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Noronha V, Rao AR, Pillai A, Kumar A, Rajappa S, Kapoor A, Mishra BK, Gupta T, Desai C, Pavithran K, Goel A, Vora C, Mailankody S, Hingmire S, Saha R, Kumar A, Sahoo TP, Chandrasekharan A, Kothari R, Kumar L, Ramaswamy A, Banavali S, Prabhash K. Prevalence and types of cancer in older Indians: A multicentric observational study across 17 institutions in India. Cancer Epidemiol 2024; 92:102628. [PMID: 39094297 DOI: 10.1016/j.canep.2024.102628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/25/2024] [Accepted: 07/19/2024] [Indexed: 08/04/2024]
Abstract
The global demographic and epidemiological transition have led to a rapidly increasing burden of cancer, particularly among older adults. There are scant data on the prevalence and demographic pattern of cancer in older Indian persons. This was a multicentric observational study conducted between January 2019 and December 2020. Data were retrieved from existing electronic databases to gather information on two key variables: the total number of patients registered with oncologists and the number of patients aged 60 years and above. The primary objective was to determine the percentage of older adults among patients with cancer served by these hospitals. Secondary objectives included understanding the prevalence of different types of cancer in the older population, and the sex- and geographic distribution of cancer in older Indian patients. We included 272,488 patients with cancer from 17 institutes across India. Among them, 97,962 individuals (36 %) were aged 60 years and above. The proportion of older adults varied between 20.6 % and 53.6 % across the participating institutes. The median age of the older patients with cancer was 67 (interquartile range, 63-72) years. Of the 54,281 patients for whom the details regarding sex were available, 32,243 (59.4 %) were male. Of the 56,903 older patients, head and neck malignancies were the most prevalent, accounting for 11,158 cases (19.6 %), followed by breast cancer (6260 cases, 11 %), genitourinary cancers (6242 cases, 10.9 %), lung cancers (6082 cases, 10.7 %), hepatopancreaticobiliary (6074, 10.7 %), and hematological malignancies (5226 cases, 9.2 %). Over one-third of Indian patients with cancer are aged 60 years and above, with a male predominance. Head and neck, breast, and genitourinary cancers are the most prevalent in this age group. Characterizing the burden of cancer in older adults is crucial to enable tailored interventions and additional research to improve the care and support for this vulnerable population.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India.
| | - Abhijith Rajaram Rao
- Department of Geriatric Medicine, All India Institute of Medical Sciences, Delhi, India.
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India.
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India.
| | - Senthil Rajappa
- Basavatakaram Indo American Cancer Hospital and Research Institute, Banjara Hills, Hyderabad, India.
| | - Akhil Kapoor
- Department of Medical Oncology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Center, Varanasi, India.
| | - B K Mishra
- Department of Medical Oncology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Center, Varanasi, India.
| | - Tarachand Gupta
- Bhagwan Mahaveer Cancer Hospital and Research Center, Jaipur, India.
| | - Chirag Desai
- Hemato-oncology Clinic (A) Pvt Ltd, HOC Vedanta, Ahmedabad, India.
| | - Keechilat Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Science and Research Center, Amrita Vishwa Vidyapeetham, Kochi, India.
| | - Alok Goel
- Department of Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, India.
| | - Chakor Vora
- Sasoon General Hospital, Pune, Maharashtra, India.
| | - Sharada Mailankody
- Department of Medical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Sachin Hingmire
- Deenanath Mangeshkar Hospital & Research Center, Pune, Maharashtra.
| | - Rajat Saha
- Max Institute of Cancer Care, Patparganj, Delhi, India.
| | - Amit Kumar
- Mahaveer Cancer Sansthan and Research Center, Patna, India.
| | - T P Sahoo
- Silver Line Hospital, Bhopal, Madhya Pradesh, India.
| | | | | | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, Delhi, India.
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India.
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India.
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India.
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Tagliaferri L, Fionda B, Casà C, Cornacchione P, Scalise S, Chiesa S, Marconi E, Dinapoli L, Di Capua B, Chieffo DPR, Marazzi F, Frascino V, Colloca GF, Valentini V, Miccichè F, Gambacorta MA. Allies not enemies-creating a more empathetic and uplifting patient experience through technology and art. Strahlenther Onkol 2024:10.1007/s00066-024-02279-7. [PMID: 39259348 DOI: 10.1007/s00066-024-02279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 07/07/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVE To understand whether art and technology (mainly conversational agents) may help oncology patients to experience a more humanized journey. METHODS This narrative review encompasses a comprehensive examination of the existing literature in this field by a multicenter, multidisciplinary, and multiprofessional team aiming to analyze the current developments and potential future directions of using art and technology for patient engagement. RESULTS We identified three major themes of patient engagement with art and three major themes of patient engagement with technologies. Two real-case scenarios are reported from our experience to practically envision how findings from the literature can be implemented in different contexts. CONCLUSION Art therapy and technologies can be ancillary supports for healthcare professionals but are not substitutive of their expertise and responsibilities. Such tools may help to convey a more empathetic and uplifting patient journey if properly integrated within clinical practice, whereby the humanistic touch of medicine remains pivotal.
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Affiliation(s)
- Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bruno Fionda
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Calogero Casà
- UOC di Radioterapia Oncologica, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Patrizia Cornacchione
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Sara Scalise
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Elisa Marconi
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Loredana Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Beatrice Di Capua
- Centro di Eccellenza Oncologia Radioterapica e Medica e Radiologia, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio Marazzi
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Vincenzo Frascino
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Vincenzo Valentini
- Centro di Eccellenza Oncologia Radioterapica e Medica e Radiologia, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Francesco Miccichè
- UOC di Radioterapia Oncologica, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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Fish K, Gao D, Raji M, Balducci L, Kuo YF. Trends in the use of granulocyte colony stimulating factors for older patients with cancer, 2010 to 2019. J Geriatr Oncol 2024:102049. [PMID: 39227214 DOI: 10.1016/j.jgo.2024.102049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/23/2024] [Accepted: 08/20/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Older patients with cancer receiving myelosuppressive treatment are at an increased risk for developing febrile neutropenia (FN) or having chemotherapy dose-reductions or delays, resulting in suboptimal health outcomes. Granulocyte colony stimulating factors (G-CSF) are effective medications to reduce these adverse events and are recommended for patients ≥65 years receiving chemotherapy with >10 % FN risk. We sought to characterize the trends and predictors of G-CSF use between the youngest-old (66-74 years), middle-old (75-84 years), and oldest-old (≥85 years) patients with cancer. MATERIALS AND METHODS We used registry data from SEER-Medicare for breast, lung, ovarian, colorectal, esophageal, gastric, uterine, prostate, pancreatic cancer, and non-Hodgkin lymphoma (NHL) diagnoses from 2010 to 2019. Cox proportional hazard analysis was used. RESULTS Overall, 41.4 % of patients received G-CSF from chemotherapy initiation to three days after completion of the first chemotherapy course. The use rate remained relatively stable for all cancers, except for an increase in use for those with pancreatic cancer. G-CSF use decreased as patients got older. The oldest-old were 43.0 % (95 % confidence interval: 40.7-45.2 %) less likely to receive G-CSF compared to the youngest-old. Patients with breast cancer or NHL were more likely to receive G-CSF than those with other cancers. Patients who were female, married, White or Hispanic, and had fewer comorbidities were more likely to receive G-CSF. DISCUSSION G-CSF is used less often in populations at higher risk of developing FN and related complications. Improving adherence to recommendations can improve health outcomes, especially in the oldest adults, older males, and Black patients.
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Affiliation(s)
- Kaylee Fish
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Daoqi Gao
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, USA.
| | - Mukaila Raji
- The University of Texas Medical Branch at Galveston, Department of Internal Medicine, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.
| | | | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.
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van der Poort EKJ, van Holstein Y, Slingerland M, Trompet S, van den Bos F, Portielje JEA, Steyerberg EW, van den Akker-van Marle ME, Bos WJW, Mooijaart SP, van den Hout WB. Allocation and value of curative oncological treatment in frail and fit older patients with esophageal cancer: An observational cohort study. J Geriatr Oncol 2024; 15:102046. [PMID: 39138114 DOI: 10.1016/j.jgo.2024.102046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/14/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION The Value-Based Health Care (VBHC) model of care provides insights into patient characteristics, outcomes, and costs of care delivery that help clinicians counsel patients. This study compares the allocation and value of curative oncological treatment in frail and fit older patients with esophageal cancer in a dedicated VBHC pathway. MATERIALS AND METHODS Data was collected from patients with primary esophageal cancer without distant metastases, aged 70 years or older, and treated at a Dutch tertiary care hospital between 2015 and 2019. Geriatric assessment (GA) was performed. Outcomes included treatment discontinuation, mortality, quality of life (QoL), and physical functioning over a one-year period. Direct hospital costs were estimated using activity-based costing. RESULTS In this study, 89 patients were included with mean age 75 years. Of 56 patients completing GA, 19 were classified as frail and 37 as fit. For frail patients, the treatment plan was chemoradiotherapy and surgery (CRT&S) in 68% (13/19) and definitive chemoradiotherapy (dCRT) in 32% (6/19); for fit patients, CRT&S in 84% (31/37) and dCRT in 16% (6/37). Frail patients discontinued chemotherapy more often than fit patients (26% (5/19) vs 11% (4/37), p = 0.03) and reported lower QoL after six months (mean 0.58 [standard deviation (SD) 0.35] vs 0.88 [0.25], p < 0.05). After one year, 11% of frail and 30% of fit patients reported no decline in physical functioning and QoL and survived. Frail and fit patients had comparable mean direct hospital costs (€24 K [SD €13 K] vs €23 K [SD €8 K], p = 0.82). DISCUSSION The value of curative oncological treatment was lower for frail than for fit patients because of slightly worse outcomes and comparable costs. The utility of the VBHC model of care depends on the availability of sufficient data. Real-world evidence in VBHC can be used to inform treatment decisions and optimization in future patients by sharing results and monitoring performance over time. TRIAL REGISTRATION The study was retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107 (date of registration: 22-10-2019).
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Affiliation(s)
- Esmée K J van der Poort
- Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands.
| | - Yara van Holstein
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Stella Trompet
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Frederiek van den Bos
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | | | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands; Department of Internal Medicine, St. Antonius Hospital, Koekoekslaan 1, 3435CM Nieuwegein, the Netherlands
| | - Simon P Mooijaart
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
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Bauer JM, Pattwell M, Barazzoni R, Battisti NML, Soto-Perez-de-Celis E, Hamaker ME, Scotté F, Soubeyran P, Aapro M. Systematic nutritional screening and assessment in older patients: Rationale for its integration into oncology practice. Eur J Cancer 2024; 209:114237. [PMID: 39096852 DOI: 10.1016/j.ejca.2024.114237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/15/2024] [Indexed: 08/05/2024]
Abstract
As the global population ages, so does the number of older people being diagnosed, treated and surviving cancer. Challenges to providing appropriate healthcare management stem from the heterogeneity common in this population. Although malnutrition is highly prevalent in older people with cancer, ranging between 30 % and 80 % according to some analyses, is associated with frailty, and has been shown to be a major risk factor for poor treatment response and worse overall survival, addressing nutrition status is not always a priority among oncology healthcare providers. Evaluation of nutritional status is a two-step process: screening identifies risk factors for reduced nutritional intake and deficits that require more in-depth assessment. Screening activities can be as simple as taking weight and BMI measurements or using short nutritional questionnaires and asking the patient about unintentional weight loss to identify potential nutritional risk. Using geriatric assessment, deficits in the nutritional domain as well as in others reveal potentially reversible geriatric and medical problems to guide specific therapeutic interventions. The authors of this paper are experts in the fields of geriatric medicine, oncology, and nutrition science and believe that there is not only substantial evidence to support regularly performing screening and assessment of nutritional status in older patients with cancer, but that these measures lead to the planning and implementation of patient-centered approaches to nutrition management and thus enhanced geriatric-oncology care. This paper presents rationale for systematic nutrition screening and assessment in older adults with cancer.
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Affiliation(s)
- Jürgen M Bauer
- Center for Geriatric Medicine, University Clinic Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Straße 149, 69126 Heidelberg, Germany.
| | | | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Nicolò Matteo Luca Battisti
- Department of Medicine, Breast Unit and Senior Adult Oncology Programme, The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico; Division of Medical Oncology, University of Colorado, Anschutz Medical Campus, USA
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, the Netherlands
| | | | - Pierre Soubeyran
- Department of Medical Oncology, Institute Bergonié, Regional Comprehensive Cancer Centre, Université de Bordeaux, Bordeaux, France
| | - Matti Aapro
- Sharing Progress in Cancer Care (SPCC), Switzerland.
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Lund CM, Nielsen DL, Schultz M, Dolin TG. Physical decline, falls, and hospitalization among vulnerable older patients in the trajectory of colorectal cancer treatment. J Geriatr Oncol 2024; 15:101820. [PMID: 38955634 DOI: 10.1016/j.jgo.2024.101820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/02/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Resilience to anticancer treatment for colorectal cancer (CRC) among older patients varies. Many experience weight loss, physical decline, falls, and hospitalization during treatment, often leading to early discontinuation of otherwise effective chemotherapy. Screening for vulnerability might help to identify patients at risk of these adverse outcomes in older adults. MATERIALS AND METHODS This is a secondary analysis from the GERICO trial. Patients aged ≥70 years assessed for chemotherapy for CRC were screened for eligibility for the GERICO trial with the geriatric-8 (G8) frailty screening tool. The present study population comprised patients who were (1) screened with G8 but for reasons not included in the GERICO study and (2) patients who were randomized to the GERICO control group. We evaluated whether patients identified as vulnerable with G8 (≤14/17) or retrospectively constructed mG8 (≥6/35) had higher risk of experiencing decline in performance status (PS), falls, and unplanned hospitalization during treatment. The association between frailty status and the adverse outcomes was analyzed with univariate and multivariate logistic regression. The discriminative ability of G8/mG8 to predict outcomes was analyzed using the area under the curve for receiver operating characteristics curves. RESULTS In total, 238 patients (median age 74 years [range 70-91]) were included in this analysis. More vulnerable than fit patients experienced decline in PS (G8: 41% vs. 14%, p = 0.006 and mG8: 28% vs. 17%, p = 0.04) during treatment. Furthermore, more vulnerable than fit patients experienced falls (G8 14% vs. 6% p = 0.04) and unplanned hospitalization (G8: 31% vs. 14%, p = 0.009 and mG8: 34% vs. 13%, p < 0.001). Multivariate analyses showed an association between G8 vulnerability and decline in PS, falls, and hospitalization. DISCUSSION Patients with G8 or mG8 vulnerability were more likely to experience decline in PS and unplanned hospitalization during chemotherapy for CRC than fit patients. More G8 vulnerable patients experienced falls compared with fit patients. Appropriate interventions should be offered to older patients with CRC assessed as vulnerable with G8 or mG8 to maintain PS during chemotherapy.
