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Soto-Perez-de-Celis E, Dale W, Katheria V, Kim H, Fakih M, Chung VM, Lim D, Mortimer J, Cabrera Chien L, Charles K, Roberts E, Vazquez J, Moreno J, Lee T, Fernandes Dos Santos Hughes S, Sedrak MS, Sun CL, Li D. Outcome prioritization and preferences among older adults with cancer starting chemotherapy in a randomized clinical trial. Cancer 2024; 130:3000-3010. [PMID: 38630903 DOI: 10.1002/cncr.35333] [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: 02/17/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Older adults with cancer facing competing treatments must prioritize between various outcomes. This study assessed health outcome prioritization among older adults with cancer starting chemotherapy. METHODS Secondary analysis of a randomized trial addressing vulnerabilities in older adults with cancer. Patients completed three validated outcome prioritization tools: 1) Health Outcomes Tool: prioritizes outcomes (survival, independence, symptoms) using a visual analog scale; 2) Now vs. Later Tool: rates the importance of quality of life at three times-today versus 1 or 5 years in the future; and 3) Attitude Scale: rates agreement with outcome-related statements. The authors measured the proportion of patients prioritizing various outcomes and evaluated their characteristics. RESULTS A total of 219 patients (median [range] age 71 [65-88], 68% with metastatic disease) were included. On the Health Outcomes Tool, 60.7% prioritized survival over other outcomes. Having localized disease was associated with choosing survival as top priority. On the Now vs. Later Tool, 50% gave equal importance to current versus future quality of life. On the Attitude Scale, 53.4% disagreed with the statement "the most important thing to me is living as long as I can, no matter what my quality of life is"; and 82.2% agreed with the statement "it is more important to me to maintain my thinking ability than to live as long as possible". CONCLUSION Although survival was the top priority for most participants, some older individuals with cancer prioritize other outcomes, such as cognition and function. Clinicians should elicit patient-defined priorities and include them in decision-making.
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Affiliation(s)
- Enrique Soto-Perez-de-Celis
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - William Dale
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Heeyoung Kim
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Vincent M Chung
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Dean Lim
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | | | | | - Elsa Roberts
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Jessica Vazquez
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Jeanine Moreno
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Ty Lee
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | | | - Mina S Sedrak
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
| | - Daneng Li
- Center for Cancer and Aging, City of Hope, Duarte, California, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
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Magnuson A, Loh KP, Stauffer F, Dale W, Gilmore N, Kadambi S, Klepin HD, Kyi K, Lowenstein LM, Phillips T, Ramsdale E, Schiaffino MK, Simmons JF, Williams GR, Zittel J, Mohile S. Geriatric assessment for the practicing clinician: The why, what, and how. CA Cancer J Clin 2024. [PMID: 39207229 DOI: 10.3322/caac.21864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Older adults with cancer heterogeneously experience health care, treatment, and symptoms. Geriatric assessment (GA) offers a comprehensive evaluation of an older individual's health status and can predict cancer-related outcomes in individuals with solid tumors and those with hematologic malignancies. In the last decade, randomized controlled trials have demonstrated the benefits of GA and GA management (GAM), which uses GA information to provide tailored intervention strategies to address GA impairments (e.g., implementing physical therapy for impaired physical function). Multiple phase 3 clinical trials in older adults with solid tumors and hematologic malignancies have demonstrated that GAM improves treatment completion, quality of life, communication, and advance care planning while reducing treatment-related toxicity, falls, and polypharmacy. Nonetheless, implementation and uptake of GAM remain challenging. Various strategies have been proposed, including the use of GA screening tools, to identify patients most likely to benefit from GAM, the systematic engagement of the oncology workforce in the delivery of GAM, and the integration of technologies like telemedicine and mobile health to enhance the availability of GA and GAM interventions. Health inequities in minoritized groups persist, and systematic GA implementation has the potential to capture social determinants of health that are relevant to equitable care. Caregivers play an important role in cancer care and experience burden themselves. GA can guide dyadic supportive care interventions, ultimately helping both patients and caregivers achieve optimal health.
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Affiliation(s)
- Allison Magnuson
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Fiona Stauffer
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - William Dale
- Department of Supportive Care, City of Hope, Antelope Valley, Duarte, California, USA
| | - Nikesha Gilmore
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Sindhuja Kadambi
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Heidi D Klepin
- Section on Hematology and Oncology, Department of Medicine, Wake Forest School of Medicine, Wake Forest, North Carolina, USA
| | - Kaitlin Kyi
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Lisa M Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics, City of Hope, Antelope Valley, Duarte, California, USA
| | - Erika Ramsdale
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Melody K Schiaffino
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, USA
| | - John F Simmons
- Cancer and Aging Research Group SCOREboard, City of Hope, Duarte, California, USA
| | - Grant R Williams
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jason Zittel
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Supriya Mohile
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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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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Diaz FC, Hamparsumian A, Loh KP, Verduzco-Aguirre H, Abdallah M, Williams GR, Hsu T, Soto-Perez-de-Celis E, Elias R. Geriatric Oncology: A 5-Year Strategic Plan. Am Soc Clin Oncol Educ Book 2024; 44:e100044. [PMID: 38709980 DOI: 10.1200/edbk_100044] [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: 05/08/2024]
Abstract
The increasing rate of the older adult population across the world over the next 20 years along with significant developments in the treatment of oncology will require a more granular understanding of the older adult population with cancer. The ASCO Geriatric Oncology Community of Practice (COP) herein provides an outline for the field along three fundamental pillars: education, research, and implementation, inspired by ASCO's 5-Year Strategic Plan. Fundamental to improving the understanding of geriatric oncology is research that intentionally includes older adults with clinically meaningful data supported by grants across all career stages. The increased knowledge base that is developed should be conveyed among health care providers through core competencies for trainees and continuing education for practicing oncologists. ASCO's infrastructure can serve as a resource for fellowship programs interested in acquiring geriatric oncology content and provide recommendations on developing training pathways for fellows interested in pursuing formalized training in geriatrics. Incorporating geriatric oncology into everyday practice is challenging as each clinical setting has unique operational workflows with barriers that limit implementation of valuable geriatric tools such as Geriatric Assessment. Partnerships among experts in quality improvement from the ASCO Geriatric Oncology COP, the Cancer and Aging Research Group, and ASCO's Quality Training Program can provide one such venue for implementation of geriatric oncology through a structured support mechanism. The field of geriatric oncology must continue to find innovative strategies using existing resources and partnerships to address the pressing needs of the older adult population with cancer to improve patient outcomes.
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Affiliation(s)
- Fernando C Diaz
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Division of Geriatrics, University of North Carolina, Chapel Hill, NC
| | - Anahid Hamparsumian
- Geriatric Research Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Haydeé Verduzco-Aguirre
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maya Abdallah
- Section of Hematology/Oncology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Grant R Williams
- Lewis and Faye Manderson Cancer Center at DCH Regional Medical Center, Tuscaloosa, AL
- Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Tina Hsu
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rawad Elias
- Division of Hematology-Oncology, UMass Chan Medical School-Baystate, Springfield, MA
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Montégut L, López-Otín C, Kroemer G. Aging and cancer. Mol Cancer 2024; 23:106. [PMID: 38760832 PMCID: PMC11102267 DOI: 10.1186/s12943-024-02020-z] [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: 04/19/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
Aging and cancer exhibit apparent links that we will examine in this review. The null hypothesis that aging and cancer coincide because both are driven by time, irrespective of the precise causes, can be confronted with the idea that aging and cancer share common mechanistic grounds that are referred to as 'hallmarks'. Indeed, several hallmarks of aging also contribute to carcinogenesis and tumor progression, but some of the molecular and cellular characteristics of aging may also reduce the probability of developing lethal cancer, perhaps explaining why very old age (> 90 years) is accompanied by a reduced incidence of neoplastic diseases. We will also discuss the possibility that the aging process itself causes cancer, meaning that the time-dependent degradation of cellular and supracellular functions that accompanies aging produces cancer as a byproduct or 'age-associated disease'. Conversely, cancer and its treatment may erode health and drive the aging process, as this has dramatically been documented for cancer survivors diagnosed during childhood, adolescence, and young adulthood. We conclude that aging and cancer are connected by common superior causes including endogenous and lifestyle factors, as well as by a bidirectional crosstalk, that together render old age not only a risk factor of cancer but also an important parameter that must be considered for therapeutic decisions.
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Affiliation(s)
- Léa Montégut
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, Villejuif, France
| | - Carlos López-Otín
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, Paris, France
- Facultad de Ciencias de la Vida y la Naturaleza, Universidad Nebrija, Madrid, Spain
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, Paris, France.
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, Villejuif, France.
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
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Voorend CG, Berkhout-Byrne NC, van Bodegom-Vos L, Diepenbroek A, Franssen CF, Joosten H, Mooijaart SP, Bos WJW, van Buren M. Geriatric Assessment in CKD Care: An Implementation Study. Kidney Med 2024; 6:100809. [PMID: 38660344 PMCID: PMC11039322 DOI: 10.1016/j.xkme.2024.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Rationale & Objective Older people with progressive chronic kidney disease (CKD) have complex health care needs. Geriatric evaluation preceding decision making for kidney replacement is recommended in guidelines, but implementation is lacking in routine care. We aimed to evaluate implementation of geriatric assessment in CKD care. Study Design Mixed methods implementation study. Setting & Participants Dutch nephrology centers were approached for implementation of geriatric assessment in patients aged ≥70 years and with an estimated glomerular filtration rate of ≤20 mL/min/1.73 m2. Quality Improvement Activities/Exposure We implemented a consensus-based nephrology-tailored geriatric assessment: a patient questionnaire and professionally administered test set comprising 16 instruments covering functional, cognitive, psychosocial, and somatic domains and patient-reported outcome measures. Outcomes We aimed for implementation in 10 centers and 200 patients. Implementation was evaluated by (i) perceived enablers and barriers of implementation, including integration in work routines (Normalization Measure Development Tool) and (ii) relevance of the instruments to routine care for the target population. Analytical Approach Variations in implementation practices were described based on field notes. The postimplementation survey among health care professionals was analyzed descriptively, using an explanatory qualitative approach for open-ended questions. Results Geriatric assessment was implemented in 10 centers among 191 patients. Survey respondents (n = 71, 88% response rate) identified determinants that facilitated implementation, ie, multidisciplinary collaboration (with geriatricians) -meetings and reports and execution of assessments by nurses. Barriers to implementation were patient illiteracy or language barrier, time constraints, and patient burden. Professionals considered geriatric assessment sufficiently integrated into work routines (mean, 6.7/10 ± 2.0 [SD]) but also subject to improvement. Likewise, the relevance of geriatric assessment for routine care was scored as 7.8/10 ± 1.2. The Clinical Frailty Score and Montreal Cognitive Assessment were perceived as the most relevant instruments. Limitations Selection bias of interventions' early adopters may limit generalizability. Conclusions Geriatric assessment could successfully be integrated in CKD care and was perceived relevant to health care professionals.
