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Gefen R, Emile SH, Garoufalia Z, Horesh N, Dourado J, Wexner SD. Local vs radical resection of stage I-III rectal cancer in very elderly patients: an exact matched analysis of the National Cancer Database. J Gastrointest Surg 2024; 28:1259-1264. [PMID: 38815802 DOI: 10.1016/j.gassur.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/13/2024] [Accepted: 05/25/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Treatment of elderly patients with cancer is challenging as they can be overtreated with respect to frailty or undertreated because of advanced age. Maintaining a good quality of life is essential for this population. This study aimed to assess the difference in overall survival and short-term outcomes according to the extent of rectal cancer resection in patients aged ≥80 years. METHODS In this retrospective cohort study, very elderly patients with stage I-III rectal cancer aged ≥80 years were identified from the National Cancer Database (2004-2019). Patients were divided into 2 groups: radical resection and local excision. The groups were matched using exact matched analysis for clinical T and N stage, tumor size, and neoadjuvant treatment. The main outcome measures were overall survival, hospital stay, 30-day unplanned readmissions, and short-term mortality. RESULTS A total of 9634 patients were included (local excision = 2710; radical resection = 6924). After matching, 1106 patients were included in each group with a median follow-up of 49.9 and 51.7 months, respectively. The radical resection group had statistically significantly longer overall survival than did the local excision group (60 vs 57.2 months, P = .026). Local excision was associated with shorter length of stay (1 vs 7 days. P < .001), lower 30-day mortality (odds ratio: 0.43; 95% CI: 0.25-0.75, P = .003), lower 90-day mortality (odds ratio: 0.47, 95% CI: 0.32-0.68, P < .001), and lower 30-day readmission (odds ratio: 0.49, 95% CI: 0.33-0.74, P < .001). A subgroup analysis of matched patients with cTis-T2 and N0 tumors who underwent curative surgery revealed similar results. CONCLUSION Radical resection of rectal cancer in very elderly patients has a modest survival benefit, whereas local excision has lower odds of readmission and short-term mortality.
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Affiliation(s)
- Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, United States; Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, United States; Colorectal Surgery Unit, Mansoura University Hospital, Mansoura, University, Mansoura, Egypt
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, United States
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, United States; Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel
| | - Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, United States
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, United States.
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Han J, Zhang Q, Lan J, Yu F, Liu J. Frailty worsens long-term survival in patients with colorectal cancer: a systematic review and meta-analysis. Front Oncol 2024; 14:1326292. [PMID: 38406806 PMCID: PMC10889110 DOI: 10.3389/fonc.2024.1326292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Background Colorectal cancer (CRC) is the 3rd most common cancer in men and 2nd most common malignancy in females across the globe leading to high mortality rates. Frailty is an age-related syndrome that has been associated with high morbidity and mortality. This systematic review aimed to examine if frailty can predict long-term (>1 year) outcomes of patients with CRC. Methods This PROSPERO registered review examined the databases of PubMed, Embase, and Web of Science till 4th September 2023 for cohort studies assessing the association between frailty and long-term outcomes of CRC. Results 15 studies with 45288 patients were included. 6573 patients (14.5%) were frail. Meta-analysis demonstrated that frailty was associated with statistically significant poor overall survival (OS) (HR: 2.11 95% CI: 1.44, 3.08 I2 = 94%) (14 studies), cancer-specific survival (CSS) (HR: 4.59 95% CI: 2.75, 7.67 I2 = 38%) (2 studies), and disease-free survival (DFS) (HR: 1.46 95% CI: 1.28, 1.66 I2 = 0%) (5 studies) after CRC. Subgroup analysis for OS based on study type, location, sample size, stage of cancer, percentage with frailty, treatment, adjustment for CRC stage and comorbidities, and follow-up did not change the results. These results were not altered in significance on sensitivity analysis. Conclusion Our results show that frail CRC patients have poor OS and DFS as compared to non-frail patients. Variations in frailty measurement tools and high inter-study heterogeneity are major limitations of the review. Systematic review registration https://www.crd.york.ac.uk/prospero/, PROSPERO, CRD42023450586.
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Affiliation(s)
- Jiangxue Han
- Oncology Department, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Qin Zhang
- Oncology Department, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Jiarong Lan
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Medicine, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, China
| | - Fang Yu
- Department of Pathology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Jie Liu
- Institute of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Fernando D, Hanna J, Cohen R, Ryan J. Adjuvant chemotherapy improves survival amongst octogenarians following resection of colorectal adenocarcinoma. ANZ J Surg 2024; 94:181-186. [PMID: 37772450 DOI: 10.1111/ans.18715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The Australian population is ageing, with an increasing number of patients diagnosed with colorectal cancer in their eighth decade. This group represents a challenging cohort to deliver multidisciplinary care, with increased morbidity and mortality related to surgical and oncological therapies. This project aimed to compare surgical and oncological outcomes in octogenarian and non-octogenarian patients with colorectal cancer. METHODS A matched case-control retrospective review of a prospectively maintained institutional database of colorectal cancer patients treated between 2005 and 2021 was conducted. Patient demographics, treatment details, peri-operative complications, and long-term survival were reported. The primary outcome, cancer-specific survival, was investigated using time-to-event analysis and interrogated with multivariate regression. RESULTS There were 747 patients included in the study. There was no difference in five-year cancer-specific survival and recurrence-free survival between cohorts. Multivariate analysis for octogenarians confirmed a significant hazard signal associated with worsening cancer stage and a survival benefit associated with the administration of adjuvant therapy. However, we noted that stage-matched octogenarian patients received less adjuvant treatment compared to non-octogenarians. CONCLUSION Octogenarians undergoing treatment for colorectal cancer have similar cancer-specific survival and recurrence-free survival to non-octogenarians. Our study demonstrates a survival benefit when adjuvant therapy is provided to octogenarians, despite only half of this cohort receiving therapy compared to their younger peers. Further research into adjuvant therapy with surgical resection for CRC in older Australians is required.
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Affiliation(s)
- Dhanushke Fernando
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Joseph Hanna
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Ryan Cohen
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jennifer Ryan
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
- Colorectal Surgery Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Normann M, Ekerstad N, Angenete E, Prytz M. Mortality and morbidity after colorectal cancer resection surgery in elderly patients: a retrospective population-based study in Sweden. World J Surg Oncol 2024; 22:23. [PMID: 38254209 PMCID: PMC10802062 DOI: 10.1186/s12957-024-03316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Colorectal cancer is primarily a condition of older adults, and surgery is the cornerstone of treatment. As life expectancy is increasing and surgical techniques and perioperative care are developing, curative surgery is often conducted even in ageing populations. However, the risk of morbidity, functional decline, and mortality following colorectal cancer resection surgery are known to increase with increasing age. This study aims to describe real-world data about postoperative mortality and morbidity after resection surgery for colorectal cancer in the elderly (≥ 70 years) compared to younger patients (< 70 years), in a Swedish setting. METHODS A cohort study including all patients diagnosed with colorectal cancer in a Swedish region of 1.7 million inhabitants between January 2016 and May 2020. Patients were identified through the Swedish Colorectal Cancer Registry, and all baseline and outcome variables were extracted from the registry. The following outcome measures were compared between the two age groups: 90-day mortality rates, postoperative complications, postoperative intensive care, reoperations, readmissions, and 1-year mortality. To adjust the analyses for baseline confounders in the comparison of the outcome variables, the following methods were used: marginal matching, calliper (ID matching), and logistic regression adjusted for baseline confounders. RESULTS The cohort consisted of 5246 patients, of which 3849 (73%) underwent resection surgery. Patients that underwent resection surgery were significantly younger than those who did not (mean ± SD, 70.9 ± 11.4 years vs 73.7 ± 12.8 years, p < 0.001). Multivariable analyses revealed that both 90-day and 1-year mortality rates were higher in older patients that underwent resection surgery (90-day mortality OR 2.12 [95% CI 1.26-3.59], p < 0.005). However, there were no significant differences in postoperative intensive care, postoperative complications, reoperations, or readmissions. CONCLUSION Elderly patients suffer increased postoperative mortality after resection surgery for colorectal cancer compared to younger individuals. Given the growing elderly population that will continue to require surgery for colorectal cancer, more efficient ways of determining and handling individual risk for older adults need to be implemented in clinical practice.
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Grants
- VGFOUREG-940671 Department of Research and Development, Västra Götalandsregionen, Sweden
- VGFOUREG-940671 Department of Research and Development, Västra Götalandsregionen, Sweden
- VGFOUREG-940671 Department of Research and Development, Västra Götalandsregionen, Sweden
- VGFOUREG-940671 Department of Research and Development, Västra Götalandsregionen, Sweden
- VGFOUFBD-937668 Department of Research and Development, Fyrbodal, Sweden
- VGFOUFBD-937668 Department of Research and Development, Fyrbodal, Sweden
- VGFOUFBD-937668 Department of Research and Development, Fyrbodal, Sweden
- VGFOUFBD-937668 Department of Research and Development, Fyrbodal, Sweden
- University of Gothenburg
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Affiliation(s)
- Maria Normann
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden.
| | - Niklas Ekerstad
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Research and Development, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
| | - Eva Angenete
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Prytz
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
- Department of Research and Development, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
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Gefen R, Emile SH, Horesh N, Garoufalia Z, Wexner SD. Age-related variations in colon and rectal cancer: An analysis of the national cancer database. Surgery 2023; 174:1315-1322. [PMID: 37735035 DOI: 10.1016/j.surg.2023.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Characteristics of colorectal diseases may vary according to the patient's age. By using a large national database, we assessed age-related differences in characteristics and treatments of colorectal cancer and to evaluate the influence of age on outcomes. METHOD Retrospective cohort analysis of all patients who underwent surgical resection for colorectal cancer in the US National Cancer Database between 2005 and 2019. Patients were divided into 3 age groups: young age onset (<50 years), middle age group (50-79 years), and very old (≥80 years). Differences in tumor characteristics among groups were assessed. The main outcomes were clinical and treatment characteristics and short-term mortality. RESULTS In total, 662,102 patients with colon cancer and 114,460 with rectal cancer were included-36.1% of young patients with colon cancer presented with metastatic disease. Older patients underwent open surgery more often and received chemotherapy and radiation therapy less often than did the other 2 groups regarding disease stage. Very old patients, compared to middle-aged and young patients, had longer hospitalization and significantly higher rates of 30-day mortality after colon (7.6% vs 2.4% vs 0.7%; P < .001) and rectal (5.9% vs 1.3% vs 0.3%; P < .001) cancer surgery and higher 90-day mortality after colon (12.9% vs 4.6% vs 1.7% P < .001) and rectal (10.3% vs 2.6% vs 0.7%; P < .001) cancer surgery.Older patients had significantly shorter overall survival than the other 2 groups, regardless of pathologic stage, Charlson -Deyo comorbidity score, or tumor side. CONCLUSION Significant age-related disparities in characteristics, treatments, and outcomes of colorectal cancer were found in this study. Recognizing these differences can be the first step toward reducing age-related treatment differences.