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Affiliation(s)
- Cecilia M Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark.
| | - Dorte L Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark; Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark
| | - Martin Schultz
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Troels G Dolin
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark
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Stout NL, Alfano CM, Liu R, Dixit N, Jefford M. Implementing a Clinical Pathway for Needs Assessment and Supportive Care Interventions. JCO Oncol Pract 2024; 20:1173-1181. [PMID: 38709984 DOI: 10.1200/op.23.00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
Despite advances in clinical cancer care, cancer survivors frequently report a range of persisting issues, unmet needs, and concerns that limit their ability to participate in life roles and reduce quality of life. Needs assessment is recognized as an important component of cancer care delivery, ideally beginning during active treatment to connect patients with supportive services that address these issues in a timely manner. Despite the recognized importance of this process, many health care systems have struggled to implement a feasible and sustainable needs assessment and management system. This article uses an implementation science framework to guide pragmatic implementation of a needs assessment clinical system in cancer care. According to this framework, successful implementation requires four steps including (1) choosing a needs assessment tool; (2) carefully considering the provider level, clinic level, and health care system-level strengths and barriers to implementation and creating a pilot system that addresses these factors; (3) making the assessment system actionable by matching needs with clinical workflow; and (4) demonstrating the value of the system to support sustainability.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology Oncology, School of Medicine, West Virginia University Cancer Institute, Morgantown, WV
- Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, WV
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, NY
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Raymond Liu
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Niharika Dixit
- Division of Hematology/Oncology, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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Giger AKW, Ditzel HM, Ewertz M, Ditzel H, Jørgensen TL, Pfeiffer P, Lund C, Ryg J. Effect of comprehensive geriatric assessment on hospitalizations in older adults with frailty initiating curatively intended oncologic treatment: The PROGNOSIS-RCT study. J Geriatr Oncol 2024; 15:101821. [PMID: 39034167 DOI: 10.1016/j.jgo.2024.101821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/09/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Frailty constitutes a risk for unplanned hospitalizations in older adults with cancer. This study examines whether comprehensive geriatric assessment (CGA) as an add-on to standard oncologic care can prevent unplanned hospitalizations in older adults with frailty and cancer who initiate curative oncological treatment. MATERIALS AND METHODS This randomized controlled trial included older adults aged ≥70 with frailty (Geriatric 8 [G8] ≤14), and solid cancers who initiated curative oncological treatment. Participants were randomized 1:1 to either standard oncologic care (control) or standard oncologic care supplemented with CGA-guided interventions (intervention). Baseline characteristics were retrieved prior to randomization. The primary endpoint, the between-group rate ratio of unplanned hospitalizations within six months of treatment initiation, was analyzed using negative binominal regression. Analyses were performed using an intention-to-treat approach, followed by per-protocol analysis, including participants receiving CGA within 30 days of randomization, and preplanned subgroup analyses based on treatment modality and Geriatric 8 screening. Secondary endpoints included acute hospital contacts, treatment adherence, and toxicity. RESULTS From November 1, 2020 to May 31, 2023, 173 participants were enrolled. Median age was 75 (interquartile range 72-79), 51.5% were female, 58% had a G8 score > 12, and 84% had Eastern Cooperative Oncology Group performance status 0-1. The most common cancer sites were lung (23%), upper gastrointestinal (15%), and breast (13%). The rate (per person-years) of unplanned hospitalization was 1.32 in the intervention group and 1.81 in the control group, with a between-group rate ratio of 0.74 (95% confidence interval [CI] 0.45-1.23, P = 0.25) favoring the intervention. The between-group rate ratio increased in the per-protocol analysis (0.64 [95% CI 0.37-1.10, P = 0.10]). Similarly, no significant between group differences were found in treatment adherence, rate of acute hospital contacts, or toxicity. DISCUSSION In this study, CGA did not significantly reduce the rate of unplanned hospitalizations. Furthermore, no between-group differences were found in treatment adherence, toxicity lead hospitalizations, or treatment completion in older adults with cancer and frailty. However, per-protocol analysis suggests that increasing adherence to CGA may improve the outcome. Larger studies ensuring higher CGA adherence are warranted to confirm our findings.
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Affiliation(s)
- Ann-Kristine Weber Giger
- Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, J.B. Winsløws vej 9A, 5000 Odense, Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark.
| | - Helena Møgelbjerg Ditzel
- Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, J.B. Winsløws vej 9A, 5000 Odense, Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Oncology, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| | - Marianne Ewertz
- Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| | - Henrik Ditzel
- Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Oncology, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| | - Trine Lembrecht Jørgensen
- Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Oncology, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| | - Per Pfeiffer
- Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Oncology, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| | - Cecilia Lund
- Department of Medicine, Copenhagen University Hospital, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark; CopenAge, Copenhagen Center for Clinical Age research, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
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9
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Walsh DJ, O'Driscoll M, Horgan AM, Tabb E, Hannan M, Morris C, Sahm LJ. Hospitalisation and adverse drug events in a geriatric oncology setting: A systematic review of the literature. Res Social Adm Pharm 2024; 20:820-827. [PMID: 38705819 DOI: 10.1016/j.sapharm.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/05/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Geriatric Oncology is a specialty where a multidisciplinary approach can address the unmet needs of older adults with cancer. Older adults are at increased risk of adverse drug events (ADE) due to age-related changes in pharmacokinetics and pharmacodynamics, increasing treatment complexity, and medication burden. OBJECTIVES To review the literature to determine the incidence of unplanned hospitalisation due to ADE for all medications, both systemic anticancer therapy (SACT) and non-SACT medications. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The search included the following databases: PubMed, CINAHL, and Embase. A manual search of Scopus was then performed. Study quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions, Mixed Methods Appraisal Tool (MMAT) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. RESULTS Overall, three studies were included. One observational study reported 19 % of unplanned hospital admissions due to ADE in patients aged ≥70 years with cancer. The first retrospective study reported 24 % of unplanned hospital admissions are due to ADE in patients aged ≥70 years with cancer, and the second retrospective study reported 26 % of patients with metastatic melanoma treated with immune checkpoint inhibitors had an unplanned hospital admission due to an ADE. CONCLUSION There is a paucity of studies assessing unplanned hospitalisation due to ADE in older adults with cancer. Future studies are needed and should account for the reporting of potential ADE relative to supportive care, ancillary medications, and indeed chronic medications used to treat long-standing comorbidities.
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Affiliation(s)
- Darren J Walsh
- University Hospital Waterford, Waterford, Ireland; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Michelle O'Driscoll
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | | | - Eoin Tabb
- University Hospital Waterford, Waterford, Ireland
| | | | | | - Laura J Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland; Department of Pharmacy, Mercy University Hospital, Grenville Place, Cork, Ireland
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10
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Baltussen JC, Cárdenas-Reyes P, Chavarri-Guerra Y, Ramirez-Fontes A, Morales-Alfaro A, Portielje JEA, Ramos-Lopez WA, Rosado-Canto V, Soto-Perez-de-Celis E. Time toxicity among older patients with cancer treated with palliative systemic therapy. Support Care Cancer 2024; 32:621. [PMID: 39212749 DOI: 10.1007/s00520-024-08844-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE The time toxicity of anticancer therapy, defined as days spent with healthcare contact during treatment, represents a critical but understudied outcome. This study aims to quantify time toxicity among older patients with cancer receiving palliative systemic treatment. METHODS All patients aged ≥ 65 years with metastatic cancer receiving cytotoxic chemotherapy, immunotherapy, or targeted therapy at a single center in Mexico were selected from a prospective patient navigation cohort. Patients completed a baseline assessment, including the G8 screening and quality of life measures. Physical healthcare contact days within the first 6 months were extracted from medical records and divided by days alive during the same period. Beta regression models were used to identify predictors of time toxicity. RESULTS We identified 158 older patients (median age 71 years); 86% received cytotoxic chemotherapy. Seventy-three percent had an impaired G8 score and were considered vulnerable/frail. Six-month overall survival was 74%. Within the first 6 months, patients spent a mean of 21% (95% confidence interval (CI) 19-23%) of days with healthcare contact. Concurrent radiotherapy (odds ratio (OR) 1.55; 95%CI 1.21-1.97), cytotoxic chemotherapy versus targeted therapy (OR 1.64; 95%CI 1.13-2.37), and an impaired G8 (OR 1.27; 95%CI 1.01-1.60) were associated with increased time toxicity. CONCLUSION Older adults with metastatic cancer spend 1 in 5 days with healthcare contact during treatment, with a higher burden of time toxicity for patients receiving radiotherapy or cytotoxic chemotherapy and those with potential frailty. These findings underscore the importance of informing patients about their expected healthcare contact days within the context of a limited life expectancy.
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Affiliation(s)
- Joosje C Baltussen
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Paula Cárdenas-Reyes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Andrea Ramirez-Fontes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Andrea Morales-Alfaro
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | | | - Wendy A Ramos-Lopez
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Valentina Rosado-Canto
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico.
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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11
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Mac Eochagain C, Power R, Sam C, Gonzalez-Senac NM, Walsh D, Roy M, Battisti NML. Inclusion, characteristics, and reporting of older adults in FDA registration studies of immunotherapy, 2018-2022. J Immunother Cancer 2024; 12:e009258. [PMID: 39209450 PMCID: PMC11367347 DOI: 10.1136/jitc-2024-009258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 09/04/2024] Open
Abstract
Immune checkpoint inhibitors (ICI) have transformed the management of cancer, particularly for older adults, who constitute a majority of the global cancer patient population. This study aimed to assess the inclusion, characteristics, and reporting of older adults enrolled in Food and Drug Administration (FDA) registration clinical trials of ICI between 2018 and 2022. Clinical trials of ICI leading to an FDA approval in solid tumor oncology between 2018 and 2022 were included. Primary study reports and all available secondary publications were assessed. The availability and completeness of older subgroup data for protocol-defined clinical efficacy endpoints, health-related quality of life (HRQOL) and toxicity outcomes, and baseline characteristics were assessed according to predefined criteria which categorized reporting completeness hierarchically in relation to the availability of published data, including effect size, sample size, and measures of precision. 53 registration trials were included, involving a total of 37,094 participants. Most trials (64.2%) were of ICI combination therapy. 42.3% of patients were aged≥65 years; 11.1% were aged≥75. No trials specified an upper age limit for eligibility. 98.1% of trials excluded patients with European Cooperative Oncology Group performance status>1. 87.2% of primary efficacy endpoints and 17.9% of secondary efficacy endpoints were reported completely for older adults. Five studies (9.4%) reported baseline characteristics, three (6.1%) reported HRQOL assessments, and four (7.5%) reported toxicity outcomes completely among older subgroups. No trials conducted baseline geriatric assessments or reported geriatric-specific symptoms or quality of life scales. This analysis highlights significant deficits in the enrollment and reporting of older subgroups in pivotal trials of ICI therapy. The findings highlight an urgent need for improved reporting and inclusion standards in clinical trials of ICI to better inform treatment decisions for older adults.
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Affiliation(s)
- Colm Mac Eochagain
- Department of Medical Oncology, Trinity St James' Cancer Institute, Dublin, Ireland
| | - Robert Power
- Department of Medical Oncology, Trinity St James' Cancer Institute, Dublin, Ireland
| | - Christine Sam
- H Lee Moffitt Cancer Center and Research Center, Tampa, Florida, USA
| | - Nicolas M Gonzalez-Senac
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Biopathology of Aging Group, Instituto de Investigacion Sanitaria Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Darren Walsh
- Department of Medical Oncology, Waterford University Hospital, Waterford, Ireland
| | - Mukul Roy
- Department of Radiation Oncology, Jaslok Hospital and Research Centre, Mumbai, India
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12
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Takashima A, Hamaguchi T, Mizusawa J, Nagashima F, Ando M, Ojima H, Denda T, Watanabe J, Shinozaki K, Baba H, Asayama M, Hasegawa S, Masuishi T, Nakata K, Tsukamoto S, Katayama H, Nakamura K, Fukuda H, Kanemitsu Y, Shimada Y. Oxaliplatin Added to Fluoropyrimidine/Bevacizumab as Initial Therapy for Unresectable Metastatic Colorectal Cancer in Older Patients: A Multicenter, Randomized, Open-Label Phase III Trial (JCOG1018). J Clin Oncol 2024:JCO2302722. [PMID: 39186709 DOI: 10.1200/jco.23.02722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 05/05/2024] [Accepted: 07/01/2024] [Indexed: 08/28/2024] Open
Abstract
PURPOSE Doublet chemotherapy with fluoropyrimidine (FP) and oxaliplatin (OX) plus bevacizumab (BEV) is a standard regimen for unresectable metastatic colorectal cancer (MCRC). However, the efficacy of adding OX to FP plus BEV (FP + BEV) remains unclear for older patients, a population for whom FP + BEV is standard. We aimed to confirm the superiority of adding OX to FP + BEV for this population. METHODS This open-label, randomized, phase III trial was conducted at 42 institutions in Japan. Patients with unresectable MCRC age 70-74 years with Eastern Cooperative Oncology Group performance status (ECOG-PS) 2 and those 75 years and older with ECOG-PS 0-2 were randomly assigned (1:1) to an FP + BEV arm or an OX addition (FP + BEV + OX) arm. Fluorouracil plus levofolinate calcium or capecitabine was declared before enrollment. The primary end point was progression-free survival (PFS). The study was registered in the Japan Registry of Clinical Trials (identifier: jRCTs031180145). RESULTS Between September 2012 and March 2019, 251 patients were randomly assigned to the FP + BEV arm (n = 125) and the FP + BEV + OX arm (n = 126). The median age was 80 and 79 years in the respective arm. The median PFS was 9.4 months (95% CI, 8.3 to 10.3) in the FP + BEV arm and 10.0 months (9.0 to 11.2) in the FP + BEV + OX arm (hazard ratio [HR], 0.84 [90.5% CI, 0.67 to 1.04]; one-sided P = .086). The median overall survival was 21.3 months (18.7 to 24.3) in the FP + BEV arm and 19.7 months (15.5 to 25.5) in the FP + BEV + OX arm (HR, 1.05 [0.81 to 1.37]). The proportion of any grade ≥3 adverse events was higher in the FP + BEV + OX arm (52% v 69%). There was one treatment-related death in the FP + BEV arm and three in the FP + BEV + OX arm. CONCLUSION No benefit of adding OX to FP + BEV as first-line treatment was demonstrated in older patients with MCRC. FP + BEV is recommended for this population.
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Affiliation(s)
- Atsuo Takashima
- Department of Gastrointestinal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Hamaguchi
- Department of Medical Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Junki Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Fumio Nagashima
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hitoshi Ojima
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Tadamichi Denda
- Division of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsunori Shinozaki
- Division of Clinical Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hideo Baba
- Department of Gastroenterology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masako Asayama
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Seiji Hasegawa
- Department of Clinical Oncology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan
| | - Toshiki Masuishi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Ken Nakata
- Department of Colorectal Surgery, Sakai City Medical Center, Osaka, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kenichi Nakamura
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Shimada
- Department of Clinical Oncology, Kochi Health Sciences Center, Kochi, Japan
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13
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Lo CT, Sheshadri A, Edmonson L, Nair D. Patient-Reported Outcomes to Achieve Person-Centered Care for Aging People With Kidney Disease. Semin Nephrol 2024:151548. [PMID: 39181804 DOI: 10.1016/j.semnephrol.2024.151548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Person-centered care is a system of care delivery that supports effective patient-clinician communication and empowers patients to partner with their clinical providers to develop goal-concordant treatment plans. Models of person-centered care often involve the implementation of patient-reported outcomes (PROs) to measure patients' symptoms and quality of life as they navigate complex chronic health conditions. Models of person-centered care have been particularly effective in improving the quality of care delivery for older adults as well as younger adults with aging-associated conditions such as physical function decline. Though PROs have been developed and validated in kidney disease, they are not routinely implemented in clinical practice. Most individuals with kidney disease are 65 and older, but many younger individuals with kidney disease also experience aging-associated conditions earlier than in the general population. Thus, PROs represent an important tool for achieving person-centered care in groups with kidney disease who are the most vulnerable to adverse health outcomes and excess health care utilization. In this article, we aim to move toward more routine implementation of PROs in kidney care for aging adults. To identify the most clinically relevant PROs for this group and understand the ideal mode and context in which to implement PROs, we will (1) provide an evidence-based summary of PROs with the greatest prognostic significance in the general population and in kidney disease, including those specific to older adults; (2) describe barriers to the implementation of PROs in kidney care with a special focus on the needs of older adults and younger adults with aging-associated conditions; and (3) conclude with our evidence-based recommendations for the content, time, and context in which PROs should be implemented to achieve person-centered kidney care for aging adults. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.
