways of coping. In addition,coping must be recognized from a systemic perspective as aninteraction between the individual and his personal and professionalcare givers. Although coping research has contributed to a betterunderstanding of the patients coping with cancer it has failed todevelop a comprehensive model explaining the complexity of thecoping process. Furthermore, until now there is no gold standard onhow to assess coping. Recent theoretical approaches such as the theoryof social cognitive transition or patient competence may give somenew ideas and may inspire the actual discussion. The presentationdiscusses coping styles against the background of age drawingconclusions how to give psychological support for the elder patients.

Disclosure of interest: None declared

Keywords: None

doi:10.1016/j.jgo.2014.09.018

S18ADJUVANT THERAPY IN OLDER ADULTS: CONTROVERSIESAND CHALLENGESBREAST CANCERHans Wildiers11General Medical Oncology, University Hospitals Leuven, Leuven, Belgium

AbstractsS6