451
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Lorimer CF, Saran F, Chalmers AJ, Brock J. Glioblastoma in the elderly - How do we choose who to treat? J Geriatr Oncol 2016; 7:453-456. [PMID: 27478132 DOI: 10.1016/j.jgo.2016.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/28/2016] [Accepted: 07/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Glioblastoma (GBM) is the commonest primary malignant brain tumour amongst the adult population. Incidence peaks in the 7th and 8th decades of life and as our global population ages, rates are increasing. GBM is an almost universally fatal disease with life expectancy in the range of 3-5months amongst the elderly. MATERIALS AND METHODS The assessment of elderly GBM patients prior to treatment decisions is poorly researched and unstandardised. In order to begin tackling this issue we performed a cross-sectional survey across all UK based consultant neuro-oncologists to review their current practice in assessing elderly GBM patients. RESULTS There were 56 respondents from a total of 93 recipients (60% response rate). All respondents confirmed that at least some patients aged 70 or over were referred to their clinics from the local multidisciplinary team meeting (MDT). Only 18% of consultants routinely performed a cognitive or frailty screening test at initial consultation. Of those who performed a screening test, the majority reported that the results of the test changed their treatment decision in approximately 50% of cases. Participants ranked performance status as the most important factor in determining treatment decisions. CONCLUSIONS Considering the heterogeneity of this patient population, we argue that performance status is a crude measure of vulnerability within this cohort. Elderly GBM patients represent a unique clinical scenario because of the complexity of distinguishing neuro-oncology related symptoms from general frailty. There is a need for specific geriatric assessment models tailored to the elderly neuro-oncology population in order to facilitate treatment decisions.
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Affiliation(s)
| | | | - Anthony J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G12 8QQ, UK.
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452
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Tomasini P, Mascaux C, Barlesi F. Elderly selection on geriatric index assessment. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:245. [PMID: 27428614 DOI: 10.21037/atm.2016.05.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Pascale Tomasini
- Multidisciplinary Oncology & Therapeutic Innovations Department, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France;; Aix Marseille University, Inserm U911 CRO2, Marseille, France
| | - Celine Mascaux
- Multidisciplinary Oncology & Therapeutic Innovations Department, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France;; Aix Marseille University, Inserm U911 CRO2, Marseille, France
| | - Fabrice Barlesi
- Multidisciplinary Oncology & Therapeutic Innovations Department, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France;; Aix Marseille University, Inserm U911 CRO2, Marseille, France
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453
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Bando H, Yamada Y, Tanabe S, Nishikawa K, Gotoh M, Sugimoto N, Nishina T, Amagai K, Chin K, Niwa Y, Tsuji A, Imamura H, Tsuda M, Yasui H, Fujii H, Yamaguchi K, Yasui H, Hironaka S, Shimada K, Miwa H, Hamada C, Hyodo I. Efficacy and safety of S-1 and oxaliplatin combination therapy in elderly patients with advanced gastric cancer. Gastric Cancer 2016; 19:919-26. [PMID: 26474989 DOI: 10.1007/s10120-015-0549-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND A randomized phase III study of Japanese patients with advanced gastric cancer, the G-SOX trial, revealed that S-1 and oxaliplatin (SOX) combination therapy was noninferior to S-1 and cisplatin (CS) combination therapy. However, it is unclear whether the efficacy and safety in elderly patients were different between the two regimens. METHODS A total of 685 patients registered in the G-SOX trial were classified as elderly (70 years or older) or not elderly (younger than 70 years), and 663 patients (SOX therapy, elderly 113 of 333 patients, 34 %; CS therapy, elderly 99 of 330 patients, 30 %) and 673 patients (SOX therapy, elderly 114 of 338 patients, 34 %; CS therapy, elderly 101 of 335 patients, 30 %) were analyzed for efficacy and safety, respectively. Treatment delivery of SOX was also compared between elderly and nonelderly groups. RESULTS No differences in efficacy were identified between the elderly and nonelderly groups for either regimen. In the elderly groups, SOX therapy showed better trends in progression-free survival (hazard ratio 0.805, 95 % confidence interval 0.588-1.102) and overall survival (hazard ratio 0.857, 95 % confidence interval 0.629-1.167) compared with CS therapy, although there were no significant differences. Grade 3 or worse adverse events were less frequent in the elderly group receiving SOX than in the elderly group receiving CS except for the low incidence of sensory neuropathy (5.3 % vs 0 %), neutropenia (25.4 % vs 42.6 %), anemia (21.1 % vs 42.6 %), febrile neutropenia (1.8 % vs 10.9 %), increased creatinine level (0.9 % vs 3.0 %), and hyponatremia (7.9 % vs 18.8 %). CONCLUSIONS SOX is an effective and feasible therapy in both nonelderly and elderly patients with advanced gastric cancer. In elderly patients, SOX demonstrated favorable efficacy and safety compared with CS.
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Affiliation(s)
- Hideaki Bando
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Yasuhide Yamada
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Tanabe
- Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Japan
| | | | - Masahiro Gotoh
- Cancer Chemotherapy Center, Osaka Medical College Hospital, Takatsuki, Japan
| | - Naotoshi Sugimoto
- Department of Clinical Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Tomohiro Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Kenji Amagai
- Department of Gastroenterology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Keisho Chin
- Department of Gastroenterology, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Yasumasa Niwa
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akihito Tsuji
- Department of Medical Oncology, Kochi Health Sciences Center, Kochi, Japan
| | | | - Masahiro Tsuda
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Hirofumi Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Hirofumi Fujii
- Division of Clinical Oncology, Jichi Medical University, Shimotsuke, Japan
| | - Kensei Yamaguchi
- Division of Gastroenterology, Saitama Cancer Center, Kita-adachi-gun, Japan
| | - Hisateru Yasui
- Department of Medical Oncology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shuichi Hironaka
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan
| | - Ken Shimada
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Tokyo, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Chikuma Hamada
- Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Ichinosuke Hyodo
- Division of Gastroenterology, University of Tsukuba, Tsukuba, Japan
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454
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[Non-small cell lung cancer irradiation in elderly]. Cancer Radiother 2016; 20:322-9. [PMID: 27342942 DOI: 10.1016/j.canrad.2016.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 12/18/2022]
Abstract
People over the age of 65 are often excluded from participation in oncological clinical trials. However, more than half of patients diagnosed with non-small-cell lung cancer are older than 65 years. Any therapeutic strategy must be discussed in multidisciplinary meetings after adapted geriatric assessment. Patients who benefit from the comprehensive geriatric assessment (CGA) of Balducci and Extermann are those whose G8 screening tool score is less than or equal to 14. Age itself does not contraindicate a curative therapeutic approach. Stereotactic radiotherapy is an alternative to surgery for early stages in elderly patients who are medically inoperable or who refuse surgery, because it significantly increases overall survival. Mostly sequential (rarely concomitant) chemoradiotherapy can be proposed to elderly patients with locally advanced stages in good general state of health. For the others, an exclusive palliative radiotherapy, a single or dual agent of chemotherapy, a targeted drug or best supportive care only may be discussed.