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Affiliation(s)
- Claire T Lo
- Division of Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Anoop Sheshadri
- Division of Nephrology, University of California, San Francisco, San Francisco, CA
| | - Larry Edmonson
- Person With Chronic Kidney Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Tennessee Valley Veterans Affairs Health System, Nashville, TN.
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14
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Rondan MA, Sánchez-Hernández A, Estellés AL, Sánchez JG, Aparisi FDAA, López JS, Benajes RT, Sarrió RG. Impact of a comprehensive geriatric assessment to manage elderly patients with locally advanced non-small-cell lung cancers: a multicenter prospective study. Clin Transl Oncol 2024:10.1007/s12094-024-03657-4. [PMID: 39158803 DOI: 10.1007/s12094-024-03657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/20/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE Concurrent chemoradiotherapy (cCRT) is the standard treatment for locally advanced and unresectable non-small-cell lung cancer. Population is aging, and Geriatric assessment (GA) has demonstrated its paper to select fit patients for active treatment and vulnerable, frail patients for interventions and/or palliative care in many histologies. Its role in locally advanced, unresectable non-small-cell lung cancer has been less explored. METHODS To assess the capability of GA to detect frail patients not suitable for active treatment, we developed this exploratory non-interventional prospective study. All patients ≥ 70 years diagnosed with stage locally advanced and unresectable non-small-cell lung cancer were invited to undergo geriatric assessment. Secondary aims were description of population, exploring GA as prognostic factor, determination of toxicity profile and look for a frailty biomarker. RESULTS From June 2017 to June 2020, 51 patients were included, of whom 35% (n:18) were classified as frail. Frail patients had less overall survival and more grade 3-4 toxicity. Exploratory results for frailty phenotype are described in the text. CONCLUSIONS With the results of our study, we confirm that GA can detect frail patients unsuitable for treatment, with a higher risk of toxicity and less overall survival. A trend toward blood-test results for phenotype frailty can be hypothesis generation.
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Affiliation(s)
| | | | | | | | | | - Jorge Soler López
- Consorcio Hospital Provincial Castellón, Castellón de la Plana, Spain
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15
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Kim DH, Rockwood K. Frailty in Older Adults. N Engl J Med 2024; 391:538-548. [PMID: 39115063 DOI: 10.1056/nejmra2301292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Affiliation(s)
- Dae Hyun Kim
- From the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife; the Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center; and Harvard Medical School - all in Boston (D.H.K.); and the Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada (K.R.)
| | - Kenneth Rockwood
- From the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife; the Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center; and Harvard Medical School - all in Boston (D.H.K.); and the Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada (K.R.)
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16
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Cao C, Fang Y, Jiang F, Jin Q, Jin T, Huang S, Hu Q, Chen Y, Piao Y, Hua Y, Feng X, Chen X. Concurrent nimotuzumab and intensity-modulated radiotherapy for elderly patients with locally advanced nasopharyngeal carcinoma. Cancer Sci 2024; 115:2729-2737. [PMID: 38806289 PMCID: PMC11309944 DOI: 10.1111/cas.16213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/30/2024] Open
Abstract
Because of the common physical condition, reduced organ function, and comorbidities, elderly patients with nasopharyngeal carcinoma (NPC) are often underrepresented in clinical trials. The optimal treatment of elderly patients with locally advanced NPC remains unclear. The purpose of this study was to evaluate the efficacy of concurrent nimotuzumab combined with intensity-modulated radiotherapy (IMRT) in elderly patients with locally advanced NPC. We conducted a single-arm, phase II trial for elderly patients with stage III-IVA NPC (according to UICC-American Joint Committee on Cancer TNM classification, 8th edition). All patients received concurrent nimotuzumab (200 mg/week, 1 week prior to IMRT) combined with IMRT. The primary end-point was complete response (CR) rate. The secondary end-points were survival, safety, and geriatric assessment. Between March 13, 2017 and November 12, 2018, 30 patients were enrolled. In total, 20 (66.7%) patients achieved CR, and objective response was observed in 30 (100.0%) patients 1 month after radiotherapy. The median follow-up time was 56.05 months (25th-75th percentile, 53.45-64.56 months). The 5-year locoregional relapse-free survival, distant metastasis-free survival, cancer-specific survival, disease-free survival, and overall survival were 89.4%, 86.4%, 85.9%, 76.5%, and 78.8%, respectively. Grade 3 mucositis occurred in 10 (33%) patients and grade 3 pneumonia in 3 (10%) patients. Concurrent nimotuzumab combined with IMRT is effective and well-tolerated for elderly patients with locally advanced NPC.
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Affiliation(s)
- Caineng Cao
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Yuting Fang
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Feng Jiang
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Qifeng Jin
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Ting Jin
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Shuang Huang
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Qiaoying Hu
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Yuanyuan Chen
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Yongfeng Piao
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Yonghong Hua
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Xinglai Feng
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
| | - Xiaozhong Chen
- Department of Radiation OncologyZhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvincePostgraduate Training Base Alliance of Wenzhou Medical UniversityHangzhouChina
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17
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Sugiyama M, Nishijima TF, Kasagi Y, Uehara H, Yoshida D, Nagai T, Koga N, Kimura Y, Morita M, Toh Y. Impact of comprehensive geriatric assessment on treatment strategies and complications in older adults with colorectal cancer considering surgery. J Surg Oncol 2024; 130:329-337. [PMID: 38881197 DOI: 10.1002/jso.27736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to assess the effectiveness of Comprehensive Geriatric Assessment (CGA) in customizing care for elderly cancer patients, specifically focusing on colorectal cancer. The research compared treatment strategies and outcomes in older adults considered for surgery before and after the initiation of a Geriatric Oncology Service (GOS). METHODS Conducting a comparative study, two cohorts of consecutive colorectal cancer patients aged 75 or older were examined: the control group (n = 156) and the GOS group (n = 158). Upon the treating surgeon's GOS consultation request, a geriatrician and an oncologist performed CGA, guiding treatment decisions and perioperative interventions. Postoperative complications were compared using propensity score matching (PSM). RESULTS In the GOS group, 91% (n = 116) underwent CGA consultations, influencing decisions to forego surgery in 12 patients. After PSM for surgical cases (controls n = 146, GOS n = 146), each group comprised 128 patients. Perioperative physical therapy and pharmacist referrals were more frequent in the GOS group. The GOS group exhibited a significantly lower incidence of postoperative complications (22%) compared to the control group (33%) (p = 0.0496). CONCLUSION Patients undergoing colorectal surgery post-GOS implementation experienced a notable reduction in postoperative complications, highlighting the positive impact of personalized geriatric assessment on surgical outcomes in the elderly.
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Affiliation(s)
- Masahiko Sugiyama
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Tomohiro F Nishijima
- Geriatric Oncology Service, NHO Kyushu Cancer Center, Fukuoka, Japan
- Department of Gastrointestinal and Medical Oncology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Yuta Kasagi
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Hideo Uehara
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
- Department of Gastrointestinal Surgery, NHO Kyushu Medical Center, Fukuoka, Japan
| | - Daisuke Yoshida
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
- Department of Gastrointestinal Surgery, Oita, Japan
| | - Taichiro Nagai
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Naomichi Koga
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Yasue Kimura
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Masaru Morita
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
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18
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Rosko AE, Elsaid MI, Woyach J, Islam N, Lepola N, Urrutia J, Christian LM, Presley C, Mims A, Burd CE. Determining the relationship of p16 INK4a and additional molecular markers of aging with clinical frailty in hematologic malignancy. J Cancer Surviv 2024; 18:1168-1178. [PMID: 38678524 PMCID: PMC11324703 DOI: 10.1007/s11764-024-01591-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Older adults with hematologic malignancies (HM) have unique challenges due to age and fitness. The primary aim of this pilot study was to benchmark the ability of multiple biomarkers of aging (p16, epigenetic clocks, T cell gene expression profiles, and T cell receptor excision circles (TREC) to identify frailty as measured by a clinical impairment index (I2) in patients with HM. METHODS 70 patients newly diagnosed with HM had peripheral blood T lymphocytes (PBTL) analyzed for p16INK4a expression using the OSU_Senescence Nanostring CodeSet. PBTL epigenetic age was measured using 7 epigenetic clocks, and TREC were quantified by qRT-PCR. A composite clinical impairment index (I2) was generated by combining values from 11 geriatric metrics (Independent Activities of Daily Living (iADL), physical health score, Short Physical Performance Battery (SPPB), Body Mass Index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, self-reported KPS, Blessed Orientation Memory Concentration (BOMC), polypharmacy, Mental Health Inventory (MHI)-17, Medical Outcomes Study (MOS) subscales). Clinical frailty was defined as a score of 7 or greater on the I2. RESULTS Age-adjusted p16INK4a was similar in newly diagnosed patients and healthy controls (p > 0.1). PBTL p16INK4a levels correlated positively with the Hannum [r = 0.35, 95% CI (0.09-0.75); p adj. = 0.04] and PhenoAge [r = 0.37, 95% CI (0.11-0.59); p adj. = 0.04] epigenetic clocks. The discrimination ability of the I2 model was calculated using the area under the receiver operating characteristic curve (AUC). After adjusting for chronologic age and disease group, baseline p16INK4a [AUC = 0.76, 95% CI (0.56-0.98); p = 0.01], Hannum [AUC = 0.70, 95% CI (0.54-0.85); p = 0.01], PhenoAge [AUC = 0.71, 95% CI (0.55-0.86); p = 0.01], and DunedinPACE [AUC = 0.73, 95% CI (0.57-0.88); p = < 0.01] measures showed the greatest potential to identify clinical frailty using the I2. CONCLUSIONS Our pilot data suggest that multiple blood-based aging biomarkers have potential to identify frailty in older adults with HM. IMPLICATIONS FOR CANCER SURVIVORS We developed the I2 index to quantify impairments across geriatric domains and discovered that PBTL p16, Hannum, PhenoAge, and DunedinPACE are promising indicators of frailty in HM.
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Affiliation(s)
- Ashley E Rosko
- Division of Hematology, The Ohio State University, Columbus, OH, USA.
- James Comprehensive Cancer Center, 300 West 10th Ave, Columbus, Ohio, 43210, United States.
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- Division of Medical Oncology, The Ohio State University, Columbus, OH, USA
| | - Jennifer Woyach
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Nowshin Islam
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Noah Lepola
- Departments of Molecular Genetics, Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Jazmin Urrutia
- Departments of Molecular Genetics, Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Lisa M Christian
- Department of Psychiatry and Behavioral Health, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, USA
| | - Carolyn Presley
- Division of Medical Oncology, The Ohio State University, Columbus, OH, USA
| | - Alice Mims
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Christin E Burd
- Departments of Molecular Genetics, Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
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19
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Loh KP, Liposits G, Arora SP, Neuendorff NR, Gomes F, Krok-Schoen JL, Amaral T, Mariamidze E, Biganzoli L, Brain E, Baldini C, Battisti NML, Frélaut M, Kanesvaran R, Mislang ARA, Papamichael D, Steer C, Rostoft S. Adequate assessment yields appropriate care-the role of geriatric assessment and management in older adults with cancer: a position paper from the ESMO/SIOG Cancer in the Elderly Working Group. ESMO Open 2024; 9:103657. [PMID: 39232585 DOI: 10.1016/j.esmoop.2024.103657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 09/06/2024] Open
Abstract
With the aging population, older adults constitute a growing proportion of the new cancer cases. Given the heterogeneous health status among older adults and their susceptibility to aging-related vulnerabilities, understanding their diversity and its implications becomes increasingly crucial for prognostication and guiding diagnostics, treatment decisions, and follow-up, as well as informing supportive care interventions. Geriatric assessment and management (GAM) refers to the comprehensive evaluation of an older individual's health status with subsequent management plans focusing on both oncologic and non-oncologic interventions. In 2019, the European Society for Medical Oncology (ESMO) and the International Society of Geriatric Oncology (SIOG) established the ESMO/SIOG Cancer in the Elderly Working Group. This position paper reflects the recommendations of the working group. Our paper summarizes the existing evidence with a focus on recent key trials and based on this, we propose several recommendations and future directions.
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Affiliation(s)
- K P Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, USA.
| | - G Liposits
- Department of Oncology, Odense University Hospital, Odense, Denmark. https://twitter.com/G_LipositsMD
| | - S P Arora
- Division of Hematology/Oncology, Department of Medicine, Mays Cancer Center, University of Texas Health San Antonio, San Antonio, USA. https://twitter.com/DrSukeshiArora
| | - N R Neuendorff
- Department of Geriatrics, Marien Hospital Herne, University Hospital, Ruhr University Bochum, Herne, Germany. https://twitter.com/neuendorff_nr
| | - F Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester; Senior Adult Oncology, The Christie NHS Foundation Trust, Manchester, UK. https://twitter.com/FabioGomes_go
| | - J L Krok-Schoen
- Comprehensive Cancer Center, The Ohio State University, Columbus; School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, USA. https://twitter.com/KrokSchoen
| | - T Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany. https://twitter.com/TeeresaSAmaral
| | - E Mariamidze
- Todua Clinic-Department of Oncology and Hematology, Tbilisi, Georgia; Ospedale Policlinico San Martino-Clinica di Oncologia Medica, Genoa. https://twitter.com/EMariamidze
| | - L Biganzoli
- "Sandro Pitigliani" Department of Medical Oncology, Hospital of Prato, Prato, Italy
| | - E Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Saint-Cloud. https://twitter.com/EtienneB66
| | - C Baldini
- Drug Development Department (DITEP), Gustave Roussy, Villejuif; Paris Saclay University, Villejuif, France. https://twitter.com/CapuBaldini
| | - N M L Battisti
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK. https://twitter.com/nicolobattisti
| | - M Frélaut
- Department of Medical Oncology, Gustave Roussy, Villejuif, France. https://twitter.com/frelaut_m
| | - R Kanesvaran
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore. https://twitter.com/ravikanesvaran
| | - A R A Mislang
- College of Medicine and Public Health, Flinders University, Adelaide; Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Adelaide, Australia. https://twitter.com/AnnaMislang
| | - D Papamichael
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - C Steer
- Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury; UNSW School of Clinical Medicine, Rural Clinical Campus, Albury; John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, Australia. https://twitter.com/drcbsteer
| | - S Rostoft
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. https://twitter.com/SRostoft
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20
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Kamaraju S, McKoy J, Williams GR, Gilmore N, Minami C, Bylow K, Rajalingam H, Cortina CS, Beckert A, Stolley M, Bullock D, Kurzrock R, Jatoi A. An Annual Symposium on Disparities in Milwaukee, WI, with a 2023 Focus on Older Adults with Cancer. Curr Oncol Rep 2024; 26:855-864. [PMID: 38801612 PMCID: PMC11300154 DOI: 10.1007/s11912-024-01525-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE OF REVIEW Cancer-related inequities are prevalent in Wisconsin, with lower survival rates for breast, colorectal, and lung cancer patients from marginalized communities. This manuscript describes the ongoing efforts at the Medical College of Wisconsin and potential pathways of community engagement to promote education and awareness in reducing inequities in cancer care. RECENT FINDINGS While some cancer inequities are related to aggressive disease biology, health-related social risks may be addressed through community-academic partnerships via an open dialogue between the community members and academic faculty. To develop potential pathways of community-academic partnerships, an annual Cancer Disparities Symposium concept evolved as a pragmatic and sustainable model in an interactive learning environment. In this manuscript, we describe the programmatic development and execution of the annual Cancer Disparities Symposium, followed by highlights from this year's meeting focused on geriatric oncology as discussed by the speakers.