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Affiliation(s)
- Carlijn G.N. Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Noeleen C. Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper F.M. Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Center for Medicine for Older People, 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 Internal Medicine, Haga Hospital, The Hague, The Netherlands
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Wood ST, Cuevas H, Kim J, Stuifbergen AK. Development and Use of a Tech-Based Data Management System for a Cognitive Rehabilitation Randomized Controlled Trial for People With Type 2 Diabetes. Comput Inform Nurs 2024; 42:252-258. [PMID: 38206176 PMCID: PMC11006582 DOI: 10.1097/cin.0000000000001094] [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] [Indexed: 01/12/2024]
Abstract
Successful technology-based interventions to improve patients' self-management are providing an incentive for researchers to develop and implement their own technology-based interventions. However, the literature lacks guidance on how to do this. In this article, we describe the electronic process with which we designed and implemented a technology-based data management system to implement a randomized controlled trial of a comprehensive cognitive rehabilitation intervention to improve cognitive function and diabetes self-management in people with type 2 diabetes. System development included feasibility assessment, interdisciplinary collaboration, design mapping, and use of institutionally and commercially available software. The resulting framework offers a template to support the development of technology-based interventions. Initial development may be time-consuming, but the benefits of the technology-based format surpass any drawbacks.
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Affiliation(s)
| | | | - Jeeyeon Kim
- The University of Texas at Austin, School of Nursing
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Hoffmann AJ, Tin AL, Vickers AJ, Shahrokni A. Cognitive function and ability to complete a web-based geriatric assessment among older adults with cancer. J Am Geriatr Soc 2024; 72:503-511. [PMID: 37971219 PMCID: PMC11229305 DOI: 10.1111/jgs.18682] [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: 07/16/2023] [Revised: 09/26/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The purpose of this study was determined whether cognitive impairment is associated with time taken to complete the electronic rapid fitness assessment (eRFA). We hypothesized that taking more time to complete the eRFA will indicate worsened cognitive function. METHODS We retrospectively identified patients who presented to the Memorial Sloan Kettering Cancer Center Geriatrics Service for preoperative evaluation and completed the eRFA as a part of their preoperative assessment from February 2015 to December 2020. Cognitive function was assessed using the Mini-Cog©, which is a screening test for cognitive function status. Patients in this study underwent elective surgery and had a hospital length of stay ≥1 day. Time to complete the eRFA was automatically recorded by a web-based tool; assistance with eRFA completion was self-reported by the patient. In total, 2599 patients were included, of which 2387 had available Mini-Cog© scores. RESULTS Overall, 50% of surveys were completed without assistance, 37% were completed with assistance, and 13% were completed by somebody else; Mini-Cog© scores were lower, corresponding to worsened cognitive function status, in patients requiring assistance (median score respectively, 5 vs. 4 vs. 3; p-value <0.0001; rates of cognitive impairment 7.5%, 22%, and 38%). Among patients who completed the questionnaire independently, greater cognitive impairment was associated with longer time to complete the eRFA (change in score per 5 min = -0.09; 95% CI -0.14, -0.03; p = 0.002). CONCLUSIONS We found evidence that requirement for assistance in completing web-based questionnaires, and time taken to complete a questionnaire, predict which patients benefit from more comprehensive cognitive function assessments. Future studies should further validate this finding in a more diverse population and establish optimal clinical pathways.
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Affiliation(s)
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Armin Shahrokni
- Department of Geriatrics, Jersey Shore University Medical Center, Neptune, New Jersey, USA
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Dotan E, Lynch SM, Ryan JC, Mitchell EP. Disparities in care of older adults of color with cancer: A narrative review. Cancer Med 2024; 13:e6790. [PMID: 38234214 PMCID: PMC10905558 DOI: 10.1002/cam4.6790] [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: 08/04/2023] [Revised: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
This review describes the barriers and challenges faced by older adults of color with cancer and highlights methods to improve their overall care. In the next decade, cancer incidence rates are expected to increase in the United States for people aged ≥65 years. A large proportion will be older adults of color who often have worse outcomes than older White patients. Many issues contribute to racial disparities in older adults, including biological factors and social determinants of health (SDOH) related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborhood where a person lives. These disparities are exacerbated by age-related challenges often experienced by older adults, such as decreased functional status, impaired cognition, high rates of comorbidities and polypharmacy, poor nutrition, and limited social support. Additionally, underrepresentation of both patients of color and older adults in cancer clinical research results in a lack of adequate data to guide the management of these patients. Use of geriatric assessments (GA) can aid providers in uncovering age-related concerns and personalizing interventions for older patients. Research demonstrates the ability of GA-directed care to result in fewer treatment-related toxicities and improved quality of life, thus supporting the routine incorporation of validated GA into these patients' care. GA can be enhanced by including evaluation of SDOH, which can help healthcare providers understand and address the needs of older adults of color with cancer who face disparities related to their age and race.
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Affiliation(s)
- Efrat Dotan
- Department of Hematology/OncologyFox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | | | | | - Edith P. Mitchell
- Clinical Professor of Medicine and Medical OncologySidney Kimmel Cancer Center at JeffersonPhiladelphiaPennsylvaniaUSA
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Mac Eochagain C, Senac NMG, Cavanagh M, Roy M, Ciccone AS, Contreras B, Testa GD, Velasco R, Marinho J, Serrano AG, Schiaffino MK, Gomes F. Digital health in geriatric oncology: A Young International Society of Geriatric Oncology review. J Geriatr Oncol 2023; 14:101649. [PMID: 38682324 DOI: 10.1016/j.jgo.2023.101649] [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: 08/31/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 05/01/2024]
Abstract
The integration of digital health technologies in geriatric oncology has the potential to enhance patient care and self-management. This review article discusses the applications of these technologies, including teleassessment, telemonitoring, and teleintervention, within geriatric oncology, and evaluates their potential to improve cancer care and patient outcomes. We also review challenges to the implementation of digital health technologies among populations of older patients with cancer. The article provides a perspective for clinicians, researchers, policymakers, and patients on the integration and utilisation of digital health technologies in current geriatric oncology practice.
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Affiliation(s)
- Colm Mac Eochagain
- Trinity St James Cancer Institute, Dublin, Ireland; Royal Marsden Hospital, London, UK.
| | - Nicolas Maria Gonzalez Senac
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mercedes Cavanagh
- Medical Oncology Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Mukul Roy
- Department of Radiation Oncology, Jaslok Hospital, Mumbai, India
| | - Andrea Sebastiano Ciccone
- Université Côte d'Azur, Sophia-Antipolis INSERM U1081, CNRS UMR 7284, Centre Hospitalier, Universitaire de Nice, Hôpital de Cimiez, Nice, France
| | | | - Giuseppe Dario Testa
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Rogelio Velasco
- Clinical Trial and Research Divison, Philippine Heart Center, Quezon City, Philippines; Lung Center of the Philippines, Quezon City, Philippines
| | - Joana Marinho
- Medical Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Adolfo Gonzalez Serrano
- Urology Department, Hospital Universitari Son Espases, Palma, Spain; Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France
| | - Melody K Schiaffino
- School of Public Health, Division of Health Management and Policy, San Diego State University, San Diego, CA, United States of America; Center for Health Equity, Education and Research (CHEER), University of California San Diego, La Jolla, CA, United States of America; UC San Diego School of Medicine, CA, United States of America
| | - Fabio Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK
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11
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Seghers PAL, Alibhai SMH, Battisti NML, Kanesvaran R, Extermann M, O'Donovan A, Pilleron S, Mislang AR, Musolino N, Cheung KL, Staines A, Girvalaki C, Soubeyran P, Portielje JEA, Rostoft S, Hamaker ME, Trépel D, O'Hanlon S. Geriatric assessment for older people with cancer: policy recommendations. Glob Health Res Policy 2023; 8:37. [PMID: 37653521 PMCID: PMC10472678 DOI: 10.1186/s41256-023-00323-0] [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: 03/15/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
Most cancers occur in older people and the burden in this age group is increasing. Over the past two decades the evidence on how best to treat this population has increased rapidly. However, implementation of new best practices has been slow and needs involvement of policymakers. This perspective paper explains why older people with cancer have different needs than the wider population. An overview is given of the recommended approach for older people with cancer and its benefits on clinical outcomes and cost-effectiveness. In older patients, the geriatric assessment (GA) is the gold standard to measure level of fitness and to determine treatment tolerability. The GA, with multiple domains of physical health, functional status, psychological health and socio-environmental factors, prevents initiation of inappropriate oncologic treatment and recommends geriatric interventions to optimize the patient's general health and thus resilience for receiving treatments. Multiple studies have proven its benefits such as reduced toxicity, better quality of life, better patient-centred communication and lower healthcare use. Although GA might require investment of time and resources, this is relatively small compared to the improved outcomes, possible cost-savings and compared to the large cost of oncologic treatments as a whole.
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Affiliation(s)
- P A L Seghers
- Department of Geriatric Medicine, Diakonessenhuis, 3582 KE, Utrecht, The Netherlands
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, M5G 2C4, Canada
| | - Nicolò Matteo Luca Battisti
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK
- Breast Cancer Research Division, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
| | | | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sophie Pilleron
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Anna Rachelle Mislang
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA, 5042, Australia
| | - Najia Musolino
- International Society of Geriatric Oncology (SIOG), International Environmental House 2, Chemin de Balexert 7-9, 1219, Chatelaine, Switzerland
| | | | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Charis Girvalaki
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonié, Inserm U1312, SIRIC BRIO, Université de Bordeaux, 33076, Bordeaux, France
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center-LUMC, 2333 ZA, Leiden, The Netherlands
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318, Oslo, Norway
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, 3582 KE, Utrecht, The Netherlands
| | - Dominic Trépel
- Global Brain Health Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - 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.
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12
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Bergerot CD, Bergerot PG, Razavi M, Philip EJ, Lakhdari S, França MVDS, Molina LNM, Freitas ANDS, Taveira MC, de Azeredo AC, Fuzita WH, Fernandes CM, Pio RB, de Araujo R, Couto MM, de Vasconcellos VF, Nonino MF, Lee D, de Matos Neto JN, Buso MM, Soto-Perez-de-Celis E, Dale W. Implementation and evaluation of a remote geriatric assessment and intervention program in Brazil. Cancer 2023; 129:2095-2102. [PMID: 36964938 DOI: 10.1002/cncr.34759] [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: 12/05/2022] [Revised: 01/31/2023] [Accepted: 02/21/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND This study sought to determine the feasibility and acceptability of a remote geriatric assessment (GA) and implementation (GAIN) program in Brazil. The authors also explored the effect of this program on health-related quality of life (HR-QOL) outcomes 3 months after initiating treatment. METHODS This is a longitudinal study enrolling older adults (65+ years), diagnosed with any type of solid tumor, scheduled to initiate chemotherapy in a networked Brazilian cancer center. The GA was performed through telehealth. We assessed the feasibility of the remote GA, acceptability to patients, and changes in patient-centered outcomes (HR-QOL, mood, function) from baseline to month 3. Linear mixed model analysis was done, adjusting for age, gender, race, income, and disease stage. RESULTS Fifty-six patients completed all intended assessments. Notably, the threshold of feasibility was 70% and there was 92% complete adherence. Average age was 76 years old (SD = 7.2). Most patients were female (57%), married (59%), and had a college degree (46%). The most common diagnoses were gastrointestinal (39%) and gynecological cancers (18%); most were diagnosed at an advance disease stage (77%). A total of 32 patients were referred to a remote appointment and 86% followed this recommendation(s). Significant improvement in Functional Assessment of Cancer Therapy - General FACT-G (mean difference, 6.04; p < .001), Geriatric Depression Scale (mean difference, -0.86; p = .008), and instrumental activities of daily living ratio (mean difference, 0.17; p < .001) were found. CONCLUSION Remote GAIN is feasible and acceptable to older adults with cancer receiving treatment in Brazil. The authors also found significant improvement in HR-QOL outcomes over time. Notably, this GAIN program could guide early detection of chemotherapy toxicity and improving patient-reported outcomes in low-resource environments.