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455
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Owusu C, Margevicius S, Schluchter M, Koroukian SM, Schmitz KH, Berger NA. Vulnerable elders survey and socioeconomic status predict functional decline and death among older women with newly diagnosed nonmetastatic breast cancer. Cancer 2016; 122:2579-86. [PMID: 27348765 DOI: 10.1002/cncr.30046] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/07/2016] [Accepted: 03/17/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The purpose of this study was to determine the ability of the Vulnerable Elders Survey (VES-13) to predict the composite outcome of functional decline and death within 12 months of breast cancer treatment among women 65 years old or older with newly diagnosed stage I to III breast cancer. METHODS Two hundred and six participants were recruited from ambulatory oncology clinics at an academic center between April 2008 and April 2013. Participants competed the VES-13 at baseline just before neoadjuvant/adjuvant treatment. The primary outcome, functional decline/death, was defined as either a decrease of at least 1 point on the Activities of Daily Living scale and/or the Instrumental Activities of Daily Living scale or death between baseline and 12 months (yes or no). RESULTS One hundred and eighty four participants (89%) completed 12 months of follow-up. Twenty-two percent functionally declined (n = 34) or died (n = 7). Univariately, with increasing VES-13 scores, the estimated risk of functional decline/death rose from 23% for participants with a VES-13 score of 3 to 76% for participants with a VES-13 score of 10. In multivariate logistic regression analysis, VES-13 scores (adjusted odds ratio, 1.37; 95% confidence interval, 1.18-1.57) and having a high school education or less (adjusted odds ratio, 2.47; 95% confidence interval, 1.08-5.65) were independent predictors of functional decline/death (area under the receiver operator curve, 0.79). CONCLUSIONS Among older women with newly diagnosed nonmetastatic breast cancer, approximately 1 in 5 functionally declined and/or died within 12 months of breast cancer treatment initiation. Women with high school education or less were disproportionately affected. The VES-13 is a useful instrument for the early identification of those at risk for functional decline and/or death. Cancer 2016;122:2579-86. © 2016 American Cancer Society.
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Affiliation(s)
- Cynthia Owusu
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Seunghee Margevicius
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Mark Schluchter
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Siran M Koroukian
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Kathryn H Schmitz
- Department of Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Nathan A Berger
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio
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456
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Delivering tailored surgery to older cancer patients: Preoperative geriatric assessment domains and screening tools - A systematic review of systematic reviews. Eur J Surg Oncol 2016; 43:1-14. [PMID: 27406973 DOI: 10.1016/j.ejso.2016.06.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/30/2016] [Accepted: 06/08/2016] [Indexed: 02/08/2023] Open
Abstract
The onco-geriatric population is increasing and thus more and more elderly will require surgery; an important treatment modality for many cancer types. This population's heterogeneity demands preoperative risk stratification, which has led to the introduction of Geriatric Assessment (GA) and associated screening tools in surgical oncology. Many reviews have investigated the use of GA in onco-geriatric patients. Discrepancies in outcomes between studies currently hamper the implementation of a preoperative GA in clinical practice. A systematic review of systematic reviews was performed in order to investigate assessment tools of the most commonly included GA domains and their predictive ability regarding the adverse postoperative outcomes. All domains - except polypharmacy - were, to a varying degree, associated with different adverse postoperative outcomes. Functional status, comorbidity and frailty were assessed most frequently and were most often significant. The association between domain impairments and adverse postoperative outcomes appeared to be greatly influenced by the study population characteristics and selection bias, as well as the type of assessment tool used due to possible ceiling effects and its sensitivity to detect domain impairments. Frailty seems to be the most important predictor, which underpins the importance of an integrated approach. As it is unlikely that one universal GA will fit all, feasibility, based on the time, expertise, and resources available in daily clinical practice as well as the patient population to hand, should be taken into consideration, when tailoring the 'optimal GA'.
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457
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Brunot A, Le Sourd S, Pracht M, Edeline J. Hepatocellular carcinoma in elderly patients: challenges and solutions. J Hepatocell Carcinoma 2016; 3:9-18. [PMID: 27574587 PMCID: PMC4994800 DOI: 10.2147/jhc.s101448] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the second most common cause of death by cancer in the world. Due to the delayed HCC development in hepatitis C carriers and nonalcoholic fatty liver disease, the incidence of HCC in the elderly is increasing and is becoming a global health issue. Elderly patients with HCC should be assessed through proper oncologic approach, namely, screening tools for frailty (Geriatric-8 or Vulnerable Elders Survey-13) and comprehensive geriatric assessment. This review of the literature supports the same treatment options for elderly patients as for younger patients, in elderly patients selected as fit following proper oncogeriatric assessment. Unfit patients should be managed through a multidisciplinary team involving both oncological and geriatrician professionals. Specific studies and recommendations for HCC in the elderly should be encouraged.
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Affiliation(s)
- Angélique Brunot
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Samuel Le Sourd
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Marc Pracht
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
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458
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Engelhardt M, Dold SM, Ihorst G, Zober A, Möller M, Reinhardt H, Hieke S, Schumacher M, Wäsch R. Geriatric assessment in multiple myeloma patients: validation of the International Myeloma Working Group (IMWG) score and comparison with other common comorbidity scores. Haematologica 2016; 101:1110-9. [PMID: 27479825 DOI: 10.3324/haematol.2016.148189] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/10/2016] [Indexed: 11/09/2022] Open
Abstract
This first validation of the International Myeloma Working Group geriatric assessment in 125 newly diagnosed multiple myeloma patients was performed using the International Myeloma Working Group score based on age, the Charlson Comorbidity Index and cognitive and physical conditions (Activities of Daily Living / Instrumental Activities of Daily Living) to classify patients as fit, intermediate-fit or frail. We verified the International Myeloma Working Group score's impact on outcome, and whether additional tools complement it. Since our prior analyses determined renal, lung and Karnofsky performance impairment as multivariate risks, and the inclusion of frailty, age and cytogenetics complements this, we included the revised myeloma comorbidity index, the Charlson Comorbidity Index, the Hematopoietic Cell Transplantation-Comorbidity Index and the Kaplan-Feinstein Index in this assessment. Multivariate analysis confirmed cytogenetics, Activities of Daily Living, Instrumental Activities of Daily Living and the Charlson Comorbidity Index as risks: 3-year overall survival for fit, intermediate-fit and frail patients was 91%, 77% and 47%, respectively. Using the Charlson Comorbidity Index, the Hematopoietic Cell Transplantation-Comorbidity Index, the Kaplan-Feinstein Index and the revised Myeloma Comorbidity Index allowed us to define fit and frail patients with distinct progression-free and overall survival rates, with the most pronounced differences evidenced via the International Myeloma Working Group score, the Charlson Comorbidity Index and the revised Myeloma Comorbidity Index. Since the Charlson Comorbidity Index is included in the International Myeloma Working Group score, we propose the latter and the revised Myeloma Comorbidity Index for future frailty measurements. Both are useful instruments for identifying myeloma patients with a geriatric risk profile and have a strong prognostic value for functional decline and overall survival. The study was registered as: (clinicaltrials.gov Identifier: 00003686).