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Affiliation(s)
- Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel. https://twitter.com/RachellGefen
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, Mansoura University Hospital, Mansoura University, Egypt. https://twitter.com/dr_samehany81
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel. https://twitter.com/nirhoresh
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/ZGaroufalia
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
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6
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Golder AM, Conlan O, McMillan DC, Mansouri D, Horgan PG, Roxburgh CS. Adverse Tumour and Host Biology May Explain the Poorer Outcomes Seen in Emergency Presentations of Colon Cancer. Ann Surg 2023; 278:e1018-e1025. [PMID: 37036099 DOI: 10.1097/sla.0000000000005872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To examine the association between tumor/host factors (including the systemic inflammatory response), mode of presentation, and short/long-term outcomes in patients undergoing curative resectional surgery for TNM I to III colon cancer. BACKGROUND Emergency presentations of colon cancer are associated with worse long-term outcomes than elective presentations despite adjustment for TNM stage. A number of differences in tumor and host factors have been identified between elective and emergency presentations and it may be these factors that are associated with adverse outcomes. METHODS Patients undergoing curative surgery for TNM I to III colon cancer in the West of Scotland from 2011 to 2014 were identified. Tumor/host factors independently associated with the emergency presentation were identified and entered into a subsequent survival model to determine those that were independently associated with overall survival/cancer-specific survival (OS/CSS). RESULTS A total of 2705 patients were identified. The emergency presentation was associated with a worse 3-year OS and CSS compared with elective presentations (70% vs 86% and 91% vs 75%). T stage, age, systemic inflammatory grade, anemia (all P < 0.001), N stage ( P = 0.077), extramural venous invasion ( P = 0.003), body mass index ( P = 0.001), and American Society of Anesthesiologists Classification classification ( P = 0.021) were independently associated with emergency presentation. Of these, body mass index [hazard ratio (HR), 0.82], American Society of Anesthesiologists Classification (HR, 1.45), anemia (HR, 1.29), systemic inflammatory grade (HR. 1.11), T stage (HR, 1.57), N stage (HR, 1.80), and adjuvant chemotherapy (HR, 0.47) were independently associated with OS. Similar results were observed for CSS. CONCLUSIONS Within patients undergoing curative surgery for colon cancer, the emergency presentation was not independently associated with worse OS/CSS. Rather, a combination of tumor and host factors account for the worse outcomes observed.
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Affiliation(s)
- Allan M Golder
- Academic Unit of Surgery-Glasgow Royal Infirmary, Glasgow, UK
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Maeda H, Takahashi M, Seo S, Hanazaki K. Frailty and Colorectal Surgery: Review and Concept of Cancer Frailty. J Clin Med 2023; 12:5041. [PMID: 37568445 PMCID: PMC10419357 DOI: 10.3390/jcm12155041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Frailty is characterized by reduced physiological reserves across multiple systems. In patients with frailty, oncological surgery has been associated with a high rate of postoperative complications and worse overall survival. Further, given that cancer and frailty can co-exist in the same patient, cancer and cancer-related symptoms can rapidly accelerate the progression of baseline frailty, which we have termed "cancer frailty". This distinction is clinically meaningful because the prioritization of interventions and the treatment outcomes may differ based on health conditions. Specifically, in patients with cancer frailty, improvements in frailty may be achieved via surgical removal of tumors, while prehabilitation may be less effective, which may in turn result in delayed treatment and cancer progression. In this review, we focused on challenges in the surgical treatment of non-metastatic colorectal cancers in patients with frailty, including those related to decision making, prehabilitation, and surgery. Potential recommendations for treating patients with cancer frailty are also discussed.
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Affiliation(s)
- Hiromichi Maeda
- Department of Surgery, Kochi Medical School Hospital, Kohasu, Oko-cho, Nankoku 783-8505, Japan; (M.T.); (S.S.); (K.H.)
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Clark CJ, Adler R, Xiang L, Shah SK, Cooper Z, Kim DH, Lin KJ, Hsu J, Lipsitz S, Weissman JS. Outcomes for patients with dementia undergoing emergency and elective colorectal surgery: A large multi-institutional comparative cohort study. Am J Surg 2023; 226:108-114. [PMID: 37031040 PMCID: PMC10330079 DOI: 10.1016/j.amjsurg.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Alzheimer's Disease and Related Dementias (ADRD) may result in poor surgical outcomes. The current study aims to characterize the risk of ADRD on outcomes for patients undergoing colorectal surgery. METHODS Colorectal surgery patients with and without ADRD from 2007 to 2017 were identified using electronic health record-linked Medicare claims data from two large health systems. Unadjusted and adjusted analyses were performed to evaluate postoperative outcomes. RESULTS 5926 patients (median age 74) underwent colorectal surgery of whom 4.8% (n = 285) had ADRD. ADRD patients were more likely to undergo emergent operations (27.7% vs. 13.6%, p < 0.001) and be discharged to a facility (49.8% vs 28.9%, p < 0.001). After multi-variable adjustment, ADRD patients were more likely to have complications (61.1% vs 48.3%, p < 0.001) and required longer hospitalization (7.1 vs 6.1 days, p = 0.001). CONCLUSIONS The diagnosis of ADRD is an independent risk factor for prolonged hospitalization and postoperative complications after colorectal surgery.
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Affiliation(s)
- Clancy J Clark
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
| | - Rachel Adler
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Lingwei Xiang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Samir K Shah
- Division of Vascular Surgery, Department of General Surgery, University of Florida, Gainesville, FL, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - John Hsu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
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Gheybi K, Buckley E, Vitry A, Roder D. Variations in colorectal cancer pattern of care by age and comorbidity in South Australia. Cancer Med 2023. [PMID: 37084009 DOI: 10.1002/cam4.5901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Advanced age is associated with decreased likelihood of colorectal cancer treatment. Here, we investigated the extent to which comorbidities are accountable for this lesser treatment. METHODS Using population-based datasets, the pattern of care among CRC cases in South Australia during 2004-2013 was investigated. Models were used to investigate associations of age with each treatment type, and differences in these associations were explored by comorbidity and cancer site. RESULTS The presence of comorbidity was associated with a significantly weaker relationship of age with surgery and chemotherapy. The association of age with surgery also varied for colon and rectal primary cancer sites. Individual comorbidity types varied in their associations with each treatment category. For example, dementia was associated with less chemotherapy provision, however, it was not significantly related to the likelihood of surgery. CONCLUSION This study indicates that the association of age with surgical treatment differed significantly by the CRC subsite. Comorbidity moderated the negative association of age with chemotherapy, and less so, with extent of surgery. Results were novel in indicating associations of multiple individual comorbidity types with CRC treatment modalities. The data suggest that different individual comorbidity types may have different effects on treatment and should be studied separately.
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Affiliation(s)
- Kazzem Gheybi
- University of South Australia Allied Health and Human Performance, South Australia, Adelaide, Australia
- Cancer epidemiology and population health, University of South Australia, South Australia, Adelaide, Australia
- Charles Perkins Centre, School of Medical Sciences, University of Sydney, New South Wales, Sydney, Australia
| | - Elizabeth Buckley
- University of South Australia Allied Health and Human Performance, South Australia, Adelaide, Australia
| | - Agnes Vitry
- University of South Australia Clinical and Health Sciences, South Australia, Adelaide, Australia
| | - David Roder
- University of South Australia Allied Health and Human Performance, South Australia, Adelaide, Australia
- Cancer epidemiology and population health, University of South Australia, South Australia, Adelaide, Australia
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Morishima T, Kuwabara Y, Saito MK, Odani S, Kudo H, Kato M, Nakata K, Miyashiro I. Patterns of staging, treatment, and mortality in gastric, colorectal, and lung cancer among older adults with and without preexisting dementia: a Japanese multicentre cohort study. BMC Cancer 2023; 23:67. [PMID: 36658524 PMCID: PMC9854163 DOI: 10.1186/s12885-022-10411-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 12/05/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Little is known about dementia's impact on patterns of diagnosis, treatment, and outcomes in cancer patients. This study aimed to elucidate the differences in cancer staging, treatment, and mortality in older cancer patients with and without preexisting dementia. METHODS Using cancer registry data and administrative data from 30 hospitals in Japan, this multicentre retrospective cohort study examined patients aged 65-99 years who were newly diagnosed with gastric, colorectal, or lung cancer in 2014-2015. Dementia status (none, mild, and moderate-to-severe) at the time of cancer diagnosis was extracted from clinical summaries in administrative data, and set as the exposure of interest. We constructed multivariable logistic regression models to analyse cancer staging and treatment, and multivariable Cox regression models to analyse three-year survival. RESULTS Among gastric (n = 6016), colorectal (n = 7257), and lung (n = 4502) cancer patients, 5.1%, 5.8%, and 6.4% had dementia, respectively. Patients with dementia were more likely to receive unstaged and advanced-stage cancer diagnoses; less likely to undergo tumour resection for stage I, II, and III gastric cancer and for stage I and II lung cancer; less likely to receive pharmacotherapy for stage III and IV lung cancer; more likely to undergo tumour resection for all-stage colorectal cancer; and more likely to die within three years of cancer diagnosis. The effects of moderate-to-severe dementia were greater than those of mild dementia, with the exception of tumour resection for colorectal cancer. CONCLUSION Older cancer patients with preexisting dementia are less likely to receive standard cancer treatment and more likely to experience poorer outcomes. Clinicians should be aware of these risks, and would benefit from standardised guidelines to aid their decision-making in diagnosing and treating these patients.
