251
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Sawaki M, Shimomura A, Shien T, Iwata H. Management of breast cancer in older patients. Jpn J Clin Oncol 2022; 52:682-689. [DOI: 10.1093/jjco/hyac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Japanese women have the highest life expectancy in the world and breast cancer is the most prevalent cancer among them. However, little data are available to support the evidence-based clinical management due to the fact that older adults are commonly excluded from most clinical trials. In Japan the rate of other cause of death in older patient was about a half, then we should consider whether or not breast cancer may affect the patient’s life expectancy to avoid either overtreatment or undertreatment. Although management principles in older patients may be similar with those of younger age, these differences would be caused by relatively short life expectancy, some comorbidity, drug interactions and low functional status. Then, their treatment needs to be individualized. To this end, employing a comprehensive geriatric assessment may be advantageous, which enables to evaluate patient vulnerability from several different aspects, to predict adverse events of chemotherapy and to identify geriatric problems in advance so that extra support and modified treatment can be provided. Before treatment we should assess the patient’s goals and values regarding the management of the cancer, especially on balancing survival benefit with immediate quality of life impairment due to anti-cancer therapy. In Japan Clinical Oncology Group (JCOG) , a randomized controlled trial for older patients with advanced stage HER2-positive breast cancer is ongoing as an inferiority design including geriatric assessment (JCOG1607, HARB TEA study). Best practice, current management and how to approach decision making in older patients with breast cancer are summarized.
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Affiliation(s)
- Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akihiko Shimomura
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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252
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Morse RT, Ganju RG, Gan GN, Cao Y, Neupane P, Kakarala K, Shnayder Y, Lominska CE. Sarcopenia and Treatment Toxicity in Older Adults Undergoing Chemoradiation for Head and Neck Cancer: Identifying Factors to Predict Frailty. Cancers (Basel) 2022; 14:2094. [PMID: 35565223 PMCID: PMC9103923 DOI: 10.3390/cancers14092094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 01/09/2023] Open
Abstract
This study was performed to identify treatment related toxicities in older adults undergoing concurrent chemoradiotherapy for head and neck cancer and nutritional and skeletal muscle measures that might identify frailty. Imaging analysis was done with the following skeletal muscle measurements: skeletal muscle index (SMI), skeletal muscle density (SMD), and skeletal muscle gauge (SMG). Patients were dichotomized by age into younger (<70 years old, 221 patients) and older age groups (≥70 years old, 51 patients). Low SMI was more common in older patients (86.7%) compared to younger patients (51.7%, p < 0.01), as were low SMD (57.8% vs. 37.3%, p = 0.012) and low SMG (76.1% vs. 44.2%, p < 0.01), despite having similar BMIs (27.3 kg/m2 versus 27.7 kg/m2, p = 0.71). Older patients were significantly more likely to experience chemotherapy toxicity than younger patients (54.9% versus 32.3%, p < 0.01). On multivariate analysis age (p < 0.01), current smoking status (p < 0.01), and low SMI (p < 0.01) remained as significant predictors for missed chemotherapy cycles or discontinuation. Older patients were more likely to require ≥5-day radiation breaks than younger patients (27.5% versus 8.6%, p < 0.01). On multivariate analysis, age (p < 0.01), low albumin status (p = 0.03), and low SMI (p = 0.04) were identified as predictors of prolonged radiation treatment breaks. Based on the results of our study, sarcopenia may be used as an additional marker for frailty alongside traditional performance status scales.
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Affiliation(s)
- Ryan T. Morse
- Department of Radiation Oncology, UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospital, Chapel Hill, NC 27514, USA
| | - Rohit G. Ganju
- Department of Radiation Oncology, Wellstar Health System, Marietta, GA 30067, USA;
| | - Gregory N. Gan
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS 66160, USA; (G.N.G.); (Y.C.); (C.E.L.)
| | - Ying Cao
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS 66160, USA; (G.N.G.); (Y.C.); (C.E.L.)
| | - Prakash Neupane
- Department of Medical Oncology, University of Kansas Cancer Center, Kansas City, KS 66160, USA;
| | - Kiran Kakarala
- Department of Otolaryngology, University of Kansas Cancer Center, Kansas City, KS 66160, USA; (K.K.); (Y.S.)
| | - Yelizaveta Shnayder
- Department of Otolaryngology, University of Kansas Cancer Center, Kansas City, KS 66160, USA; (K.K.); (Y.S.)
| | - Christopher E. Lominska
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS 66160, USA; (G.N.G.); (Y.C.); (C.E.L.)
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253
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Validity of the Cancer and Aging Research Group Predictive Tool in Older Japanese Patients. Cancers (Basel) 2022; 14:cancers14092075. [PMID: 35565205 PMCID: PMC9104937 DOI: 10.3390/cancers14092075] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background: This study aimed to evaluate the usefulness of the Cancer and Aging Research Group (CARG) predictive tool in older Japanese patients with cancer. Methods: Patients aged 65 years or older with solid tumors treated with new anticancer regimens in Kakogawa Central City Hospital between April 2016 and March 2019 were included. Grade 3 or higher risks of developing chemotherapy-related adverse events (CRAEs) were calculated using the tool (low-, intermediate-, or high-risk scores). The association between grade 3−5 CRAE incidence during the first course of each regimen and the calculated risk or the patient characteristics was evaluated. The difference in the incidences of CRAEs between the groups was evaluated by Fisher’s exact test. Results: This study examined 76 patients (mean age: 71 (65−82) years). The incidence of grade 3−5 CRAE was 38%, 55%, and 76% in patients classified as low, medium, and high CARG risk scores (p = 0.035), and the incidence of severe non-hematological toxicities was 4%, 31%, and 52% (p < 0.01), respectively. Eastern Cooperative Oncology Group performance status and age were not associated with chemotherapy toxicity. Conclusions: The CARG predictive tool was valid, suggesting its usefulness in optimizing chemotherapy outcomes in older patients with cancer.