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Affiliation(s)
- Cristiane Decat Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil
| | - Paulo Gustavo Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil
| | - Marianne Razavi
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Errol J Philip
- University of California San Francisco, San Francisco, California, USA
| | - Sabri Lakhdari
- Clínica Médica Cronos, Brasilia, Distrito Federal, Brazil
| | | | | | - Alici Natalia de Sousa Freitas
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil
| | - Mariane Cunha Taveira
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil
| | | | | | - Cristiano Menezes Fernandes
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil
| | - Raquel Batista Pio
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil
| | - Romildo de Araujo
- Centro Pernambucano de Oncologia, Grupo Oncoclinicas, Recife, Pernambuco, Brazil
| | - Milena Macedo Couto
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil
| | | | - Maria Fernanda Nonino
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil
| | - David Lee
- University of New Mexico, Albuquerque, New Mexico, USA
| | - João Nunes de Matos Neto
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil
| | - Marco Murilo Buso
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Grupo Oncoclinicas, Brasília, Distrito Federal, Brazil
| | | | - William Dale
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
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13
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Cuadra A, Tin AL, Moffat GT, Alexander K, Downey RJ, Korc-Grodzicki B, Vickers AJ, Shahrokni A. The association between perioperative frailty and ability to complete a web-based geriatric assessment among older adults with cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:662-666. [PMID: 36404252 PMCID: PMC9974608 DOI: 10.1016/j.ejso.2022.11.011] [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: 04/25/2022] [Revised: 10/19/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The aim of this study was to assess the degree to which patient frailty is associated with both need for assistance and time required to complete the eRFA, a web-based GA tool. MATERIALS AND METHODS We retrospectively identified patients who underwent surgery for cancer from 2015 to 2020, had a hospital length of stay ≥1 day, and completed the eRFA before surgery. Frailty was assessed using two methods: the MSK-FI (score 0-11) and the AGD (score 0-13). Time to complete the eRFA was automatically recorded by a web-based tool; assistance with eRFA completion was self-reported by the patient. RESULTS In total, 3456 patients were included (median age, 78 years). Overall, 58% of surveys were completed without assistance, 30% were completed with assistance, and 12% were completed by someone other than the patient. Younger age (median age: without assistance, 77 years; with assistance, 80 years; completed by someone else, 80 years) and lower frailty score (median AGD: 4, 6, and 8, respectively; median MSK-FI: 2, 3, and 3, respectively) were associated with independency (all p < 0.001). Higher frailty score was associated with longer time to complete the eRFA (all nonlinear association p < 0.001). CONCLUSION Frail patients are more likely to benefit from completion of GA to determine appropriate treatment. Given that not all cancer patients have a caregiver who can assist completing a digital questionnaire, innovative solutions are needed to help frail patients complete the eRFA without assistance.
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Affiliation(s)
- Andrea Cuadra
- Computer Science Department, Stanford University, Stanford, CA, USA.
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Koshy Alexander
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Beatriz Korc-Grodzicki
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Armin Shahrokni
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Williams AM, Mandelblatt J, Wang M, Armstrong GT, Bhakta N, Brinkman TM, Chemaitilly W, Ehrhardt MJ, Mulrooney DA, Small BJ, Wang Z, Srivastava D, Robison LL, Hudson MM, Ness KK, Krull KR. Premature aging as an accumulation of deficits in young adult survivors of pediatric cancer. J Natl Cancer Inst 2023; 115:200-207. [PMID: 36370084 PMCID: PMC9905971 DOI: 10.1093/jnci/djac209] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/26/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to characterize premature aging as an accumulation of deficits in survivors of pediatric cancer compared with community controls and examine associations with host and treatment factors, neurocognition, and mortality. METHODS Pediatric cancer survivors (n = 4000, median age = 28.6, interquartile range [IQR] = 23-35 years; 20 years postdiagnosis: IQR = 15-27), and community participants without a history of cancer serving as controls (n = 638, median age = 32, IQR = 25-40 years) completed clinical assessments and questionnaires and were followed for mortality through April 30, 2020 (mean [SD] follow-up = 7.0 [3.4] years). A deficit accumulation index (DAI) score was calculated from 44 aging-related items including self-reported daily function, psychosocial symptoms, and health conditions. Items were weighted from 0 (absent) to 1 (present and/or most severe), summed and divided by the total yielding a ratio (higher = more deficits). Scores less than 0.20 are robust, and 0.06 is a clinically meaningful difference. Linear regression compared the DAI in survivors and controls with an age*survivor or control interaction. Logistic regression and Cox-proportional hazards estimated the risk of neurocognitive impairment and death. Models were minimally adjusted for age, sex, and race and ethnicity. RESULTS The adjusted mean DAI among survivors at age 30 years was 0.16 corresponding to age 63 years in controls (33 years premature aging; β = 0.07, 95% confidence interval [CI] = 0.06 to 0.08; P < .001). Cranial and abdominal radiation, alkylators, platinum, and neurosurgery were associated with worse DAI (P ≤ .001). Higher scores were associated with increased risk of neurocognitive impairment in all domains (P < .001) and increased risk of death (DAI = 0.20-0.35, hazard ratio = 2.80, 95% CI = 1.97 to 3.98; DAI ≥ 0.35, hazard ratio = 5.08, 95% CI = 3.52 to 7.34). CONCLUSION Pediatric cancer survivors experience clinically significant premature aging. The DAI may be used to identify survivors at greatest risk of poor health outcomes.
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Affiliation(s)
- AnnaLynn M Williams
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Current affiliation: Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | | | - Mingjuan Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Wassim Chemaitilly
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Deokumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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15
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Cook S, Munteanu C, Papadopoulos E, Abrams H, Stinson JN, Pitters E, Stephens D, Lumchick M, Emmenegger U, Koneru R, Papadakos J, Shahrokni A, Durbano S, Menjak I, Mehta R, Haase K, Jang R, Krzyzanowska MK, Dale C, Jones J, Lemonde M, Alibhai S, Puts M. The development of an electronic geriatric assessment tool: Comprehensive health assessment for my plan (CHAMP). J Geriatr Oncol 2023; 14:101384. [PMID: 36216760 DOI: 10.1016/j.jgo.2022.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/06/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Geriatric assessment (GA) provides information on key health domains of older adults and is recommended to help inform cancer treatment decisions and cancer care. However, GA is not feasible in many health institutions due to lack of geriatric staff and/or resources. To increase accessibility to GA and improve treatment decision making for older adults with cancer (≥65 years), we developed a self-reported, electronic geriatric assessment tool: Comprehensive Assessment for My Plan (CHAMP). MATERIALS AND METHODS Older adults with cancer were invited to join user-centered design sessions to develop the layout and content of the tool. Subsequently, they participated in usability testing to test the usability of the tool (ease of use, acceptability, etc.). Design sessions were also conducted with oncology clinicians (oncologists and nurses) to develop the tool's clinician interface. GA assessment questions and GA recommendations were guided by a systematic review and Delphi expert panel. RESULTS A total of seventeen older adults participated in the study. Participants were mainly males (82.4%) and 75% were aged 75 years and older. Nine oncology clinicians participated in design sessions. Older adults and clinicians agreed that the tool was user-friendly. Domains in the final CHAMP tool (with questions and recommendations) included functional status, falls risk, cognitive impairment, nutrition, medication review, social supports, depression, substance use disorder, and miscellaneous items. DISCUSSION CHAMP was designed for use by older adults and oncologists and may enhance access to GA for older adults with cancer. The next phase of the CHAMP study will involve field validation in oncology clinics.
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Affiliation(s)
- Simon Cook
- Technologies for Aging Gracefully Lab, University of Toronto, Toronto, Canada
| | - Cosmin Munteanu
- Technologies for Aging Gracefully Lab, University of Toronto, Toronto, Canada
| | | | - Howard Abrams
- Openlab, Toronto General Hospital, University Health Network, Toronto, Canada; Department of Medicine, University Health Network, University of Toronto, Canada
| | - Jennifer N Stinson
- Research Institute, The Hospital for Sick Children, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | | | | | | | - Urban Emmenegger
- Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rama Koneru
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada
| | - Janet Papadakos
- Cancer Education, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Armin Shahrokni
- Department of Geriatrics and Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, United States of America
| | - Sara Durbano
- Openlab, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Ines Menjak
- Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rajin Mehta
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kristen Haase
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Raymond Jang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Jennifer Jones
- ELLICSR: Health, Wellness and Cancer Survivorship Centre, University Health Network, Toronto, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Shabbir Alibhai
- Department of Medicine, University Health Network, University of Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
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16
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Magnuson A, Van der Walde N, McKoy JM, Wildes TM, Wong ML, Le-Rademacher J, Little RF, Klepin HD. Integrating Geriatric Assessment Measures into National Cancer Institute Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:142-150. [PMID: 36519816 PMCID: PMC9949568 DOI: 10.1093/jncimonographs/lgac021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022] Open
Abstract
To improve the care of older adults with cancer, the traditional approach to clinical trial design needs to be reconsidered. Older adults are underrepresented in clinical trials with limited or no information on geriatric-specific factors, such as cognition or comorbidities. To address this knowledge gap and increase relevance of therapeutic clinical trial results to the real-life population, integration of aspects relevant to older adults is needed in oncology clinical trials. Geriatric assessment (GA) is a multidimensional tool comprising validated measures assessing specific health domains that are more frequently affected in older adults, including aspects related to physical function, comorbidity, medication use (polypharmacy), cognitive and psychological status, social support, and nutritional status. There are several mechanisms for incorporating either the full GA or specific GA measures into oncology therapeutic clinical trials to contribute to the overarching goal of the trial. Mechanisms include utilizing GA measures to better characterize the trial population, define trial eligibility, allocate treatment receipt within the context of the trial, develop predictive models for treatment outcomes, guide supportive care strategies, personalize care delivery, and assess longitudinal changes in GA domains. The objective of this manuscript is to review how GA measures can contribute to the overall goal of a clinical trial, to provide a framework to guide the selection and integration of GA measures into clinical trial design, and ultimately enable accrual of older adults to clinical trials by facilitating the design of trials tailored to older adults treated in clinical practice.