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Affiliation(s)
- Toshitaka Morishima
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567, Osaka, Japan.
| | - Yoshihiro Kuwabara
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Mari Kajiwara Saito
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Satomi Odani
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Haruka Kudo
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Mizuki Kato
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Kayo Nakata
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
| | - Isao Miyashiro
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567 Osaka, Japan
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Kuryba AJ, Boyle JM, van der Meulen J, Aggarwal A, Walker K, Fearnhead NS, Braun MS. Severity of Dementia and Survival in Patients Diagnosed with Colorectal Cancer: A National Cohort Study in England and Wales. Clin Oncol (R Coll Radiol) 2023; 35:e67-e76. [PMID: 36216698 DOI: 10.1016/j.clon.2022.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/08/2022] [Accepted: 08/25/2022] [Indexed: 01/04/2023]
Abstract
AIMS There is little evidence about the survival of patients with colorectal cancer (CRC) also diagnosed with dementia. We quantified dementia severity and estimated how it is associated with 2-year overall survival. MATERIALS AND METHODS Records of patients aged 65 years or older diagnosed with CRC in England and Wales were identified. A novel proxy for dementia severity combined dementia diagnosis in administrative hospital data with Eastern Cooperative Oncology Group performance status. Cox regression was used to estimate hazard ratios with and without risk adjustment. RESULTS In total, 4033 of 105 250 CRC patients (3.8%) had dementia recorded. Two-year survival decreased with increasing dementia severity from 65.4% without dementia, 53.5% with mild dementia, 33.0% with moderate dementia to 16.5% with severe dementia (hazard ratio comparing severe with no dementia: 2.97; 95% confidence interval 2.79, 3.16). Risk adjustment for comorbidity and cancer stage reduced this association slightly (hazard ratio 2.52; 95% confidence interval 2.37, 2.68) and additional adjustment for treatment factors reduced it further (hazard ratio 1.60; 95% confidence interval 1.50, 1.70). CONCLUSIONS Survival of CRC patients varied strongly according to dementia severity, suggesting that a 'one-size-fits-all' policy for the care of CRC patients with dementia is not appropriate. Comprehensive assessment of cancer patients with dementia that considers dementia severity is essential in a shared decision-making process that ensures patients receive the most appropriate treatment for their individual needs and preferences.
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Affiliation(s)
- A J Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - J M Boyle
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Department of Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - K Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - N S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M S Braun
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK; School of Medical Sciences, University of Manchester, Manchester, UK
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12
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Factors associated with survival in older patients with stage I-III colorectal carcinoma who were not managed curatively in the Netherlands. J Geriatr Oncol 2022; 13:667-672. [PMID: 35304069 DOI: 10.1016/j.jgo.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
Abstract
AIM Some patients with stage I-III colorectal cancer (CRC) do not undergo tumor resection. Little is known about survival of these non-curatively managed patients. The aim of this study is to report all-cause mortality and to identify which factors are associated with survival in these patients. METHODS A retrospective review of electronic medical records was performed in two hospitals in the Netherlands. Patients diagnosed with CRC without distant metastases (radiologically determined stage I-III) and managed without tumor resection between 2011 and 2017 were included. The primary outcome was all-cause mortality. The effect of several variables on survival was evaluated with a multivariate logistic regression. RESULTS Of the 107 patients with stage I-III CRC that did not undergo resection of the primary tumor, 80% died within two years; median survival time was 8.5 months (IQR 2.5-22 months). Malnutrition risk (OR 6.36 (CI 1.21-33.25); p = 0.03) and comorbidity burden (OR 1.51 (CI 1.05-2.18 p = 0.03) were significantly associated with decreased survival after two years in a multivariate model. Age and disease stage were not. When treatment decision was mainly patient driven instead of based on the multi-disciplinary tumor board's decision, survival was longer (mean overall survival 16 months vs 10 months, respectively) p < 0.05. CONCLUSION Survival of patients with radiologically determined stage I-III CRC who did not undergo surgical resection was approximately 20% at two years and associated with the number of comorbidities, malnutrition risk status and dependent living, but not with age or disease stage.
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13
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Golder AM, McMillan DC, Horgan PG, Roxburgh CSD. Determinants of emergency presentation in patients with colorectal cancer: a systematic review and meta-analysis. Sci Rep 2022; 12:4366. [PMID: 35288664 PMCID: PMC8921241 DOI: 10.1038/s41598-022-08447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
Colorectal cancer remains a significant cause of morbidity and mortality, even despite curative treatment. A significant proportion of patients present emergently and have poorer outcomes compared to elective presentations, independent of TNM stage. In this systematic review and meta-analysis, differences between elective/emergency presentations of colorectal cancer were examined to determine which factors were associated with emergency presentation. A literature search was carried out from 1990 to 2018 comparing elective and emergency presentations of colon and/or rectal cancer. All reported clinicopathological variables were extracted from identified studies. Variables were analysed through either systematic review or, if appropriate, meta-analysis. This study identified multiple differences between elective and emergency presentations of colorectal cancer. On meta-analysis, emergency presentations were associated with more advanced tumour stage, both overall (OR 2.05) and T/N/M/ subclassification (OR 2.56/1.59/1.75), more: lymphovascular invasion (OR 1.76), vascular invasion (OR 1.92), perineural invasion (OR 1.89), and ASA (OR 1.83). Emergencies were more likely to be of ethnic minority (OR 1.58). There are multiple tumour/host factors that differ between elective and emergency presentations of colorectal cancer. Further work is required to determine which of these factors are independently associated with emergency presentation and subsequently which factors have the most significant effect on outcomes.
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14
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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: 9] [Impact Index Per Article: 4.5] [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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15
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Peponis T, Stafford C, Cusack J, Cauley C, Goldstone R, Berger D, Bordeianou L, Kunitake H, Francone T, Ricciardi R. The growing trend for no primary surgery in colorectal cancer. Colorectal Dis 2021; 23:2659-2670. [PMID: 34288327 DOI: 10.1111/codi.15828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/13/2021] [Accepted: 07/12/2021] [Indexed: 02/08/2023]
Abstract
AIM In colorectal cancer (CRC), surgery of the primary site is commonly curative. Our aim was to determine estimates of 'no surgery' for primary CRC while identifying common reasons for no surgery. METHOD We identified all patients with a diagnosis of colorectal adenocarcinoma from the National Cancer Database between January 2004 and December 2016. Then, we identified patients who did not undergo surgery on the primary tumour and their demographic, tumour and institutional characteristics. Kaplan-Meier and logistic regression analyses were used to evaluate specific factors associated with overall survival as related to no surgery and recommendations against operative management. RESULTS A total of 1,208,878 patients with CRC were identified, 14.5% of whom had no surgery of the primary cancer. No surgery was more common in rectal cancer than in colon cancer. Despite a steady incidence of CRC diagnoses, the likelihood of no surgery grew by 170% over the study period. Metastatic disease was noted in 53.7% of the no surgery cohort. Nine per cent of the no surgery patient cohort received a recommendation against surgery despite the absence of metastatic disease, 7.5% refused surgery and only 2% underwent palliative surgery. On multivariable analysis, patients who were not recommended to have surgery were more likely to be older, uninsured, comorbid and receive care at a single hospital. The no surgery patients had significantly lower overall survival. CONCLUSION A substantial proportion of patients with CRC do not have surgery. Interventions aimed at expanding access and promoting second opinions at other cancer hospitals might reduce the growing rate of no surgery in CRC.
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Affiliation(s)
- Thomas Peponis
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Caitlin Stafford
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James Cusack
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christy Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert Goldstone
- Department of Surgery, Newton Wellesley Hospital, Newton, Massachusetts, USA
| | - David Berger
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Todd Francone
- Department of Surgery, Newton Wellesley Hospital, Newton, Massachusetts, USA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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16
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Caba Y, Dharmarajan K, Gillezeau C, Ornstein KA, Mazumdar M, Alpert N, Schwartz RM, Taioli E, Liu B. The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review. JNCI Cancer Spectr 2021; 5:pkab002. [PMID: 34056540 PMCID: PMC8152697 DOI: 10.1093/jncics/pkab002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/21/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022] Open
Abstract
Dementia and cancer occur commonly in older adults. Yet, little is known about the effect of dementia on cancer treatment and outcomes in patients diagnosed with cancer, and no guidelines exist. We performed a mixed studies review to assess the current knowledge and gaps on the impact of dementia on cancer treatment decision-making, cancer treatment, and mortality. A search in PubMed, Medline, and PsycINFO identified 55 studies on older adults with a dementia diagnosis before a cancer diagnosis and/or comorbid cancer and dementia published in English from January 2004 to February 2020. We described variability using range in quantitative estimates, ie, odds ratios (ORs), hazard ratios (HRs), and risk ratios (RR) when appropriate and performed narrative review of qualitative data. Patients with dementia were more likely to receive no curative treatment (including hospice or palliative care) (OR, HR, and RR range = 0.40-4.4, n = 8), while less likely to receive chemotherapy (OR and HR range = 0.11-0.68, n = 8), radiation (OR range = 0.24-0.56, n = 2), and surgery (OR range = 0.30-1.3, n = 4). Older adults with cancer and dementia had higher mortality than those with cancer alone (HR and OR range = 0.92-5.8, n = 33). Summarized findings from qualitative studies consistently revealed that clinicians, caregivers, and patients tended to prefer less aggressive care and gave higher priority to quality of life over life expectancy for those with dementia. Current practices in treatment-decision making for patients with both cancer and dementia are inconsistent. There is an urgent need for treatment guidelines for this growing patient population that considers patient and caregiver perspectives.