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254
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Corry J, Ng WT, Ma SJ, Singh AK, de Graeff P, Oosting SF. Disadvantaged Subgroups Within the Global Head and Neck Cancer Population: How Can We Optimize Care? Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35439036 DOI: 10.1200/edbk_359482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the global head and neck cancer population, there are subgroups of patients with poorer cancer outcomes independent from tumor characteristics. In this article, we review three such groups. The first group comprises patients with nasopharyngeal cancer in low- and middle-income countries where access to high-volume, well-resourced radiotherapy centers is limited. We discuss a recent study that is aiming to improve outcomes through the instigation of a comprehensive radiotherapy quality assurance program. The second group comprises patients with low socioeconomic status in a high-income country who experience substantial financial toxicity, defined as financial hardship for patients due to health care costs. We review causes and consequences of financial toxicity and discuss how it can be mitigated. The third group comprises older patients who may poorly tolerate and not benefit from intensive standard-of-care treatment. We discuss the role of geriatric assessment, particularly in relation to the use of chemotherapy. Through better recognition and understanding of disadvantaged groups within the global head and neck cancer population, we will be better placed to instigate the necessary changes to improve outcomes and quality of life for patients with head and neck cancer.
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Affiliation(s)
- June Corry
- Division Radiation Oncology, GenesisCare Radiation OncologySt Vincent's Hospital, Melbourne, Australia.,Department of MedicineThe University of Melbourne, Parkville, Australia
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of MedicineThe University of Hong Kong, Hong Kong, China.,Clinical Oncology CentreThe University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Pauline de Graeff
- University Center for Geriatric MedicineUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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255
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Hindsight and Foresight: How Comorbidity Assessment Helps Us in Cancer Care. Clin Oncol (R Coll Radiol) 2022; 34:480-482. [PMID: 35450771 DOI: 10.1016/j.clon.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022]
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256
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Webb T, Verduzco-Aguirre HC, Rao AR, Ramaswamy A, Noronha V. Addressing the Needs of Older Adults With Cancer in Low- and Middle-Income Settings. Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35427187 DOI: 10.1200/edbk_349829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The number of older adults in the world is projected to increase steeply over the next 30 years; most older adults will live in low- and middle-income countries. This will have a direct impact on the global cancer burden, as cancer is largely a disease of aging. A revolution in the way we care for older adults in low- and middle-income settings is needed to meet rapidly rising demands. Regardless of a nation's relative wealth or resources, implementing the geriatric assessment in cancer care has presented a challenge because of omission of the principles of geriatric oncology from formal training and continuing education, lack of time, and a shortage of qualified personnel. To meet the challenge of caring for older adults globally, we must: (1) re-imagine aging-focused training for providers and nurses, (2) create and strengthen collaborations/partnerships between geriatric oncology teams and aging-service organizations, and (3) increase advocacy for age-friendly health care policy. By harnessing technology, the reach of specialized oncology education and care can be extended even-or especially-to low- and middle-income settings.
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Affiliation(s)
- Tracy Webb
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Abhijith Rajaram Rao
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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257
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Abstract
PURPOSE OF REVIEW Validated metrics to optimize older adult patient selection for Chimeric Antigen Receptor T-cell therapy (CART) are lacking; however, some preliminary data suggests that geriatric assessments and cumulative illness rating score may be useful tools. In addition, interventions capable of enhancing outcomes in older adults receiving CART have yet to be elucidated. The purpose of this review is to present data extrapolating from other diseases and therapeutic modalities, related to product selection, toxicity mitigation strategies, comprehensive coordinated models of care, and functional optimization of patients. RECENT FINDINGS The most robust data in older adults are among relapsed and refractory (r/r) diffuse large B-cell lymphoma (DLBCL) patients where three products are available with the longest clinical follow up and the most abundant real-world evidence (RWE). Data for the approved CART products for follicular lymphoma (FL) and mantle cell lymphoma (MCL) are relatively new and RWE is lacking in general. Data for CART products in multiple myeloma (MM) and B-cell acute lymphoblastic leukemia (B-ALL) are even more recent, but preliminary data in older adults seem to follow the trend of excellent efficacy in this age group with age-stratified toxicity data limited. Landmark trials and RWE studies indicate that the high response rates of CART for older adult patients, age 65 years and older, are maintained, while toxicity may be amplified. Clinically important toxicities include grade 3 or higher cytokine release syndrome (CRS), neurotoxicity, and infections.