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Affiliation(s)
- Sailaja Kamaraju
- Department of Medicine, Medical College of Wisconsin, 8800 W. Doyne Avenue, Milwaukee, WI, 53226, USA.
| | - June McKoy
- Division of Hematology-Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Christina Minami
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathryn Bylow
- Department of Medicine, Medical College of Wisconsin, 8800 W. Doyne Avenue, Milwaukee, WI, 53226, USA
| | | | - Chandler S Cortina
- Department of Medicine, Medical College of Wisconsin, 8800 W. Doyne Avenue, Milwaukee, WI, 53226, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Angela Beckert
- Department of Medicine, Medical College of Wisconsin, 8800 W. Doyne Avenue, Milwaukee, WI, 53226, USA
| | - Melinda Stolley
- Department of Medicine, Medical College of Wisconsin, 8800 W. Doyne Avenue, Milwaukee, WI, 53226, USA
| | - Dan Bullock
- Department of Medicine, Medical College of Wisconsin, 8800 W. Doyne Avenue, Milwaukee, WI, 53226, USA
- Hematology, Oncology and Transplantation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Razelle Kurzrock
- Department of Medicine, Medical College of Wisconsin, 8800 W. Doyne Avenue, Milwaukee, WI, 53226, USA
| | - Aminah Jatoi
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
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21
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Goede V, Wedding U. [Frailty in Oncology: Updated Recommendations for Clinical Practice]. Dtsch Med Wochenschr 2024; 149:1009-1014. [PMID: 39146747 DOI: 10.1055/a-2115-0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Frailty is a clinical condition associated with aging and resulting in increased risk of adverse outcomes upon exogenous or endogenous stressors. In oncology, cancer treatment itself can be a stressor event. In older cancer patients, frailty therefore not only enhances the probability of age-related health events such as institutionalization or falls, but also of treatment complications such as toxicity and interruption or discontinuation of therapy. As demonstrated by recent randomized-controlled trials conducted in older cancer patients receiving systemic treatment, the evaluation of frailty by geriatric assessment (GA) followed by an adjustment of the oncological therapy as well as targeted frailty interventions help to improve cancer treatment tolerability and feasibility. Based on these data, the American Society of Clinical Oncology (ASCO) updated the clinical practice guidelines for the assessment and management of vulnerabilities in older adults receiving systemic cancer therapy. The guideline recommends the use of a new GA-tool named 'practical geriatric assessment' (PGA) to foster the implementation of GA-based frailty assessment and management in routine cancer care. This article describes the background and key aspects of these recent advances.
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Affiliation(s)
- Valentin Goede
- Abteilung für Onkologische Geriatrie, Cellitinnen-Krankenhaus St. Marien, Köln, Deutschland
| | - Ulrich Wedding
- Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Germany
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22
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Seghers PALN, Rostoft S, O'Hanlon S, O'Donovan A, Schulkes K, Montroni I, Portielje JEA, Wildiers H, Soubeyran P, Hamaker ME. How to incorporate chronic health conditions in oncologic decision-making and care for older patients with cancer? A survey among healthcare professionals. Eur Geriatr Med 2024; 15:1055-1067. [PMID: 38507039 PMCID: PMC11377634 DOI: 10.1007/s41999-023-00919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/13/2023] [Indexed: 03/22/2024]
Abstract
PURPOSE A substantial proportion of patients with cancer are older and experience multimorbidity. As the population is ageing, the management of older patients with multimorbidity including cancer will represent a significant challenge to current clinical practice. METHODS This study aimed to (1) identify which chronic health conditions may cause change in oncologic decision-making and care in older patients and (2) provide guidance on how to incorporate these in decision-making and care provision of older patients with cancer. Based on a scoping literature review, an initial list of prevalent morbidities was developed. A subsequent survey among healthcare providers involved in the care for older patients with cancer assessed which chronic health conditions were relevant and why. RESULTS A list of 53 chronic health conditions was developed, of which 34 were considered likely or very likely to influence decision-making or care according to the 39 healthcare professionals who responded. These conditions were further categorized into five patient profiles. From these conditions, five patient profiles were developed, namely, (1) a somatic profile consisting of cardiovascular, metabolic, and pulmonary disease, (2) a functional profile, including conditions that cause disability, dependency or a high caregiver burden, (3) a psychosocial profile, including cognitive impairment, (4) a nutritional profile also including digestive system diseases, and finally, (5) a concurrent cancer profile. All profiles were considered likely to impact decision-making with differences between treatment modalities. The impact on the care trajectory was generally considered less significant, except for patients with care dependency and psychosocial health problems. CONCLUSIONS Chronic health conditions have various ways of influencing oncologic decision-making and the care trajectory in older adults with cancer. Understanding why specific chronic health conditions may impact the oncologic care trajectory can aid clinicians in the management of older patients with multimorbidity, including cancer.
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Affiliation(s)
- P A L Nelleke Seghers
- Department of Geriatric Medicine, Diakonessenhuis, Bosboomstraat 1, 3572 KE, Utrecht, The Netherlands.
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway
| | - Shane O'Hanlon
- Department of Geriatric Medicine, St Vincent's University Hospital, Dublin, D04 T6F4, Ireland
- Department of Geriatric Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Karlijn Schulkes
- Department of Pulmonology, Diakonessenhuis, 3582 KE, Utrecht, The Netherlands
| | - Isacco Montroni
- Division of Colorectal Surgery, Ospedale Santa Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center-LUMC, 2333 ZA, Leiden, The Netherlands
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Louvain, Belgium
| | - Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonié, Inserm U1312, SIRIC BRIO, Université de Bordeaux, 33076, Bordeaux, France
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Bosboomstraat 1, 3572 KE, Utrecht, The Netherlands
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23
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Wang X, Allen MJ, Espin-Garcia O, Suzuiki C, Bach Y, Panov E, Ma LX, Jang RW, Chen EX, Darling GE, Yeung J, Swallow CJ, Brar SS, Kalimuthu S, Wong R, Veit-Haibach P, Elimova E. Outcomes in older adults with metastatic esophageal and gastric carcinoma treated with palliative chemotherapy. Oncologist 2024:oyae190. [PMID: 39046894 DOI: 10.1093/oncolo/oyae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The incidence of esophageal and gastric carcinoma (GEC) in elderly patients is increasing, yet patients ≥75 years have historically been underrepresented in clinical trials. We sought to investigate palliative chemotherapy administration patterns and survival outcomes in older adults. MATERIALS AND METHODS A retrospective analysis identified patients aged 65-74 (young-old) and ≥75 years (older-old) diagnosed with advanced GEC. Patient and tumor characteristics were recorded, with descriptive analysis, time-to-event data analysis using Kaplan-Meier curves and multivariate Cox proportional hazards regression analysis performed. RESULTS One hundred and ninety-eight "young-old" and 109 'older-old' patients were identified. Patient characteristics were similar between groups except for Charlson Co-morbidity Index (CCI), with lower co-morbidities in the "young-old" compared to "older-old" cohort (P < .001; CCI = 0 in 103 (52%) "young-old" vs 31 (28%) "older-old"). The primary diagnosis in both groups was adenocarcinoma. 119 (60%) "young-old" and 25 (23%) "older-old" patients received chemotherapy (P < .001). Performance status was the primary explanation for chemotherapy non-receipt in both cohorts; age was the explanation in 21 (25%) "older-old" patients and none in the "young-old" patients. PFS for first-line systemic therapy in "young-old" patients was 6.4 (95% CI 5.9-7.6) versus 7.5 months (95% CI 5.1-11.3) in "older-old" patients (P = .69) whilst respective OS was 12.3 (95% CI 10.1-15.5) and 10.4 months (95% CI 9.0-14.6) (P = .0816). Toxicity prompted chemotherapy cessation in 17 (15%) "young-old" and 3 (13%) "older-old" patients (P = .97). Multivariate analysis identified CCI and ECOG performance status as predictive for PFS and OS, respectively. No causative relationship was identified with other variables. CONCLUSION Our study of real-world older-adults show that significant number of "older-old" patients with GEC do not receive chemotherapy. Among "older-old" adults who do receive systemic therapy, outcomes are comparable; this underscores the importance of geriatric assessment-guided care and suggests that age alone should not be a barrier to receipt of chemotherapy in patients with advanced GEC.
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Affiliation(s)
- Xin Wang
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada
| | - Michael J Allen
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada
| | - Osvaldo Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Chihiro Suzuiki
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada
| | - Yvonne Bach
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada
| | - Elan Panov
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada
| | - Lucy X Ma
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada
| | - Raymond W Jang
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada
| | - Eric X Chen
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto ON, Canada
| | - Jonathan Yeung
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto ON, Canada
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Sangeetha Kalimuthu
- Division of Pathology, Toronto General Hospital, University Health Network, Toronto ON, Canada
| | - Rebecca Wong
- Division of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto ON, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto ON, Canada
| | - Elena Elimova
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto ON, Canada
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24
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Loh KP, Soto-Perez-de-Celis E. Addressing Ageism With Geriatric Assessment in Clinical Practice and Research. JCO Oncol Pract 2024:OP2400324. [PMID: 39008787 DOI: 10.1200/op.24.00324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/13/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024] Open
Abstract
Addressing ageism in clinical practice & research: #awareness #education #language and #geriassessment.
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Affiliation(s)
- Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Khalagi K, Hoveidaei AH, AziziKia H, Karimi A, Sattarpour R, Fahimfar N, Sanjari M, Mansourzadeh MJ, Nabipour I, Larijani B, Ostovar A. Identifying determinants for falls among Iranian older adults: insights from the Bushehr Elderly Health Program. BMC Geriatr 2024; 24:588. [PMID: 38982344 PMCID: PMC11232168 DOI: 10.1186/s12877-024-05180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Falls are a common cause of fractures in older adults. This study aimed to investigate the factors associated with spontaneous falls among people aged ≥ 60 years in southern Iran. METHODS The baseline data of 2,426 samples from the second stage of the first phase of a prospective cohort, the Bushehr Elderly Health (BEH) program, were included in the analysis. A history of spontaneous falls in the year before recruitment was measured by self-report using a standardized questionnaire. Demographic characteristics, as well as a history of osteoarthritis, rheumatoid arthritis, low back pain, Alzheimer's disease, epilepsy, depression, and cancer, were measured using standardized questionnaires. A tandem gait (heel-to-toe) exam, as well as laboratory tests, were performed under standard conditions. A multiple logistic regression model was used in the analysis and fitted backwardly using the Hosmer and Lemeshow approach. RESULTS The mean (standard deviation) age of the participants was 69.34 (6.4) years, and 51.9% of the participants were women. A total of 260 (10.7%, 95% CI (9.5-12.0)%) participants reported a spontaneous fall in the year before recruitment. Adjusted for potential confounders, epilepsy (OR = 4.31), cancer (OR = 2.73), depression (OR = 1.81), low back pain (OR = 1.79), and osteoarthritis (OR = 1.49) increased the risk of falls in older adults, while the ability to stand ≥ 10 s in the tandem gait exam (OR = 0.49), being male (OR = 0.60), engaging in physical activity (OR = 0.69), and having high serum triglyceride levels (OR = 0.72) reduced the risk of falls. CONCLUSION The presence of underlying diseases, combined with other risk factors, is significantly associated with an increased risk of falls among older adults. Given the relatively high prevalence of falls in this population, it is crucial to pay special attention to identifying and addressing these risk factors.
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Affiliation(s)
- Kazem Khalagi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute , Tehran University of Medical Sciences, No.10- Jalal-e-ale-ahmad st, Chamran hwy, 14117-13137, Tehran, Iran
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Human Hoveidaei
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hani AziziKia
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Sattarpour
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute , Tehran University of Medical Sciences, No.10- Jalal-e-ale-ahmad st, Chamran hwy, 14117-13137, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute , Tehran University of Medical Sciences, No.10- Jalal-e-ale-ahmad st, Chamran hwy, 14117-13137, Tehran, Iran
| | - Mohammad Javad Mansourzadeh
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute , Tehran University of Medical Sciences, No.10- Jalal-e-ale-ahmad st, Chamran hwy, 14117-13137, Tehran, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bagher Larijani
- Endocrinology Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute , Tehran University of Medical Sciences, No.10- Jalal-e-ale-ahmad st, Chamran hwy, 14117-13137, Tehran, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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O’Keefe K, Chen M, Lesser KJ, DuVall AS, Dils AT. Treating Mental Health and Quality of Life in Older Cancer Patients with Cognitive Behavioral Therapy: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:881. [PMID: 39063458 PMCID: PMC11277493 DOI: 10.3390/ijerph21070881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/21/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) has been successfully utilized in improving mental health (MH) and quality of life (QoL) in the general population, regardless of age. Cancer, which is most frequently diagnosed in older adults, is a debilitating illness that has a detrimental and long-lasting effect on patients' MH and QoL. While numerous studies have demonstrated CBT's efficacy, little evidence exists for its role in older cancer patients. This study, using MH and QoL metrics, evaluates the effectiveness of CBT for older adult cancer patients. METHODS Focusing on MH and QoL and an average age of over 60 years old, a final analysis was performed on 17 clinical trials with a total of 124 effect sizes, including 3073 participants receiving CBT. "Metaphor" and "Robumeta" packages in R Statistical Software (version 4.2.2) were used for analysis, which included robust variance estimation (RVE) in intercept-only meta-regression, and univariate meta-regression for moderator analysis. RESULTS With 17 clinical trials and 124 effect sizes, our results show that CBT moderately improves MH and QoL in cancer patients d = 0.19, 95% CI 0.0166-0.364, p < 0.0399. The delivery format was shown to be a strong moderator of CBT effectiveness with interpersonal technological interventions combined with pre-programmed segments having a very strong treatment effect size (d = 1.7307, 95% CI 1.5244-1.937, p < 0.001). CONCLUSIONS The use of CBT in older adult cancer patients statistically improves MH and QoL, with delivery format and stages of treatment having important roles. Tech-only interpersonal interventions combined with pre-programmed CBT provide an avenue for targeting older adult cancer patients.
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Affiliation(s)
- Kathryn O’Keefe
- College of Medicine, Central Michigan University, Mt Pleasant, MI 48859, USA; (K.O.)
| | - Meiyan Chen
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kevin J. Lesser
- College of Medicine, Central Michigan University, Mt Pleasant, MI 48859, USA; (K.O.)
| | - Adam S. DuVall
- Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Alexander T. Dils
- College of Medicine, Central Michigan University, Mt Pleasant, MI 48859, USA; (K.O.)