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Affiliation(s)
- Yaelin Caba
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kavita Dharmarajan
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Gillezeau
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Healthcare Delivery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rebecca M Schwartz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Tucker-Seeley RD, Wallington SF, Canin B, Tang W, McKoy JM. Health Equity for Older Adults With Cancer. J Clin Oncol 2021; 39:2205-2216. [PMID: 34043411 DOI: 10.1200/jco.21.00207] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Reginald D Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA.,USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Sherrie F Wallington
- The George Washington University School of Nursing & Milken Institute School of Public Health, Washington, DC
| | - Beverly Canin
- Cancer and Aging Research Group, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Weizhou Tang
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
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18
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Frasca M, Orazio S, Amadeo B, Sabathe C, Berteaud E, Galvin A, Burucoa B, Coureau G, Baldi I, Monnereau A, Mathoulin-Pelissier S. Palliative care referral in cancer patients with regard to initial cancer prognosis: a population-based study. Public Health 2021; 195:24-31. [PMID: 34034002 DOI: 10.1016/j.puhe.2021.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/23/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES More than half of cancer patients require palliative care; however, inequality in access and late referral in the illness trajectory are major issues. This study assessed the cumulative incidence of first hospital-based palliative care (HPC) referral, as well as the influence of patient-, tumor-, and care-related factors. STUDY DESIGN This is a retrospective population-based study. METHODS The study included patients from the 2014 population-based cancer registry of Gironde, France. International Classification of Diseases, Tenth Revision, coding for palliative care identified HPC referrals from 2014 to 2018. The study included 8424 patients. Analyses considered the competing risk of death and were stratified by initial cancer prognosis (favorable vs unfavorable [if metastatic or progressive cancer]). RESULTS The 4-year incidence of HPC was 16.7% (95% confidence interval, 16.6-16.8). Lung cancer led to more referrals, whereas breast, colorectal, and prostatic locations were associated to less frequent HPC compared with other solid tumors. Favorable prognosis central nervous system tumors and unfavorable prognosis hematological malignancies also showed less HPC. The incidence of HPC was higher in tertiary centers, particularly for older patients. In the favorable prognosis subgroup, older and non-deprived patients received more HPC. In the unfavorable prognosis subgroup, the incidence of HPC was lower in patients who lived in rural areas than those who lived in urban areas. CONCLUSIONS One-sixth of cancer patients require HPC. Some factors influencing referral depend on the initial cancer prognosis. Our findings support actions to improve accessibility, especially for deprived patients, people living in rural areas, those with hematological malignancies, and those treated outside tertiary centers. In addition, consideration of age as factor of HPC may allow for improved design of the referral system.
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Affiliation(s)
- Matthieu Frasca
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France; Department of Palliative Medicine, CHU Bordeaux, 33000, Bordeaux, France.
| | - Sébastien Orazio
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Brice Amadeo
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Camille Sabathe
- Biostatistic team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Biostatistic Team, UMR 1219, 33000, Bordeaux, France
| | - Emilie Berteaud
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Angeline Galvin
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Benoît Burucoa
- Department of Palliative Medicine, CHU Bordeaux, 33000, Bordeaux, France
| | - Gaelle Coureau
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Isabelle Baldi
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Alain Monnereau
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Simone Mathoulin-Pelissier
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France; Unité d'épidémiologie et de recherche cliniques, Institut Bergonié, 33000, Bordeaux, France
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19
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Niemeläinen S, Huhtala H, Ehrlich A, Kössi J, Jämsen E, Hyöty M. Long-term survival following elective colon cancer surgery in the aged. A population-based cohort study. Colorectal Dis 2020; 22:1585-1596. [PMID: 32645253 DOI: 10.1111/codi.15242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/18/2020] [Indexed: 01/01/2023]
Abstract
AIM The number of colorectal cancer patients increases with age. Long-term data support personalized management due to heterogeneity within the older population. This registry- and population-based study aimed to analyse long-term survival, and causes of death, after elective colon cancer surgery in the aged, focusing on patients who survived more than 3 months postoperatively. METHODS The data included patients ≥ 80 years who had elective surgery for Stage I-III colon cancer in four Finnish centres. The prospectively collected data included comorbidities, functional status, postoperative outcomes and long-term survival. Univariate and multivariate Cox regression analysis were conducted to determine factors associated with long-term survival. RESULTS A total of 386 surgical patients were included, of whom 357 survived over 3 months. Survival rates for all patients at 1, 3 and 5 years were 85%, 66% and 55%, compared to 92%, 71% and 59% for patients alive 3 months postoperatively, respectively. Higher age, American Society of Anesthesiologists (ASA) score ≥ 4, Charlson Comorbidity Index ≥ 6, tumour Stage III, open compared to laparoscopic surgery and severe postoperative complications were independently associated with reduced overall survival. Higher age (hazard ratio 1.97, 1.14-3.40), diabetes (1.56, 1.07-2.27), ASA score ≥ 4 (3.27, 1.53-6.99) and tumour Stage III (2.04, 1.48-2.81) were the patient-related variables affecting survival amongst those surviving more than 3 months postoperatively. Median survival time for patients given adjuvant chemotherapy was 5.4 years, compared to 3.3 years for patients not given postoperative treatment. CONCLUSIONS Fit aged colon cancer patients can achieve good long-term outcomes and survival with radical, minimally invasive surgical treatment, even with additional chemotherapy.
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Affiliation(s)
- S Niemeläinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - H Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - A Ehrlich
- Central Hospital of Central Finland, Jyväskylä, Finland
| | - J Kössi
- Päijät-Häme Central Hospital, Lahti, Finland
| | - E Jämsen
- Centre of Geriatrics, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Gerontology Research Center (GEREC), Tampere, Finland
| | - M Hyöty
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
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20
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Park H, Parys S, Tan J, Entriken F, Hodder R. Post-operative outcomes in the elderly following colorectal cancer surgery. ANZ J Surg 2020; 91:387-391. [PMID: 33089941 DOI: 10.1111/ans.16394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the prevalence of colorectal cancer in the elderly, there has been a lack of recent studies examining surgical outcomes in these patients. Post-operative outcomes of colorectal cancer surgeries in those aged 80 and above will be compared to those younger than 80. METHODS A retrospective study was conducted of adults receiving surgical resections at a single tertiary centre for colorectal cancer diagnosed between January 2017 and December 2019. Patient demographics, mode of presentation, tumour demographics, operative data and post-operative outcomes were investigated. RESULTS Of the 326 patients included, 56 were aged 80 and above. Older patients were more likely to be female (P = 0.02), present with surgical emergencies or from other workup rather than through screening (P = 0.002), have more locally advanced cancers (P = 0.009) and receive less neoadjuvant therapy (P = 0.016). Despite this, they had comparable outcomes to those younger than 80 in terms of length of stay (P = 0.21) and rates of complications including mortality (P = 0.67). CONCLUSION With appropriate patient selection and management, elderly patients can achieve comparable post-operative outcomes to their younger counterparts.
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Affiliation(s)
- Hyerin Park
- Colorectal Surgery Unit, Department of Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Simon Parys
- Colorectal Surgery Unit, Department of Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jonathan Tan
- Colorectal Surgery Unit, Department of Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Fiona Entriken
- Colorectal Surgery Unit, Department of Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rupert Hodder
- Colorectal Surgery Unit, Department of Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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21
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Franklyn J, Abdalkoddus M, Rossi B, Limnatitou D, Ahmed M, Sokker A, Douie WJ, Smolarek S. Prognosis of non-operative management of non-metastatic colorectal cancer in octa- and nonagenarians. Ann R Coll Surg Engl 2020; 102:504-509. [PMID: 32799666 DOI: 10.1308/rcsann.2020.0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of the study was to establish the natural history of elderly patients with non-metastatic colorectal cancer who underwent non-operative management in comparison with those who underwent operative management. MATERIALS AND METHODS A retrospective analysis of patients aged 80 years and above diagnosed with colorectal cancer between 2007 and 2015 in a tertiary care hospital in the Southwest of England was done. Patients were divided into non-operatively managed and operatively managed groups. Clinical demographics, Charlson Comorbidity Index, location of the tumour and overall survival between the two groups were compared. RESULTS A total of 407 patients were studied; 132 were treated non-operatively and 275 operatively. The non-operative group included fewer right-sided colon cancers (28.7% vs 54.9%), but significantly more rectal cancers were managed non-operatively (43.9 vs 23.6%, respectively). The two and five year overall survival was 38.9% and 11.3% respectively in the non-operative group, significantly lower than patients in the operative group where the two and five year survival was 78.9% and 59.6% respectively (p = .0001). The median Charlson Comorbidity Index was 7.99 for the non-operative group and 7.49 in the operative group (p = 0.109). Patients treated non-operatively were deemed unfit without objective frailty assessment and only 43/132(32.6%) had formal anaesthetic assessment before being deemed unfit for surgery. CONCLUSION The survival of octa- and nonagenarians with non-metastatic colorectal cancer managed conservatively is significantly less than counterparts managed operatively. Our present strategy of deciding and denying treatment of the elderly patient with colorectal cancer is arbitrary, highlighting the need for robust geriatric and frailty assessment.