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258
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Wieland J, Jordan BL, Jatoi A. Equity. Cancer 2022; 128:2240-2242. [PMID: 35403209 DOI: 10.1002/cncr.34179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Jana Wieland
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Barbara L Jordan
- Office of Education Diversity, Equity, and Inclusion, Mayo Clinic, Rochester, Minnesota
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
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259
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The use of immunotherapy in older patients with advanced non-small cell lung cancer. Cancer Treat Rev 2022; 106:102394. [DOI: 10.1016/j.ctrv.2022.102394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/04/2022] [Accepted: 04/10/2022] [Indexed: 12/17/2022]
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260
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Yilmaz S, Sanapala C, Schiaffino MK, Schumacher JR, Wallington SF, McKoy JM, Canin B, Tang W, Tucker-Seeley RD, Simmons J, Gilmore N. Social Justice and Equity: Why Older Adults With Cancer Belong-A Life Course Perspective. Am Soc Clin Oncol Educ Book 2022; 42:1-13. [PMID: 35649203 PMCID: PMC11070065 DOI: 10.1200/edbk_349825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The population of older adults with cancer in the United States is rapidly increasing, which will have a substantial impact on the oncology and public health workforces across the cancer continuum, from prevention to end of life. Unfortunately, inequities in existing social structures that cause increased psychosocial stressors have led to disparities in the incidence of cancer and the morbidity and mortality of cancer for individuals from marginalized backgrounds. It is imperative that older adults, especially those from historically marginalized backgrounds, be adequately represented in all stages of cancer research to address health inequities. Continued efforts and progress toward achieving social justice and health equity require a deeper commitment to and better understanding of the impact of social determinants of health within the cancer domain. Undoubtedly, a more holistic and integrated view that extends beyond the biologic and genetic factors of health must be adopted for health entities to recognize the critical role of environmental, behavioral, and social determinants in cancer health disparities. Against this backdrop, this paper uses a life course approach to present a multifactorial framework for understanding and addressing cancer disparities in an effort to advance social justice and health equity for racially and ethnically diverse older adults.
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Affiliation(s)
- Sule Yilmaz
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Chandrika Sanapala
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Jessica R Schumacher
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Sherrie F Wallington
- The George Washington School of Nursing & Milken Institute School of Public Health, Washington, DC
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | | | - Weizhou Tang
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - Reginald D Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
- ZERO-The End of Prostate Cancer, Alexandria, VA
| | - John Simmons
- Cancer and Aging Research Group, City of Hope, CA
- Ethnic Health Institute, Center for Community Engagement, Samuel Merritt University, Oakland, CA
| | - Nikesha Gilmore
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY
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261
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Verduzco-Aguirre HC, Bolaño Guerra LM, Culakova E, Chargoy JM, Martínez-Said H, Quintero Beulo G, Mohile SG, Soto-Perez-De-Celis E. Barriers and Facilitators for the Implementation of Geriatric Oncology Principles in Mexico: A Mixed-Methods Study. JCO Glob Oncol 2022; 8:e2100390. [PMID: 35353596 PMCID: PMC9005260 DOI: 10.1200/go.21.00390] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
There is limited information regarding the use of the geriatric assessment (GA) for older adults with cancer in developing countries. We aimed to describe geriatric oncology practice among Mexican oncology professionals and to identify barriers and facilitators for the implementation of GA into the routine care of older adults with cancer in Mexico. Routine use of geriatric oncology principles in Mexico is limited by insufficient personnel and knowledge.![]()
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Affiliation(s)
- Haydee C Verduzco-Aguirre
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Laura M Bolaño Guerra
- Department of Thoracic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Eva Culakova
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY
| | - Javier Monroy Chargoy
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Gregorio Quintero Beulo
- Breast Tumor Unit, Oncology Service, Hospital General de México "Dr Eduardo Liceaga," Mexico City, Mexico
| | - Supriya G Mohile
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY.,Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Enrique Soto-Perez-De-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Presley CJ, Mohamed MR, Culakova E, Flannery M, Vibhakar PH, Hoyd R, Amini A, VanderWalde N, Wong ML, Tsubata Y, Spakowicz DJ, Mohile SG. A Geriatric Assessment Intervention to Reduce Treatment Toxicity Among Older Adults With Advanced Lung Cancer: A Subgroup Analysis From a Cluster Randomized Controlled Trial. Front Oncol 2022; 12:835582. [PMID: 35433441 PMCID: PMC9008713 DOI: 10.3389/fonc.2022.835582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/04/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction More older adults die from lung cancer worldwide than breast, prostate, and colorectal cancers combined. Current lung cancer treatments may prolong life, but can also cause considerable treatment-related toxicity. Objective This study is a secondary analysis of a cluster-randomized clinical trial which evaluated whether providing a geriatric assessment (GA) summary and GA-guided management recommendations can improve grade 3-5 toxicity among older adults with advanced lung cancer. Methods We analyzed participants aged ≥70 years(y) with stage III & IV (advanced) lung cancer and ≥1 GA domain impairment starting a new cancer treatment with high-risk of toxicity within the National Cancer Institute's Community Oncology Research Program. Community practices were randomized to the intervention arm (oncologists received GA summary & recommendations) versus usual care (UC: no summary or recommendations given). The primary outcome was grade 3-5 toxicity through 3 months post-treatment initiation. Secondary outcomes included 6-month (mo) and 1-year overall survival (OS), treatment modifications, and unplanned hospitalizations. Outcomes were analyzed using generalized linear mixed and Cox proportional hazards models with practice site as a random effect. Trial Registration: NCT02054741. Results & Conclusion Among 180 participants with advanced lung cancer, the mean age was 76.3y (SD 5.1), 39.4% were female and 82.2% had stage IV disease. The proportion of patients who experienced grade 3-5 toxicity was significantly lower in the intervention arm vs UC (53.1% vs 71.6%, P=0.01). More participants in the intervention arm received lower intensity treatment at cycle 1 (56.3% vs 35.3%; P<0.01). Even with a cycle 1 dose reduction, OS at 6mo and 1 year was not significantly different (adjusted hazard ratio [HR] intervention vs. UC: 6mo HR=0.90, 95% CI: 0.52-1.57, P=0.72; 1 year HR=0.89, 95% CI: 0.58-1.36, P=0.57). Frequent toxicity checks, providing education and counseling materials, and initiating direct communication with the patient's primary care physician were among the most common GA-guided management recommendations. Providing a GA summary and management recommendations can significantly improve tolerability of cancer treatment among older adults with advanced lung cancer.