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Benderra MA, Paillaud E, Broussier A, Layese R, Tapia CM, Mebarki S, Boudou-Rouquette P, Laurent M, Piero M, Rollot-Trad F, Gligorov J, Caillet P, Canoui-Poitrïne F. Prediction of moderate and severe toxicities of chemotherapy in older patients with cancer: a propensity weighted analysis of ELCAPA cohort. Oncologist 2024:oyae157. [PMID: 38970398 DOI: 10.1093/oncolo/oyae157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/24/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Currently available predictive models for chemotherapy-related toxicity are not sufficiently discriminative in older patients with cancer and do not consider moderate toxicities. The purpose of this study was to identify factors associated with moderate and severe chemotherapy toxicities in older patients with cancer. MATERIALS AND METHODS Patients aged 70+ recruited in the prospective ELCAPA cohort were analyzed. A total of 837 patients with data on toxicities had received chemotherapy without other systemic treatment and were included between 2015 and 2022. To adjust for any imbalances in the distribution of covariates between patients receiving single-agent chemotherapy vs combination chemotherapy, we applied overlap weighting (a propensity-score-based technique). We used multinomial logistic regression. RESULTS Median (interquartile range) age was 81 (77-84). Forty-one percent experienced moderate toxicity, and 33% experienced severe toxicity. Hematologic toxicities accounted for 53% of severe toxicities and 66% of moderate toxicities. Age <80 years, cancer type, metastatic status, Eastern Cooperative Oncology Group performance status (ECOG-PS) >1, no cognitive impairment were associated with combination chemotherapy decision. In a univariate analysis with overlap weighting, no factors were associated with moderate toxicity. Hemoglobin < 0 g/dL and a CIRS-G score >12 were associated with severe toxicity. In a multivariate analysis, only hemoglobin < 10 g/dL was independently associated with severe toxicity, adjusted OR 2.96 (95% CI, 1.20-7.29). CONCLUSION By addressing indication bias for combination chemotherapy decision, only anemia and not cancer type, combination chemotherapy was predicting for severe chemotherapy-related toxicity in older patients with cancer. We did not find any predictors of moderate chemotherapy-related toxicity.
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Affiliation(s)
- Marc-Antoine Benderra
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Henri-Mondor, Public Health Department and Clinical Research Unit (URC Mondor), F-94010 Créteil, France
- Institut Universitaire de Cancérologie (IUC), AP-HP, Sorbonne Université, F-75013 Paris, France
| | - Elena Paillaud
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Européen Georges Pompidou, Paris Cancer Institute CARPEM, Department of Geriatrics, F-75015 Paris, France
| | - Amaury Broussier
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopitaux Henri Mondor/Emile Roux, Department of Geriatrics, F-94456 Limeil-Brevannes, France
| | - Richard Layese
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Henri-Mondor, Public Health Department and Clinical Research Unit (URC Mondor), F-94010 Créteil, France
| | - Claudia M Tapia
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Soraya Mebarki
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Européen Georges Pompidou, Paris Cancer Institute CARPEM, Department of Geriatrics, F-75015 Paris, France
| | - Pascale Boudou-Rouquette
- AP-HP, Hopital Cochin, Cancer Research for PErsonalized Medicine (CARPEM), Department of Medical Oncology, ARIANE Program, Paris Cité University, F-75015 Paris, France
| | - Marie Laurent
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopitaux Henri Mondor/Emile Roux, Department of Geriatrics, F-94456 Limeil-Brevannes, France
| | - Monica Piero
- AP-HP, Hopital Cochin, Cancer Research for PErsonalized Medicine (CARPEM), Department of Medical Oncology, ARIANE Program, Paris Cité University, F-75015 Paris, France
- Hopital Institut Curie, Unité d'oncogériatrie, Department of Supportive Care, F-92210 Saint-Cloud, France
| | - Florence Rollot-Trad
- Hopital Institut Curie, Unité d'oncogériatrie, Department of Supportive Care, F-92210 Saint-Cloud, France
| | - Joseph Gligorov
- Institut Universitaire de Cancérologie (IUC), AP-HP, Sorbonne Université, F-75013 Paris, France
- AP-HP, Hopital Tenon, Department of Medical Oncology, F-75020 Paris, France
| | - Philippe Caillet
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Européen Georges Pompidou, Paris Cancer Institute CARPEM, Department of Geriatrics, F-75015 Paris, France
| | - Florence Canoui-Poitrïne
- Université Paris-Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hopital Henri-Mondor, Public Health Department and Clinical Research Unit (URC Mondor), F-94010 Créteil, France
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Uchiyama M, Miyazaki M, Hayashi T, Shimokawa M, Nakano T, Kakimoto H, Takaki S, Fukue H, Inoue T, Inoue R, Mashima K, Kawata S, Sumi Y, Igarashi Y, Kamimura H, Imakyure O, Matsuo K. Assessing the ability of the Cancer and Aging Research Group tool to predict chemotherapy toxicity in older Japanese patients: A prospective observational study. J Geriatr Oncol 2024; 15:101814. [PMID: 38851083 DOI: 10.1016/j.jgo.2024.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION The Cancer and Aging Research Group (CARG) prediction tool was designed in the United States to predict grade ≥ 3 chemotherapy-related adverse events (CRAE) in older patients. However, its usefulness among Japanese people, who have different sensitivities to anticancer drugs and life expectancy, remains unknown. We aimed to prospectively evaluate the utility of the CARG tool for predicting severe CRAE in older Japanese patients with cancer. MATERIAL AND METHODS Patients with solid tumors aged 65 years and older who commenced anticancer drug regimens from April 2018 to October 2020 were divided into three groups (low, medium, and high-risk) based on their CARG risk scores. Toxicity was prospectively observed by a pharmacist. The primary objective was to evaluate the correlation between the incidence of grade ≥ 3 CRAE and the CARG risk score. The secondary objective was to evaluate hematological and non-hematological toxicities. CRAE incidence was compared among the three groups using a closed testing procedure: (1) Cochran-Armitage test for trend and (2) chi-square test for paired comparison. RESULTS The patients (N = 165) had a median age of 71 years (range: 65-89 years). CRAE in patients divided into low-, medium-, and high-risk groups, based on CARG risk scores, were 39%, 55%, and 82%, respectively (low vs high; p < 0.001, medium vs high; p < 0.01). The incidence of severe hematologic toxicity was 37%, 35%, and 50% in the low-, medium-, and high-risk groups, respectively; the incidence of severe non-hematologic toxicity was 15%, 36%, and 65%, respectively (low vs medium; p < 0.01, low vs high; p < 0.001, and medium vs high; p < 0.01). DISCUSSION To our knowledge, this is the first prospective observational study to validate the CARG prediction tool in older Japanese patients with cancer. The CARG risk score may be effective in predicting the development of non-hematologic toxicities. These results should be considered when administering chemotherapy to older Japanese patients with advanced solid tumors.
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Affiliation(s)
- Masanobu Uchiyama
- Department of Oncology and Infectious Disease Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma Jonan-ku, Fukuoka 814-0180, Japan; Department of Pharmacy, Fukuoka University Hospital; 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Motoyasu Miyazaki
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma Jonan-ku, Fukuoka 814-0180, Japan; Department of Pharmacy, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino-shi, Fukuoka 818-8502, Japan
| | - Toshinobu Hayashi
- Department of Emergency and Disaster Medical Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamiogushi, Ube, Yamaguchi 755-8505, Japan
| | - Takafumi Nakano
- Department of Oncology and Infectious Disease Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma Jonan-ku, Fukuoka 814-0180, Japan; Department of Pharmacy, Fukuoka University Hospital; 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Hideki Kakimoto
- Department of Pharmacy, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino-shi, Fukuoka 818-8502, Japan
| | - Satoko Takaki
- Department of Pharmacy, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino-shi, Fukuoka 818-8502, Japan
| | - Haruka Fukue
- Department of Pharmacy, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino-shi, Fukuoka 818-8502, Japan
| | - Takafumi Inoue
- Department of Pharmacy, Fukuoka University Hospital; 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Ryuichi Inoue
- Department of Pharmacy, Fukuoka University Hospital; 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Kouta Mashima
- Department of Pharmacy, Fukuoka University Hospital; 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Satoshi Kawata
- Department of Pharmacy, Fukuoka University Hospital; 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Yasutaka Sumi
- Department of Pharmacy, Fukuoka University Hospital; 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Yasuaki Igarashi
- Department of Pharmacy, Fukuoka University Hospital; 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Hidetoshi Kamimura
- Department of Pharmacy, Fukuoka University Hospital; 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma Jonan-ku, Fukuoka 814-0180, Japan
| | - Osamu Imakyure
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma Jonan-ku, Fukuoka 814-0180, Japan; Department of Pharmacy, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino-shi, Fukuoka 818-8502, Japan
| | - Koichi Matsuo
- Department of Oncology and Infectious Disease Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma Jonan-ku, Fukuoka 814-0180, Japan; Department of Pharmacy, Fukuoka University Hospital; 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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Meerkerk CDA, Bruijnen CP, van den Bos F, Emmelot-Vonk MH, de Bree R. The geriatric assessment and sarcopenia to assess frailty in older patients with cancer. J Geriatr Oncol 2024; 15:101776. [PMID: 38677936 DOI: 10.1016/j.jgo.2024.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/23/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Christiaan D A Meerkerk
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Cheryl P Bruijnen
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Frederiek van den Bos
- Department of Geriatrics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Marielle H Emmelot-Vonk
- Department of Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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Alibhai SMH, Puts M, Jin R, Godhwani K, Antonio M, Abdallah S, Feng G, Krzyzanowska MK, Soto-Perez-de-Celis E, Papadopoulos E, Mach C, Nasiri F, Sridhar SS, Glicksman R, Moody L, Bender J, Clarke H, Matthew A, McIntosh D, Klass W, Emmenegger U. TOward a comPrehensive supportive Care intervention for Older men with metastatic Prostate cancer (TOPCOP3): A pilot randomized controlled trial and process evaluation. J Geriatr Oncol 2024; 15:101750. [PMID: 38521641 DOI: 10.1016/j.jgo.2024.101750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Current management of metastatic prostate cancer (mPC) includes androgen receptor axis-targeted therapy (ARATs), which is associated with substantial toxicity in older adults. Geriatric assessment and management and remote symptom monitoring have been shown to reduce toxicity and improve quality of life in patients undergoing chemotherapy, but their efficacy in patients being treated with ARATs has not been explored. The purpose of this study is to examine whether these interventions, alone or in combination, can improve treatment tolerability and quality of life (QOL) for older adults with metastatic prostate cancer on ARATs. MATERIALS AND METHODS TOPCOP3 is a multi-centre, factorial pilot clinical trial coupled with an embedded process evaluation. The study includes four treatment arms: geriatric assessment and management (GA + M); remote symptom monitoring (RSM); geriatric assessment and management plus remote symptom monitoring; and usual care and will be followed for six months. The aim is to recruit 168 patients between two cancer centres in Toronto, Canada. Eligible participants will be randomized equally via REDCap. Participants in all arms will complete a comprehensive baseline assessment upon enrollment following the Geriatric Core dataset, as well as follow-up assessments at 1.5, 3, 4.5, and 6 months. The co-primary outcomes will be grade 3-5 toxicity and QOL. Toxicities will be graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. QOL will be measured by patient self-reporting using the EuroQol 5 dimensions of health questionnaire. Secondary outcomes include fatigue, insomnia, and depression. Finally, four process evaluation outcomes will also be observed, namely feasibility, fidelity, and acceptability, along with implementation barriers and facilitators. DISCUSSION Data will be collected to observe the effects of GA + M and RSM on QOL and toxicities experienced by older adults receiving ARATs for metastatic prostate cancer. Data will also be collected to help the design and conduct of a definitive multicentre phase III randomized controlled trial. This study will extend supportive care interventions for older adults with cancer into new areas and inform the design of larger trials. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov (registration number: NCT05582772).
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Affiliation(s)
- Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada.
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rana Jin
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kian Godhwani
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Maryjo Antonio
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Soha Abdallah
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Gregory Feng
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Calvin Mach
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ferozah Nasiri
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rachel Glicksman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network; Department of Radiation Oncology, University of Toronto, Canada
| | - Lesley Moody
- Varian Medical Systems, Winnipeg, Manitoba, Canada
| | - Jacqueline Bender
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | | | | | - Urban Emmenegger
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Gallois C, Shi Q, Pederson LD, André T, Iveson TJ, Sobrero AF, Alberts S, de Gramont A, Meyerhardt JA, George T, Schmoll HJE, Souglakos I, Harkin A, Labianca R, Sinicrope FA, Oki E, Shields AF, Boukovinas I, Kerr R, Lonardi S, Yothers G, Yoshino T, Goldberg RM, Taieb J, Papamichael D. Oxaliplatin-Based Adjuvant Chemotherapy in Older Patients With Stage III Colon Cancer: An ACCENT/IDEA Pooled Analysis of 12 Trials. J Clin Oncol 2024; 42:2295-2305. [PMID: 38547438 DOI: 10.1200/jco.23.01326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/30/2023] [Accepted: 02/28/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE A number of studies suggest that older patients may have reduced or no benefit from the addition of oxaliplatin to fluoropyrimidines as adjuvant chemotherapy for stage III colon cancer (CC). MATERIALS AND METHODS We studied the prognostic impact of age, as well as treatment adherence/toxicity patterns according to age, in patients with stage III CC who received 3 or 6 months of infusional fluorouracil, leucovorin, and oxaliplatin/capecitabine and oxaliplatin (CAPOX) on the basis of data collected from trials from the ACCENT and IDEA databases. Associations between age and time to recurrence (TTR), disease-free survival (DFS), overall survival (OS), survival after recurrence (SAR), and cancer-specific survival (CSS) were assessed by a Cox model or a competing risk model, stratified by studies and adjusted for sex, performance status, T and N stage, and year of enrollment. RESULTS A total of 17,909 patients were included; 24% of patients were age older than 70 years (n = 4,340). Patients age ≥70 years had higher rates of early treatment discontinuation. Rates of grade ≥3 adverse events were similar between those older and younger than 70 years, except for diarrhea and neutropenia that were more frequent in older patients treated with CAPOX (14.2% v 11.2%; P = .01 and 12.1% v 9.6%; P = .04, respectively). In multivariable analysis, TTR was not significantly different between patients <70 years and those ≥70 years, but DFS, OS, SAR, and CSS were significantly shorter in those patients ≥70 years. CONCLUSION In patients ≥70 years with stage III CC fit enough to be enrolled in clinical trials, oxaliplatin-based adjuvant chemotherapy was well tolerated and led to similar TTR compared with younger patients, suggesting similar efficacy. TTR may be a more appropriate end point for efficacy in this patient population.