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Affiliation(s)
- Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Noam Van der Walde
- Department of Radiation Oncology, West Cancer Center and Research Institute, University of Tennessee Health Science Center, Germantown, TN, USA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tanya M Wildes
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine, Omaha, NE, USA
| | - Melisa L Wong
- Divisions of Hematology and Oncology and Geriatrics, Department of Internal Medicine, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | | | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Heidi D Klepin
- Correspondence to: Heidi D. Klepin, MD, MS, Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA (e-mail: )
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Advances in Transversal Topics Applicable to the Care of Bladder Cancer Patients in the Real-World Setting. Cancers (Basel) 2022; 14:cancers14163968. [PMID: 36010964 PMCID: PMC9406347 DOI: 10.3390/cancers14163968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary There are a number of scientific questions that are novel or controversial, which are clinically relevant in the real-world setting for patients diagnosed with bladder cancer, independently of the stage of disease or the histological type and grade of the tumors. These transversal topics have been discussed by a panel of expert specialists who participated in the Genitourinary Alliance Project, aimed to develop actions focused on the integration of relevant information into clinical practice. Advances in radiological imaging techniques have the potential of improving accuracy of staging methods, resulting in a more personalized planning and therapeutic option. The use of liquid biopsy will undoubtedly contribute to an increase in the efficiency of the evaluation of the clinical response and outcome of the disease. It is important to consider specific conditions of elderly people with bladder cancer, as well as the implementation of appropriate measures to enhance safe drug administration. Abstract Recommendations regarding transversal topics applicable to bladder cancer patients independent of tumor grade and stage were established by members of the Spanish Oncology Genitourinary Multidisciplinary Working Group (SOGUG). Liquid biopsy in urine and blood samples is useful in the surveillance of non-muscle-invasive and muscle-invasive bladder cancer, respectively. Multiparametric MRI is an accurate, faster and non-invasive staging method overcoming the understaging risk of other procedures. The combination of FDG-PET/MRI could improve diagnostic reliability, but definite criteria for imaging interpretation are still unclear. Hospital oncology pharmacists as members of tumor committees improve the safety of drug use. Additionally, safety recommendations during BCG preparation should be strictly followed. The initial evaluation of patients with bladder cancer should include a multidimensional geriatric assessment. Orthotopic neobladder reconstruction should be offered to motivated patients with full information of self-care requirements. Bladder-sparing protocols, including chemoradiation therapy and immune checkpoints inhibitors (ICIs), should be implemented in centers with well-coordinated multidisciplinary teams and offered to selected patients. The optimal strategy of treatment with ICIs should be defined from the initial diagnostic phase with indications based on scientific evidence. Centralized protocols combined with the experience of professional groups are needed for the integral care of bladder cancer patients.
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Assessing psychological health and social support in older adults with cancer, a how-to guide - A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative. J Geriatr Oncol 2022; 13:1050-1053. [PMID: 35717534 DOI: 10.1016/j.jgo.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022]
Abstract
Older adults with cancer frequently have several unmet needs related to overlapping vulnerabilities caused by medical and social health challenges which are often overlooked in typical oncological assessments 1. Social support and psychological health are critical considerations for older adults with cancer and are therefore key components of a geriatric assessment.
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19
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Alfano CM, Oeffinger K, Sanft T, Tortorella B. Engaging TEAM Medicine in Patient Care: Redefining Cancer Survivorship From Diagnosis. Am Soc Clin Oncol Educ Book 2022; 42:1-11. [PMID: 35649204 DOI: 10.1200/edbk_349391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
New approaches to cancer survivorship care must address the rising number of survivors who need complex care; the need to personalize care to improve health equity; workforce shortages and clinician knowledge deficits about the long-term and late effects of cancer; the need to engage and coordinate oncology, primary care, and a large multidisciplinary team of subspecialists and programs to meet survivors' needs; and the need to control costs and deliver better value. This review proposes eight core tenets of an evolved standard of care to meet these needs by starting at diagnosis and continuing throughout oncology and into follow-up to: (1) facilitate team medicine by connecting oncology, primary care, subspecialists and programs, researchers, and patients and caregivers; (2) educate patients and support them in self-management; (3) mitigate toxicities; (4) manage comorbidities; (5) promote healthy behaviors and wellness; (6) improve health equity; (7) provide clear personalized follow-up; and (8) provide ongoing opportunities for participation in research as the standard of care. Strategies to successfully implement this care are discussed from the perspectives of oncology, primary care, and health care administration.
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Affiliation(s)
- Catherine M Alfano
- Northwell Health Cancer Institute, New York, NY.,Institute of Health System Science, Feinstein Institutes for Medical Research, New York, NY
| | - Kevin Oeffinger
- Duke University, Durham, NC.,Duke Cancer Institute, Durham, NC
| | - Tara Sanft
- Smilow Cancer Hospital at Yale New Haven, Yale Cancer Center, New Haven, CT
| | - Brooke Tortorella
- Northwell Health Cancer Institute, New York, NY.,Institute of Health System Science, Feinstein Institutes for Medical Research, New York, NY
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20
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Webb T, Verduzco-Aguirre HC, Rao AR, Ramaswamy A, Noronha V. Addressing the Needs of Older Adults With Cancer in Low- and Middle-Income Settings. Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35427187 DOI: 10.1200/edbk_349829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The number of older adults in the world is projected to increase steeply over the next 30 years; most older adults will live in low- and middle-income countries. This will have a direct impact on the global cancer burden, as cancer is largely a disease of aging. A revolution in the way we care for older adults in low- and middle-income settings is needed to meet rapidly rising demands. Regardless of a nation's relative wealth or resources, implementing the geriatric assessment in cancer care has presented a challenge because of omission of the principles of geriatric oncology from formal training and continuing education, lack of time, and a shortage of qualified personnel. To meet the challenge of caring for older adults globally, we must: (1) re-imagine aging-focused training for providers and nurses, (2) create and strengthen collaborations/partnerships between geriatric oncology teams and aging-service organizations, and (3) increase advocacy for age-friendly health care policy. By harnessing technology, the reach of specialized oncology education and care can be extended even-or especially-to low- and middle-income settings.
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Affiliation(s)
- Tracy Webb
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Abhijith Rajaram Rao
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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21
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Abstract
Cancer is predominantly a disease of aging, and older adults represent the majority of cancer diagnoses and deaths. Older adults with cancer differ significantly from younger patients, leading to important distinctions in cancer treatment planning and decision-making. As a consequence, the field of geriatric oncology has blossomed and evolved over recent decades, as the need to bring personalized cancer care to older adults has been increasingly recognized and a focus of study. The geriatric assessment (GA) has become the cornerstone of geriatric oncology research, and the past year has yielded promising results regarding the implementation of GA into routine cancer treatment decisions and outcomes for older adults. In this article, we provide an overview of the field of geriatric oncology and highlight recent breakthroughs with the use of GA in cancer care. Further work is needed to continue to provide personalized, evidence-based care for each older adult with cancer.
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22
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Geriatric screening in older adults with cancer using electronic patient-reported outcome measures (PROMs) – A feasible approach in a resource-limited setting. J Geriatr Oncol 2022; 13:880-884. [DOI: 10.1016/j.jgo.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022]
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23
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Puts M, Papadopoulos E, Brennenstuhl S, Durbano S, Hossain N, Santos B, Cleverley K, Alibhai SMH. The Development of Geriatric Assessment and Intervention Guidelines for an Online Geriatric Assessment Tool: A Canadian Modified Delphi Panel Study. Curr Oncol 2022; 29:853-868. [PMID: 35200572 PMCID: PMC8870933 DOI: 10.3390/curroncol29020073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There are no guidelines available for what assessment tools to use in a patient's self-completed online geriatric assessment (GA) with management recommendations. Therefore, we used a modified Delphi approach with Canadian expert clinicians to develop a consensus online GA plus recommendations tool. METHODS The panel consisted of experts in geriatrics, oncology, nursing, and pharmacy. Experts were asked to rate the importance and feasibility of assessments and interventions to be included in an online GA for patients. The items included in the first round were based on guidelines for in-person GA and literature review. The first two rounds were conducted using an online survey. A virtual 2 h meeting was held to discuss the items where no consensus was reached and then voted on in the final round. RESULTS 34 experts were invited, and 32 agreed to participate. In round 1, there were 85 items; in round 2, 50 items; and in round 3, 25 items. The final tool consists of fall history, assistive device use, weight loss, medication review, need help taking medication, social supports, depressive symptoms, self-reported vision and hearing, and current smoking status and alcohol use. CONCLUSION This first multidisciplinary consensus on online GA will benefit research and clinical care for older adults with cancer.
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Affiliation(s)
- Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada; (S.B.); (B.S.); (K.C.)
| | - Efthymios Papadopoulos
- Department of Medicine, University Health Network, Toronto, ON M5G 2C1, Canada; (E.P.); (S.D.); (N.H.); (S.M.H.A.)
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada; (S.B.); (B.S.); (K.C.)
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, ON M5G 2C1, Canada; (E.P.); (S.D.); (N.H.); (S.M.H.A.)
| | - Nazia Hossain
- Department of Medicine, University Health Network, Toronto, ON M5G 2C1, Canada; (E.P.); (S.D.); (N.H.); (S.M.H.A.)
| | - Brenda Santos
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada; (S.B.); (B.S.); (K.C.)
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada; (S.B.); (B.S.); (K.C.)
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Shabbir M. H. Alibhai
- Department of Medicine, University Health Network, Toronto, ON M5G 2C1, Canada; (E.P.); (S.D.); (N.H.); (S.M.H.A.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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24
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Flannery MA, Mohile S, Culakova E, Norton S, Kamen C, Dionne-Odom JN, DiGiovanni G, Griggs L, Bradley T, Hopkins JO, Liu JJ, Loh KP. Completion of Patient-Reported Outcome Questionnaires Among Older Adults with Advanced Cancer. J Pain Symptom Manage 2022; 63:301-310. [PMID: 34371137 PMCID: PMC8816807 DOI: 10.1016/j.jpainsymman.2021.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023]
Abstract
CONTEXT Systematic collection of patient-reported outcomes (PROs) reduces symptom burden and improves quality of life. The ability of older adults to complete PROs, however, has not been thoroughly studied. OBJECTIVES To determine whether older adults with advanced cancer received assistance completing PROs, the nature of the assistance, the factors associated with receiving assistance, and how the prevalence of assistance changed over time. METHODS Data were obtained from a multisite cluster randomized controlled study of geriatric assessment (Clinicaltrials.gov: NCT02107443). Adults ≥70 years with advanced cancer completed multiple PROs at 4 time points (enrollment, 6 weeks, 3 months, 6 months). Factors associated with receipt of assistance were assessed with bivariate and multivariate analyses. RESULTS The study included 541 adults (range 70-96 years, 49% female, mixed incurable cancer diagnoses). Twenty-eight percent (153/541) received assistance completing PROs. Of these, 42% received assistance from caregivers, 37% from research staff, and 15% from both. Factors associated with receiving assistance included older age [Adjusted Odds Ratio (AOR) 3.71, 95% Confidence Interval (CI) 1.03-13.38], lower education level (3.92, 2.11-7.29), impaired cognition (1.90, 1.23-2.93), impaired functional status (2.16, 1.33-3.52), and impaired hearing (1.38, 1.05-1.80). Eighty percent of individuals who received assistance were identified at study initiation. Receiving assistance decreased over time from 28% to 18%, partially due to drop-outs. CONCLUSION Over a quarter of older adults with advanced cancer in this study received assistance completing PROs. Completing PROs is a key aspect of many clinical programs and cancer trials; assistance in completing PROs should be offered and provided.