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Affiliation(s)
- Carolyn J. Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Mostafa R. Mohamed
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Eva Culakova
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, United States
| | - Marie Flannery
- Department of Radiation Oncology, School of Nursing, University of Rochester, Rochester, NY, United States
| | - Pooja H. Vibhakar
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Rebecca Hoyd
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Arya Amini
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Noam VanderWalde
- West Cancer Center & Research Institute, Memphis, TN, United States
| | - Melisa L. Wong
- Divisions of Hematology/Oncology and Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Yukari Tsubata
- Division of Medical Oncology and Respiratory Medicine, Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Daniel J. Spakowicz
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Supriya G. Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, United States
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263
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Thibaud V, Billy C, Prud’homm J, Garin J, Hue B, Cattenoz C, Somme D, Corvol A. Inside the Black Box: A Narrative Review on Comprehensive Geriatric Assessment-Driven Interventions in Older Adults with Cancer. Cancers (Basel) 2022; 14:cancers14071642. [PMID: 35406414 PMCID: PMC8996864 DOI: 10.3390/cancers14071642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Comprehensive geriatric assessment is defined as a multi-dimensional, multi-disciplinary diagnostic and therapeutic process that is conducted to determine the medical, mental, and functional problems that older people with frailty have so that a coordinated and integrated plan for treatment and follow-up can be developed. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients. This review highlights the scarcity of published studies on this topic. Comprehensive geriatric assessment-based interventions have not yet demonstrated their specific impact. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. Abstract There is a consensus that the use of comprehensive geriatric assessment (CGA) is good clinical practice for older patients with solid tumors or hematological malignancies. To be complete, a CGA must include a geriatric assessment and an intervention plan. According to the SIOG consensus, a CGA should assess several domains: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and the presence of geriatric syndromes. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients in each domain mentioned in the SIOG consensus. An online search of the PubMed database was performed using predefined search algorithms specific for each domain of the CGA. Eligible articles had to have well-defined interventions targeting specific domains of the CGA. We screened 1864 articles, but only a few trials on single-domain interventions were found, and often, these studies involved small groups of patients. This review highlights the scarcity of published studies on this topic. The specific impacts of CGA-based interventions have not yet been demonstrated. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. New studies are necessary in multiple care contexts, and innovative designs must be used to balance internal and external validity. An accurate description of the intervention and what “usual care” means will improve the external validity of such studies.
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Affiliation(s)
- Vincent Thibaud
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
- Department of Hematology, CHU Rennes, Université Rennes 1, 35000 Rennes, France
- Department of Hematology, Hôpital Saint-Vincent, Université Catholique de Lille, 59000 Lille, France
- Correspondence:
| | - Claire Billy
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
| | - Joaquim Prud’homm
- Laboratoire Traitement du Signal et de l’Image (INSERM LTSI—UMR 1099), CHU Rennes, Université Rennes 1, 35000 Rennes, France;
| | - Jeanne Garin
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
| | - Benoit Hue
- Department of Pharmacy, CHU Rennes, Université Rennes 1, 35000 Rennes, France;
| | - Catherine Cattenoz
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
- Centre Eugène Marquis, Department of Medical Oncology, Université Rennes 1, 35000 Rennes, France
| | - Dominique Somme
- Laboratoire Arènes(CNRS UMR 6051), CHU Rennes, Université Rennes 1, 35000 Rennes, France; (D.S.); (A.C.)
| | - Aline Corvol
- Laboratoire Arènes(CNRS UMR 6051), CHU Rennes, Université Rennes 1, 35000 Rennes, France; (D.S.); (A.C.)
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Predicting Chemotherapy-Related Adverse Events in Elderly Cancer Patients with Prior Anticancer Therapy. Curr Oncol 2022; 29:2185-2192. [PMID: 35448151 PMCID: PMC9029698 DOI: 10.3390/curroncol29040177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
To test the usefulness of the Cancer and Aging Research Group (CARG) predictive tool, it was used to assess elderly cancer patients with prior anticancer therapy. Among patients with solid malignancies aged ≥ 65 years receiving second-line chemotherapy who were admitted to the Department of Medical Oncology/Hematology at Kakogawa Central City Hospital between April 2016 and September 2019, the risk ≥ grade 3 of developing chemotherapy-related adverse events (CRAEs) (low, intermediate, or high) was calculated using the tool. Correlations between grades 3 and 5 CRAE incidence rates in the first course of each regimen and CARG risk score, age, and Eastern Cooperative Oncology Group performance status (ECOG PS) were assessed. Included patients (n = 62) had a mean age of 71 years (range, 65−82 years). Severe CRAE incidence in patients with low, medium, or high CARG risk was 27%, 54%, and 71%, respectively (p = 0.026). The incidence of severe non-hematological toxicities was 5%, 35%, and 64%, respectively (p < 0.01). There was no association between age or ECOG PS and chemotherapy toxicity. The results suggest the validity of the CARG predictive tool in elderly cancer patients with prior anticancer therapy. Particularly, the tool showed potential for predicting non-hematological toxicity.