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Affiliation(s)
- J Franklyn
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Abdalkoddus
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - B Rossi
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - D Limnatitou
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Ahmed
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - A Sokker
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - W J Douie
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - S Smolarek
- University Hospitals Plymouth NHS Trust, Plymouth, UK
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22
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Frasca M, Galvin A, Raherison C, Soubeyran P, Burucoa B, Bellera C, Mathoulin-Pelissier S. Palliative versus hospice care in patients with cancer: a systematic review. BMJ Support Palliat Care 2020; 11:188-199. [PMID: 32680891 DOI: 10.1136/bmjspcare-2020-002195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Guidelines recommend an early access to specialised palliative medicine services for patients with cancer, but studies have reported a continued underuse. Palliative care facilities deliver early care, alongside antineoplastic treatments, whereas hospice care structures intervene lately, when cancer-modifying treatments stop. AIM This review identified factors associated with early and late interventions of specialised services, by considering the type of structures studied (palliative vs hospice care). DESIGN We performed a systematic review, prospectively registered on PROSPERO (ID: CRD42018110063). DATA SOURCES We searched Medline and Scopus databases for population-based studies. Two independent reviewers extracted the data and assessed the study quality using Joanna Briggs Institute critical appraisal checklists. RESULTS The 51 included articles performed 67 analyses. Most were based on retrospective cohorts and US populations. The median quality scores were 19/22 for cohorts and 15/16 for cross-sectional studies. Most analyses focused on hospice care (n=37). Older patients, men, people with haematological cancer or treated in small centres had less specialised interventions. Palliative and hospice facilities addressed different populations. Older patients received less palliative care but more hospice care. Patients with high-stage tumours had more palliative care while women and patients with a low comorbidity burden received more hospice care. CONCLUSION Main disparities concerned older patients, men and people with haematological cancer. We highlighted the challenges of early interventions for older patients and of late deliveries for men and highly comorbid patients. Additional data on non-American populations, outpatients and factors related to quality of life and socioeconomic status are needed.
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Affiliation(s)
- Matthieu Frasca
- Department of Palliative Medicine, CHU of Bordeaux, Bordeaux, Aquitaine, France .,Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Angeline Galvin
- Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Chantal Raherison
- Department of Pneumology, CHU of Bordeaux, Bordeaux, Aquitaine, France
| | - Pierre Soubeyran
- CIC1401, Bergonie institute, Comprehensive Cancer Center, Bordeaux, Aquitaine, France.,UMR 1218, ACTION, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Benoît Burucoa
- Department of Palliative Medicine, CHU of Bordeaux, Bordeaux, Aquitaine, France
| | - Carine Bellera
- Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France.,CIC1401, Bergonie institute, Comprehensive Cancer Center, Bordeaux, Aquitaine, France
| | - Simone Mathoulin-Pelissier
- Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France.,UMR 1218, ACTION, University of Bordeaux, Bordeaux, Aquitaine, France
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23
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Quezada-Gutiérrez C, Álvarez-Bañuelos MT, Morales-Romero J, Sampieri CL, Guzmán-García RE, Montes-Villaseñor E. Factors associated with the survival of colorectal cancer in Mexico. Intest Res 2020; 18:315-324. [PMID: 32418415 PMCID: PMC7385577 DOI: 10.5217/ir.2019.09179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS Colorectal cancer (CRC) is a public health problem. In Mexico, there have been no recent studies conducted on survival in terms of this pathology or on the influence of prognostic factors. The study aims to determine the probability of survival in patients with CRC presence of low levels of schooling and a rural population, adjusted for clinical stage and type of treatment. METHODS A retrospective study was conducted in a cohort of 305 patients with CRC treated at State Cancer Center, located in Veracruz-Mexico; the follow-up period of 60 months (2012-2016). The survival probability was calculated using the Kaplan-Meier estimator and the log-rank test with 95% confidence intervals (CIs). Prognostic factors were determined using hazard ratio (HR) multivariate Cox regression analysis. RESULTS Overall survival was 40% at 60 months. Subjects in the age group ≥ 65 years had a low survival rate of 28% (P= 0.026) and an advanced clinical stage of 22% (P< 0.001). Of the patients with bone metastasis, none survived longer than 5 years (P= 0.008). With respect to the unfavorable prognostic factors identified in the multivariate analysis, a decreased level of schooling was associated with an HR of 7.6 (95% CI, 1.1-54.7), advanced clinical stage was associated with an HR of 2.1 (95% CI, 1.2-4.0), and the presence of metastasis had an HR of 1.8 (95% CI, 1.1-2.9). CONCLUSIONS Poor prognostic factors include an advanced clinical stage, the presence of metastasis and a low level of schooling. These findings confirm the importance of screening for early diagnosis, diminishing the barriers to accessing treatment and prospectively monitoring the population.
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24
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Huerta S, Pham T, Foster S, Livingston EH, Dineen S. Outcomes of Emergent Inguinal Hernia Repair in Veteran Octogenarians. Am Surg 2020. [DOI: 10.1177/000313481408000519] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Outcomes from emergent inguinal hernia (IH) repair in veteran octogenarians are not well described. We reviewed outcomes for this cohort from 2005 to 2012 at the VA North Texas Health Care System. There were 15 emergent (Group I) and 86 elective (Group II) operations performed in octogenarians. Age and American Society of Anesthesiologists status were similar in both groups. The rate of minor and major complications was higher in Group I compared with Group II (33 and 19% vs 22 and 2%, respectively; both Ps < 0.001). Hospital length of stay (LOS) and intensive care unit LOS were also longer in Group I compared with Group II (6.7 ± 7.0 and 2.5 ± 4.4 vs 0.8 ± 1.9 and 0.12 ± 0.6 days, respectively; both Ps < 0.001). Thirty-day mortality was 13 per cent for Group I and 0 per cent for Group II. Despite the high rate of comorbid conditions in our group, the risk associated with elective repair of IH was not prohibitive. In contrast, we observed that 15 per cent of patients presented with an incarcerated hernia during the study period and the mortality rate was 13 per cent in this cohort. Factors that might predict incarceration in veteran octogenarians need to be further investigated.
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Affiliation(s)
- Sergio Huerta
- From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas
| | - Thai Pham
- From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas
| | - Scott Foster
- From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas
| | - Edward H. Livingston
- From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas
| | - Sean Dineen
- From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas
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25
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Guo J, Yu J, Xu Z, Sun X, Zheng J. The role of surgery in patients aged 85 years or older with resectable gastric cancer: a propensity score matching analysis of the SEER database. Scand J Gastroenterol 2020; 55:694-700. [PMID: 32459113 DOI: 10.1080/00365521.2020.1769175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: An increasing number of newly diagnosed resectable gastric cancer (GC) patients are over 85 years of age. However, studies on surgical treatment in these patients are limited. This study aimed to explore the prognosis of a large sample of the oldest old GC patients receiving surgery.Methods: A total of 2914 oldest old patients with stage I-III GC were included in the linked Surveillance, Epidemiology, and End Results (SEER) database from 2006 to 2015. Based on their treatment, we assigned these patients to the surgery and no surgery groups. We used propensity score matching (1:1) to balance the baseline characteristics. The Kaplan-Meier method was used for the survival analysis. Multivariate Cox regression analysis was used to analyse the independent risk factors.Results: After propensity score matching, the median overall survival (OS) times in the surgery and no surgery groups were 24.0 (95% CI: 20.3-27.7) and 4.0 (95% CI: 3.5-4.5) months, respectively (p < .01). Age, sex, stage, histological type, and treatment with surgery and chemotherapy were independent risk factors for OS in the oldest old patients with GC. In total, 19% of the oldest old patients with GC died from causes unrelated to cancer.Conclusions: The current large-scale study demonstrated that the oldest old patients with stage I-III GC could benefit from elective surgery.
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Affiliation(s)
- Jing Guo
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junhui Yu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhengshui Xu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuejun Sun
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianbao Zheng
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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26
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de Jager E, Levine AA, Udyavar NR, Burstin HR, Bhulani N, Hoyt DB, Ko CY, Weissman JS, Britt LD, Haider AH, Maggard-Gibbons MA. Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map. J Am Coll Surg 2020; 228:276-298. [PMID: 30803548 DOI: 10.1016/j.jamcollsurg.2018.12.028] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Elzerie de Jager
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Adele A Levine
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - N Rhea Udyavar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | | | - Nizar Bhulani
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | | | - Clifford Y Ko
- American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Joel S Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - L D Britt
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Adil H Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - Melinda A Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA.
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27
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Zattoni D, Christoforidis D. How best to palliate and treat emergency conditions in geriatric patients with colorectal cancer. Eur J Surg Oncol 2020; 46:369-378. [PMID: 31973923 DOI: 10.1016/j.ejso.2019.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/12/2019] [Accepted: 12/19/2019] [Indexed: 12/21/2022] Open
Abstract
Almost one third of colorectal cancer (CRC) cases are diagnosed in an emergency setting, mostly among geriatric patients. Clinical scenarios are often complex and decision making delicate. Besides the obvious need to consider the patient's and/or family and care givers' desires, the surgeon should be able to make the best educated guess on future outcomes in three areas: oncological prognosis, morbidity and mortality risk, and long-term functional loss. Using simple and brief tools for frailty screening reasonable treatment goals with curative or palliative intent can be planned. The most frequent clinical scenarios of CRC in emergency are bowel obstruction and perforation. We propose treatment algorithms based on assessment of the patient's overall reserve and discuss the indications, techniques and impact of a stoma in the geriatric patient. Bridge to surgery strategies may be best adapted to help the frail geriatric patient overcome the acute disease and maybe return to previous state of function. Post-operative morbidity and mortality rates are high in emergency surgery for CRC, but if the geriatric patient survives the post-operative period, oncological prognosis seems to be similar to younger patients. Because the occurrence of complications is the strongest predictor of functional decline and death, post-operative care plays a major role to optimize outcomes. Future studies should further investigate emergency surgery of CRC in the older adults focusing in particular on functional outcomes in order to help physicians counsel patients and families for a tailored treatment.