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Affiliation(s)
- Marie A Flannery
- School of Nursing (M.A.F., S.N.), University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Supriya Mohile
- University of Rochester School of Medicine and Dentistry (S.M., E.C., C.K., G.D., K.P.L.), Rochester, New York, USA
| | - Eva Culakova
- University of Rochester School of Medicine and Dentistry (S.M., E.C., C.K., G.D., K.P.L.), Rochester, New York, USA
| | - Sally Norton
- School of Nursing (M.A.F., S.N.), University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Charles Kamen
- University of Rochester School of Medicine and Dentistry (S.M., E.C., C.K., G.D., K.P.L.), Rochester, New York, USA
| | - J Nicholas Dionne-Odom
- University of Alabama (J.N.D.-O.), Birmingham, School of Nursing, Birmingham, Alabama, USA
| | - Grace DiGiovanni
- University of Rochester School of Medicine and Dentistry (S.M., E.C., C.K., G.D., K.P.L.), Rochester, New York, USA
| | - Lorraine Griggs
- University of Rochester Medical Center (L.G.), SCOREBOARD, Patient Advisory Board, Rochester, New York, USA
| | | | - Judith O Hopkins
- Southeast Clinical Oncology Research Consortium NCORP (J.O.H.), Winston Salem, North Carolina, USA
| | - Jane Jijun Liu
- Illinois Cancer Care and Heartland NCORP (J.J.L.), Illnois, USA
| | - Kah Poh Loh
- University of Rochester School of Medicine and Dentistry (S.M., E.C., C.K., G.D., K.P.L.), Rochester, New York, USA
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25
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Donison V, Chesney TR, Wills A, Santos B, McLean B, Alqurini N, Hossain N, Durbano S, Lemonde M, Alibhai SMH, Puts M. Self-management interventions for issues identified in a geriatric assessment: A systematic review. J Am Geriatr Soc 2021; 70:1268-1279. [PMID: 34902156 DOI: 10.1111/jgs.17601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the development of electronic geriatric assessment (GA), recommendations for self-management can be provided to patients without the presence of health care providers. Our research question was to identify what self-management interventions can be used by patients to address issues identified in GA and to determine their effect on patient-centered outcomes such as quality of life, health, mood, cognition, and functional status. METHODS Searches were conducted on July 13, 2021, by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database-specific subject headings and text word searches was used such as self-management, a key word for each of the geriatric assessment domains and older adults. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings. RESULTS Among 28,520 abstracts reviewed, 34 randomized controlled trials were included. The most frequently studied geriatric domains were mood (n = 13 studies), mobility/falls (n = 12), quality of life (n = 11), and functional status (n = 7). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 5), comorbidity (4 of 4), and medication management (4 of 4). Most studies were of low to moderate quality. All geriatric domains were targeted in at least one study. CONCLUSIONS Low- to moderate-quality studies show a variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long-term effects, validation, and scalability of these interventions remain largely unknown.
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Affiliation(s)
- Valentina Donison
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler R Chesney
- Department of Surgery, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Brenda Santos
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Bianca McLean
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Naser Alqurini
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | - Nazia Hossain
- Postgraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada.,Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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26
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Li D, Sun CL, Kim H, Soto-Perez-de-Celis E, Chung V, Koczywas M, Fakih M, Chao J, Cabrera Chien L, Charles K, Hughes SFDS, Katheria V, Trent M, Roberts E, Jayani R, Moreno J, Kelly C, Sedrak MS, Dale W. Geriatric Assessment-Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults With Cancer: A Randomized Clinical Trial. JAMA Oncol 2021; 7:e214158. [PMID: 34591080 DOI: 10.1001/jamaoncol.2021.4158] [Citation(s) in RCA: 233] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Although geriatric assessment-driven intervention improves patient-centered outcomes, its influence on chemotherapy-related toxic effects remains unknown. Objective To assess whether specific geriatric assessment-driven intervention (GAIN) can reduce chemotherapy-related toxic effects in older adults with cancer. Design, Setting, and Participants A randomized clinical trial enrolled 613 participants from a National Cancer Institute-designated cancer center between 2015 and 2019. Patients were 65 years and older with a solid malignant neoplasm, were starting a new chemotherapy regimen, and completed a geriatric assessment. Patients were followed up until chemotherapy completion or 6 months after initiation, whichever occurred first. Data analysis was done by intention-to-treat principle. Interventions Patients were randomized (2:1) to either the GAIN (intervention) or standard of care (SOC) arm. In the GAIN arm, a geriatrics-trained multidisciplinary team composed of an oncologist, nurse practitioner, social worker, physical/occupation therapist, nutritionist, and pharmacist reviewed geriatric assessment results and implemented interventions based on prespecified thresholds built into the geriatric assessment's domains. In the SOC arm, geriatric assessment results were sent to treating oncologists for consideration. Main Outcomes and Measures The primary outcome was incidence of grade 3 or higher chemotherapy-related toxic effects (graded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0). Secondary outcomes included advance directive completion, emergency department visits, unplanned hospitalizations, average length of stay, unplanned hospital readmissions, chemotherapy dose modifications, and early discontinuation. Overall survival analysis was performed up to 12 months after chemotherapy initiation. Results Among the 605 eligible participants for analysis, median (range) age was 71 (65-91) years, 357 (59.0%) were women, and 432 (71.4%) had stage IV disease. Cancer types included gastrointestinal (202 [33.4%]), breast (136 [22.5%]), lung (97 [16.0%]), genitourinary (91 [15.0%]), gynecologic (54 [8.9%]), and other (25 [4.1%]). Incidence of grade 3 or higher chemotherapy-related toxic effects was 50.5% (95% CI, 45.6% to 55.4%) in the GAIN arm and 60.6% (95% CI, 53.9% to 67.3%) in the SOC arm, resulting in a significant 10.1% reduction (95% CI, -1.5 to -18.2%; P = .02). A significant absolute increase in advance directive completion of 28.4% with GAIN vs 13.3% with SOC (P < .001) was observed. No significant differences were observed in emergency department visits, unplanned hospitalizations, average length of stay, unplanned readmissions, chemotherapy dose modifications or discontinuations, or overall survival. Conclusions and Relevance In this randomized clinical trial, integration of multidisciplinary GAIN significantly reduced grade 3 or higher chemotherapy-related toxic effects in older adults with cancer. Implementation of GAIN into oncology clinical practice should be considered among older adults receiving chemotherapy. Trial Registration ClinicalTrials.gov Identifier: NCT02517034.
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Affiliation(s)
- Daneng Li
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Can-Lan Sun
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Heeyoung Kim
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | - Vincent Chung
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | - Marwan Fakih
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Joseph Chao
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | | | | | - Vani Katheria
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Monica Trent
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Elsa Roberts
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Reena Jayani
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeanine Moreno
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Cynthia Kelly
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Mina S Sedrak
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, California
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Uranga C, Chien LC, Liposits G. Geriatric screening in older adults with cancer - A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative. J Geriatr Oncol 2021; 13:374-377. [PMID: 34509397 DOI: 10.1016/j.jgo.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Gabor Liposits
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense, Denmark.
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Guerard E, Dodge AB, Le-Rademacher JG, Kemeny MM, Ojelabi M, Sedrak MS, Hopkins J, Shahrokni A, Harlos E, Muss H, Cohen HJ, Lafky J, Sloan J, Jatoi A, Hurria A. Electronic Geriatric Assessment: Is It Feasible in a Multi-Institutional Study That Included a Notable Proportion of Older African American Patients? (Alliance A171603). JCO Clin Cancer Inform 2021; 5:435-441. [PMID: 33852323 DOI: 10.1200/cci.20.00163] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study determined whether an electronic version of the geriatric assessment is feasible in a multi-institutional, diverse setting. METHODS Ten sites within the Alliance for Clinical Trials in Oncology participated. Patients who had active cancer or a history of cancer and were 65 years of age or older were eligible. The geriatric assessment was completed with an electronic data capture system that had been loaded onto iPads. Feasibility was defined a priori as completion in at least 70% of patients either with or without help. To enhance racial diversity, the original sample size was later changed and augmented by 50% with the intention of increasing enrollment of older minority patients. RESULTS A total of one hundred fifty-four patients were registered with a median age of 72 years (range, 65-91 years). Forty-three (28%) identified themselves as African American or Black. One hundred forty-one patients (92%) completed the electronic geriatric assessment. Feasibility was observed across all subgroups, regardless of race, education, performance status, comorbidities, and cognition; 124 patients (81%) completed the geriatric assessment without help. Reasons for not completing the geriatric assessment are as follows: clinic visit did not occur (n = 6), no iPad connection to the Internet (n = 3), patient declined (n = 2), prolonged hospitalization (n = 1), and patient died (n = 1). Reasons for needing help, as reported by study personnel, were as follows: the patient preferred that research personnel ask the questions (n = 9), vision problem (n = 3), lack of comfort with the iPad (n = 2), questions were not clear (n = 1), less proficient in English (n = 1), and challenge in pressing the green button to go to the next question (n = 1). CONCLUSION The electronic geriatric assessment is feasible in a multi-institutional setting that includes a notable proportion of African American or Black patients.
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Affiliation(s)
- Emily Guerard
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - Andrew B Dodge
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | | | | | - Mina S Sedrak
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | | | | | - Hyman Muss
- University of North Carolina, Chapel Hill, NC
| | | | | | - Jeff Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Duarte, CA.,Deceased
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29
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Martin NA, Harlos ES, Cook KD, O'Connor JM, Dodge A, Guerard E, Lafky JM, Jatoi A, Le-Rademacher JG. How Did a Multi-Institutional Trial Show Feasibility of Electronic Data Capture in Older Patients With Cancer? Results From a Multi-Institutional Qualitative Study (Alliance A171902). JCO Clin Cancer Inform 2021; 5:442-449. [PMID: 33877885 DOI: 10.1200/cci.20.00164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE New technology might pose problems for older patients with cancer. This study sought to understand how a trial in older patients with cancer (Alliance A171603) was successful in capturing electronic patient-reported data. METHODS Study personnel were invited via e-mail to participate in semistructured phone interviews, which were audio-recorded and qualitatively analyzed. RESULTS Twenty-four study personnel from the 10 sites were interviewed; three themes emerged. The first was that successful patient-reported electronic data capture shifted work toward patients and toward study personnel at the beginning of the study. One interviewee explained, "I mean it kind of lost all advantages…by being extremely laborious." Study personnel described how they ensured electronic devices were charged, wireless internet access was up and running, and login codes were available. The second theme was related to the first and dealt with data filtering. Study personnel described high involvement in data gathering; for example, one interviewee described, "I answered on the iPad, whatever they said. They didn't even want to use it at all." A third theme dealt with advantages of electronic data entry, such as prompt data availability at study completion. Surprisingly, some remarks described how electronic devices brought people together, "Some of the patients, you know, it just gave them a chance to kinda talk about, you know, what was going on." CONCLUSION High rates of capture of patient-reported electronic data were viewed favorably but occurred in exchange for increased effort from patients and study personnel and in exchange for data that were not always patient-reported in the strictest sense.