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265
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Geriatrisches Assessment sollte bei fortgeschrittenen Tumoren Standard sein. Dtsch Med Wochenschr 2022. [DOI: 10.1055/a-1711-9973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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266
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Geriatric assessment-informed treatment decision making and downstream outcomes: what are the research priorities? Curr Opin Support Palliat Care 2022; 16:25-32. [DOI: 10.1097/spc.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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267
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Balachandran K, Kalsi T. The Impact of Age on Assessment and Treatment of Breast Cancer in Older People: You Are Only as Old as Your Oncologist Thinks You Are …. Clin Oncol (R Coll Radiol) 2022; 34:363-367. [DOI: 10.1016/j.clon.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/31/2022] [Accepted: 02/18/2022] [Indexed: 12/26/2022]
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268
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Elucidating the effect of geriatric parameters on COVID-19 outcomes for older adults with cancer. THE LANCET. HEALTHY LONGEVITY 2022; 3:e122-e123. [PMID: 35187515 PMCID: PMC8843064 DOI: 10.1016/s2666-7568(22)00026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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269
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Li D, Sedrak MS, Dale W. Interpretation of the Efficacy of Multidisciplinary Geriatric Assessment Intervention on Chemotherapy-Related Toxic Effects in Older Adults With Cancer-Reply. JAMA Oncol 2022; 8:1. [PMID: 35201284 DOI: 10.1001/jamaoncol.2021.8067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daneng Li
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Mina S Sedrak
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, California
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270
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Chan WL, Chow JCH, Xu ZY, Li J, Kwong WTG, Ng WT, Lee AWM. Management of Nasopharyngeal Carcinoma in Elderly Patients. Front Oncol 2022; 12:810690. [PMID: 35178346 PMCID: PMC8844547 DOI: 10.3389/fonc.2022.810690] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/03/2022] [Indexed: 12/27/2022] Open
Abstract
Nasopharyngeal cancer (NPC) is one of the most difficult cancers in the head and neck region due to the complex geometry of the tumour and the surrounding critical organs. High-dose radical radiotherapy with or without concurrent platinum-based chemotherapy is the primary treatment modality. Around 10%–15% of NPC patients have their diagnosis at age after 70. The management of NPC in elderly patients is particularly challenging as they encompass a broad range of patient phenotypes and are often prone to treatment-related toxicities. Chronologic age alone is insufficient to decide on the management plan. Comprehensive geriatric assessment with evaluation on patients’ functional status, mental condition, estimated life expectancy, comorbidities, risks and benefits of the treatment, patients’ preference, and family support is essential. In addition, little data from randomized controlled trials are available to guide treatment decisions in elderly patients with NPC. In deciding which treatment strategy would be suitable for an individual elderly patient, we reviewed the literature and reviewed the analysis of primary studies, reviews, and guidelines on management of NPC. This review also summarises the current evidence for NPC management in elderly adults from early to late stage of disease.
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Affiliation(s)
- Wing Lok Chan
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - James Chung Hang Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital (QEH), Hong Kong SAR, China
| | - Zhi-Yuan Xu
- Department of Clinical Oncology, Shenzhen Hospital, University of Hong Kong, Shenzhen, China
| | - Jishi Li
- Department of Clinical Oncology, Shenzhen Hospital, University of Hong Kong, Shenzhen, China
| | - Wing Tung Gobby Kwong
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wai Tong Ng
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Anne W M Lee
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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271
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Wee CW. Radiotherapy for Newly Diagnosed Glioblastoma in the Elderly: What Is the Standard? Brain Tumor Res Treat 2022; 10:12-21. [PMID: 35118843 PMCID: PMC8819463 DOI: 10.14791/btrt.2022.10.e34] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
Nearly half of the patients with newly diagnosed glioblastomas are aged ≥65 years. Unfortunately, these elderly patients with glioblastoma (GBM-e) demonstrate detrimental survival. However, the optimal treatment for GBM-e after surgery remains controversial. Conventionally fractionated radiotherapy (CFRT) of 60 Gy, hypofractionated radiotherapy (HFRT), temozolomide (TMZ), or a combination of these treatments with or without tumor treating fields can be considered. Although evidence has indicated a non-inferiority of HFRT compared to CFRT in GBM-e treated with radiotherapy (RT) alone throughout the past, the optimal RT scheme (CFRT vs. HFRT), when combined with TMZ, has never been investigated in a prospective randomized fashion for GBM-e patients suitable for radiochemotherapy. Several other issues make the treatment of GBM-e even more challenging. In this review, current evidence regarding RT in GBM-e, as well as issues that need to be addressed, is discussed.