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Affiliation(s)
- Monika Engelhardt
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Sandra Maria Dold
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Alexander Zober
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Mandy Möller
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Heike Reinhardt
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Stefanie Hieke
- Institute for Medical Biometry and Statistics, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Martin Schumacher
- Institute for Medical Biometry and Statistics, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Ralph Wäsch
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Germany
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459
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Kanesvaran R, Roy Chowdhury A, Krishna L. Practice pearls in the management of lung cancer in the elderly. J Geriatr Oncol 2016; 7:362-7. [PMID: 27267093 DOI: 10.1016/j.jgo.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/10/2016] [Accepted: 05/18/2016] [Indexed: 11/27/2022]
Abstract
Lung cancer is a disease that afflicts the elderly. It is a leading cause of cancer mortality worldwide. Treatment of lung cancer which was predominantly combination chemotherapy was initially thought to be too toxic for older patients with cancer due to their frail state. However a number of recent studies have shown that this is not necessarily true and many elderly can actually tolerate combination chemotherapy and derive just as much benefit from it as younger patients with lung cancer do. More recently it has been found that a significant proportion of lung cancer patients have tumors that harbor mutations that are targetable by molecularly targeted therapy (MTT). These targeted therapies have a much better tolerated side effect profile, hence have been used in elderly patient with lung cancer with great success. A new generation of drugs called immune checkpoint inhibitors have now come into the fray with exciting results in the second line treatment of lung cancer with a low side effect profile. A key element in deciding whether an elderly patient with lung cancer can tolerate treatment involves a detailed assessment using the comprehensive geriatric assessment (CGA). A number of CGA and clinical factors have also been found to be able to predict chemotherapy associated toxicity. This review of lung cancer in the elderly was part of a lecture on "Practice pearls in the management of lung cancer in the elderly" presented at the SIOG Annual Meeting in Prague in November 2015.
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Affiliation(s)
- Ravindran Kanesvaran
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Graduate Medical School, Singapore.
| | | | - Lalit Krishna
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Graduate Medical School, Singapore
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460
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Thinggaard M, McGue M, Jeune B, Osler M, Vaupel JW, Christensen K. Survival Prognosis in Very Old Adults. J Am Geriatr Soc 2016; 64:81-8. [PMID: 26782855 DOI: 10.1111/jgs.13838] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine whether simple functional indicators are predictors of survival prognosis in very old adults. DESIGN In-person survey conducted over a 3-month period in 1998; assessment of survival over a 15-year follow-up period. SETTING Denmark. PARTICIPANTS All 3,600 Danes born in 1905 and living in Denmark in 1998, were invited to participate regardless of residence and health; 2,262 (63%) participated in the survey: 1,814 (80.2%) in person and 448 (19.8%) through a proxy. MEASUREMENTS Socioeconomic factors, medications and diseases, activities of daily living, physical performance, cognition, depression symptomatology, self-rated health, and all-cause mortality, evaluated as average remaining lifespan and chance of surviving to 100 years. RESULTS Men aged 92 to 93 had an overall 6.0% chance of surviving to 100 years, whereas the chance for women was 11.4%. Being able to rise without use of hands increased the chance for men to 11.2% (95% confidence interval (CI)=7.7-14.7) and for women to 22.0% (95% CI=18.9-25.1). When combining this with a Mini-Mental State Examination (MMSE) scores from 28 to 30, the chances were 21.7% (95% CI=11.5-31.9) for men and 34.2% (95% CI=24.8-43.5) for women. CONCLUSION Chair stand score combined with MMSE score is a quick and easy way to estimate overall chance of survival in very old adults, which is particularly relevant when treatment with potential side effects for nonacute diseases is considered.
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Affiliation(s)
- Mikael Thinggaard
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Matt McGue
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark.,Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Bernard Jeune
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Merete Osler
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| | - James W Vaupel
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark.,Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark.,Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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461
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Winther SB, Jørgensen TL, Pfeiffer P, Qvortrup C. Can we predict toxicity and efficacy in older patients with cancer? Older patients with colorectal cancer as an example. ESMO Open 2016; 1:e000021. [PMID: 27843604 PMCID: PMC5070237 DOI: 10.1136/esmoopen-2015-000021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 12/29/2022] Open
Abstract
Colorectal cancer is a disease of the elderly. As older and frail patients are under-represented in clinical trials, most of the evidence available on treatment of older metastatic colorectal patients with cancer originates from pooled analyses of the older patients included in large prospective clinical trials and from community-based studies. The aging process is highly individual and cannot be based on the chronological age alone. It is characterised by a decline in organ function with an increased risk of comorbidity and polypharmacy. These issues can result in an increased susceptibility to the complications of both the disease and treatment. Therefore, evaluation of performance status and the chronological age alone is not sufficient, and additionally assessment must be included in the treatment decision process. In the present review, we will focus on clinical aspects of treating older and frail metastatic colorectal patients with cancer, but also on the present knowledge on how to select and tailor therapy for this particular group of patients. TRIAL REGISTRATION NUMBER EudraCT 2014-000394-39, pre-results.
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Affiliation(s)
- Stine Braendegaard Winther
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Qvortrup
- Department of Oncology, Odense University Hospital, Odense, Denmark
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462
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Whittle AK, Kalsi T, Babic-Illman G, Wang Y, Fields P, Ross PJ, Maisey NR, Hughes S, Kwan W, Harari D. A comprehensive geriatric assessment screening questionnaire (CGA-GOLD) for older people undergoing treatment for cancer. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27132979 DOI: 10.1111/ecc.12509] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 12/12/2022]
Abstract
Oncology services do not routinely assess broader needs of older people with cancer. This study evaluates a comprehensive geriatric assessment and comorbidity screening questionnaire (CGA-GOLD) covering evidence-based domains and quality of life (EORTC-QLQ-C30). Patients aged 65+ attending oncology services were recruited into (1) Observational cohort (completed CGA-GOLD, received standard oncology care), (2) Intervention cohort (responses categorised 'low-risk', 'high-risk', 'possible need' by geriatricians). N = 417 observational patients (1002 invited by post, 418 consented, age 73.9 ± 5.4) completed CGA-GOLD in 11.7 ± 7.9 min, 86.3% required no assistance, 3.1% overall missing responses. Multiple problems reported: hypertension (18.1%), diabetes (16.9%), dyspnoea on flat surfaces (27.6%), polypharmacy (46%), difficulty walking (14.9%), fatigue (40.5%), living alone (30.9%), social isolation (11.2%), recent functional dependence (27.8%), urinary incontinence (21.4%), falls (13.3%). 237/239 intervention patients completed CGA-GOLD and consecutive subsets examined. The doctor and nurse specialist independently identified same need level in 87.3% (high inter-rater reliability kappa = 0.80), taking 1-2 min per questionnaire. Need level remained unchanged following hospital notes review against responses in 90% (75/83). 'Possible need' patients were telephoned with change in 29% (16/55) to low-risk and none to high-risk, confirming high need was not being missed. CGA-GOLD screening questionnaire was acceptable to older patients, feasibly administered in NHS cancer services, described comorbidities, CGA and QOL needs, and reliably identified higher risk patients requiring further input for optimal cancer treatment.