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Affiliation(s)
| | | | | | | | - Andrew Dodge
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | | | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN
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30
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Nipp RD, Subbiah IM, Loscalzo M. Convergence of Geriatrics and Palliative Care to Deliver Personalized Supportive Care for Older Adults With Cancer. J Clin Oncol 2021; 39:2185-2194. [PMID: 34043435 PMCID: PMC8260927 DOI: 10.1200/jco.21.00158] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ryan D. Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ishwaria M. Subbiah
- Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
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Pérez-de-Acha-Chávez A, Gómez-Moreno C, Aguilar-Velazco JC, Moreno-García ML, Pérez-de-Celis-Herrero C, Lira-Huerta E, Chavarri-Guerra Y, Soto-Perez-de-Celis E. Feasibility and reliability of a self-administered geriatric assessment tool for Spanish-speaking Mexican older adults with cancer. J Geriatr Oncol 2021; 12:1266-1269. [PMID: 34090842 DOI: 10.1016/j.jgo.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/27/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Pérez-de-Acha-Chávez
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carolina Gómez-Moreno
- Department of Emergency Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Carlos Aguilar-Velazco
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Luisa Moreno-García
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Ernesto Lira-Huerta
- Faculty of Computer Sciences, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Improving Care for Spanish-Speaking Older Adults with Breast Cancer: Feasibility, Reliability, and Validity of a Self-Administered Spanish Language Geriatric Assessment. Cancers (Basel) 2021; 13:cancers13112685. [PMID: 34072404 PMCID: PMC8198244 DOI: 10.3390/cancers13112685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Conducting a geriatric assessment represents the standard of care for the management of older adults with cancer. However, most studies of the geriatric assessment in oncology have included non-Hispanic white populations with high educational levels living in developed countries. In this study, we assessed the feasibility, reliability, and validity of two methods of administration (electronic touchscreen tablet and paper/pencil) of the Spanish language version of a self-administered geriatric assessment among older women with breast cancer in the United States. Our results show that implementing a self-administered geriatric assessment using either an electronic tablet or paper/pencil is feasible, reliable, and valid in Spanish-speaking older adults. However, in order to complete the geriatric assessment, participants with lower educational levels were more likely to need help and took significantly longer to do so. This study highlights the importance of tailoring assessments and questionnaires to the cultural, social, and educational level of older adults with cancer. Abstract We evaluated the feasibility, reliability, and validity of a Spanish-language self-administered geriatric assessment (GA) in older (age ≥ 65) Spanish-speaking women with breast cancer in the United States. Eligible participants (n = 181) were recruited and randomized. Feasibility was defined as the participant’s unassisted GA completion rate, completion time, and perception on ease of completion. Reliability and validity were assessed using Spearman’s correlation coefficients. Two-sided p < 0.05 was considered significant. Ninety-eight percent of participants (n = 177) completed the GA at least once. Median age was 70 years (range: 65–95) and 55% had ≤8th grade education. Forty-one percent (n = 73) were unable to complete the GA unassisted, median completion time was 28 min (range 8–90), and 77% (n = 136) rated the GA as “easy”/“very easy”. Patients with ≤8th grade education took longer to complete the GA (30 vs. 25 min, p = 0.0036) and needed more assistance (59% vs. 19%, p < 0.001) than those with ≥9th grade education. Test–retest reliability was high (≥0.82) for all domains except social activity (0.73). Validity among similar scales was found. The self-administered GA is a feasible, reliable, and valid tool for Spanish-speaking older women with breast cancer. Tailoring GA tools to the patients’ educational level is important when implementing tools in multicultural environments.
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McLean B, Hossain N, Donison V, Gray M, Durbano S, Haase K, Alibhai SMH, Puts M. Providing Medical Information to Older Adults in a Web-Based Environment: Systematic Review. JMIR Aging 2021; 4:e24092. [PMID: 33560228 PMCID: PMC8294635 DOI: 10.2196/24092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/10/2020] [Accepted: 01/06/2021] [Indexed: 01/16/2023] Open
Abstract
Background Cancer is a disease that predominantly affects older adults, and several organizations recommend the completion of a geriatric assessment to help with cancer treatment decision-making. Owing to a shortage of geriatric teams and the vast number of older adults diagnosed with cancer each year, a web-based geriatric assessment may improve access to geriatric assessment for older adults. We systematically reviewed the literature to obtain the latest evidence for the design of our web-based geriatric assessment tool Comprehensive Health Assessment for My Plan. Objective This review aimed to probe the following questions: what is the impact of providing health test results to older adults in a web-based environment without the presence of a health care provider for patient-centered outcomes, including satisfaction, perceived harm, empowerment, quality of life, and health care use (eg, hospitalization, physician visits, emergency room visits, and costs), and what recommendations do older adults and developers have for designing future apps or websites for older adults? Methods This systematic review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement. Studies were limited to publications in English that examined a web-based tool that provided test results to older adults (aged ≥65 years) without the presence of a health care provider. A health sciences librarian performed the search on November 29, 2019, on the following electronic databases: MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Library. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool Version 2018. The findings are summarized narratively and in tabular format. Results A total of 26,898 titles and abstracts were screened by 2 independent reviewers, of which 94 studies were selected for a full-text review, and 9 studies were included in this review. There were only 2 randomized controlled trials of high quality that explored the effects of receiving health care results on the web via eHealth tools for older adults or provided evidence-based recommendations for designing such tools. Older adults were generally satisfied with receiving screening results via eHealth tools, and several studies suggested that receiving health screening results electronically improved participants’ quality of life. However, user interfaces that were not designed with older adults in mind and older adults’ lack of confidence in navigating eHealth tools proved challenging to eHealth uptake and use. All 9 studies included in this systematic review made recommendations on how to design eHealth tools that are intuitive and useful for older adults. Conclusions eHealth tools should incorporate specific elements to ensure usability for older adults. However, more research is required to fully elucidate the impact of receiving screening and results via eHealth tools without the presence of a health care provider for patient-centered outcomes in this target population.
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Affiliation(s)
- Bianca McLean
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nazia Hossain
- Department of Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Valentina Donison
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Mikaela Gray
- Gerstein Science Information Centre, University of Toronto, Toronto, ON, Canada
| | | | - Kristen Haase
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Shabbir Muhammad Husayn Alibhai
- Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Martine Puts
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Loh KP, Abdallah M, Kadambi S, Wells M, Kumar AJ, Mendler J, Liesveld J, Wittink M, O’Dwyer K, Becker MW, McHugh C, Stock W, Majhail NS, Wildes TM, Duberstein P, Mohile SG, Klepin HD. Treatment decision-making in acute myeloid leukemia: a qualitative study of older adults and community oncologists. Leuk Lymphoma 2021; 62:387-398. [PMID: 33040623 PMCID: PMC7878016 DOI: 10.1080/10428194.2020.1832662] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/13/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023]
Abstract
Little is known about the characteristics of patients, physicians, and organizations that influence treatment decisions in older patients with AML. We conducted qualitative interviews with community oncologists and older patients with AML to elicit factors that influence their treatment decision-making. Recruitment was done via purposive sampling and continued until theoretical saturation was reached, resulting in the inclusion of 15 patients and 15 oncologists. Participants' responses were analyzed using directed content analysis. Oncologists and patients considered comorbidities, functional status, emotional health, cognition, and social factors when deciding treatment; most oncologists evaluated these using clinical gestalt. Sixty-seven percent of patients perceived that treatment was their only option and that they had not been offered a choice. In conclusion, treatment decision-making is complex and influenced by patient-related factors. These factors can be assessed as part of a geriatric assessment which can help oncologists better determine fitness and guide treatment decision-making.
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Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Maya Abdallah
- Department of Medicine, Sections of Geriatrics and Hematology/Oncology, Boston University School of Medicine, Boston, , Massachusetts
| | - Sindhuja Kadambi
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Megan Wells
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | | | - Jason Mendler
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Jane Liesveld
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester Medical Center
| | - Kristen O’Dwyer
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Michael W. Becker
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Colin McHugh
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Wendy Stock
- The University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois
| | - Navneet S. Majhail
- Blood and Marrow Transplant Program, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Tanya M. Wildes
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | | | - Supriya Gupta Mohile
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Heidi D. Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC
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Okoli GN, Stirling M, Racovitan F, Lam OL, Reddy VK, Copstein L, Hsu T, Abou-Setta AM, Dawe DE. Integration of geriatric assessment into clinical oncology practice: A scoping review. Curr Probl Cancer 2021; 45:100699. [PMID: 33468334 DOI: 10.1016/j.currproblcancer.2020.100699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/04/2020] [Indexed: 02/03/2023]
Abstract
Sixty percent of newly diagnosed cancers occur in older adults and more complex planning is required to sustain quality care for older populations. Individualized care incorporating geriatric assessment can predict early mortality and treatment toxicity for older cancer patients. We mapped and summarized the available evidence on the integration of geriatric assessment into clinical oncology practice, and ascertained which domains have been implemented. We systematically searched bibliographic databases and trial registries for reports of clinical studies, clinical practice guidelines, systematic and non-systematic reviews, and grey literature published in English. We gathered data on study characteristics, geriatric domains and strategies evaluated, and relevant study objectives and findings. From a total of 10,124 identified citations, 38 articles met our eligibility criteria, 3 of which were clinical practice guidelines. Nearly half of these articles came from the United States. Domains of the geriatric assessment implemented in studies ranged from 1 to 12, with varied combinations. We identified 27 studies on strategies for implementing geriatric assessment and 24 studies on feasibility of implementing geriatric assessment, into clinical oncology practice. We also identified 3 main geriatric assessment models: 2 from the United States and 1 from Australia. Furthermore, we identified 2 reviews that reported varied components of geriatric assessment models. There is increasingly robust evidence to implement formal geriatric assessment in oncology practice. There remains a great deal of variation in the tools recommended to address each of the domains in a geriatric assessment, with only 1 guideline (American Society of Clinical Oncology guideline) settling on a specific best practice. Protocol registration: Open Science Framework osf.io/mec93.
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Affiliation(s)
- George N Okoli
- George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Florentin Racovitan
- George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Otto Lt Lam
- George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Viraj K Reddy
- George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie Copstein
- George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tina Hsu
- The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David E Dawe
- CancerCare Manitoba, Winnipeg, Manitoba, Canada; Section of Hematology/Oncology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
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VanderWalde NA, Williams GR. Developing an electronic geriatric assessment to improve care of older adults with cancer receiving radiotherapy. Tech Innov Patient Support Radiat Oncol 2020; 16:24-29. [PMID: 33385071 PMCID: PMC7769846 DOI: 10.1016/j.tipsro.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 01/02/2023] Open
Abstract
Older adults make up a substantial proportion of patients diagnosed with cancer. Gaps in evidence of care for older adults with cancer leads to treatment heterogeneity and poor outcomes. Medical and Surgical Oncology clinics throughout the world are increasingly using Geriatric Assessment (GA) based approaches to treatment that are beginning to improve care through treatment decision-making communication, health-related quality of life outcomes, and reducing chemotherapy toxicities. Yet, GA based approaches are not often used in radiation oncology clinics. This manuscript aims to describe the ongoing development of an electronic patient-reported GA with real-time data interpretation and recommendation delivery to help increase the use of a personalized GA based approach to the care of older adults within radiation oncology clinics. Future studies demonstrating the utility and benefit of GA based approaches to help older adults undergoing radiotherapy for their cancers are still sorely needed.
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Affiliation(s)
- Noam A. VanderWalde
- Department of Radiation Oncology, West Cancer Center and Research Institute, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Grant R. Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama Birmingham, Birmingham, AL, United States
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Kadambi S, Loh KP, Dunne R, Magnuson A, Maggiore R, Zittel J, Flannery M, Inglis J, Gilmore N, Mohamed M, Ramsdale E, Mohile S. Older adults with cancer and their caregivers - current landscape and future directions for clinical care. Nat Rev Clin Oncol 2020; 17:742-755. [PMID: 32879429 PMCID: PMC7851836 DOI: 10.1038/s41571-020-0421-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 12/13/2022]
Abstract
Despite substantial improvements in the outcomes of patients with cancer over the past two decades, older adults (aged ≥65 years) with cancer are a rapidly increasing population and continue to have worse outcomes than their younger counterparts. Managing cancer in this population can be challenging because of competing health and ageing-related conditions that can influence treatment decision-making and affect outcomes. Geriatric screening tools and comprehensive geriatric assessment can help to identify patients who are most at risk of poor outcomes from cancer treatment and to better allocate treatment for these patients. The use of evidence-based management strategies to optimize geriatric conditions can improve communication and satisfaction between physicians, patients and caregivers as well as clinical outcomes in this population. Clinical trials are currently underway to further determine the effect of geriatric assessment combined with management interventions on cancer outcomes as well as the predictive value of geriatric assessment in the context of treatment with contemporary systemic therapies such as immunotherapies and targeted therapies. In this Review, we summarize the unique challenges of treating older adults with cancer and describe the current guidelines as well as investigational studies underway to improve the outcomes of these patients.