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Affiliation(s)
- Davide Zattoni
- Department of General Surgery, Ospedale per gli Infermi di Faenza, Viale Stradone 9, 48018, Faenza, Italy.
| | - Dimitri Christoforidis
- Department of General Surgery, Ospedale Civico di Lugano, Via Tesserete 46, 6900, Lugano, Switzerland; Department of Visceral Surgery, Lausanne University Hospital and Lausanne University, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
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28
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Li X, Lu H, Gu Y, Zhang X, Zhang G, Shi T, Chen W. Tim-3 suppresses the killing effect of Vγ9Vδ2 T cells on colon cancer cells by reducing perforin and granzyme B expression. Exp Cell Res 2019; 386:111719. [PMID: 31726050 DOI: 10.1016/j.yexcr.2019.111719] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/24/2019] [Accepted: 11/09/2019] [Indexed: 02/06/2023]
Abstract
Gamma delta (γδ) T cell-based tumor immunotherapy has been one of the most promising cancer immunotherapeutic strategies. However, the key regulators of the Vγ9Vδ2 T cell-mediated antitumor response remain unclear. Recently, mounting reports have indicated that Tim-3 performs critical roles in the regulation of the activities of immune cells, including Vγ9Vδ2 T cells. However, the roles of Tim-3 in Vγ9Vδ2 T cell-mediated killing of colon cancer cells and the underlying mechanism remain largely unknown. Here, the proportion of Tim-3+ γδ T cells was significantly increased in both the peripheral blood and colon cancer tissue of patients and was significantly associated with TNM staging and tumor volume. Additionally, the activation of Tim-3 signaling significantly inhibited the killing efficiency of Vγ9Vδ2 T cells against colon cancer cells. In addition, Tim-3 signaling reduced the expression of perforin and granzyme B in Vγ9Vδ2 T cells. Blocking the perforin/granzyme B pathway also decreased the cytotoxicity of Vγ9Vδ2 T cells to colon cancer cells. Moreover, Tim-3 signaling reduced the perforin and granzyme B expression of Vγ9Vδ2 T cells in an ERK1/2 signaling pathway-dependent manner. This knowledge reveals that Tim-3 may be a promising therapeutic target to improve Vγ9Vδ2 T cell-based adoptive immunotherapy for colon cancer.
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Affiliation(s)
- Xiaomi Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Road, Suzhou, China
| | - Huimin Lu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Road, Suzhou, China; Jiangsu Institute of Clinical Immunology, The First Affiliated Hospital of Soochow University, 708 Renmin Road, Suzhou, China; Jiangsu Key Laboratory of Clinical Immunology, Soochow University, 708 Renmin Road, Suzhou, China
| | - Yanzheng Gu
- Jiangsu Institute of Clinical Immunology, The First Affiliated Hospital of Soochow University, 708 Renmin Road, Suzhou, China
| | - Xueguang Zhang
- Jiangsu Institute of Clinical Immunology, The First Affiliated Hospital of Soochow University, 708 Renmin Road, Suzhou, China; Jiangsu Key Laboratory of Clinical Immunology, Soochow University, 708 Renmin Road, Suzhou, China
| | - Guangbo Zhang
- Jiangsu Key Laboratory of Gastrointestinal Tumor Immunology, The First Affiliated Hospital of Soochow University, 708 Renmin Road, Suzhou, China
| | - Tongguo Shi
- Jiangsu Institute of Clinical Immunology, The First Affiliated Hospital of Soochow University, 708 Renmin Road, Suzhou, China; Jiangsu Key Laboratory of Clinical Immunology, Soochow University, 708 Renmin Road, Suzhou, China.
| | - Weichang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Road, Suzhou, China.
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29
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Costa G, Frezza B, Fransvea P, Massa G, Ferri M, Mercantini P, Balducci G, Buondonno A, Rocca A, Ceccarelli G. Clinico-pathological Features of Colon Cancer Patients Undergoing Emergency Surgery: A Comparison Between Elderly and Non-elderly Patients. Open Med (Wars) 2019; 14:726-734. [PMID: 31637303 PMCID: PMC6778396 DOI: 10.1515/med-2019-0082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/07/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common cancers in patients older than 65 years. Emergency presentation represents about 30% of cases, with increased morbidity and mortality rates. The aim of this study is to compare the perioperative outcome between elderly and non-elderly patients undergoing emergency surgery. METHOD We retrospectively analysed CRC patients that underwent emergency surgery at the Departments of Surgery of the Sapienza University Sant'Andrea Hospital in Rome, and at San Donato Hospital in Arezzo, between June 2012 and June 2017. Patients were divided into two groups: non-elderly (< 65 years) and elderly (≥ 65 years). Variables analysed were sex, onset symptoms, associated disease, ASA score, tumor site and TNM stage, surgical procedures and approach, and morbidity and mortality. RESULTS Of a total of 123 patients, 29 patients were non-elderly and 94 patients were elderly. No significant differences were observed in sex, onset symptoms and tumor site between the two groups. Comorbidities were significantly higher in elderly patients (73.4% vs 41.4%, p<0.001). No significant differences were observed between the two groups in surgical approach and the rate of one-stage procedures. Elderly patients were more frequently treated by Hartmann's procedure compared to non-elderly patients (20.2% vs 6.9%). Left colorectal resection with protective ileostomy was most frequent in the non-elderly group (27.6% vs 11.7%). No significant differences were found in the pT and pN categories of the TNM system between the two groups. However, a higher number of T3 in non-elderly patients was observed. A consistent number of non-oncologically adequate resections were observed in the elderly (21.3% vs 3.5%; p<0.03). The morbidity rate was significantly higher in the elderly group (31.9 % vs 3.4%, p<0.001). No significant difference was found in the mortality rate between the two groups, being 13.8% in the elderly and 6.9% in the non-elderly. CONCLUSIONS Emergency colorectal surgery for cancer still presents significant morbidity and mortality rates, especially in elderly patients. More aggressive tumors and advanced stages were more frequent in the non-elderly group and as a matter it should be taken into account when treating such patients in the emergency setting in order to perform a radical procedure as much as possible.
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Affiliation(s)
- Gianluca Costa
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Barbara Frezza
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
- Department of Surgery, Division of General Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100Arezzo, Italy
| | - Pietro Fransvea
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Giulia Massa
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Mario Ferri
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Paolo Mercantini
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Genoveffa Balducci
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Antonio Buondonno
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Aldo Rocca
- Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale” IRCCS, Naples, Italy
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Graziano Ceccarelli
- Department of Surgery, Division of General Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100Arezzo, Italy
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30
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Feng Y, Mo S, Dai W, Li Q, Cai G, Cai S. Increasing age-related survival gap among patients with colorectal cancer: a population-based retrospective study. Int J Clin Oncol 2019; 25:100-109. [PMID: 31531787 DOI: 10.1007/s10147-019-01538-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 08/29/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Survival for patients with colorectal cancer (CRC) has improved over the past decades. However, it is unclear whether older patients have benefited to the same extent as younger patients. METHODS The Surveillance, Epidemiology, and End Results (SEER) 9 registries database was queried for CRC patients from 1975 to 2009. We presented yearly data for survival with overlying loess-smoothing lines across all age groups. Another cohort was created using the SEER 18 registries database for patients diagnosed with CRC from 1973 to 2014. Yearly data for surgery-performed rate, stage proportion, and multivariate hazard ratio were performed with overlying smoothing lines across all age groups. RESULTS In the analysis SEER 9, 5-year cause-specific survival (CSS) of patients aged ≤ 54, 55-64, and 65-74 years showed robust increase since 1975; however, the survival of patients aged 75-84 years remained low despite modest improvement, and patients aged 85 or older even showed no survival gains since 1990. In the analysis of SEER 18, there has been a steady increase in the survival of patients aged ≤ 54, 55-64, 65-74, and 75-84 years as time period advanced; however, of CRC patients aged ≥ 85 years, the survival curves of period 1990-1999 and 2000-2012 could not be distinguished from each other presented with negligibly a small gap from the curve of 1980-1989. CONCLUSIONS The strong interaction between age and year of diagnosis implies that older patients have benefited less over time than younger patients, especially for patients aged ≥ 85 years.
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Affiliation(s)
- Yang Feng
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Shaobo Mo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Weixing Dai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Guoxiang Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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31
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Peng JS, Lad NL, Spangenthal EJ, Mattson DM, Nurkin SJ. Preoperative radiation as part of a multidisciplinary strategy for a medically inoperable patient with a bleeding colon cancer. BMJ Case Rep 2019; 12:12/8/e229488. [PMID: 31439568 DOI: 10.1136/bcr-2019-229488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 84-year-old man with a history of deep vein thrombosis on warfarin and coronary artery disease presented with haematochezia and was diagnosed with an ascending colon cancer. He was short of breath with lower extremity oedema at the initial surgical consultation. Evaluation revealed an acute exacerbation of congestive heart failure, and further workup and treatment were recommended by the cardiology team. After multidisciplinary discussion, he underwent radiation for the control of bleeding, followed by cardiac catheterisation and placement of a bare metal stent. The patient subsequently underwent robotic-assisted right hemicolectomy. Pathology demonstrated a complete response, and the patient recovered uneventfully. He is alive swith no evidence of disease recurrence 12 months after surgery and 18 months after initial diagnosis.