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Affiliation(s)
- Claire Gallois
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, SIRIC CARPEM, Paris-Cité University, Paris, France
| | - Qian Shi
- Department of Quantitative Health Science, Mayo Clinic, Rochester, MN
| | - Levi D Pederson
- Department of Quantitative Health Science, Mayo Clinic, Rochester, MN
| | - Thierry André
- Department of Medical Oncology, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Timothy J Iveson
- Department of Medical Oncology, University of Southampton, Southampton, United Kingdom
| | | | | | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Thomas George
- University of Florida Health Cancer Center, Gainesville, FL
| | - Hans-Joachim E Schmoll
- Department Internal Medicine, Clinic of Internal Medicine IV, University Clinic Halle, Martin-Luther University, Halle, Germany
| | - Ioannis Souglakos
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece
| | - Andrea Harkin
- Cancer Research UK Glasgow Clinical Trials Unit, Glasgow, United Kingdom
| | - Roberto Labianca
- Cancer Center, Ospedale Papa Giovanni XXIII Bergamo, Bergamo, Italy
| | | | - Eiji Oki
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | | | | | - Rachel Kerr
- Department of Oncology, Oxford University, Oxford, United Kingdom
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Richard M Goldberg
- West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center, Morgantown, WV
| | - Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, SIRIC CARPEM, Paris-Cité University, Paris, France
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Gendarme S, Zebachi S, Corre R, Greillier L, Justeau G, Bylicki O, Decroisette C, Auliac JB, Guisier F, Geier M, Ricordel C, Frelaut M, Paillaud E, Chouaïd C, Canouï-Poitrine F. Predictors of three-month mortality and severe chemotherapy-related adverse events in patients aged 70 years and older with metastatic non-small-cell lung cancer: A secondary analysis of ESOGIA-GFPC-GECP 08-02 study. J Geriatr Oncol 2024; 15:101506. [PMID: 37211514 DOI: 10.1016/j.jgo.2023.101506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 04/21/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Predictors for mortality and toxicity in older patients with cancer are mainly studied in cohorts with various cancers at different stages. This study aims to identify predictive geriatric factors (PGFs) for early death and severe chemotherapy related adverse events (CRAEs) in patients aged ≥70 years with metastatic non-small-cell lung cancer (mNSCLC). MATERIAL AND METHODS This is a secondary analysis of the multicenter, randomized, phase 3 ESOGIA trial that compared, for patients ≥70 years with mNSCLC, a treatment algorithm based on performance status and age to another algorithm based on geriatric assessment. To identify PGFs of three-month mortality and grade 3, 4, or 5 CRAEs, multivariate Cox models and logistic models, adjusted for treatment group and center, and stratified by randomization arm, were constructed. RESULTS Among 494 included patients, 145 (29.4%) had died at three months and 344 (69.6%) had severe chemotherapy toxicity. For three-month mortality, multivariate analyses retained mobility (Test Get up and Go), instrumental activity of daily living (IADL) dependence and weight loss as PGFs. The combined effect of IADL ≤2/4 and weight loss ≥3 kg was strongly associated with three-month mortality (adjusted hazard ratio: 5.71 [95% confidence interval [CI]: 2.64-12.32]). For chemotherapy toxicity, Charlson Comorbidity Index ≥2 was independently associated with grade3, 4, or 5 CRAEs (adjusted odds ratio [95% CI]: 1.94 [1.06-3.56]). DISCUSSION Mobility, IADL dependence, and weight loss were predictive of three-month mortality in a population aged ≥70 years treated for mNSCLC, while comorbidities were independently associated with severe chemotherapy toxicity.
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Affiliation(s)
- Sébastien Gendarme
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France.
| | - Sonia Zebachi
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Santé Publique et Unité de Recherche Clinique, 1 Rue Gustave Eiffel, 94010 Créteil, France
| | - Romain Corre
- Centre Hospitalier Intercommunal de Cornouaille, Service de Pneumologie, 14 Av. Yves Thépot, 29000 Quimper, France
| | - Laurent Greillier
- Aix-Marseille Université, AP-HM, INSERM, CNRS, CRCM, Hôpital Nord, Service d'Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France
| | - Grégoire Justeau
- CHU d'Angers, Service de Pneumologie, 4 Rue Larrey, 49100 Angers, France
| | - Olivier Bylicki
- HIA Sainte-Anne, Service de Pneumologie, 2, boulevard Saint-Anne, 83000 Toulon, France
| | - Chantal Decroisette
- CH d'Annecy, Service de Pneumologie, 1, avenue de l'Hôpital, Metz-Tessy, 74374 Annecy, France
| | - Jean-Bernard Auliac
- Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France
| | - Florian Guisier
- Univ Rouen Normandie, LITIS Lab QuantIF team EA4108, CHU Rouen, France; Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care & CIC-CRB INSERM 1404 F, 76000, Rouen, France
| | - Margaux Geier
- CHU Morvan, Service de Pneumologie, 2, avenue Foch, 29200 Brest, France
| | - Charles Ricordel
- CHU Rennes, Service de Pneumologie, 2 Rue Henri le Guilloux, 35033 Rennes, France
| | - Maxime Frelaut
- Gustave Roussy, Département d'Oncologie Médicale, 39 rue Camille-Desmoulins, 94805 Villejuif Cedex, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service de Gériatrie, 20, rue Leblanc, 75908 Paris Cedex 15, France
| | - Christos Chouaïd
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Santé Publique et Unité de Recherche Clinique, 1 Rue Gustave Eiffel, 94010 Créteil, France
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Portielje J, van den Bos F. Increasing the evidence for comprehensive geriatric assessment. J Geriatr Oncol 2024; 15:101702. [PMID: 38220590 DOI: 10.1016/j.jgo.2023.101702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
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Faour E, Guo S, Puts M. Geriatric Assessment in the Era of Targeted and Immunotherapy. Drugs Aging 2024; 41:577-582. [PMID: 38914823 DOI: 10.1007/s40266-024-01126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/26/2024]
Abstract
Cancer is a disease that mostly affects older adults and because of the aging of the population, the number of older adults diagnosed with cancer will increase significantly around the world. With increasing age, more older adults are living with frailty, and this may impact the tolerability of cancer treatments. International guidelines, such as the American Society for Clinical Oncology geriatric oncology guideline, recommend a geriatric assessment and management for all older adults with cancer to support the treatment decision-making process as well as develop a plan for supportive care interventions to support the older adults during cancer treatments. While there is clinical trial evidence to support a geriatric assessment and management for older adults receiving chemotherapy, there is less evidence to support a geriatric assessment for older adults starting immunotherapy. There are increasing numbers of new immunotherapies and targeted therapies available for older adults with cancer but often few older adults have been included in the clinical trials, leaving less evidence for clinicians to guide treatment decisions. In this current opinion, we review the current evidence on the use of a geriatric assessment and management in the context of immunotherapy and targeted therapy. We review how a geriatric assessment could support older adults making treatment decisions for immunotherapy, review how geriatric assessment parameters are linked with outcomes and provide guidance on how geriatric assessment can guide the supportive care plan during immunotherapy treatment.
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Cook S, Alibhai S, Mehta R, Savard MF, Mariano C, LeBlanc D, Desautels D, Pezo R, Zhu X, Gelmon KA, Hsu T. Improving Care for Older Adults with Cancer in Canada: A Call to Action. Curr Oncol 2024; 31:3783-3797. [PMID: 39057151 PMCID: PMC11275828 DOI: 10.3390/curroncol31070279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/27/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Most patients diagnosed with and dying from cancer in Canada are older adults, with aging contributing to the large projected growth in cancer incidence. Older adults with cancer have unique needs, and on a global scale increasing efforts have been made to address recognized gaps in their cancer care. However, in Canada, geriatric oncology remains a new and developing field. There is increasing recognition of the value of geriatric oncology and there is a growing number of healthcare providers interested in developing the field. While there is an increasing number of dedicated programs in geriatric oncology, they remain limited overall. Developing novel methods to delivery geriatric care in the oncology setting and improving visibility is important. Formal incorporation of a geriatric oncology curriculum into training is critical to both improve knowledge and demonstrate its value to healthcare providers. Although a robust group of dedicated researchers exist, increased collaboration is needed to capitalize on existing expertise. Dedicated funding is critical to promoting clinical programs, research, and training new clinicians and leaders in the field. By addressing challenges and capitalizing on opportunities for improvement, Canada can better meet the unique needs of its aging population with cancer and ultimately improve their outcomes.
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Affiliation(s)
- Sarah Cook
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Shabbir Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Rajin Mehta
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Marie-France Savard
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Caroline Mariano
- BC Cancer Vancouver Centre, University of British Columbia, Vancouver, BC V5Z 4E6, Canada
| | - Dominique LeBlanc
- Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC G1V 0A6, Canada
| | - Danielle Desautels
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Rossanna Pezo
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Xiaofu Zhu
- Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Karen A. Gelmon
- BC Cancer Vancouver Centre, University of British Columbia, Vancouver, BC V5Z 4E6, Canada
| | - Tina Hsu
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H 8L6, Canada
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Sanchez DN, Derks MGM, Verstijnen JA, Menges D, Portielje JEA, Van den Bos F, Bastiaannet E. Frequency of use and characterization of frailty assessments in observational studies on older women with breast cancer: a systematic review. BMC Geriatr 2024; 24:563. [PMID: 38937703 PMCID: PMC11212278 DOI: 10.1186/s12877-024-05152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Breast cancer and frailty frequently co-occur in older women, and frailty status has been shown to predict negative health outcomes. However, the extent to which frailty assessments are utilized in observational research for the older breast cancer population is uncertain. Therefore, the aim of this review was to determine the frequency of use of frailty assessments in studies investigating survival or mortality, and characterize them, concentrating on literature from the past 5 years (2017-2022). METHODS MEDLINE, EMBASE and Cochrane Library were systematically queried to identify observational studies (case-control, cohort, cross-sectional) published from 2017-2022 that focus on older females (≥ 65 years) diagnosed with breast cancer, and which evaluate survival or mortality outcomes. Independent reviewers assessed the studies for eligibility using Covidence software. Extracted data included characteristics of each study as well as information on study design, study population, frailty assessments, and related health status assessments. Risk of bias was evaluated using the appropriate JBI tool. Information was cleaned, classified, and tabulated into review level summaries. RESULTS In total, 9823 studies were screened for inclusion. One-hundred and thirty studies were included in the final synthesis. Only 11 (8.5%) of these studies made use of a frailty assessment, of which 4 (3.1%) quantified frailty levels in their study population, at baseline. Characterization of frailty assessments demonstrated that there is a large variation in terms of frailty definitions and resulting patient classification (i.e., fit, pre-frail, frail). In the four studies that quantified frailty, the percentage of individuals classified as pre-frail and frail ranged from 18% to 29% and 0.7% to 21%, respectively. Identified frailty assessments included the Balducci score, the Geriatric 8 tool, the Adapted Searle Deficits Accumulation Frailty index, the Faurot Frailty index, and the Mian Deficits of Accumulation Frailty Index, among others. The Charlson Comorbidity Index was the most used alternative health status assessment, employed in 56.9% of all 130 studies. Surprisingly, 31.5% of all studies did not make use of any health status assessments. CONCLUSION Few observational studies examining mortality or survival outcomes in older women with breast cancer incorporate frailty assessments. Additionally, there is significant variation in definitions of frailty and classification of patients. While comorbidity assessments were more frequently included, the pivotal role of frailty for patient-centered decision-making in clinical practice, especially regarding treatment effectiveness and tolerance, necessitates more deliberate attention. Addressing this oversight more explicitly could enhance our ability to interpret observational research in older cancer patients.
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Affiliation(s)
- Dafne N Sanchez
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zürich, Hirschengraben 82, Zurich, CH-8001, Switzerland
| | - Marloes G M Derks
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jose A Verstijnen
- Department of Medical Oncology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zürich, Hirschengraben 82, Zurich, CH-8001, Switzerland
| | | | - Frederiek Van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther Bastiaannet
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zürich, Hirschengraben 82, Zurich, CH-8001, Switzerland.
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Xu W, Yang H, Li W, Wang Y, Zhang X, Chen Y. The Impact of Frailty on Chemotherapy Outcomes in Patients With Digestive System Tumors: A Systematic Review and Meta-analysis. Cancer Nurs 2024:00002820-990000000-00261. [PMID: 38865649 DOI: 10.1097/ncc.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND The prevalence of patients with digestive system tumors has been high. In recent years, frailty has been considered to be associated with poor prognosis of digestive system tumors, but there are conflicting research results. A better understanding of the relationship between frailty and outcomes after chemotherapy can help advance the development of oncology care. OBJECTIVE The aim of this study was to evaluate the effects of prechemotherapy frailty on chemotherapy toxicity, overall mortality, unplanned hospitalization, and overall survival in patients with digestive system tumors. METHODS Up to April 2023, observational studies assessing the impact of frailty on chemotherapy outcomes in patients with digestive system tumors were collected through searching 10 online research databases. Two evaluators independently extracted literature based on the inclusion and exclusion criteria and evaluated the quality of the studies using the Newcastle-Ottawa Scale. RESULTS Eventually, 11 cohort studies encompassing 2380 patients were included. The meta-analysis revealed that the frail group exhibited an increased risk of overall mortality, with poorer overall survival than the nonfrail group. CONCLUSION Frailty increases the risk of chemotherapy-induced toxic effects, unplanned hospitalization, and death in patients. However, because of this study's limited number of participants, large-sample, multicenter studies to verify these findings are required. IMPLICATIONS FOR PRACTICE This study provides theoretical support for incorporating frailty assessment into the nursing evaluation of patients with digestive system tumors before chemotherapy. This integration aids in predicting patients at a high risk of chemotherapy toxicity, mortality, and unplanned hospitalization, therefore providing corresponding interventions in advance to reduce adverse outcomes.
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Affiliation(s)
- Weiyan Xu
- Author Affiliations: School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University (Miss Xu, Wang and Zhang); and Qilu Hospital of Shandong University (Mrs Yang, Mrs Li, and Mrs Chen), Jinan, China
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Slaaen M, Røyset IM, Saltvedt I, Grønberg BH, Halsteinli V, Døhl Ø, Vossius C, Kirkevold Ø, Bergh S, Rostoft S, Oldervoll L, Bye A, Melby L, Røsstad T, Eriksen GF, Sollid MIV, Rolfson D, Šaltytė Benth J. Geriatric assessment with management for older patients with cancer receiving radiotherapy: a cluster-randomised controlled pilot study. BMC Med 2024; 22:232. [PMID: 38853251 PMCID: PMC11163782 DOI: 10.1186/s12916-024-03446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/24/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Geriatric assessment and management (GAM) improve outcomes in older patients with cancer treated with surgery or chemotherapy. It is unclear whether GAM may provide better function and quality of life (QoL), or be cost-effective, in a radiotherapy (RT) setting. METHODS In this Norwegian cluster-randomised controlled pilot study, we assessed the impact of a GAM intervention involving specialist and primary health services. It was initiated in-hospital at the start of RT by assessing somatic and mental health, function, and social situation, followed by individually adapted management plans and systematic follow-up in the municipalities until 8 weeks after the end of RT, managed by municipal nurses as patients' care coordinators. Thirty-two municipal/city districts were 1:1 randomised to intervention or conventional care. Patients with cancer ≥ 65 years, referred for RT, were enrolled irrespective of cancer type, treatment intent, and frailty status, and followed the allocation of their residential district. The primary outcome was physical function measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Secondary outcomes were overall quality of life (QoL), physical performance, use and costs of health services. Analyses followed the intention-to-treat principle. Study registration at ClinicalTrials.gov ID NCT03881137. RESULTS We included 178 patients, 89 in each group with comparable age (mean 74.1), sex (female 38.2%), and Edmonton Frail Scale scores (mean 3.4 [scale 0-17], scores 0-3 [fit] in 57%). More intervention patients received curative RT (76.4 vs 61.8%), had higher irradiation doses (mean 54.1 vs 45.5 Gy), and longer lasting RT (mean 4.4 vs 3.6 weeks). The primary outcome was completed by 91% (intervention) vs 88% (control) of patients. No significant differences between groups on predefined outcomes were observed. GAM costs represented 3% of health service costs for the intervention group during the study period. CONCLUSIONS In this heterogeneous cohort of older patients receiving RT, the majority was fit. We found no impact of the intervention on patient-centred outcomes or the cost of health services. Targeting a more homogeneous group of only pre-frail and frail patients is strongly recommended in future studies needed to clarify the role and organisation of GAM in RT settings.
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Affiliation(s)
- Marit Slaaen
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb 1171 Blindern, Oslo, 0318, Norway
| | - Inga Marie Røyset
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway.
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim, Norway.
- Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Box 3250 Torgarden , Trondheim, NO-7006, Norway.