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Affiliation(s)
- A K Whittle
- Department of Ageing & Health, Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - T Kalsi
- Department of Ageing & Health, Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.,Division of Health and Social Care Research, King's College London, London, UK
| | - G Babic-Illman
- Department of Ageing & Health, Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Y Wang
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - P Fields
- Department of Haematology, Guys & St Thomas' NHS Trust, Guys Hospital, London, UK
| | - P J Ross
- Department of Medical Oncology, Guys & St Thomas' NHS Trust, Guys Hospital, London, UK
| | - N R Maisey
- Department of Medical Oncology, Guys & St Thomas' NHS Trust, Guys Hospital, London, UK
| | - S Hughes
- Department of Clinical Oncology, Guys & St Thomas' NHS Trust, London, UK
| | - W Kwan
- Bexley Clinical Commissioning Group/Macmillan GP, Crook Log General Practice Surgery, Bexleyheath, Kent, UK
| | - D Harari
- Department of Ageing & Health, Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.,Division of Health and Social Care Research, King's College London, London, UK
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463
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Brouwers B, Dalmasso B, Hatse S, Laenen A, Kenis C, Swerts E, Neven P, Smeets A, Schöffski P, Wildiers H. Biological ageing and frailty markers in breast cancer patients. Aging (Albany NY) 2016; 7:319-33. [PMID: 25989735 PMCID: PMC4468313 DOI: 10.18632/aging.100745] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Older cancer patients are a highly heterogeneous population in terms of global health and physiological reserves, and it is often difficult to determine the best treatment. Moreover, clinical tools currently used to assess global health require dedicated time and lack a standardized end score. Circulating markers of biological age and/or fitness could complement or partially substitute the existing screening tools. In this study we explored the relationship of potential ageing/frailty biomarkers with age and clinical frailty. On a population of 82 young and 162 older non-metastatic breast cancer patients, we measured mean leukocyte telomere length and plasma levels of interleukin-6 (IL-6), regulated upon activation, normal T cell expressed and secreted (RANTES), monocyte chemotactic protein 1 (MCP-1), insulin-like growth factor 1 (IGF-1). We also developed a new tool to summarize clinical frailty, designated Leuven Oncogeriatric Frailty Score (LOFS), by integrating GA results in a single, semi-continuous score. LOFS' median score was 8, on a scale from 0=frail to 10=fit. IL-6 levels were associated with chronological age in both groups and with clinical frailty in older breast cancer patients, whereas telomere length, IGF-1 and MCP-1 only correlated with age. Plasma IL-6 should be further explored as frailty biomarker in cancer patients.
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Affiliation(s)
- Barbara Brouwers
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Bruna Dalmasso
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium.,Department of Internal Medicine, Istituto di Ricerca a Carattere Clinico e Scientifico (IRCCS), Azienda Ospedaliera Universitaria (AOU) San Martino Istituto Nazionale Tumori (IST), Genoa, Italy
| | - Sigrid Hatse
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Cindy Kenis
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Evalien Swerts
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Patrick Neven
- Leuven Multidisciplinary Breast Center, University Hospitals Leuven, Belgium
| | - Ann Smeets
- Leuven Multidisciplinary Breast Center, University Hospitals Leuven, Belgium
| | - Patrick Schöffski
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Hans Wildiers
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium.,Leuven Multidisciplinary Breast Center, University Hospitals Leuven, Belgium
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464
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Hentschel L, Rentsch A, Lenz F, Hornemann B, Schmitt J, Baumann M, Ehninger G, Schuler M. A Questionnaire Study to Assess the Value of the Vulnerable Elders Survey, G8, and Predictors of Toxicity as Screening Tools for Frailty and Toxicity in Geriatric Cancer Patients. Oncol Res Treat 2016; 39:210-6. [DOI: 10.1159/000445365] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/10/2016] [Indexed: 11/19/2022]
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465
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Liuu E, Caillet P, Curé H, Anfasi N, De Decker L, Pamoukdjian F, Canouï-Poitrine F, Soubeyran P, Paillaud E. [Comprehensive geriatric assessment (CGA) in elderly with cancer: For whom?]. Rev Med Interne 2016; 37:480-8. [PMID: 26997159 DOI: 10.1016/j.revmed.2016.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/17/2015] [Accepted: 02/20/2016] [Indexed: 12/27/2022]
Abstract
Scientific societies recommend the implementation of a comprehensive geriatric assessment (CGA) in cancer patients aged 70 and older. The EGA is an interdisciplinary multidimensional diagnostic process seeking to assess the frail older person in order to develop a coordinated plan of treatment and long-term follow-up. Identification of comorbidities and age-induced physiological changes that may increase the risk of anticancer treatment toxicities is essential to better assess the risk-benefit ratio in elderly cancer patients. The systematic implementation of a CGA for each patient is difficult to perform in daily practice. Therefore, it is recommended to screen vulnerable patients who will benefit from a complete CGA. Our work presents the vulnerability screening tools validated by at least two independent studies in a cancer elderly population setting. Among seven screening tools, the G8 and the VES13 are the most effective, and have been validated specifically in older population with cancer. The G8 is recommended by scientific societies and the French National Cancer Institute (INCa) because of its easy implementation in daily clinical practice, its high sensitivity and fair specificity. Although studies are underway to improve its performance, the G8 is currently the simplest tool to routinely identify older cancer patients who should have a complete assessment in geriatric oncology.
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Affiliation(s)
- E Liuu
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France
| | - P Caillet
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France
| | - H Curé
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Medical oncology department, Grenoble university hospital, CS 10127 Grenoble, France
| | - N Anfasi
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - L De Decker
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Department of internal medicine and geriatrics, Nantes university hospital, 44093 Nantes, France
| | - F Pamoukdjian
- Unité de coordination en oncogériatrie, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - F Canouï-Poitrine
- CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Service de santé publique, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - P Soubeyran
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Institut Bergonié, université de Bordeaux, CS 61283 Bordeaux, France
| | - E Paillaud
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France.