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Affiliation(s)
- Chan Woo Wee
- Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
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272
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Puts M, Papadopoulos E, Brennenstuhl S, Durbano S, Hossain N, Santos B, Cleverley K, Alibhai SMH. The Development of Geriatric Assessment and Intervention Guidelines for an Online Geriatric Assessment Tool: A Canadian Modified Delphi Panel Study. Curr Oncol 2022; 29:853-868. [PMID: 35200572 PMCID: PMC8870933 DOI: 10.3390/curroncol29020073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There are no guidelines available for what assessment tools to use in a patient's self-completed online geriatric assessment (GA) with management recommendations. Therefore, we used a modified Delphi approach with Canadian expert clinicians to develop a consensus online GA plus recommendations tool. METHODS The panel consisted of experts in geriatrics, oncology, nursing, and pharmacy. Experts were asked to rate the importance and feasibility of assessments and interventions to be included in an online GA for patients. The items included in the first round were based on guidelines for in-person GA and literature review. The first two rounds were conducted using an online survey. A virtual 2 h meeting was held to discuss the items where no consensus was reached and then voted on in the final round. RESULTS 34 experts were invited, and 32 agreed to participate. In round 1, there were 85 items; in round 2, 50 items; and in round 3, 25 items. The final tool consists of fall history, assistive device use, weight loss, medication review, need help taking medication, social supports, depressive symptoms, self-reported vision and hearing, and current smoking status and alcohol use. CONCLUSION This first multidisciplinary consensus on online GA will benefit research and clinical care for older adults with cancer.
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Affiliation(s)
- Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada; (S.B.); (B.S.); (K.C.)
| | - Efthymios Papadopoulos
- Department of Medicine, University Health Network, Toronto, ON M5G 2C1, Canada; (E.P.); (S.D.); (N.H.); (S.M.H.A.)
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada; (S.B.); (B.S.); (K.C.)
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, ON M5G 2C1, Canada; (E.P.); (S.D.); (N.H.); (S.M.H.A.)
| | - Nazia Hossain
- Department of Medicine, University Health Network, Toronto, ON M5G 2C1, Canada; (E.P.); (S.D.); (N.H.); (S.M.H.A.)
| | - Brenda Santos
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada; (S.B.); (B.S.); (K.C.)
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada; (S.B.); (B.S.); (K.C.)
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Shabbir M. H. Alibhai
- Department of Medicine, University Health Network, Toronto, ON M5G 2C1, Canada; (E.P.); (S.D.); (N.H.); (S.M.H.A.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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273
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Alibhai SMH, Alam Z, Saluja R, Malik U, Warde P, Jin R, Berger A, Romanovsky L, Chan KKW. Economic Evaluation of a Geriatric Oncology Clinic. Cancers (Basel) 2022; 14:789. [PMID: 35159056 PMCID: PMC8833958 DOI: 10.3390/cancers14030789] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022] Open
Abstract
Geriatric assessment (GA) is supported by recent trials and guidelines yet rarely implemented due to a lack of resources. We performed an economic evaluation of a geriatric oncology clinic. Pre-GA proposed treatments and post-GA actual treatments were obtained from a detailed chart review of patients seen at a single academic centre. GA-based costs for investigations and referrals were calculated. Unit costs were obtained for surgical, radiation, systemic therapy, laboratory, imaging, physician, nursing, and allied health care (all in 2019 Canadian dollars). A six-month time horizon and government payer perspective were used. Consecutive patients aged 65 years or older (n = 152, mean age 82 y) and referred in the pre-treatment setting between July 2016 and June 2018 were included. Treatment plans were modified for 51% of patients. Costs associated with planned treatment were CAD 3,655,015. Costs associated with GA and related interventions were CAD 95,798. Final treatment costs were CAD 2,436,379. Net savings associated with the clinic were CAD 1,122,837, or CAD 7387 per patient seen. Findings were robust in multiple sensitivity analyses. Combined with mounting trial data demonstrating the clinical benefits of GA, our data can inform a strong business case for geriatric oncology clinics in health care environments similar to ours, but additional studies in diverse health care settings are warranted.
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Affiliation(s)
- Shabbir M. H. Alibhai
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada; (Z.A.); (R.S.); (U.M.); (A.B.); (L.R.)
- Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Zuhair Alam
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada; (Z.A.); (R.S.); (U.M.); (A.B.); (L.R.)
| | - Ronak Saluja
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada; (Z.A.); (R.S.); (U.M.); (A.B.); (L.R.)
| | - Uzair Malik
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada; (Z.A.); (R.S.); (U.M.); (A.B.); (L.R.)
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Rana Jin
- Department of Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Arielle Berger
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada; (Z.A.); (R.S.); (U.M.); (A.B.); (L.R.)
- Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Lindy Romanovsky
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada; (Z.A.); (R.S.); (U.M.); (A.B.); (L.R.)
- Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Kelvin K. W. Chan
- Department of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, ON M5G 2C4, Canada;
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2C4, Canada
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274
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Nagashima F, Furuse J. Treatments for elderly cancer patients and reforms to social security systems in Japan. Int J Clin Oncol 2022; 27:310-315. [PMID: 35098370 PMCID: PMC8801270 DOI: 10.1007/s10147-021-02099-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/28/2021] [Indexed: 11/05/2022]
Abstract
In Japan, the population aged 65 years and above accounts for 29% of the total population. Furthermore, the number of cancer patients among the elderly is increasing. Geriatric oncology is a discipline that deals with appropriate care for elderly cancer patients based on their characteristics. The International Society of Geriatric Oncology considers education, treatment, research, and partnership building areas of significance and priority for policy goals. In Japan, the Third Term of the Basic Plan to Promote Cancer Control is an initiative to improve the infrastructure and health services involved in cancer care. Content related to "cancer in the elderly" was added to establish guidelines for treating cancer in the elderly. Thus far, "Clinical Practice Guidelines of Cancer Drug Therapies for the Elderly" have been published. With the increasing age of the population, social security expenditures will increase substantially after the fiscal year 2022. Reforms to social security systems, such as pensions, medical care, and nursing care, are underway. It is important to enhance cooperation between oncology and geriatrics and to support cooperative systems among families and medical professionals to promote geriatric oncology. Since the working-age population and the total population have begun to decline, Japan is facing many challenges. As a leader of a super-aging society, Japan has the potential to share its experience on a global scale and address potential long-term outcomes.
