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Background Following optimal local therapy, adjuvant Procarbazine, Lomustine and Vincristine (PCV) improves overall survival (OS) in low-grade glioma (LGG). However, 1 year of PCV is associated with significant toxicities. In the pivotal RTOG 9802 randomised control trial, approximately half of the patients discontinued treatment after 6 months. As patients on clinical trials may be fitter, we aimed to further explore the tolerability of PCV chemotherapy in routine clinical practice. Methods We conducted a retrospective study between 2014 and 2018 at a National Neuro-Oncology centre. Patients who had received PCV during this time period were included. The primary objective was to assess tolerability of treatment. Secondary objectives included evaluation of treatment delays, dose modifications and toxicities. Results Overall, 41 patients were included, 24 (58%) were male and 21 (51%) aged ≥40 years. 38 (93%) underwent surgical resection and all patients received adjuvant radiotherapy prior to chemotherapy. The median number of cycles completed was 3,2,4 for procarbazine, lomustine and vincristine respectively. Only 4 (10%) completed all 6 cycles of PCV without dose modifications. There was a universal decline in dose intensity as cycles of chemotherapy progressed. Dose intensity for cycle 1 versus cycle 6 respectively: procarbazine (98% versus 46%), lomustine (94% versus 48%) and vincristine (93% versus 50%). Haematological toxicities were common. Six (14%) patients experienced Grade III-IV thrombocytopaenia and 13 (31%) experienced Grade III-IV neutropaenia. Conclusion Toxicities are frequently observed with the PCV regimen in clinical practice. It might be preferable to adjust doses from the start of chemotherapy to improve tolerability or consider alternative chemotherapy, particularly in older patients with LGG.

e24187 Background: Systemic treatments can improve symptom burden and prolong life in patients with advanced cancer. However, these therapies come with associated toxicities and in some cases can result in reduced quality of life for patients with no possibility of cure. International data has suggested that this cohort of patients have a poor understanding surrounding the goals of treatment in the advanced disease setting. We aimed to evaluate the expectations for cure and palliation from systemic therapies among patients with advanced, incurable cancer in our institution. Methods: Patients on active treatment attending the Oncology Day Ward completed anonymous questionnaires over a four week period. Personal demographics, decision making for treatment and expectation of benefit and toxicity was assessed. Analysis was carried out on patients assessed to have advanced metastatic disease. Results: 254 patients completed the questionnaire. 217 patients were assessed to have metastatic/incurable disease based on responses. 57% were male, 56% were age 30-64 and 35% had completed university level education. 42% of patients stated that treatment was very likely or somewhat likely to cure their cancer. Among patients who reported that a cure was very likely, there were more men (62%) compared to women (38%), more patients were aged less than 65 (62%) compared to over 65 (38%) and more patients had only completed elementary school level education (71%) compared to university level education (29%). Most patients (84%) felt treatment was either very likely or somewhat likely to help them live longer. 68% of patients felt treatment would help them with problems related to their cancer and 33% of patients felt that treatment was very likely to have side effects or complications. 22% of patients stated that doctors made decisions without their input. Conclusions: Many patients receiving treatment for incurable cancers do not understand that it is unlikely to be curative. Male gender, younger age and a lower level of education appears to be associated with unrealistic expectations. This could compromise their ability to make informed treatment decisions. More effective communication around goals of treatment and end of life care may help to improve patients understanding and expectations around the outcomes of chemotherapy.

e24178 Background: Medicinal cannabis is currently approved for symptom control in cancer patients. There is limited evidence to suggest cannabis is efficacious in the treatment of cancer. In this study we aim to characterise the extent of cannabis use in patients receiving anti-cancer therapies and what impact they think cannabis use has on their cancer. Methods: An anonymous survey was distributed to patients with cancer attending the Beaumont Hospital Oncology Day Unit for anti-cancer therapy over a period of 4 weeks. Results: 175 patients completed the survey. 166 (95%) of patients said they would be comfortable talking to their oncologist about cannabis use. 161 (92%) felt their oncologist should prescribe cannabis as part of their cancer treatment. 17% thought cannabis would cure their cancer. 38% thought cannabis would slow the growth of their cancer and 33% thought cannabis would treat cancer related symptoms. 42 (24%) of all patients had tried some form of cannabis at least once in their life. 26 (15%) were actively taking CBD (Cannabidiol) oil as part of their treatment independently of any healthcare professional guidance. More females (15) were taking CBD compared to males (11). A higher proportion of patients < 50 years (14) were taking CBD during their treatment. 30% of patients using CBD had breast cancer and 23% had a primary CNS malignancy. Of the patients taking CBD, 20 (77%) patients felt it would cure or slow cancer growth and 10 (38%) patients believed it would help with cancer related symptoms. Conclusions: Patients with cancer appear to have a positive attitude towards cannabis as part of their treatment despite limited evidence to support this. With the increasing availability of cannabis-based products globally, medical oncologists must now take into consideration patient’s attitude towards cannabis while treating their cancer. [Table: see text]

Background The first confirmed case of COVID-19 in Ireland was on February 29th 2020. From March until late April, the number of cases increased exponentially. The delivery of anti-cancer therapy during the COVID-19 pandemic was extremely challenging. In order to balance the benefits of continuing anti-cancer therapy with the associated increased hospital visits, combined with the risk of COVID-19 infection, we undertook a series of system changes in the delivery of cancer care. Methods Patients who attended our dayward over a 4-month period were included. Data were obtained from patient and chemotherapy prescribing records. Patients were screened for symptoms of COVID-19 at two separate timepoints: prior to their visit via telephone, and using a symptom questionnaire on arrival at the hospital. If patients displayed COVID-19 symptoms, they were isolated and a viral swab arranged. Results A total of 456 patients attended from January 1st to April 30th. The numbers of visits from January to April were 601, 586, 575, and 607, respectively. During this period, there were 2369 patient visits to the dayward and 1953 (82%) intravenous regimens administered. Of the 416 visits that did not lead to treatment, 114 (27%) were scheduled non-treatment review visits, 194 (47%) treatments were held due to disease-related illness, and 108 (26%) treatments were held due to treatment-related complications. Screening measurements were implemented on March 18th due to rising COVID-19 prevalence in the general population. Overall, 53 treatments were held due to the screening process: 19 patients (36%) elicited COVID-19 symptoms via telephone screening; 34 patients (64%) were symptomatic in our pre-assessment area and referred for swabs, of which 4 were positive. Those with a negative swab were rescheduled for chemotherapy the following week. Conclusions With careful systematic changes, safe and continued delivery of systemic anti-cancer therapy during the COVID-19 pandemic is possible.