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466
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Detection of frailty in elderly cancer patients: Improvement of the G8 screening test. J Geriatr Oncol 2016; 7:99-107. [DOI: 10.1016/j.jgo.2016.01.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/16/2015] [Accepted: 01/20/2016] [Indexed: 12/27/2022]
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467
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Stepney R. Advances in caring for the older cancer patient: a report from the 2015 conference of the International Society of Geriatric Oncology. Cancer Biol Med 2016; 13. [PMCID: PMC4850124 DOI: 10.28092/j.issn.2095-3941.2016.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology (SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.
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Affiliation(s)
- Rob Stepney
- Freelance Medical Writer. Charlbury, OX7 3HJ, UK
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468
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Bellmunt J, Mottet N, De Santis M. Urothelial carcinoma management in elderly or unfit patients. EJC Suppl 2016; 14:1-20. [PMID: 27358584 PMCID: PMC4917740 DOI: 10.1016/j.ejcsup.2016.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicolas Mottet
- Department of Urology, CHU de Saint-Etienne, University Jean Monnet, St Etienne, France
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469
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Van Cleave JH, Kenis C, Sattar S, Jabloo VG, Ayala AP, Puts M. A Research Agenda for Gero-Oncology Nursing. Semin Oncol Nurs 2016; 32:55-64. [DOI: 10.1016/j.soncn.2015.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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470
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471
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Abstract
OBJECTIVES This article summarizes the evolution of gero-oncology nursing and highlights key educational initiatives, clinical practice issues, and research areas to enhance care of older adults with cancer. DATA SOURCES Peer-reviewed literature, position statements, clinical practice guidelines, Web-based materials, and professional organizations' resources. CONCLUSION Globally, the older adult cancer population is rapidly growing. The care of older adults with cancer requires an understanding of their diverse needs and the intersection of cancer and aging. Despite efforts to enhance competence in gero-oncology and to develop a body of evidence, nurses and health care systems remain under-prepared to provide high-quality care for older adults with cancer. IMPLICATIONS FOR NURSING PRACTICE Nurses must take a leadership role in integrating gerontological principles into oncology settings. Working closely with interdisciplinary team members, nurses should utilize available resources and continue to build evidence through gero-oncology nursing research.
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Affiliation(s)
- Stewart M. Bond
- William F. Connell School of Nursing, 378C Maloney Hall, 140 Commonwealth Ave, Chestnut Hill, MA 02467
| | - Ashley Leak Bryant
- School of Nursing, The University of North Carolina at Chapel Hill, 401 Carrington Hall, Chapel Hill, NC 27599,
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, Canada M5T1P8,
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472
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Martinez-Tapia C, Canoui-Poitrine F, Bastuji-Garin S, Soubeyran P, Mathoulin-Pelissier S, Tournigand C, Paillaud E, Laurent M, Audureau E. Optimizing the G8 Screening Tool for Older Patients With Cancer: Diagnostic Performance and Validation of a Six-Item Version. Oncologist 2016; 21:188-95. [PMID: 26764250 DOI: 10.1634/theoncologist.2015-0326] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/27/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A multidimensional geriatric assessment (GA) is recommended in older cancer patients to inventory health problems and tailor treatment decisions accordingly but requires considerable time and human resources. The G8 is among the most sensitive screening tools for selecting patients warranting a full GA but has limited specificity. We sought to develop and validate an optimized version of the G8. PATIENTS AND METHODS We used a prospective cohort of cancer patients aged ≥ 70 years referred to geriatricians for GA (2007-2012: n = 729 [training set]; 2012-2014: n = 414 [validation set]). Abnormal GA was defined as at least one impaired domain across seven validated tests. Multiple correspondence analysis, multivariate logistic regression, and bootstrapped internal validation were performed sequentially. RESULTS The final model included six independent predictors for abnormal GA: weight loss, cognition/mood, performance status, self-rated health status, polypharmacy (≥ 6 medications per day), and history of heart failure/coronary heart disease. For the original G8, sensitivity was 87.2% (95% confidence interval, 84.3-89.7), specificity 57.7% (47.3-67.7), and area under the receiver-operating characteristic curve (AUROC) 86.5% (83.5-89.6). The modified G8 had corresponding values of 89.2% (86.5-91.5), 79.0% (69.4-86.6), and 91.6% (89.3; 93.9), with higher AUROC values for all tumor sites and stable properties on the validation set. CONCLUSION A modified G8 screening tool exhibited better diagnostic performance with greater uniformity across cancer sites and required only six items. If these features are confirmed in other settings, the modified tool may facilitate selection for a full GA in older patients with cancer. IMPLICATIONS FOR PRACTICE Several screening tools have been developed to identify older patients with cancer likely to benefit from a complete geriatric assessment, but none combines appropriate sensitivity and specificity. Based on a large prospective cohort study, an optimized G8 tool was developed, combining a systematic statistical approach with expert judgment to ensure optimal discriminative power and clinical relevance. The improved screening tool achieves high sensitivity, high specificity, better homogeneity across cancer types, and greater parsimony with only six items needed, facilitating selection for a full geriatric assessment.
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Affiliation(s)
| | - Florence Canoui-Poitrine
- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), IMRB, A-TVB DHU Public Health Department, Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - Sylvie Bastuji-Garin
- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), IMRB, A-TVB DHU Public Health Department, Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France Clinical Research Unit (URC Mondor), Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France Université de Bordeaux, Bordeaux, France
| | - Simone Mathoulin-Pelissier
- INSERM U897, CIC-EC07, ISPED, Université de Bordeaux, France Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France
| | - Christophe Tournigand
- EC2M3 Unit, VIC DHU, Université Paris Est (UPE) Department of Medical Oncology Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - Elena Paillaud
- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), IMRB, A-TVB DHU Internal Medicine and Geriatric Department, Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - Marie Laurent
- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), IMRB, A-TVB DHU Internal Medicine and Geriatric Department, Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - Etienne Audureau
- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), IMRB, A-TVB DHU Public Health Department, Assistance Publique Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
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473
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Kenis C, Heeren P, Decoster L, Van Puyvelde K, Conings G, Cornelis F, Cornette P, Moor R, Luce S, Libert Y, Van Rijswijk R, Jerusalem G, Rasschaert M, Langenaeken C, Baitar A, Specenier P, Geboers K, Vandenborre K, Debruyne PR, Vanoverbeke K, Van den Bulck H, Praet JP, Focan C, Verschaeve V, Nols N, Goeminne JC, Petit B, Lobelle JP, Flamaing J, Milisen K, Wildiers H. A Belgian Survey on Geriatric Assessment in Oncology Focusing on Large-Scale Implementation and Related Barriers and Facilitators. J Nutr Health Aging 2016; 20:60-70. [PMID: 26728935 DOI: 10.1007/s12603-016-0677-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study is to describe a large-scale, Belgian implementation project about geriatric assessment (=GA) in daily oncology practice and to identify barriers and facilitators for implementing GA in this setting. Design / setting / participants: The principal investigator of every participating hospital (n=22) was invited to complete a newly developed questionnaire with closed- and open-ended questions. The closed-ended questions surveyed how GA was implemented. The open-ended questions identified barriers and facilitators for the implementation of GA in daily oncology practice. Descriptive statistics and conventional content analysis were performed as appropriate. RESULTS Qualifying criteria (e.g. disease status and cancer type) for GA varied substantially between hospitals. Thirteen hospitals (59.1%) succeeded to screen more than half of eligible patients. Most hospitals reported that GA data and follow-up data had been collected in almost all screened patients. Implementing geriatric recommendations and formulating new geriatric recommendations at the time of follow-up are important opportunities for improvement. The majority of identified barriers were organizational, with high workload, lack of time or financial/staffing problems as most cited. The most cited facilitators were all related to collaboration. CONCLUSION Interventions to improve the implementation of GA in older patients with cancer need to address a wide range of factors, with organization and collaboration as key elements. All stakeholders, seeking to improve the implementation of GA in older patients with cancer, should consider and address the identified barriers and facilitators.