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Affiliation(s)
- June S Peng
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Neha L Lad
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Edward J Spangenthal
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - David M Mattson
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Steven J Nurkin
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Heller DR, Jean RA, Chiu AS, Feder SI, Kurbatov V, Cha C, Khan SA. Regional Differences in Palliative Care Utilization Among Geriatric Colorectal Cancer Patients Needing Emergent Surgery. J Gastrointest Surg 2019; 23:153-162. [PMID: 30328071 PMCID: PMC6751557 DOI: 10.1007/s11605-018-3929-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/10/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The benefits of palliative care (PC) in critical illness are validated across a range of diseases, yet it remains underutilized in surgical patients. This study analyzed patient and hospital factors predictive of PC utilization for elderly patients with colorectal cancer (CRC) requiring emergent surgery. METHODS The National Inpatient Sample was queried for patients aged ≥ 65 years admitted emergently with CRC from 2009 to 2014. Patients undergoing colectomy, enterectomy, or ostomy formation were included and stratified according to documentation of PC consultation during admission. Chi-squared testing identified unadjusted group differences, and multivariable logistic regression identified predictors of PC. RESULTS Of 86,573 discharges meeting inclusion criteria, only 3598 (4.2%) had PC consultation. Colectomy (86.6%) and ostomy formation (30.4%) accounted for the operative majority. PC frequency increased over time (2.9% in 2009 to 6.2% in 2014, P < 0.001) and was nearly twice as likely to occur in the West compared with the Northeast (5.7 vs. 3.3%, P < 0.001) and in not-for-profit compared with proprietary hospitals (4.5 vs. 2.3%, P < 0.001). PC patients were more likely to have metastases (60.1 vs. 39.9%, P < 0.001) and die during admission (41.5 vs. 6.4%, P < 0.001). On multivariable logistic regression, PC predictors (P < 0.05) included region outside the Northeast, increasing age, more recent year, and metastatic disease. CONCLUSIONS In the USA, PC consultation for geriatric patients with surgically managed complicated CRC is low. Regional variation appears to play an important role. With mounting evidence that PC improves quality of life and outcomes, understanding the barriers associated with its provision to surgical patients is paramount.
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Affiliation(s)
- Danielle R Heller
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520-8062, USA
| | - Raymond A Jean
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520-8062, USA
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, P.O. Box 208088, New Haven, CT, 06520-8088, USA
| | - Alexander S Chiu
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520-8062, USA
| | - Shelli I Feder
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, P.O. Box 208088, New Haven, CT, 06520-8088, USA
- US Department of Veterans Affairs, 950 Campbell Ave, West Haven, CT, 06516, USA
| | - Vadim Kurbatov
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520-8062, USA
| | - Charles Cha
- Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520-8062, USA
| | - Sajid A Khan
- Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520-8062, USA.
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Galvin A, Helmer C, Coureau G, Amadeo B, Joly P, Sabathé C, Monnereau A, Baldi I, Rainfray M, Soubeyran P, Delva F, Mathoulin-Pélissier S. Determinants of cancer treatment and mortality in older cancer patients using a multi-state model: Results from a population-based study (the INCAPAC study). Cancer Epidemiol 2018; 55:39-44. [DOI: 10.1016/j.canep.2018.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
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Shervani S, Lu G, Sager K, Wajima T, Wong L. Prognostic factors and hazard ratios in colorectal cancer patients over 80 years of age: a retrospective, 20-year, single institution review. J Gastrointest Oncol 2018; 9:254-262. [PMID: 29755763 DOI: 10.21037/jgo.2018.01.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background An aging population and a high incidence of colorectal cancer (CRC) in patients over the age of 80 make it important to understand survival times, hazard ratios and prognostic factors in this group. A better understanding of these factors will help clinicians determine appropriate therapeutic strategies for such patients, including when more aggressive treatment strategies may be preferred to palliative treatment. Methods A retrospective analysis of 619 CRC patients of ≥80 years of age from 1991-2010 at Baylor Scott & White Hospital in Temple, Texas. Twelve variables were analyzed through statistical analysis as potential prognostic factors for survival. Univariate and multivariate Cox proportional hazard models were used to determine hazard ratios. The elderly population was further stratified by age subgroup (80-84, 85-89, ≥90). Results Median survival time was 53.6, 30.0, and 11.3 months for age groups of 80-84, 85-89, and ≥90, respectively. Median survival time for stage 0/I, II, III, and IV patients was 72.4, 53.5, 28.0, and 5.9 months, respectively. Patients not receiving surgery had significantly higher mortality (hazard ratio 2.605; 95% CI, 1.826-3.694). For stage III CRC patients, those not receiving chemotherapy had significantly higher mortality (hazard ratio 1.808; 95% CI, 1.018-1.827). Conclusions Our study provides evidence to support the benefits of surgery and chemotherapy (for stage III) patients over 80, potentially contributing to improved clinical decisions in treating elderly CRC patients. Such patients are sometimes undertreated due to their underrepresentation in clinical trials. Additional prospective studies with a higher proportion of patients over 80 are needed.
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Affiliation(s)
- Saira Shervani
- Department of Internal Medicine, Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Gary Lu
- Division of Hematology and Oncology, Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Kristen Sager
- Lafayette General Health and Cancer Center of Acadiana at Savoy Medical Center, Mamou, LA, USA
| | - Takeshi Wajima
- Olin E. Teague Veterans Medical Center and Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Lucas Wong
- Division of Hematology and Oncology, Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine, Temple, TX, USA
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Lim YK, Jackson C, Dauway EL, Richter KK. Risk Factors for Adverse Outcome for Elderly Patients undergoing Curative Oncological Resection for Gastrointestinal Malignancies. Visc Med 2017; 33:254-261. [PMID: 29034253 DOI: 10.1159/000475938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The incidence of gastrointestinal cancer increases with age, with approximately 20% of these cases in people over 80 years of age. Due to pre-existing comorbidities, this onco-geriatric population often presents diagnostic and therapeutic challenges. METHODS A systematic review of articles on PubMed was performed to determine the predictive ability of screening tools and their components regarding the occurrence of adverse outcomes in elderly onco-surgical patients with gastrointestinal malignancies. RESULTS Surgical procedures in this patient cohort, particularly complex resections, may result in increased morbidity and mortality. The decision to treat an elderly patient with curative intent requires sound clinical judgment based on knowledge, consideration of objective parameters, and experience. These patients could potentially be optimized for surgery with the improvement of nutritional and overall performance status as well as with stabilizing comorbidities. CONCLUSION Various geriatric assessment and screening tools have been developed to identify risk factors to assist the surgeon and the interdisciplinary team in treatment planning, including the Frailty Assessment Score, Timed Up and Go test, nutritional status, and Activities of Daily Living test. It is important to emphasize that transparent and open communication between the treating surgeon and the patient is crucial in that the patient fully understands the implications of the treatment plan.
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Affiliation(s)
- Yukai K Lim
- Southern District Health Board, Invercargill, New Zealand
| | - Christopher Jackson
- Southern District Health Board, Invercargill, New Zealand.,University of Otago, Dunedin, New Zealand.,Cancer Society of New Zealand, Wellington, New Zealand
| | - Emilia L Dauway
- School of Medicine, University of Queensland, Brisbane, QLD, Australia.,Rural Clinical School, Mater Misericordia Hospital Gladstone, Gladstone, QLD, Australia
| | - Konrad Klaus Richter
- Department of Surgery, Southland Hospital, Invercargill, New Zealand.,Dunedin Hospital and School of Medicine, Dunedin, New Zealand
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Fagard K, Casaer J, Wolthuis A, Flamaing J, Milisen K, Lobelle JP, Wildiers H, Kenis C. Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer. Colorectal Dis 2017; 19:O329-O338. [PMID: 28733982 DOI: 10.1111/codi.13821] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/17/2017] [Indexed: 02/08/2023]
Abstract
AIM This study aims to describe the nature, incidence, severity and outcomes of in-hospital postoperative complications (POCs) in older patients undergoing elective surgery for colorectal cancer. METHOD Patients ≥ 70 years old were identified from a prospectively collected database (2009-2015) focusing on the implementation of geriatric screening and assessment in patients with cancer. Medical and surgical POCs were retrieved retrospectively from the medical records, and the severity of the POCs was graded by the Clavien-Dindo (CD) grading system. The following outcomes were analysed comparing patients with and without CD ≥ 2 and CD ≥ 3 POCs: length of stay (LOS), transfer to the intensive care unit, 30-day readmission rates, 30-day and 1-year mortality. RESULTS In the 190 patients included, medical POCs (40.5%) were more frequent than surgical POCs (17.9%), and 37.9% experienced CD ≥ 2 POCs. The most common medical POCs were infections (26.8%), transient confusion or altered mental function (12.1%), cardiac arrhythmia (4.7%), and ileus/gastroparesis/prolonged recovery of transit (4.7%). The most common surgical POCs were surgical site infections (12.1%), wound dehiscence/bleeding (4.7%), anastomotic leak (3.7%) and surgical site bleeding (3.7%). The reoperation rate was 7.9%. CD ≥ 2 POCs led to 11 intensive care unit admissions and increased median postoperative LOS by 114% (P < 0.0001 for both), but did not significantly alter 30-day readmission and 30-day and 1-year mortality rates. CD ≥ 3 POCs increased LOS by 162% (P < 0.0001) and showed an increased 1-year mortality (P = 0.07). CONCLUSION This study shows that in-hospital medical and surgical complications after surgery for colorectal cancer in patients ≥ 70 years old are frequent and that complications lead to less favourable outcomes.
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Affiliation(s)
- K Fagard
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - J Casaer
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - A Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - J Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - K Milisen
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | | | - H Wildiers
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - C Kenis
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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Moran B, Cunningham C, Singh T, Sagar P, Bradbury J, Geh I, Karandikar S. Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Surgical Management. Colorectal Dis 2017. [PMID: 28632309 DOI: 10.1111/codi.13704] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Brendan Moran
- Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | | | | | | | | | - Ian Geh
- Queen Elizabeth Hospital, Birmingham, UK
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Mäkelä JT, Klintrup KH, Rautio TT. Mortality and Survival after Surgical Treatment of Colorectal Cancer in Patients Aged over 80 Years. Gastrointest Tumors 2017; 4:36-44. [PMID: 29071263 DOI: 10.1159/000477721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/08/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify the clinical factors and tumor characteristics that predict the outcome of colorectal cancer patients aged >80 years. MATERIALS AND METHODS The data of 186 patients aged >80 years with colorectal cancer were collected from a computer database, and the variables were analyzed by both uni- and multivariate analyses. RESULTS The 30-day mortality was 4% and the 90-day mortality 10%. The 1-year survival was 76%, and 27 (61%) of the 44 deaths were unrelated to cancer. The overall 5-year survival was 36%, the median survival 38 months, and the cancer-specific survival 40%. The recurrence rate after radical surgery was 22% and it was not affected by age. Kaplan-Meier estimates indicated that age, number of underlying diseases, radical operation, Union for International Cancer Control stage of the tumor, tumor size, number of lymph nodes involved, venous invasion, and recurrent disease were significant predictors of survival, but in the Cox regression model, only radical operation and venous invasion were independent prognostic factors for survival. CONCLUSIONS After good surgical selection, low early mortality and acceptable long-term survival can be achieved even in the oldest old patients with colorectal cancer. However, low early mortality seems to underestimate the effects of surgery during the first postoperative year.