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim, Norway
- Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Box 3250 Torgarden , Trondheim, NO-7006, Norway
| | - Bjørn Henning Grønberg
- Department of Oncology, St. Olav Hospital, St. Olavs Hospital, Trondheim University Hospital, Box 3250 Torgarden , Trondheim, NO-7006, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Vidar Halsteinli
- Regional Center for Health Care Improvement, St. Olavs Hospital, Trondheim University Hospital, Box 3250 Torgarden , Trondheim, NO-7006, Norway
| | - Øystein Døhl
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim, Norway
- Trondheim Municipality, Trondheim Kommune, Postboks , Trondheim, Norway
| | - Corinna Vossius
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Øyvind Kirkevold
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Postboks , Tønsberg, 2136, 3103, Norway
- Department of Health Sciences in Gjøvik, NTNU, Box 191, N-2802, Gjøvik, Norway
| | - Sverre Bergh
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Postboks , Tønsberg, 2136, 3103, Norway
| | - Siri Rostoft
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb 1171 Blindern, Oslo, 0318, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Pb , Nydalen, Norway
| | - Line Oldervoll
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, 7807, 5020, Bergen, PB, Norway
- Department of Public Health and Nursing, NTNU, 8905, 7491, Trondheim, PB, Norway
| | - Asta Bye
- Oslo Metropolitan University (Oslomet), Postboks 4, St. Olavs Plass, 0130, Oslo, Norway
- European Palliative Care Research Centre (PRC), Institute of Clinical Medicine, Faculty of Medicine, Department of Oncology, University of Oslo, and, Oslo University Hospital, Nydalen, Norway
| | - Line Melby
- Department of Health Sciences in Gjøvik, NTNU, Box 191, N-2802, Gjøvik, Norway
| | - Tove Røsstad
- Trondheim Municipality, Trondheim Kommune, Postboks , Trondheim, Norway
- Department of Public Health and Nursing, NTNU, 8905, 7491, Trondheim, PB, Norway
| | - Guro Falk Eriksen
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Pb 1171 Blindern, Oslo, 0318, Norway
- Department of Internal Medicine, Hamar Hospital, Innlandet Hospital Trust, Skolegata 32, 2318, Hamar, Norway
| | - May Ingvild Volungholen Sollid
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Department of Health Sciences in Gjøvik, NTNU, Box 191, N-2802, Gjøvik, Norway
| | - Darryl Rolfson
- Division of Geriatric Medicine, Clinical Sciences Building, University of Alberta, 1-19811350 83 Ave, Edmonton, AB, T6G 2P4, Canada
| | - Jūratė Šaltytė Benth
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Box 68, 2312, Ottestad, Norway
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, P.O.Box 1171, 0318, Blindern, Norway
- Health Services Research Unit, Akershus University Hospital, P.O.Box 1000, 1478, Lørenskog, Norway
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Karnakis T, de Souza PMR, Kanaji AL, Chinaglia L, Bezerra MR, Almeida OLS. The role of geriatric oncology in the care of older people with cancer: some evidence from Brazil and the world. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S118. [PMID: 38865538 PMCID: PMC11164271 DOI: 10.1590/1806-9282.2024s118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/30/2023] [Indexed: 06/14/2024]
Affiliation(s)
- Theodora Karnakis
- Universidade de São Paulo, Cancer Institute of the State of São Paulo – São Paulo (SP), Brazil
- Teaching and Research Institute, Sírio-Libanês Hospital – São Paulo (SP), Brazil
- Brazilian Society of Geriatrics and Gerontology, Geriatric Oncology Commission – Brazil
- São Paulo Medical School, Laboratory of Medical Investigation in Aging (LIM 66) – São Paulo (SP), Brazil
| | - Polianna Mara Rodrigues de Souza
- Brazilian Society of Geriatrics and Gerontology, Geriatric Oncology Commission – Brazil
- Albert Einstein Israelite Hospital – São Paulo (SP), Brazil
| | - Ana Lumi Kanaji
- Teaching and Research Institute, Sírio-Libanês Hospital – São Paulo (SP), Brazil
- Brazilian Society of Geriatrics and Gerontology, Geriatric Oncology Commission – Brazil
| | - Lessandra Chinaglia
- Brazilian Society of Geriatrics and Gerontology, Geriatric Oncology Commission – Brazil
- Oncology Center of Prevent Senior – São Paulo (SP), Brazil
| | - Mirella Rebello Bezerra
- Brazilian Society of Geriatrics and Gerontology, Geriatric Oncology Commission – Brazil
- Institute of Integral Medicine Professor Fernando Figueira – Recife (PE), Brazil
| | - Olga Laura Sena Almeida
- Universidade de São Paulo, Cancer Institute of the State of São Paulo – São Paulo (SP), Brazil
- Brazilian Society of Geriatrics and Gerontology, Geriatric Oncology Commission – Brazil
- São Paulo Medical School, Laboratory of Medical Investigation in Aging (LIM 66) – São Paulo (SP), Brazil
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Tripathi N, Gebrael G, Chigarira B, Sahu KK, Balasubramanian I, Caparas C, Mathew Thomas V, Cohan JN, Pelletier K, Maughan BL, Agarwal N, Swami U, Gupta S. Treatment Patterns and Outcomes by Age in Metastatic Urinary Tract Cancer: A Retrospective Tertiary Cancer Center Analysis. Cancers (Basel) 2024; 16:2143. [PMID: 38893262 PMCID: PMC11172373 DOI: 10.3390/cancers16112143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Metastatic urinary tract cancer (mUTC) is challenging to treat in older adults due to comorbidities. We compared the clinical courses of younger and older (≥70 years) adults with mUTC receiving first-line (1L) systemic therapy in a tertiary cancer center. Baseline clinical characteristics, treatments received, tolerability, and survival outcomes were analyzed. Among 212 patients (103 older vs. 109 younger), the older patients had lower hemoglobin at baseline (84% vs. 71%, p = 0.03), the majority were cisplatin-ineligible (74% vs. 45%, p < 0.001), received more immunotherapy-based treatments in the 1L (52% vs. 36%, p = 0.01), received fewer subsequent lines of treatment (median 0 vs. 1, p = 0.003), and had lower clinical trial participation (30% vs. 18%, p = 0.05) compared to the younger patients. When treated with 1L chemotherapy, older patients required more dose adjustments (53.4% vs. 23%, p = 0.001) and received fewer cycles of chemotherapy (median 4 vs. 5, p= 0.01). Older patients had similar OS (11.2 months vs. 14 months, p = 0.06) and similar rates of treatment-related severe toxicity and healthcare visits, independent of the type of systemic treatment received, compared to younger patients. We conclude that select older adults with mUTC can be safely treated with immunotherapy and risk-adjusted regimens of chemotherapy with tangible survival benefits.
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Affiliation(s)
- Nishita Tripathi
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
- Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
| | - Georges Gebrael
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Beverly Chigarira
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Kamal Kant Sahu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Ishwarya Balasubramanian
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Constance Caparas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Vinay Mathew Thomas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Jessica N. Cohan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Kaitlyn Pelletier
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Benjamin L. Maughan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Sumati Gupta
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA
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Walsh DJ, O'Driscoll M, Sahm LJ, Meagher AM, Doblas P, McGowan E, Smith-Lehane G, Hannan M, Goggin C, Buckley C, Horgan AM. Ageing-related considerations for medication used in supportive care in cancer. J Geriatr Oncol 2024; 15:101760. [PMID: 38556399 DOI: 10.1016/j.jgo.2024.101760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/23/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
Both randomized controlled trials (RCTs) and retrospective studies have shown that a comprehensive geriatric assessment (CGA) prior to a patient commencing systemic anti-cancer therapy (SACT) results in improved quality of life outcomes and is associated with a decreased risk of grade 3-5 toxicity; however, data are lacking in relation to adverse drug events (ADE) associated with supportive care medications. Supportive care medications are prescribed as prophylactic agents in a SACT regimen, for management of treatment related toxicity and for symptoms caused by the disease itself. While necessary, the commencement of SACT and supportive medications may cause, or exacerbate, a significant drug burden in older patients, some of whom may have existing comorbidities. For many medications, older adults are underrepresented in pharmacokinetic and pharmacodynamic modelling studies. In this article we will review ageing-related changes in pharmacokinetics and pharmacodynamics, as well as how these changes may impact supportive care medications. Additional considerations for prescribing these medications in older adults with cancer, such as polypharmacy, potentially inappropriate medications, drug-drug interactions, and anticholinergic burden, as well as ageing-related considerations and recommendations for supportive care medications commonly used in older adults with cancer are also reviewed.
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Affiliation(s)
- Darren J Walsh
- Pharmacy Department, University Hospital Waterford, Waterford, Ireland; Oncology Department, University Hospital Waterford, Waterford, Ireland; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Michelle O'Driscoll
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Laura J Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland; Department of Pharmacy, Mercy University Hospital, Grenville Place, Cork. Ireland
| | - Anne Marie Meagher
- Pharmacy Department, University Hospital Waterford, Waterford, Ireland; Oncology Department, University Hospital Waterford, Waterford, Ireland
| | - Pedro Doblas
- Pharmacy Department, University Hospital Waterford, Waterford, Ireland; Oncology Department, University Hospital Waterford, Waterford, Ireland
| | - Eimear McGowan
- Pharmacy Department, University Hospital Waterford, Waterford, Ireland; Oncology Department, University Hospital Waterford, Waterford, Ireland
| | - Gráinne Smith-Lehane
- Pharmacy Department, University Hospital Waterford, Waterford, Ireland; Oncology Department, University Hospital Waterford, Waterford, Ireland
| | - Michelle Hannan
- Oncology Department, University Hospital Waterford, Waterford, Ireland
| | - Caitríona Goggin
- Oncology Department, University Hospital Waterford, Waterford, Ireland
| | - Carol Buckley
- Oncology Department, University Hospital Waterford, Waterford, Ireland
| | - Anne M Horgan
- Oncology Department, University Hospital Waterford, Waterford, Ireland
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Obama K, Fujimori M, Boku N, Matsuoka A, Mori K, Okizaki A, Miyaji T, Okamura M, Majima Y, Goto S, Shimazu T, Uchitomi Y. Shared decision-making support program for older patients with advanced cancer using a question prompt list and geriatric assessment: A pilot randomized controlled trial. J Geriatr Oncol 2024; 15:101778. [PMID: 38704911 DOI: 10.1016/j.jgo.2024.101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/10/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Older patients with cancer are less likely to express their treatment preferences than younger patients. Question prompt lists (QPLs) facilitate communication between patients and physicians. Geriatric assessment (GA) is recommended when older patients with cancer make treatment decisions. This study estimated the effect size of a shared decision-making (SDM) support program combining QPLs with GA in terms of patients' subjective evaluation of the SDM process for a future definitive randomized controlled trial. We also evaluated the number and quality of aging-related communication during consultations, and feasibility and acceptability of the study for exploratory purposes. MATERIALS AND METHODS This is a pilot study with randomized allocation and blind evaluation. Patients aged 65 years or older at the National Cancer Center Hospital, Tokyo, Japan, scheduled to discuss the changes of their treatment, were randomly assigned in a 1:1 ratio to the SDM support program or usual care. This program consisted of 30-60 min of face-to-face coaching, with QPLs and GA provided before the coaching. As the primary endpoint, the decisional conflict scores given by the patients immediately after the consultation were compared between the two groups. For the secondary endpoints, the number and quality of aging-related communications during the consultations were assessed by evaluators (blinded) using audio-recordings. Adherence, burden, and usefulness were assessed for evaluating feasibility and acceptability of the SDM support program. RESULTS Forty patients were enrolled. All patients completed the GA questionnaire, for which 70% did not require any individual assistance. Answering the questionnaires took approximately 11 min. The decisional conflict scores were mean [standard deviation (SD)]: 19.3 [10.8] vs. 18.0 [11.1] (effect size: Cohen's d = 0.12) for the SDM support program and usual care groups, respectively. The number of aging-related communications during the consultation for the new treatment was higher in the SDM support program group than the usual care (mean [SD]: 3.3 [1.2] vs. 2.2 [1.5], effect size: cohen's d = 1.32). Patients felt that the SDM support program was useful but not burdensome or difficult. DISCUSSION The SDM support program was considered useful and feasible for older patients and able to facilitate communication regarding aging-related concerns. TRIAL REGISTRATION NUMBER The study protocol was registered on September 23, 2020, in the UMIN Clinical Trials Registry (UMIN000041867).
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Affiliation(s)
- Kyoko Obama
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Maiko Fujimori
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan.
| | - Narikazu Boku
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Ayumu Matsuoka
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Keita Mori
- Department of Biostatistics, Clinical Research Center, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Ayumi Okizaki
- Innovation Center for Supportive, Palliative, and Psychosocial Care, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Tempei Miyaji
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan; Innovation Center for Supportive, Palliative, and Psychosocial Care, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Masako Okamura
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Yoshiyuki Majima
- NPO Pancreatic Cancer Action Network Japan, Sodegaura, Chiba, Japan
| | - Shinichi Goto
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Taichi Shimazu
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Yosuke Uchitomi
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan; Innovation Center for Supportive, Palliative, and Psychosocial Care, National Cancer Center, Chuo-ku, Tokyo, Japan
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43
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Madariaga A, Cole H, Pittman T, Grant RC, Dhani NC, Liu A, Bowering V, Sellman S, Oza AM, Lheureux S. High grade adverse event reporting and enrolment in gynecologic oncology clinical trials. Gynecol Oncol 2024; 185:1-7. [PMID: 38342004 DOI: 10.1016/j.ygyno.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/09/2024] [Accepted: 02/03/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE The primary objective is to assess factors associated with treatment related high grade (CTCAE grade ≥ 3) adverse event (AE) reporting among participants in gynecologic oncology clinical trials. METHODS All AEs recorded in the Princess Margaret Clinical Trial adverse event database between 01/2016 and 12/2018 were evaluated. Gynecologic oncology clinical trials assessing systemic therapy were included. Inferential statistics on risk factors of related grade ≥ 3 adverse event reporting and GEE logistic models with Odds Ratios (OR) were performed. Multivariable analysis adjusting for age, clinical trial phase, sponsor, and therapy type. RESULTS The gynecology cancer clinical trials accrued 317 unique patients (359 nested on trials) in 42 systemic therapy trials. In the period, 17,175 related AEs were reported in the gynecological cancer trials, 7.4% were grade ≥ 3. On multivariable analysis, no odds differences of grade ≥ 3 related AEs were detected according to study phase. Patients in immunotherapy clinical trials had lower odds of related grade ≥ 3 AEs than patients on targeted or other therapy (adjusted OR [aOR] 0.43; 95% CI 0.24-0.75). There was greater odds of related grade ≥ 3 AEs in clinical trials assessing combination vs single therapeutics (aOR 2.26, 95% CI 1.34-3.80). Patients aged ≥65 (aOR 1.77; 95% CI 1.08-2.89) had greater odds of related grade ≥ 3 AEs than patients aged 50 to 65 years. When compared to other disease sites, the odds of having a grade ≥ 3 related AE reported in gynecology clinical trials was no different. CONCLUSIONS In this cohort, factors influencing the odds of related grade ≥ 3 AE reporting in gynecologic trials included type of therapy and age. The study phase did not correlate with odds of high-grade AE reporting.