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Affiliation(s)
- C Kenis
- Hans Wildiers, Herestraat 49, 3000 Leuven, Belgium, Tel.: +32 16 34 69 20, Fax.: +32 16 34 69 01, E-mail address:
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474
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Korc-Grodzicki B, Holmes HM, Shahrokni A. Geriatric assessment for oncologists. Cancer Biol Med 2015; 12:261-74. [PMID: 26779363 PMCID: PMC4706523 DOI: 10.7497/j.issn.2095-3941.2015.0082] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 10/21/2015] [Indexed: 01/18/2023] Open
Abstract
The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient's physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment (GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed.
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Affiliation(s)
- Beatriz Korc-Grodzicki
- 1 Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA ; 2 Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Holly M Holmes
- 1 Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA ; 2 Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Armin Shahrokni
- 1 Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA ; 2 Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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475
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Home management of acute medical complications in cancer patients: a prospective pilot study. Support Care Cancer 2015; 24:2129-2137. [DOI: 10.1007/s00520-015-3006-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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476
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Carver JR. Cardiac toxicity in the elderly and the role of cardio oncology. PROGRESS IN PEDIATRIC CARDIOLOGY 2015. [DOI: 10.1016/j.ppedcard.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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477
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Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int 2015; 88:1178-86. [DOI: 10.1038/ki.2015.245] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/23/2015] [Accepted: 06/25/2015] [Indexed: 12/14/2022]
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478
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Abstract
The impact of localized prostate cancer in the elderly depends on disease aggressiveness and life expectancy. In men with localized prostate cancer, those with low-risk disease or a shorter life expectancy should be managed expectantly, whereas those with long life expectancy or more aggressive disease may benefit from curative treatment. Comorbidity and quality-of-life concerns are key considerations during the selection of therapeutic modalities in the elderly in localized and metastatic settings. A variety of new agents have changed the therapeutic landscape in castrate-resistant prostate cancer, but their benefits need to be considered alongside their side effects and cost.
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Affiliation(s)
- Kae Jack Tay
- Division of Urology, Duke University Medical Center, DUMC Box 103861, Durham, NC 27710, USA
| | - Judd W Moul
- Division of Urology, Duke University Medical Center, DUMC Box 103861, Durham, NC 27710, USA
| | - Andrew J Armstrong
- Department of Medical Oncology, Duke University Medical Center, DUMC Box 103861, Durham, NC 27710, USA.
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479
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Goede V, Bahlo J, Chataline V, Eichhorst B, Dürig J, Stilgenbauer S, Kolb G, Honecker F, Wedding U, Hallek M. Evaluation of geriatric assessment in patients with chronic lymphocytic leukemia: Results of the CLL9 trial of the German CLL study group. Leuk Lymphoma 2015; 57:789-96. [PMID: 26377031 DOI: 10.3109/10428194.2015.1091933] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Multidimensional geriatric assessment (GA) has been demonstrated to predict outcomes in older patients with cancer. This study evaluated GA in a cohort of older patients with chronic lymphocytic leukemia (CLL). Seventy-five of 97 subjects with CLL who were enrolled in a clinical trial of the German CLL Study Group underwent GA prior to the start of study treatment (low-dose chemotherapy with fludarabine). GA included cumulative illness rating scale (CIRS), timed-up-and-go (TUG) test, dementia detection (DEMTECT) test and instrumental activities of daily living (IADL) index. There was little correlation between CIRS, TUG, DEMTECT or IADL results and treatment toxicity, feasibility or efficacy in this study. CIRS and IADL had no statistically significant impact on overall prognosis. However, under-performance in TUG or DEMTECT test was strongly associated with poor survival. The latter findings provide a rationale to further investigate geriatric assessment in CLL and in the context with other CLL treatments.
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Affiliation(s)
- Valentin Goede
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany .,b Department of Geriatric Medicine , St Marien Hospital , Cologne , Germany
| | - Jasmin Bahlo
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany
| | - Viktoria Chataline
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany
| | - Barbara Eichhorst
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany
| | - Jan Dürig
- c Department of Hematology , University Hospital Essen , Essen , Germany
| | | | - Gerald Kolb
- e Department of Geriatric Medicine , Bonifatius Hospital , Lingen , Germany
| | - Friedemann Honecker
- f Department of Oncology , Hematology, Bone Marrow Transplantation with section Pneumology, University Hospital Hamburg-Eppendorf , Hamburg , Germany .,g Tumor and Breast Center ZeTuP , St. Gallen , Switzerland
| | - Ulrich Wedding
- h Department II of Internal Medicine , University Hospital Jena , Jena , Germany , and
| | - Michael Hallek
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany .,i Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD), University of Cologne , Cologne , Germany
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480
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Affiliation(s)
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
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481
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Kim JW, Kim SH, Kim YJ, Lee KW, Kim KI, Lee JS, Kim CH, Kim JH. A Novel Geriatric Screening Tool in Older Patients with Cancer: The Korean Cancer Study Group Geriatric Score (KG)-7. PLoS One 2015; 10:e0138304. [PMID: 26401951 PMCID: PMC4581840 DOI: 10.1371/journal.pone.0138304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/28/2015] [Indexed: 12/27/2022] Open
Abstract
Geriatric assessment (GA) is resource-consuming, necessitating screening tools to select appropriate patients who need full GA. The objective of this study is to design a novel geriatric screening tool with easy-to-answer questions and high performance objectively selected from a large dataset to represent each domain of GA. A development cohort was constructed from 1284 patients who received GA from May 2004 to April 2007. Items representing each domain of functional status, cognitive function, nutritional status, and psychological status in GA were selected according to sensitivity (SE) and specificity (SP). Of the selected items, the final questions were chosen by a panel of oncologists and geriatricians to encompass most domains evenly and also by feasibility and use with cancer patients. The selected screening questions were validated in a separate cohort of 98 cancer patients. The novel screening tool, the Korean Cancer Study Group Geriatric Score (KG)-7, consisted of 7 items representing each domain of GA. KG-7 had a maximal area under the curve (AUC) of 0.93 (95% confidence interval (CI) 0.92−0.95) in the prediction of abnormal GA, which was higher than that of G-8 (0.87, 95% CI 0.85–0.89) within the development cohort. The cut-off value was decided at ≤ 5 points, with a SE of 95.0%, SP of 59.2%, positive predictive value (PPV) of 85.3%, and negative predictive value (NPV) of 82.6%. In the validation cohort, the AUC was 0.82 (95% CI 0.73−0.90), and the SE, SP, PPV, and NPV were 89.5%, 48.6%, 77.3%, and 75.0%, respectively. Furthermore, patients with higher KG-7 scores showed significantly longer overall survival (OS) in the development and validation cohorts. In conclusions, the KG-7 showed high SE and NPV to predict abnormal GA. The KG-7 also predicted OS. Given the results of our studies, the KG-7 could be used effectively in countries with high patient burden and low resources to select patients in need of full GA and intervention.