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Affiliation(s)
- Fumio Nagashima
- Department of Medical Oncology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Junji Furuse
- Department of Medical Oncology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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Maurus J, Terzer T, Benner A, Goisser S, Eidam A, Roth A, Janssen M, Jaramillo S, Lorenz HM, Micol W, Hauer K, Müller‐Tidow C, Bauer JM, Jordan K, Neuendorff NR. Validation of a proxy-reported SARC-F questionnaire for current and retrospective screening of sarcopenia-related functional impairments. J Cachexia Sarcopenia Muscle 2022; 13:264-275. [PMID: 34898035 PMCID: PMC8818621 DOI: 10.1002/jcsm.12871] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The strength, assistance walking, rise from a chair, climb stairs, and falls (SARC-F) questionnaire is a well-established instrument for screening of sarcopenia and sarcopenia-related functional impairments. As it is based on self-reporting, its use precludes patients who are unable to answer the questionnaire as a consequence of severe acute diseases or cognitive impairment. Therefore, we aimed to validate a proxy-reported version of the SARC-F for both ad-hoc as well as retrospective screening for severe sarcopenia-related functional impairments. METHODS Patients aged ≥60 years completed the SARC-F and performed the short physical performance battery (SPPB) at baseline (T1). Proxies in Cohort A gave a simultaneous assessment of the patients' functional status with the proxy-reported SARC-F at T1 and again, retrospectively, after 3 months (T2). Proxies in Cohort B only completed the SARC-F retrospectively at T2. The questionnaires' performances were assessed through sensitivity/specificity analyses and receiver operating characteristic (ROC) curves. For non-inferiority analyses, results of both the patient-reported and proxy-reported SARC-F were correlated with the SPPB total score as well as the results of the chair-rise test subcategory; the respective correlation coefficients were tested against each other. RESULTS One hundred and four patients and 135 proxies participated. Using a SPPB score < 9 points as the reference standard, the proxy-reported SARC-F identified patients at high risk for sarcopenia-related functional impairment with a sensitivity of 0.81 (ad-hoc), 0.88 (retrospective Cohort A), and 0.87 (retrospective Cohort B) as well as a specificity of 0.89 (ad-hoc), 0.78 (retrospective Cohort A), and 0.64 (retrospective Cohort B). Areas under the ROC curves were ≥ 0.9 for the ad-hoc proxy-reported SARC-F and the retrospective proxy-reported SARC-F in both cohorts. The proxy-reported SARC-F showed a non-inferior correlation with the SPPB compared with the patient-reported SARC-F for ad-hoc (P = <0.001) as well as retrospective screening for severe sarcopenia-related functional impairment in both Cohorts A (P = 0.007) and B (P = 0.026). CONCLUSIONS Proxy-reported SARC-F is a valid instrument for both ad-hoc as well as retrospective screening for sarcopenia-related functional impairment and could become the standard tool for evaluating this risk in older adults with severe acute disease, for example, in patients with quickly evolving haematological conditions.
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Affiliation(s)
- Johannes Maurus
- Department of Medicine V – Haematology, Oncology and RheumatologyUniversity Hospital HeidelbergHeidelbergGermany
- Clinic for UrologyUniversity Hospital AugsburgAugsburgGermany
| | - Tobias Terzer
- Division of BiostatisticsGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Axel Benner
- Division of BiostatisticsGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Sabine Goisser
- Center of Geriatric MedicineHeidelberg University, AGAPLESION Bethanien Hospital HeidelbergHeidelbergGermany
| | - Annette Eidam
- Center of Geriatric MedicineHeidelberg University, AGAPLESION Bethanien Hospital HeidelbergHeidelbergGermany
| | - Anja Roth
- Center of Geriatric MedicineHeidelberg University, AGAPLESION Bethanien Hospital HeidelbergHeidelbergGermany
| | - Maike Janssen
- Department of Medicine V – Haematology, Oncology and RheumatologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Sonia Jaramillo
- Department of Medicine V – Haematology, Oncology and RheumatologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Hannes Martin Lorenz
- Department of Medicine V – Haematology, Oncology and RheumatologyUniversity Hospital HeidelbergHeidelbergGermany
| | - William Micol
- Center of Geriatric MedicineHeidelberg University, AGAPLESION Bethanien Hospital HeidelbergHeidelbergGermany
| | - Klaus Hauer
- Center of Geriatric MedicineHeidelberg University, AGAPLESION Bethanien Hospital HeidelbergHeidelbergGermany
| | - Carsten Müller‐Tidow
- Department of Medicine V – Haematology, Oncology and RheumatologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Jürgen M. Bauer
- Center of Geriatric MedicineHeidelberg University, AGAPLESION Bethanien Hospital HeidelbergHeidelbergGermany
- Network Aging Research (NAR)Heidelberg UniversityHeidelbergGermany
| | - Karin Jordan
- Department of Medicine V – Haematology, Oncology and RheumatologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Nina Rosa Neuendorff
- Department of Medicine V – Haematology, Oncology and RheumatologyUniversity Hospital HeidelbergHeidelbergGermany
- Clinic for Haematology and Stem‐Cell TransplantationUniversity Hospital EssenEssenGermany
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Neuendorff N, Gómez-Moreno C. News and hot topics in geriatric medicine that are of interest for geriatric oncologists: Insights from the 17th EuGMS meeting 2021 – A report from Young SIOG. J Geriatr Oncol 2022; 13:758-760. [DOI: 10.1016/j.jgo.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/05/2022] [Indexed: 10/19/2022]