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Affiliation(s)
- Sindhuja Kadambi
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
| | - Kah Poh Loh
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Richard Dunne
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Allison Magnuson
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Ronald Maggiore
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Jason Zittel
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Marie Flannery
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Julia Inglis
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Nikesha Gilmore
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Mostafa Mohamed
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Erika Ramsdale
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
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O'Donovan A, Leech M. Personalised treatment for older adults with cancer: The role of frailty assessment. Tech Innov Patient Support Radiat Oncol 2020; 16:30-38. [PMID: 33102819 PMCID: PMC7568178 DOI: 10.1016/j.tipsro.2020.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
Abstract
It is widely accepted in clinical practice that chronological age is a poor predictor of treatment tolerance and outcomes in older adults with cancer. Intrinsic vulnerability is more a function of underlying frailty, rather than chronological age. Frailty is a state of increased vulnerability to stressors, such as cancer and its treatment, which can lead to adverse health outcomes for patients. Capturing this heterogeneity in reserve capacity is the cornerstone of management in geriatricmedicine, but remains poorly understood or adopted in radiation oncology. A two-step approach, using a shorter screening tool, followed by full assessment for those who need it, is the mostresourceful way of implementing frailty assessment in radiotherapy departments. It is important for radiation oncology professionals to identify frailty and to use this information in multidisciplinary decision making in order to develop a personalised radiotherapy approach for the older person. There are many ways we can effectively use this information, such as considering treatment fractionation schedules that would limit the burden of travel for those with social frailty, or reviewing the range of modalities at our disposal, which might limit toxicity in the older person at high risk of deterioration during treatment. Frailty assessment is not carried out in many radiotherapy departments presently, but there are many international models to use as exemplars as to how it may be implemented in clinical practice. There are many opportunities for further research and role development in this field at the current time.
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The Role of e-Health in the Delivery of Care for Patients with Hematological Cancers: A Systematic Literature Review. Telemed J E Health 2020; 26:1093-1105. [DOI: 10.1089/tmj.2019.0231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Simcock R, Wright J. Beyond Performance Status. Clin Oncol (R Coll Radiol) 2020; 32:553-561. [PMID: 32684503 PMCID: PMC7365102 DOI: 10.1016/j.clon.2020.06.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
Oncologists should recognise the need to move beyond the Eastern Cooperative Oncology Group Performance Status (ECOG PS) score. ECOG PS is a longstanding and ubiquitous feature of oncology. It was evolved 40 years ago as an adaption of the 70-year-old Karnofsky performance score. It is short, easily understood and part of the global language of oncology. The wide prevalence of the ECOG PS attests to its proven utility and worth to help triage patient treatment. The ECOG PS is problematic. It is a unidimensional functional score. It is mostly physician assessed, subjective and therefore open to bias. It fails to account for multimorbidity, frailty or cognition. Too often the PS is recorded only once in wilful ignorance of a patient's changing physical state. As modern oncology offers an ever-widening array of therapies that are ‘personalised’ to tumour genotype, modern oncologists must strive to better define patient phenotype. Using a wider range of scoring and assessment tools, oncologists can identify deficits that may be reversed or steps taken to mitigate detrimental effects of treatment. These tools can function well to identify those patients who would benefit from comprehensive assessment. This overview identifies the strengths of ECOG PS but highlights the weaknesses and where these are supported by other measures. A strong recommendation is made here to move to routine use of the Clinical Frailty Score to start to triage patients and most appropriately design treatments and rehabilitation interventions.
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Affiliation(s)
- R Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - J Wright
- Brighton and Sussex Medical School, Brighton, UK
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McKenzie GAG, Bullock AF, Greenley SL, Lind MJ, Johnson MJ, Pearson M. Implementation of geriatric assessment in oncology settings: A systematic realist review. J Geriatr Oncol 2020; 12:22-33. [PMID: 32680826 DOI: 10.1016/j.jgo.2020.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/04/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
Older adults with cancer are more likely to have worse clinical outcomes than their younger counterparts, and shared decision-making can be difficult, due to both complexity from adverse ageing and under-representation in clinical trials. Geriatric assessment (GA) has been increasingly recognised as a predictive and prehabilitative tool for older adults with cancer. However, GA has been notoriously difficult to implement in oncological settings due to workforce, economic, logistical, and practical barriers. We aimed to review the heterogenous literature on implementation of GA in oncology settings to understand the different implementation context configurations of GA and the mechanisms they trigger to enable successful implementation. A systematic realist review was undertaken in two stages: i) systematic searches with structured data extraction combined with iterative key stakeholder consultations to develop programme theories for implementing GA in oncology settings; ii) synthesis to refine programme theories. Medline, Embase, PsycInfo, Cochrane Library, CINAHL, Web of Science, Scopus, ASSIA, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, DARE and Health Technology Assessment were searched. Four programme theories were developed from 53 included articles and 20 key stakeholder consultations addressing the major barriers of GA implementation in oncology practice: time (leveraging non-specialists), funding (creating favourable health economics), practicalities (establishing the use of GA in cancer care), and managing limited resources. We demonstrate that a whole system approach is required to improve the implementation of GA in cancer settings. This review will help inform policy decisions regarding implementation of GA and provide a basis for further implementation research.
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Affiliation(s)
- Gordon A G McKenzie
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom.
| | - Alex F Bullock
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Sarah L Greenley
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Michael J Lind
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
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Zhu B, Feng T, Izci-Balserak B. Using Research Electronic Data Capture for Longitudinal Assessment Among Older Adults With Diabetes Enhances Real-Time Data Collection. Comput Inform Nurs 2020; 39:32-41. [PMID: 32604206 DOI: 10.1097/cin.0000000000000641] [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: 11/26/2022]
Abstract
The aim of this study was to provide evidence on the application of Research Electronic Data Capture for collecting repeated data during a 7-day period among older adults. Fifty-seven adults (≥50 years) with type 2 diabetes were recruited. Participants completed one sleep diary upon awaking and one self-care diary before going to bed each day for 7 days. The diaries were administered via the Research Electronic Data Capture Web-based system and were completed via participants' own electronic devices. Objective compliance rate, time used to complete each diary, and participant experience were described. Approximately 80% (n = 45) of the participants used Research Electronic Data Capture. Among these participants, the noncompliance rate ranged between 0% and 8.9% for the sleep diary and 0% and 13.1% for the self-care diary. Participants spent 4.2 to 8.7 minutes on the sleep diary and 3.5 to 7.1 minutes on the self-care diary. It took the participants a longer time to complete the diaries during the first day than during the following 6 days. Few participants reported technical issues or felt inconvenient or stressful with completing the Research Electronic Data Capture diaries. Overall, the compliance rates were high. Completing the diaries was not time-consuming and participants were largely satisfied with the Research Electronic Data Capture data collection. Research Electronic Data Capture has aided the longitudinal data collection. With adequate training, Research Electronic Data Capture is an efficient tool to collect repeated data among older adults and thus is recommended for future research.
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Affiliation(s)
- Bingqian Zhu
- Author Affiliations: School of Nursing, Shanghai Jiao Tong University, Shanghai, China (Dr Zhu); Clinical Research Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Dr Feng); and College of Nursing, University of Illinois at Chicago (Izci-Balserak)
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Guida JL, Ahles TA, Belsky D, Campisi J, Cohen HJ, DeGregori J, Fuldner R, Ferrucci L, Gallicchio L, Gavrilov L, Gavrilova N, Green PA, Jhappan C, Kohanski R, Krull K, Mandelblatt J, Ness KK, O'Mara A, Price N, Schrack J, Studenski S, Theou O, Tracy RP, Hurria A. Measuring Aging and Identifying Aging Phenotypes in Cancer Survivors. J Natl Cancer Inst 2020; 111:1245-1254. [PMID: 31321426 DOI: 10.1093/jnci/djz136] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/17/2019] [Accepted: 07/03/2019] [Indexed: 02/07/2023] Open
Abstract
Observational data have shown that some cancer survivors develop chronic conditions like frailty, sarcopenia, cardiac dysfunction, and mild cognitive impairment earlier and/or at a greater burden than similarly aged individuals never diagnosed with cancer or exposed to systemic or targeted cancer therapies. In aggregate, cancer- and treatment-related physical, cognitive, and psychosocial late- and long-term morbidities experienced by cancer survivors are hypothesized to represent accelerated or accentuated aging trajectories. However, conceptual, measurement, and methodological challenges have constrained efforts to identify, predict, and mitigate aging-related consequences of cancer and cancer treatment. In July 2018, the National Cancer Institute convened basic, clinical, and translational science experts for a think tank titled "Measuring Aging and Identifying Aging Phenotypes in Cancer Survivors." Through the resulting deliberations, several research and resource needs were identified, including longitudinal studies to examine aging trajectories that include detailed data from before, during, and after cancer treatment; mechanistic studies to elucidate the pathways that lead to the emergence of aging phenotypes in cancer survivors; long-term clinical surveillance to monitor survivors for late-emerging effects; and tools to integrate multiple data sources to inform understanding of how cancer and its therapies contribute to the aging process. Addressing these needs will help expand the evidence base and inform strategies to optimize healthy aging of cancer survivors.
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Trevino KM, Stern A, Prigerson HG. Adapting psychosocial interventions for older adults with cancer: A case example of Managing Anxiety from Cancer (MAC). J Geriatr Oncol 2020; 11:1319-1323. [PMID: 32253159 DOI: 10.1016/j.jgo.2020.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 01/06/2023]
Affiliation(s)
| | - Amy Stern
- Weill Cornell Medicine, USA; NewYork Presbyterian Hospital, USA
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Kadambi S, Soto-Perez-de-Celis E, Garg T, Loh KP, Krok-Schoen JL, Battisti NML, Moffat GT, Gil-Jr LA, Mohile S, Hsu T. Social support for older adults with cancer: Young International Society of Geriatric Oncology review paper. J Geriatr Oncol 2020; 11:217-224. [PMID: 31628066 PMCID: PMC7384244 DOI: 10.1016/j.jgo.2019.09.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/04/2019] [Accepted: 09/05/2019] [Indexed: 12/20/2022]
Abstract
Older adults with cancer have increasing needs in physical, cognitive, and emotional domains, and they can experience decline in all domains with the diagnosis and treatment of cancer. Social support plays a key role in supporting these patients, mitigating negative effects of diagnosis and treatment of cancer, and improving cancer outcomes. We review the importance of social support in older adults with cancer, describe the different components of social support and how they are measured, discuss current interventions that are available to improve social support in older adults, and describe burdens on caregivers. We also highlight Dr. Arti Hurria's contributions to recognizing the integral role of social support to caring for older adults with cancer.