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Affiliation(s)
- Jin Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Se-Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Keun-Wook Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kwang-Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jong Seok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Cheol-Ho Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jee Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- * E-mail:
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482
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[How to identify frailty in older patients with cancer? Available tools]. Cancer Radiother 2015; 19:382-5. [PMID: 26321648 DOI: 10.1016/j.canrad.2015.07.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/17/2015] [Indexed: 11/23/2022]
Abstract
Management of cancer in the elderly needs more attention than in younger patients mainly because of comorbidities and geriatric syndromes. Each frailty encountered will facilitate adverse events and complications which are more frequent and more severe in the elderly and have to be anticipated to control for the risk of organ failure and dependencies. Fortunately, tools which have been developed and validated by geriatricians, are available to the oncologists and their validity has been demonstrated in oncology. Yet, they are quite time-consuming and consequently available for a minority of patients. Furthermore, it appears that some of the older patients can be proposed standard therapy and do not need the intervention of geriatricians. This is the reason why screening tools have been developed and validated among which the G8 questionnaire appears to be one of the best. This approach is beginning to be implemented in the daily routine in France and abroad but their appropriate use according to cancer types and treatment intensity should be further improved for the benefit of our patients.
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483
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Puts M, Alibhai SMH. Surgical geriatric oncology: It is time for interventions. J Geriatr Oncol 2015; 6:341-3. [PMID: 26276038 DOI: 10.1016/j.jgo.2015.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, Institute of Health Policy Management and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada.
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484
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Mislang AR, Biganzoli L. Adjuvant Systemic Therapy in Older Breast Cancer Women: Can We Optimize the Level of Care? Cancers (Basel) 2015; 7:1191-214. [PMID: 26151681 PMCID: PMC4586766 DOI: 10.3390/cancers7030833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/17/2015] [Accepted: 06/26/2015] [Indexed: 01/03/2023] Open
Abstract
Defining optimal adjuvant treatment for older women with breast cancer is challenged by the lack of level-1 clinical evidence and the heterogeneity of the older population. Nevertheless, recommendations based on reviews of available evidence mainly from retrospective subgroup analyses and extrapolation of study results from younger patients, and expert opinions, may be useful to guide treatment decisions in fit patients. But how can we properly define a "fit" older patient? In clinical practice, age by itself and clinical impression generally drive treatment decision, although the appropriateness of this judgment is under-documented. Such an approach risks overtreatment or, more frequently, undertreatment. A geriatric assessment can be valuable in oncology practice to address this issue. In this review article, we will focus only on systemic treatment and will discuss "standard" adjuvant systemic treatment strategies for fit older breast cancer patients and the role of "personalized" systemic therapy in unfit patients. The concepts conveyed in this review cannot be extrapolated to locoregional therapy.
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Affiliation(s)
- Anna Rachelle Mislang
- Sandro Pitigliani Medical Oncology Unit, Nuovo Ospedale Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Nuovo Ospedale Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy.
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485
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Luciani A, Biganzoli L, Colloca G, Falci C, Castagneto B, Floriani I, Battisti N, Dottorini L, Ferrari D, Fiduccia P, Zafarana E, Del Monte F, Galli F, Monfardini S, Foa P. Estimating the risk of chemotherapy toxicity in older patients with cancer: The role of the Vulnerable Elders Survey-13 (VES-13). J Geriatr Oncol 2015; 6:272-9. [PMID: 26088748 DOI: 10.1016/j.jgo.2015.02.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Some parameters of the Comprehensive Geriatric Assessment (CGA) are predictive of chemotherapy toxicity. The Vulnerable Elders Survey-13 (VES-13) is a short instrument that has been tested as a means of identifying patients who need a full CGA, but its ability to predict chemotherapy toxicity is still unclear. We performed a pooled analysis of four published clinical trials studying VES-13 as a means of diagnosing vulnerability, in order to evaluate its accuracy in predicting the risk of grade 3/4 toxicity in older patients undergoing chemotherapy. MATERIALS AND METHODS The study involved patients aged ≥ 66 years with a diagnosis of solid or hematological cancer, all of whom were administered VES-13. The number of medications taken by each patient, their comorbidities, their Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score and index, the type of chemotherapy and treatment line, and their Mini Mental State Evaluation (MMSE), and Mini Nutritional Assessment (MNA) scores were recorded. Information was available concerning the grades 3-4 hematological and non-hematological toxicities experienced by each patient. RESULTS The study involved 648 patients aged ≥ 66 years (mean age 76.2±4.5, range 66-90) of whom 336 (51.9%) were female. VES-13 identified 287 patients (44.3%) as vulnerable. Grades 3-4 hematological and non-hematological toxicities were more prevalent in the vulnerable subjects (35.2% vs 20.8%, p<0.0001, and 18.5% vs 10.8%, p=0.0055), who were also at higher risk of both (adjusted ORs 2.15, 95% CI 1.46-3.17, p<0.001); and 1.66 (95% CI 1.02-2.72, p=0.043). CONCLUSIONS VES-13 could be considered to be a good candidate for future prospective studies to assess older patients with cancer at risk of toxicity.
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Affiliation(s)
- Andrea Luciani
- Department of Oncology, San Paolo Hospital, Milan, Italy.