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Affiliation(s)
- Ainhoa Madariaga
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Medical Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Heather Cole
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tyler Pittman
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert C Grant
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Neesha C Dhani
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Valerie Bowering
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Susanna Sellman
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Amit M Oza
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Lheureux
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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Berkhout-Byrne NC, Voorend CGN, Meuleman Y, Mooijaart SP, Brunsveld-Reinders AH, Bos WJW, Van Buren M. Nephrology-tailored geriatric assessment as decision-making tool in kidney failure. J Ren Care 2024; 50:112-127. [PMID: 37031361 DOI: 10.1111/jorc.12466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/26/2023] [Accepted: 03/16/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Dialysis might not benefit all older patients with kidney failure, particularly those with multimorbid conditions and frailty. Patients' and healthcare professionals' awareness of the presence of geriatric impairments could improve outcomes by tailoring treatment plans and decisions for individual patients. OBJECTIVE We aimed to explore the perspectives of patients and healthcare professionals on nephrology-tailored geriatric assessment to fuel decision-making for treatment choices in older patients with kidney failure. DESIGN In an exploratory qualitative study using focus groups, participants discussed perspectives on the use and value of nephrology-tailored geriatric assessment for the decision-making process to start or forego dialysis. PARTICIPANTS AND MEASUREMENTS Patients (n = 18) with kidney failure, caregivers (n = 4), and professionals (n = 25) were purposively sampled from 10 hospitals. Interviews were audio-recorded, transcribed verbatim and inductively analysed using thematic analysis. RESULTS Three main themes emerged that supported or impeded decision-making in kidney failure: (1) patient psycho-social situation; (2) patient-related factors on modality choice; (3) organisation of health care. Patients reported feeling vulnerable due to multiple chronic conditions, old age, experienced losses in life and their willingness to trade longevity for quality of life. Professionals recognised the added value of nephrology-tailored geriatric assessment in three major themes: (i) facilitating continual holistic assessment, (ii) filling the knowledge gap, and (iii) uncovering important patient characteristics. CONCLUSIONS nephrology-tailored geriatric assessment was perceived as a valuable tool to identify geriatric impairments in older patients with kidney failure. Integration of its outcomes can facilitate a more holistic approach to inform choices and decisions about kidney replacement therapy.
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Affiliation(s)
- Noeleen C Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Carlijn G N Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Willem Jan W Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolijn Van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Haga Hospital, The Hague, The Netherlands
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Berger ML, Ganz PA, Zou KH, Greenfield S. When Will Real-World Data Fulfill Its Promise to Provide Timely Insights in Oncology? JCO Clin Cancer Inform 2024; 8:e2400039. [PMID: 38950323 DOI: 10.1200/cci.24.00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 07/03/2024] Open
Abstract
Randomized trials provide high-quality, internally consistent data on selected clinical questions, but lack generalizability for the aging population who are most often diagnosed with cancer and have comorbid conditions that may affect the interpretation of treatment benefit. The need for high-quality, relevant, and timely data is greater than ever. Promising solutions lie in the collection and analysis of real-world data (RWD), which can potentially provide timely insights about the patient's course during and after initial treatment and the outcomes of important subgroups such as the elderly, rural populations, children, and patients with greater social health needs. However, to inform practice and policy, real-world evidence must be created from trustworthy and comprehensive sources of RWD; these may include pragmatic clinical trials, registries, prospective observational studies, electronic health records (EHRs), administrative claims, and digital technologies. There are unique challenges in oncology since key parameters (eg, cancer stage, biomarker status, genomic assays, imaging response, side effects, quality of life) are not recorded, siloed in inaccessible documents, or available only as free text or unstructured reports in the EHR. Advances in analytics, such as artificial intelligence, may greatly enhance the ability to obtain more granular information from EHRs and support integrated diagnostics; however, they will need to be validated purpose by purpose. We recommend a commitment to standardizing data across sources and building infrastructures that can produce fit-for-purpose RWD that will provide timely understanding of the effectiveness of individual interventions.
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Affiliation(s)
| | - Patricia A Ganz
- UCLA Jonsson Comprehensive Cancer Center, UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kelly H Zou
- Global Medical Analytics, Real World Evidence, and Health Economics & Outcomes Research, Viatris Inc, Canonsburg, PA
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46
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Naito S. Editorial Comment from Dr Naito to The significance of G8 and other geriatric assessments in urologic cancer management: A comprehensive review. Int J Urol 2024; 31:615-616. [PMID: 38699904 DOI: 10.1111/iju.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Sei Naito
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
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47
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Gately L, Mesía C, Sepúlveda JM, Del Barco S, Pineda E, Gironés R, Fuster J, Dumas M, Gill S, Navarro LM, Herrero A, Dowling A, de Las Peñas R, Vaz MA, Alonso M, Lwin Z, Harrup R, Peralta S, Long A, Perez-Segura P, Ahern E, Garate CO, Wong M, Campbell R, Cuff K, Jennens R, Gallego O, Underhill C, Martinez-Garcia M, Covela M, Cooper A, Brown S, Rosenthal M, Torres J, Collins IM, Gibbs P, Balana C. Exploring management and outcomes of elderly patients with glioblastoma using data from two randomised trials (GEINO1401/EX-TEM). J Neurooncol 2024; 168:299-306. [PMID: 38630385 DOI: 10.1007/s11060-024-04668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE The impact of age on optimal management of glioblastoma remains unclear. A recent combined analysis of two randomised trials, GEINO14-01 and EX-TEM, found no benefit from extending post-radiation temozolomide in newly diagnosed glioblastoma. Here, we explore the impact of age. METHODS Relevant intergroup statistics were used to identify differences in tumour, treatment and outcome characteristics based on age with elderly patients (EP) defined as age 65 years and over. Survival was estimated using the Kaplan Meier method. RESULTS Of the combined 205 patients, 57 (28%) were EP. Of these, 95% were ECOG 0-1 and 65% underwent macroscopic resection compared with 97% and 61% of younger patients (YP) respectively. There were numerically less MGMT-methylated (56% vs. 63%, p = 0.4) and IDH-mutated (4% vs. 13%, p = 0.1) tumours in EP vs. YP. Following surgery, EP were more likely to receive short course chemoradiation (17.5% vs. 6%, p = 0.017). At recurrence, EP tended to receive or best supportive care (28.3% vs. 15.4%, p = 0.09) or non-surgical options (96.2% vs. 84.6%, p = 0.06), but were less likely to receive bevacizumab (23.1% vs. 49.5%, p < 0.01). Median PFS was similar at 9.3months in EP and 8.5months in YP, with similar median OS at 20months. CONCLUSION In this trial population of predominantly fit EP, survival was similar to YP despite a proportion receiving less aggressive therapy at diagnosis and recurrence. Advancing age does not appear to be an adverse prognostic factor for glioblastoma when patients are fit for treatment, and a less aggressive approach in selected patients may not compromise outcomes.
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Affiliation(s)
- Lucy Gately
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
- Department of Medical Oncology, Alfred Health, Prahran, VIC, Australia.
| | - C Mesía
- Medical Oncology Service, Institut Català d'Oncologia, Hospitalet de Llobregat, Spain
| | - J M Sepúlveda
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Del Barco
- Medical Oncology Service, Institut Català d'Oncologia Girona, Girona, Spain
| | - E Pineda
- Medical Oncology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - R Gironés
- Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | - J Fuster
- Medical Oncology Service, Hospital Son Espases, Palma De Mallorca, Spain
| | - M Dumas
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - S Gill
- Department of Medical Oncology, Alfred Health, Prahran, VIC, Australia
| | - L M Navarro
- Medical Oncology Service, Hospital de Salamanca, Salamanca, Spain
| | - A Herrero
- Medical Oncology Service, Hospital Miguel Servet, Zaragoza, Spain
| | - A Dowling
- Department of Medical Oncology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - R de Las Peñas
- Medical Oncology Service, Hospital Provincial de Castellón, Castellón, Spain
| | - M A Vaz
- Medical Oncology Service, Hospital Ramón y Cajal, Madrid, Spain
| | - M Alonso
- Medical Oncology Service, Hospital Virgen del Rocio, Sevilla, Spain
| | - Z Lwin
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - R Harrup
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - S Peralta
- Medical Oncology Service, Hospital Sant Joan de Reus, Reus, Spain
| | - A Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - P Perez-Segura
- Medical Oncology Service, Hospital Clinico San Carlos, Madrid, Spain
| | - E Ahern
- Department of Medical Oncology, Monash Health, Bentleigh, VIC, Australia
| | - C O Garate
- Medical Oncology Service, Hospital Universitario Fundación Alcorocón, Alcorcón, Spain
| | - M Wong
- Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - R Campbell
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | - K Cuff
- Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - R Jennens
- Department of Medical Oncology, Epworth Health, Insert City, VIC, Australia
| | - O Gallego
- Medical Oncology Service, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - C Underhill
- Department of Medical Oncology, Border Medical Oncology Research Unit, East Albury, NSW, Australia
- University of New South Wales Rural Medical School, Albury Campus, Albury, NSW, Australia
| | | | - M Covela
- Medical Oncology Service, Hospital Lucus Augusti, Lugo, Spain
| | - A Cooper
- Department of Medical Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - S Brown
- Department of Medical Oncology, Ballarat Health Services, Ballarat, VIC, Australia
| | - M Rosenthal
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Torres
- Department of Medical Oncology, Goulburn Valley Health, Melbourne, VIC, Australia
| | - I M Collins
- Department of Medical Oncology, South West Regional Cancer Centre, Warrnambool, VIC, Australia
| | - P Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - C Balana
- Medical Oncology Service, Institut Català d'Oncologia Girona, Badalona, Spain
- Applied Research Group in Oncology (B-ARGO) from the Institut Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
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48
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Mangan BL, DuMontier C, Hopkins JO, Abel GA, McCurdy SR. Tailoring Therapy in Older Adults With Hematologic Malignancies. Am Soc Clin Oncol Educ Book 2024; 44:e432220. [PMID: 38788182 DOI: 10.1200/edbk_432220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Hematologic malignancies most often present in the sixth or seventh decade of life. Even so, many older adults may be unable to tolerate standard chemotherapy or require supplementary care or dose adjustments to do so. Both in community and academic centers, geriatric assessment (GA) can be used to improve the care of older adults with blood cancers. For example, hematologic oncologists can use GA to guide treatment selection, adjusting for patient frailty and goals, as well as prompt initiation of enhanced supportive care. After initial therapy, GA can improve the identification of older adults with aggressive myeloid malignancies who would benefit from hematopoietic cell transplantation (HCT), inform shared decision making, as well as allow transplanters to tailor conditioning regimen, donor selection, graft-versus-host disease prophylaxis, and pre- and post-HCT treatments. As in HCT, GA can improve the care of older patients with relapsed lymphoma or multiple myeloma eligible for chimeric antigen receptor-T therapy, identifying patients at higher risk for toxicity and providing a baseline for subsequent neurocognitive testing. Here, we review the data supporting GA for the care of older adults with blood cancers, from the community to the academic center. In addition, we explore future directions to optimize outcomes for older adults with hematologic malignancies.
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Affiliation(s)
- Brendan L Mangan
- Department of Pharmacy, University of Pennsylvania, Philadelphia, PA
| | - Clark DuMontier
- Brigham and Women's Hospital, Boston, MA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | | | - Gregory A Abel
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Shannon R McCurdy
- Division of Hematology-Oncology/Department of Medicine, University of Pennsylvania, Philadelphia, PA
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49
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Zhang L, Zhang Q, Wu Q, Zhao L, Gao Y, Li X, Guan S, Yan M. Establishment of a prognostic nomogram for elderly patients with limited-stage small cell lung cancer receiving radiotherapy. Sci Rep 2024; 14:11990. [PMID: 38796503 PMCID: PMC11127957 DOI: 10.1038/s41598-024-62533-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 05/17/2024] [Indexed: 05/28/2024] Open
Abstract
The present study explored the risk factors associated with radiotherapy in seniors diagnosed with limited-stage small cell lung cancer (LS-SCLC) to construct and validate a prognostic nomogram. The study retrospectively included 137 elderly patients with LS-SCLC who previously received radiotherapy. Univariate and multivariate COX analyses were conducted to identify independent risk factors and determine optimal cut-off values. Kaplan-Meier survival curves and nomograms were constructed to predict survival. Calibration and receiver operating characteristic (ROC) curves were used to evaluate the accuracy and consistency of the nomogram. Illness rating scale-geriatric (CIRS-G) score, treatment strategy, lymphocyte-to-monocyte ratio (LMR), white blood cell-to-monocyte ratio (WMR), and prognostic nutritional index (PNI) were discovered to be independent prognostic factors. Based on the findings of our multivariate analysis, a risk nomogram was developed to assess patient prognosis. Internal bootstrap resampling was utilized to validate the model, and while the accuracy of the AUC curve at 1 year was modest at 0.657 (95% CI 0.458-0.856), good results were achieved in predicting 3- and 5 year survival with AUCs of 0.757 (95% CI 0.670-0.843) and 0.768 (95% CI 0.643-0.893), respectively. Calibration curves for 1-, 3-, and 5 year overall survival probabilities demonstrated good cocsistency between expected and actual outcomes. Patients with concurrent chemoradiotherapy, CIRS-G score > 5 points and low PNI, WMR and LMR correlated with poor prognosis. The nomogram model developed based on these factors demonstrated good predictive performance and provides a simple, accessible, and practical tool for clinicians to guide clinical decision-making and study design.
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Affiliation(s)
- Lixia Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Qingfen Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Qian Wu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Lujun Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.
| | - Yunbin Gao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Xue Li
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Song Guan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Meng Yan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
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50
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Liu WY, Tang Y, Li N, Tang Y, Cheng YJ, Yang L, Fang H, Lu NN, Qi SN, Chen B, Wang SL, Song YW, Liu YP, Li YX, Liu Z, Liang JW, Pei W, Wang XS, Zhang HZ, Wang J, Zhou HT, Jin J. Preoperative chemoradiotherapy in older patients with rectal cancer guided by comprehensive geriatric assessment within a multidisciplinary team-a multicenter phase II trial. BMC Geriatr 2024; 24:442. [PMID: 38773457 PMCID: PMC11106876 DOI: 10.1186/s12877-024-05046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/06/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the safety and efficacy of preoperative concurrent chemoradiotherapy (preCRT) for locally advanced rectal cancer in older people who were classified as "fit" by comprehensive geriatric assessment (CGA). METHODS A single-arm, multicenter, phase II trial was designed. Patients were eligible for this study if they were aged 70 years or above and met the standards of "fit" (SIOG1) as evaluated by CGA and of the locally advanced risk category. The primary endpoint was 2-year disease-free survival (DFS). Patients were scheduled to receive preCRT (50 Gy) with raltitrexed (3 mg/m2 on days 1 and 22). RESULTS One hundred and nine patients were evaluated by CGA, of whom eighty-six, eleven and twelve were classified into the fit, intermediate and frail category. Sixty-eight fit patients with a median age of 74 years were enrolled. Sixty-four patients (94.1%) finished radiotherapy without dose reduction. Fifty-four (79.3%) patients finished the prescribed raltitrexed therapy as planned. Serious toxicity (grade 3 or above) was observed in twenty-four patients (35.3%), and fourteen patients (20.6%) experienced non-hematological side effects. Within a median follow-up time of 36.0 months (range: 5.9-63.1 months), the 2-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) rates were 89.6% (95% CI: 82.3-96.9), 92.4% (95% CI: 85.9-98.9) and 75.6% (95% CI: 65.2-86.0), respectively. Forty-eight patients (70.6%) underwent surgery (R0 resection 95.8%, R1 resection 4.2%), the corresponding R0 resection rate among the patients with positive mesorectal fascia status was 76.6% (36/47). CONCLUSION This phase II trial suggests that preCRT is efficient with tolerable toxicities in older rectal cancer patients who were evaluated as fit based on CGA. TRIAL REGISTRATION The registration number on ClinicalTrials.gov was NCT02992886 (14/12/2016).
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Affiliation(s)
- Wen-Yang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yun-Jie Cheng
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Wei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Pei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Shan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Zeng Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Hai-Tao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Department of Radiation Oncology, National Cancer Center/ Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
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