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Affiliation(s)
- Sindhuja Kadambi
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Tullika Garg
- Department of Urology, Department of Epidemiology & Health Services Research, Geisinger, Danville, PA, USA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Jessica L Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | | | - Luiz A Gil-Jr
- Division of Geriatrics, Department of Internal Medicine, Instituto do Câncer do Estado de São Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Supriya Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Tina Hsu
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.
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Shahrokni A, Lichtman S, Korc-Grodzicki B. When It Comes to Geriatric Assessment, Rome Was Not Built in One Day. Oncologist 2020; 25:279-280. [PMID: 32077560 DOI: 10.1634/theoncologist.2020-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/27/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Armin Shahrokni
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Stuart Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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47
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Klepin HD, Ritchie E, Major-Elechi B, Le-Rademacher J, Seisler D, Storrick L, Sanford BL, Marcucci G, Zhao W, Geyer SA, Ballman KV, Powell BL, Baer MR, Stock W, Cohen HJ, Stone RM, Larson RA, Uy GL. Geriatric assessment among older adults receiving intensive therapy for acute myeloid leukemia: Report of CALGB 361006 (Alliance). J Geriatr Oncol 2020; 11:107-113. [PMID: 31668825 PMCID: PMC6943189 DOI: 10.1016/j.jgo.2019.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To demonstrate feasibility of performing geriatric assessment (GA) in the National Clinical Trials Network (NCTN) and to explore the utility of GA to characterize treatment tolerance. MATERIALS AND METHODS We conducted a multisite companion study (CALGB 361006) to CALGB 11001, a phase 2 trial of adults ≥60 years old with newly diagnosed FLT3- mutated AML, testing the efficacy of adding sorafenib to intensive chemotherapy. On 361006, a GA was administered prior to induction and prior to post-remission therapy. The GA is divided into items requiring administration by a health care professional (HCP) and patient self-administered questionnaires. Feasibility outcomes were recruitment rate, time to GA completion, difficulty with GA administration, percent of patients requiring assistance, and satisfaction. Change in GA measures pre- and post-induction were compared using Wilcoxon signed rank test and McNemar's tests. RESULTS The recruitment rate was 80% (N = 43, median age 68 years). Median completion time of the GA was 30 min; (10 and 21 min for HCP and patients, respectively). HCP reported no difficulty completing assessments (100%). Most patients completed questionnaires without assistance (77%), and were satisfied with the length (89%). Self-reported physical function, mental health, social activity and nutritional parameters worsened after induction. CONCLUSION GA is feasible to administer in the setting of intensive induction for older adults with AML in the NCTN and provides evidence of the impact of induction therapy on physical and emotional health.
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Affiliation(s)
- Heidi D Klepin
- Wake Forest University Health Sciences, Winston-Salem, NC, United States of America.
| | - Ellen Ritchie
- Weill Medical College of Cornell University, New York, NY, United States of America
| | - Brittny Major-Elechi
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Jennifer Le-Rademacher
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Drew Seisler
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Libby Storrick
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States of America
| | - Ben L Sanford
- Alliance Statistics and Data Center, Duke University, Durham, NC, United States of America
| | - Guido Marcucci
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Weiqiang Zhao
- The Ohio State University Cancer Center, Columbus, OH, United States of America
| | - Susan A Geyer
- Alliance Statistics and Data Center, The Ohio State University Medical Center, Columbus, OH, United States of America
| | - Karla V Ballman
- Weill Medical College of Cornell University, New York, NY, United States of America
| | - Bayard L Powell
- Wake Forest University Health Sciences, Winston-Salem, NC, United States of America
| | - Maria R Baer
- Greenebaum Cancer Center, University of Maryland, Baltimore, MD, United States of America
| | - Wendy Stock
- University of Chicago Comprehensive Cancer Center, Chicago, IL, United States of America
| | - Harvey Jay Cohen
- Duke Cancer Institute, Duke University, Durham, NC, United States of America
| | - Richard M Stone
- Dana-Farber/Partners CancerCare, Boston, MA, United States of America
| | - Richard A Larson
- University of Chicago Comprehensive Cancer Center, Chicago, IL, United States of America
| | - Geoffrey L Uy
- Washington University School of Medicine, St. Louis, MO, United States of America
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48
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Mohile SG, Magnuson A, Pandya C, Velarde C, Duberstein P, Hurria A, Loh KP, Wells M, Plumb S, Gilmore N, Flannery M, Wittink M, Epstein R, Heckler CE, Janelsins M, Mustian K, Hopkins JO, Liu J, Peri S, Dale W. Community Oncologists' Decision-Making for Treatment of Older Patients With Cancer. J Natl Compr Canc Netw 2019. [PMID: 29523669 DOI: 10.6004/jnccn.2017.7047] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: This study's objectives were to describe community oncologists' beliefs about and confidence with geriatric care and to determine whether geriatric-relevant information influences cancer treatment decisions. Methods: Community oncologists were recruited to participate in 2 multisite geriatric oncology trials. Participants shared their beliefs about and confidence in caring for older adults. They were also asked to make a first-line chemotherapy recommendation (combination vs single-agent vs no chemotherapy) for a hypothetical vignette of an older patient with advanced pancreatic cancer. Each oncologist received one randomly chosen vignette that varied on 3 variables: age (72/84 years), impaired function (yes/no), and cognitive impairment (yes/no). Other patient characteristics were held constant. Logistic regression models were used to identify associations between oncologist/vignette-patient characteristics and treatment decisions. Results: Oncologist response rate was 61% (n=305/498). Most oncologists agreed that "the care of older adults with cancer needs to be improved" (89%) and that "geriatrics training is essential" (72%). However, <25% were "very confident" in recognizing dementia or conducting a fall risk or functional assessment, and only 23% reported using the geriatric assessment in clinic. Each randomly varied patient characteristic was independently associated with the decision to treat: younger age (adjusted odds ratio [aOR], 5.01; 95% CI, 2.73-9.20), normal cognition (aOR, 5.42; 95% CI, 3.01-9.76), and being functionally intact (aOR, 3.85; 95% CI, 2.12-7.00). Accounting for all vignettes across all scenarios, 161 oncologists (52%) said they would offer chemotherapy. All variables were independently associated with prescribing single-agent over combination chemotherapy (older age: aOR, 3.22; 95% CI 1.43-7.25, impaired cognition: aOR, 3.13; 95% CI, 1.36-7.20, impaired function: aOR, 2.48; 95% CI, 1.12-5.72). Oncologists' characteristics were not associated with decisions about providing chemotherapy. Conclusion: Geriatric-relevant information, when available, strongly influences community oncologists' treatment decisions.
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Affiliation(s)
- Supriya G Mohile
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Allison Magnuson
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Chintan Pandya
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Carla Velarde
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Paul Duberstein
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Arti Hurria
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Kah Poh Loh
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Megan Wells
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Sandy Plumb
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Nikesha Gilmore
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Marie Flannery
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Marsha Wittink
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Ronald Epstein
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Charles E Heckler
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Michelle Janelsins
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Karen Mustian
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Judith O Hopkins
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Jane Liu
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Srihari Peri
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - William Dale
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
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DuMontier C, Sedrak MS, Soo WK, Kenis C, Williams GR, Haase K, Harneshaug M, Mian H, Loh KP, Rostoft S, Dale W, Cohen HJ. Arti Hurria and the progress in integrating the geriatric assessment into oncology: Young International Society of Geriatric Oncology review paper. J Geriatr Oncol 2019; 11:203-211. [PMID: 31451439 DOI: 10.1016/j.jgo.2019.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/11/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022]
Abstract
Until recently, the progress in the diagnosis and management of cancer has not been matched by similar progress in the assessment of the increasing numbers of older and more complex patients with cancer. Dr. Arti Hurria identified this gap at the outset of her career, which she dedicated toward studying the geriatric assessment (GA) as an improvement over traditional methods used in oncology to assess vulnerability in older patients with cancer. This review documents the progress of the GA and its integration into oncology. First, we detail the GA's origins in the field of geriatrics. Next, we chronicle the early rise of geriatric oncology, highlighting the calls of early thought-leaders to meet the demands of the rapidly aging cancer population. We describe Dr. Hurria's early efforts toward meeting these calls though the implementation of the GA in oncology research. We then summarize some of the seminal studies constituting the evidence base supporting GA's implementation. Finally, we lay out the evolution of cancer-focused guidelines recommending the GA, concluding with future needs to advance the next steps toward more widespread implementation in routine cancer care. Throughout, we describe Dr. Hurria's vision and its execution in driving progress of the GA in oncology, from her fellowship training to her co-authored guidelines recommending GA for all older adults with cancer-published in the year of her untimely death.
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Affiliation(s)
- Clark DuMontier
- Brigham and Women's Hospital, Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States of America.
| | - Mina S Sedrak
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Wee Kheng Soo
- Eastern Health Clinical School, Monash University, 5 Arnold St, Box Hill, VIC, Australia; Department of Aged Medicine, Eastern Health, 8 Arnold St, Box Hill, VIC, Australia; Department of Cancer Services, Eastern Health, 8 Arnold St, Box Hill, VIC, Australia
| | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Grant R Williams
- Division of Hematology/Oncology, Geriatrics, and Palliative Care, Institute of Cancer Outcomes and Survivorship, O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, UK
| | - Kristen Haase
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, Canada
| | - Magnus Harneshaug
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, 2313 Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 4956, Nydalen, 0424 Oslo, Norway
| | - Hira Mian
- Juravinski Cancer Center, Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Siri Rostoft
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America
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50
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Blair CK, Jacobs DR, Demark-Wahnefried W, Cohen HJ, Morey MC, Robien K, Lazovich D. Effects of cancer history on functional age and mortality. Cancer 2019; 125:4303-4309. [PMID: 31418826 DOI: 10.1002/cncr.32449] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cancer, its treatment, and associated adverse effects may accelerate the functional aging of cancer survivors. In the current study, the authors used geriatric assessment (GA) to compare the functional age of long-term cancer survivors with that of similarly aged women without a cancer history, and to examine whether functional age influences all-cause mortality differently between these 2 groups. METHODS Participants included 1723 cancer survivors and 11,145 age-matched, cancer-free women enrolled in the Iowa Women's Health Study in 1986 who completed the 2004 questionnaire (at ages 73-88 years). GA domain deficits included ≥2 physical function limitations, ≥2 comorbidities, poor general health, poor mental health, and underweight. The risk of all-cause mortality was estimated for deficits in each GA domain between 4 groups based on the cross-classification of the presence and/or absence of cancer history and GA domain deficit (the referent group was cancer-free women without a GA deficit). RESULTS Both cancer history and GA domain deficits significantly predicted 10-year mortality for all GA domains. Cancer survivors without deficits had a 1.3-fold to 1.4-fold risk of mortality, similar to the 1.1-fold to 1.7-fold risk noted among cancer-free women with deficits (all P < .05). Cancer survivors with deficits were found to have the highest mortality risk for 4 of 5 domains (hazard ratio range, 1.6-2.0). Mortality risk increased with the increasing number of GA deficits, which was greater in cancer survivors compared with cancer-free women. CONCLUSIONS Even without GA deficits, cancer survivors appear to have an excess risk of death compared with women without cancer, and these deficits add to mortality risk. Interventions are needed to maintain or improve functional/physiological capacity as women age, especially in cancer survivors.
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Affiliation(s)
- Cindy K Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.,Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama.,Cancer Prevention and Control, O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Harvey J Cohen
- Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Miriam C Morey
- Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.,Geriatric Research, Education, and Clinical Care, VA Medical Center, Durham, North Carolina
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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