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Prato, Italy
| | - Giuseppe Colloca
- Aging and Medicine Centre, Università Cattolica Sacro Cuore, Rome, Italy
| | - Cristina Falci
- Department of Oncology, Istituto Oncologico, Veneto, Padua, Italy
| | | | - Irene Floriani
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | | | - Daris Ferrari
- Department of Oncology, San Paolo Hospital, Milan, Italy
| | | | - Elena Zafarana
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Prato, Italy
| | | | - Francesca Galli
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Paolo Foa
- Department of Oncology, San Paolo Hospital, Milan, Italy
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486
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Deckx L, van den Akker M, Daniels L, De Jonge ET, Bulens P, Tjan-Heijnen VCG, van Abbema DL, Buntinx F. Geriatric screening tools are of limited value to predict decline in functional status and quality of life: results of a cohort study. BMC FAMILY PRACTICE 2015; 16:30. [PMID: 25888485 PMCID: PMC4358725 DOI: 10.1186/s12875-015-0241-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/13/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Geriatric screening tools are increasingly implemented in daily practice, especially in the oncology setting, but also in primary care in some countries such as the Netherlands. Nonetheless, validation of these tools regarding their ability to predict relevant outcomes is lacking. In this study we evaluate if geriatric screening tools predict decline in functional status and quality of life after one year, in a population of older cancer patients and an older primary care population without cancer with a life expectancy of at least six months. METHODS Older cancer patients and a general older primary care population without a history of cancer (≥ 70 years) were included in an on-going prospective cohort study. Data were collected at baseline and after one-year follow-up. Functional decline was based on the Katz Index and Lawton IADL-scale and was defined as deterioration on one or more domains. Decline in quality of life was measured using the global health related subscale of the EORTC QLQ-C30, and was defined as a decline ≥ 10 points. The selected geriatric screening tools were the abbreviated Comprehensive Geriatric Assessment, Groningen Frailty Indicator, Vulnerable Elders Survey-13, and G8. We calculated sensitivity, specificity, predictive values, and odds ratios to assess if normal versus abnormal scores predict functional decline and decline in quality of life. RESULTS One-year follow-up data were available for 134 older cancer patients and 220 persons without cancer. Abnormal scores of all screening tools were significantly associated with functional decline. However, this was only true for older persons without cancer, and only in univariate analyses. For functional decline, sensitivity ranged from 54% to 71% and specificity from 33% to 66%. For decline in quality of life, sensitivity ranged from 40% to 67% and specificity from 37% to 54%. CONCLUSION In older persons with a relatively good prognosis, geriatric screening tools are of limited use in identifying persons at risk for decline in functional status or quality of life after one year. Hence, a geriatric screening tool cannot be relied on in isolation, but they do provide very valuable information and may prompt physicians to also consider different aspects of functioning.
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Affiliation(s)
- Laura Deckx
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium.
| | - Marjan van den Akker
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium.
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Liesbeth Daniels
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium.
| | - Eric T De Jonge
- Department of Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Paul Bulens
- Limburgs Oncologisch Centrum, Stadsomvaart 11, 3500, Hasselt, Belgium.
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Doris L van Abbema
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Frank Buntinx
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium.
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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487
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Lycke M, Pottel L, Boterberg T, Ketelaars L, Wildiers H, Schofield P, Weller D, Debruyne P. Integration of geriatric oncology in daily multidisciplinary cancer care: the time is now. Eur J Cancer Care (Engl) 2015; 24:143-6. [DOI: 10.1111/ecc.12301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
- M. Lycke
- Cancer Centre; General Hospital Groeninge; Kortrijk Belgium
| | - L. Pottel
- Cancer Centre; General Hospital Groeninge; Kortrijk Belgium
| | - T. Boterberg
- Department of Radiation Oncology; Ghent University Hospital; Ghent Belgium
| | - L. Ketelaars
- Department of Psycho-oncology; General Hospital Groeninge; Kortrijk Belgium
| | - H. Wildiers
- Department of General Medical Oncology & Leuven Cancer Institute; Leuven University Hospital; Leuven Belgium
| | - P. Schofield
- Centre for Positive Ageing; University of Greenwich; London UK
| | - D. Weller
- Centre for Population Health Sciences; University of Edinburgh; Edinburgh UK
| | - P.R. Debruyne
- Cancer Centre; General Hospital Groeninge; Kortrijk Belgium
- Centre for Positive Ageing; University of Greenwich; London UK
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488
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Owusu C, Berger NA. Comprehensive geriatric assessment in the older cancer patient: coming of age in clinical cancer care. ACTA ACUST UNITED AC 2014; 11:749-762. [PMID: 25642321 DOI: 10.2217/cpr.14.72] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cancer care at the extremes of life, in the young and the old, is characterized by unique issues associated with pediatrics and geriatric medicine, accentuated by the special vulnerabilities of these groups. In response to these needs, the field of pediatric oncology has been well honed to deal with the special problems associated with juvenile cancer patients. While most adult oncologists consider themselves well prepared to deal with older cancer patients, the current expansion of the geriatric population - their variable levels of fitness, frailty and vulnerability, the fact that cancer is primarily a disease of older adults, the significant expansion of agents and approaches to treat cancer, as well as their resultant toxicities and complications - has led to the development of specialized geriatric oncologists. Moreover, the special characteristics and needs of these patients have led to the evolution of new guidelines for evaluation, management and the conduct of research in older patients with cancer.
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Affiliation(s)
- Cynthia Owusu
- Hematology-Oncolog Division, Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA ; Department of Genetics, Case Western Reserve University, Cleveland, OH 44106, USA ; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA ; University Hospitals Case Medical Center, Cleveland, OH 44106, USA
| | - Nathan A Berger
- Hematology-Oncolog Division, Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA ; Department of Biochemistry, Case Western Reserve University, Cleveland, OH 44106, USA ; Department of Genetics, Case Western Reserve University, Cleveland, OH 44106, USA ; Center for Science, Health and Society, Case Western Reserve University, Cleveland, OH 44106, USA ; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA ; University Hospitals Case Medical Center, Cleveland, OH 44106, USA
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489
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Sattar S, Alibhai SMH, Wildiers H, Puts MTE. How to implement a geriatric assessment in your clinical practice. Oncologist 2014; 19:1056-68. [PMID: 25187477 PMCID: PMC4200997 DOI: 10.1634/theoncologist.2014-0180] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/17/2014] [Indexed: 12/21/2022] Open
Abstract
Cancer is a disease that mostly affects older adults. Other health conditions, changes in functional status, and use of multiple medications change the risks and benefits of cancer treatment for older adults. Several international organizations, such as the International Society of Geriatric Oncology, the European Organization for Research and Treatment of Cancer, recommend the conduct of a geriatric assessment (GA) for older adults with cancer to help select the most appropriate treatment and identify any underlying undetected medical, functional, and psychosocial issues that can interfere with treatment. The aim of this review is to describe what a GA is and how to implement it in daily clinical practice for older adults with cancer in the oncology setting. We provide an overview of commonly used tools. Key considerations in performing the GA include the resources available (staff, space, and time), patient population (who will be assessed), what GA tools to use, and clinical follow-up (who will be responsible for using the GA results for developing care plans and who will provide follow-up care). Important challenges in implementing GA in clinical practice include not having easy and timely access to geriatric expertise, patient burden of the additional hospital visits, and establishing collaboration between the GA team and oncologists regarding expectations of the population referred for GA and expected outcomes of the GA. Finally, we provide some possible interventions for problems identified during the GA.
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Affiliation(s)
- Schroder Sattar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Shabbir M H Alibhai
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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