Estimating the risk of chemotherapy toxicity in older patients with cancer: The role of the Vulnerable Elders Survey-13 (VES-13)

Update on the Management of Pancreatic Cancer in Older Adults

Pancreatic cancer is more common in older adults, who are underrepresented in clinical trials and frequently under treated. Chronological age alone should not deter clinicians from offering treatment to geriatric patients, as they are a heterogeneous population. Geriatric assessment, frailty assessment tools, and toxicity risk scores help clinicians select appropriate patients for therapy. For resectable disease, surgery can be safe but should be done at a high-volume center. Adjuvant therapy is important; though there remains controversy on the role of radiation, chemotherapy is well studied and efficacious. In locally advanced unresectable disease, chemoradiation or chemotherapy alone is an option. Neoadjuvant therapy improves the chances of resectability in borderline resectable disease. Chemotherapy extends survival in metastatic disease, but treatment goals and risk-benefit ratios have to be clarified. Adequate symptom management and supportive care are important. There are now many new treatment strategies and novel therapies for this disease.

Implications of frailty screening in clinical practice

PURPOSE OF REVIEW

Many frailty screening instruments have been proposed due to the lack of consensus on a unified operational definition of frailty. This review reports on recent frailty screening tools in addition to revisiting the frailty concept.

RECENT FINDINGS

Although there are two representative frailty models, both have issues that prevent them from being implemented in clinical settings despite their remarkable advantages. Due to their different characteristics, these models are thought to be complementary rather than substitutive. The recent introduction of frailty identification into primary care and specific clinical settings has led to both a focus on its importance and the development of new screening methods.

SUMMARY

The phenotype model is rather faithfully based on biological change with aging, while the deficit model comprehensively captures risk of disability. Most of the current frailty screening tools are based on these models. Screening tools based on the former model primarily capture declines in physical functions, whereas screening tools based on the latter model involve questionnaires that examine functional impairments in multiple domains. Implementation of a model in a clinical setting depends on both the model characteristics and the clinical settings.

[Are cancer outpatients ready for e-medicine?]

INTRODUCTION

E-health offers new opportunities for improving cancer outpatients' monitoring. The aim of this study was to assess the level and the use of electronic communication tools owned by cancer outpatients currently undergoing antitumoral treatment.

METHODS

This observational study consecutively recruited patients undergoing treatment at two day hospital oncology units from 1st to 31 October 2015. Each patient completed one standardised, anonymous questionnaire.

RESULTS

Overall, 386 questionnaires were analysed, of which 244 and 142 patients were from each hospital. Of these patients, 73% had access to the Internet either directly or through a third party. More than 90% of the patients owned a mobile phone, and half of them had a smartphone with Internet access. An increasing age and the socioeconomic class level were significantly associated with the use of the Internet and of a smartphone. Half of the patients had accessed websites dedicated to health topics and a quarter had used mobile applications on health topics. One-third of those patients found these electronic tools helpful. After adjustment, an increasing age was significantly associated with a decreased use of such tools. The majority (87%) of the patients enjoyed receiving text message reminders from their hospital about their consultation schedule.

CONCLUSION

Three in four cancer outpatients under treatment have access to the Internet and half use websites dedicated to health topics, with an impact of the age and the socioeconomic class level. Developing e-communication tools between caregivers and patients might be considered to improve their home monitoring.

Which better predicts mortality among older men, a prostate cancer (PCa) diagnosis or vulnerability on the Vulnerable Elders Survey (VES-13)? A retrospective cohort study

OBJECTIVES

Older men with a prostate cancer (PCa) diagnosis face competing mortality risks. Little is known about the prevalence of vulnerability and predictors of mortality in this population compared to men without a PCa diagnosis. We examined the predictive utility of the Vulnerable Elders Survey (VES-13) for mortality in older men with a PCa diagnosis as compared to controls.

MATERIALS AND METHODS

Men aged ≥65years from an urban geriatrics clinic completed the VES-13 between 2003 and 2008. Each patient with a PCa diagnosis was matched by age to five controls, resulting in 59 patients with a PCa diagnosis and 318 controls. Cox proportional hazard models were used to determine the association of a PCa diagnosis and vulnerability on the VES-13 with mortality.

RESULTS AND CONCLUSIONS

The mean age for men with a PCa diagnosis and controls was 77.9years and 76.1years, respectively. Of those with a PCa diagnosis, 74.6% had no active disease or a rising PSA only. Regardless of PCa diagnosis, vulnerable individuals on the VES-13 were more likely to die during the study period (VES-13≥3: HR=4.46, p<0.01; VES13≥6: HR=3.77, p<0.01). Men with a PCa diagnosis were not more likely to die compared to age-matched controls (VES-13≥3: HR=1.14, p=0.59; VES13≥6: HR=1.06, p=0.83). Vulnerability for men with a PCa diagnosis was more predictive of mortality. Therefore, the assessment of vulnerability is important for establishing goals of care.

Vulnerable elders survey and socioeconomic status predict functional decline and death among older women with newly diagnosed nonmetastatic breast cancer

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.