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Chen S, Ma T, Cui W, Li T, Liu D, Chen L, Zhang G, Zhang L, Fu Y. Frailty and long-term survival of patients with colorectal cancer: a meta-analysis. Aging Clin Exp Res 2022; 34:1485-1494. [PMID: 35103954 DOI: 10.1007/s40520-021-02072-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frailty has been related with the risk of postoperative complication in patients with colorectal cancer (CRC). However, the association between frailty and long-term survival in patients with CRC has not been comprehensively evaluated. We performed a meta-analysis to systematically evaluate the relationship between frailty and long-term survival of these patients. METHODS Relevant cohort studies with follow-up duration ≥ 1 year were identified from Medline, Embase, and Web of Science. A random-effect model after incorporation of the between-study heterogeneity was selected to pool the results. RESULTS Ten cohort studies with 35,546 patients were included, and 4100 (11.5%) of them had frailty. Pooled results showed that patients with frailty had worse overall survival compared to those without frailty at baseline (relative risk [RR]: 2.21, 95% confidence interval [CI] 1.43-3.41, P < 0.001; I2 = 92%). Results were consistent for studies adjusting age (RR: 2.20, P < 0.001) or including older cancer patients only (RR: 2.28, P = 0.002). Subgroup analyses showed that difference in study design, follow-up duration, or study quality scores may not significantly affect the findings (P for subgroup analyses all > 0.05). Further meta-analyses with two datasets showed that frailty was also associated with worse cancer-specific survival (RR: 4.60, 95% CI 2.75-7.67, P < 0.001; I2 = 38%) and recurrence-free survival (RR: 1.72, 95% CI 1.30-2.28, P < 0.001; I2 = 0%). CONCLUSIONS Frailty at admission is associated with worse survival of patients with colorectal cancer.
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Affiliation(s)
- Suhua Chen
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China.
| | - Tianjiang Ma
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Wei Cui
- Department of Spinal Surgery, Luohe Central Hospital, Luohe, 462000, China
| | - Taowei Li
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Duoping Liu
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Lang Chen
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Guoyao Zhang
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Lei Zhang
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Yali Fu
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
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278
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津端 由. [Approach to shared decision-making based on geriatric assessments in older cancer patients]. Nihon Ronen Igakkai Zasshi 2022; 59:457-463. [PMID: 36476692 DOI: 10.3143/geriatrics.59.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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279
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Seedor RS, Meeker CR, Lewis B, Handorf EA, Filchner KA, Varadarajan R, Hensold J, Padmanabhan A, Negin B, Blankstein K, Chawla NR, Song W(F, Epstein J, Winn J, Goldstein L, Dotan E. OUP accepted manuscript. Oncologist 2022; 27:e133-e141. [PMID: 35641214 PMCID: PMC8895742 DOI: 10.1093/oncolo/oyab032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/24/2021] [Indexed: 11/14/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Rino S Seedor
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
| | - Caitlin R Meeker
- Cancer Prevention and Control Department, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Bianca Lewis
- Cancer Prevention and Control Department, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Kelly A Filchner
- Cancer Prevention and Control Department, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Ramya Varadarajan
- Medical Oncology Hematology Consultants, Christiana Care Helen F. Graham Cancer Center & Research Institute, Newark, DE, USA
| | | | - Aruna Padmanabhan
- Medical Oncology Department, Fox Chase Cancer Center at Temple University Hospital, Philadelphia, PA, USA
| | - Benjamin Negin
- Southern Oncology Hematology Associates, Vineland, NJ, USA
| | | | - Neha R Chawla
- AtlantiCare Cancer Care Institute, Egg Harbor Township, NJ, USA
| | | | - Jessica Epstein
- Cancer Prevention and Control Department, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jennifer Winn
- Medical Oncology Department, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Lori J Goldstein
- Medical Oncology Department, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Efrat Dotan
- Medical Oncology Department, Fox Chase Cancer Center, Philadelphia, PA, USA
- Corresponding author: Efrat Dotan, MD, Department of Medical Oncology, 333 Cottman Avenue Fox Chase Cancer Center, Philadelphia, PA 19128, USA. Tel: +1 215 728 2500;
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長島 文, 古瀬 純. [Cancer treatment and supportive management in elderly]. Nihon Ronen Igakkai Zasshi 2022; 59:1-8. [PMID: 35264523 DOI: 10.3143/geriatrics.59.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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281
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Hernandez-Torres C, Korc-Grodzicki B, Hsu T. Models of clinical care delivery for geriatric oncology in Canada and the United States: A survey of geriatric oncology care providers. J Geriatr Oncol 2022; 13:447-453. [DOI: 10.1016/j.jgo.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
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Hamaker ME, Rostoft S. Geriatric assessment in older patients with cancer: a new standard of care. Lancet 2021; 398:1853-1855. [PMID: 34741813 DOI: 10.1016/s0140-6736(21)01998-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, 3782 KE Utrecht, Netherlands.
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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