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Affiliation(s)
- Jyrki Tapani Mäkelä
- Department of Surgery, Surgical Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Kai Hans Klintrup
- Department of Surgery, Surgical Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tero Tapani Rautio
- Department of Surgery, Surgical Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
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Nagtegaal ID. Never too old to fight cancer? What do we know about colorectal cancer in the elderly? Colorectal Dis 2017; 19:223. [PMID: 28251787 DOI: 10.1111/codi.13610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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40
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Schlichtemeier S, Logaraj A, Gill AJ, Engel A. Colorectal cancer resection in the Australian nonagenarian patient. Colorectal Dis 2017; 19:243-250. [PMID: 27354302 DOI: 10.1111/codi.13434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/11/2016] [Indexed: 12/22/2022]
Abstract
AIM The nonagenarian population is a rapidly growing segment of the Australian population. Surgical resection continues to offer the best chance of long-term survival in colorectal cancer. The primary aims of the present study were to evaluate the 30-day mortality and survival of Australian patients ≥ 90 years of age undergoing surgical resection for colorectal cancer in our health service. The secondary aims were to examine the clinicopathological characteristics of the patients and their tumours. METHOD All patients ≥ 90 years of age undergoing surgical resection for colorectal cancer from 1998 to 2012 were identified in a centralized multihospital database. Key clinicopathological data, 30-day mortality and long-term overall survival were recorded for each patient. RESULTS There were 121 patients identified of median age 91 years, 74% of whom were female. The median tumour size was 40 mm, and 51% of operations were carried out as an emergency. The TNM stage was Stage I/II in 57%, Stage III in 40% and Stage IV in 3%. The 30-day mortality was 6.6% (eight of 121) and the 1-, 3- and 5-year overall survival rates were 82.6%, 50.2% and 32.3%, respectively. CONCLUSION Surgical resection in the nonagenarian patient has an acceptable mortality and offers good overall survival.
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Affiliation(s)
- S Schlichtemeier
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - A Logaraj
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - A J Gill
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Anatomical Pathology, Royal North Shore Hospital and Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - A Engel
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Healthy Ageing and Sydney Vital Translational Cancer Research, Kolling Institute of Medical Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
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van Deudekom FJ, Schimberg AS, Kallenberg MH, Slingerland M, van der Velden LA, Mooijaart SP. Functional and cognitive impairment, social environment, frailty and adverse health outcomes in older patients with head and neck cancer, a systematic review. Oral Oncol 2017; 64:27-36. [DOI: 10.1016/j.oraloncology.2016.11.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/24/2016] [Accepted: 11/24/2016] [Indexed: 12/13/2022]
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Biondi A, Vacante M, Ambrosino I, Cristaldi E, Pietrapertosa G, Basile F. Role of surgery for colorectal cancer in the elderly. World J Gastrointest Surg 2016; 8:606-613. [PMID: 27721923 PMCID: PMC5037333 DOI: 10.4240/wjgs.v8.i9.606] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/15/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
The prevalence of subjects with colorectal cancer is expected to grow in the next future decades and surgery represents the most successful treatment modality for these patients. Anyway, currently elderly subjects undergo less elective surgical procedures than younger patients mainly due to the high rates of postoperative morbidity and mortality. Some authors suggest extensive surgery, including multistage procedures, as carried out in younger patients while others promote less aggressive surgery. In older patients, laparoscopic-assisted colectomy showed a number of advantages compared to conventional open surgery that include lower stress, higher rate of independency after surgery, quicker return to prior activities and a decrease in costs. The recent advances in chemotherapy and the introduction of new surgical procedures such as the endoluminal stenting, suggest the need for a revisitation of surgical practice patterns and the role of palliative surgery, mainly for patients with advanced disease. In this article, we discuss the current role of surgery for elderly patients with colorectal cancer.
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43
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Kim H, Jeon B, Lee J, Paek SH. Can deep brain stimulation be a therapeutic option for Parkinson's disease dementia? ACTA ACUST UNITED AC 2016. [DOI: 10.1111/ncn3.12081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Han‐Joon Kim
- Department of Neurology and Movement Disorder Center Parkinson Study Group, and Neuroscience Research Institute College of Medicine Seoul National University Seoul Korea
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center Parkinson Study Group, and Neuroscience Research Institute College of Medicine Seoul National University Seoul Korea
| | - Jee‐Young Lee
- Department of Neurology Metropolitan Boramae Hospital College of Medicine Seoul National University Seoul Korea
| | - Sun Ha Paek
- Department of Neurosurgery Movement Disorder Center, and Neuroscience Research Institute College of Medicine Seoul National University Seoul Korea
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Libert Y, Dubruille S, Borghgraef C, Etienne AM, Merckaert I, Paesmans M, Reynaert C, Roos M, Slachmuylder JL, Vandenbossche S, Bron D, Razavi D. Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival? PLoS One 2016; 11:e0159734. [PMID: 27479248 PMCID: PMC4968794 DOI: 10.1371/journal.pone.0159734] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/07/2016] [Indexed: 01/08/2023] Open
Abstract
Introduction Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated. Purpose To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age. Methods Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA<26). Socio-demographic, disease-related, and geriatric vulnerabilities were assessed using validated tools. Univariate and subsequent multivariate Cox proportional hazards models stratified for diagnosis (breast/prostate cancer versus colorectal cancer) and disease status (metastatic versus non-metastatic) were used. Results A cognitive impairment was detected in 46% (n = 163) of patients. Survival was significantly influenced by a cognitive impairment (HR = 6.13; 95% confidence interval [CI] = 2.07–18.09; p = 0.001), a loss in instrumental autonomy (IADL ≤7) (HR = 3.06; 95% CI = 1.31–7.11; p = 0.009) and fatigue (Mob-T<5) (HR = 5.98; 95% CI = 2.47–14.44; p <0.001). Conclusions During the two years following cancer treatment initiation, older patients with a cognitive impairment were up to six times more likely to die than patients without. Older patients should be screened for cognitive impairments at cancer treatment initiation to enable interventions to reduce morbidity and mortality. Further studies should address processes underlying the relationship between cognitive impairments and an increased risk of dying in older cancer patients.
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Affiliation(s)
- Yves Libert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l’Éducation, Brussels, Belgium
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - Stéphanie Dubruille
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l’Éducation, Brussels, Belgium
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - Cindy Borghgraef
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l’Éducation, Brussels, Belgium
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - Anne-Marie Etienne
- Université de Liège, Faculté des Sciences psychologiques et de l’Education, Liège, Belgium
| | - Isabelle Merckaert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l’Éducation, Brussels, Belgium
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - Marianne Paesmans
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - Christine Reynaert
- Université Catholique de Louvain, Service de Médecine Psychosomatique, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgium
| | - Myriam Roos
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - Jean-Louis Slachmuylder
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l’Éducation, Brussels, Belgium
| | | | - Dominique Bron
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l’Éducation, Brussels, Belgium
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
- * E-mail:
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Bethune R, Sbaih M, Brosnan C, Arulampalam T. What happens when we do not operate? Survival following conservative bowel cancer management. Ann R Coll Surg Engl 2016; 98:409-12. [PMID: 27055410 DOI: 10.1308/rcsann.2016.0146] [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] [Indexed: 11/22/2022] Open
Abstract
Introduction While surgery is the cornerstone of bowel cancer treatment, it comes with significant risks. Among patients aged over 80 years, 30-day mortality is 13%-15%, and additionally 12% will not return home and go on to live in supportive care. The question for patients and clinicians is whether operative surgery benefits elderly, frail patients. Methods Multidisciplinary team outcomes between October 2010 and April 2012 were searched to conduct a retrospective analysis of patients with known localised colorectal cancer who did not undergo surgery due to being deemed unfit. Results Twenty six patients survived for more than a few weeks following surgery, of whom 20% survived for at least 36 months. The average life expectancy following diagnosis was 1 year and 176 days, with a mean age at diagnosis of 87 years (range 77-93 years). One patient survived for 3 years and 240 days after diagnosis. Conclusions Although surgeons are naturally focused on surgical outcomes, non-operative outcomes are equally as important for patients. Elderly, frail patients benefit less from surgery for bowel cancer and have higher risks than younger cohorts, and this needs to be carefully discussed when jointly making the decision whether or not to operate.
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Affiliation(s)
- R Bethune
- Colchester Hospital University NHS Trust , UK
| | - M Sbaih
- Colchester Hospital University NHS Trust , UK.,ICENI Centre for Surgical Education and Research , Colchester , UK
| | - C Brosnan
- Colchester Hospital University NHS Trust , UK
| | - T Arulampalam
- Colchester Hospital University NHS Trust , UK.,ICENI Centre for Surgical Education and Research , Colchester , UK
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E-PASS score as a useful predictor of postoperative complications and mortality after colorectal surgery in elderly patients. Int J Colorectal Dis 2016; 31:217-25. [PMID: 26607908 DOI: 10.1007/s00384-015-2456-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to clarify whether a surgical-specific risk scoring system estimating the physiologic ability and surgical stress (E-PASS) score was useful for prediction of postoperative morbidity and mortality. METHODS The E-PASS score consists of the preoperative risk score (PRS), surgical stress score (SSS), and the comprehensive risk score (CRS). Conventional scoring systems [colorectal physiologic and operative severity score for the enumeration of mortality (CR-POSSUM) and the prognostic nutritional index (PNI)] were also examined. We retrospectively compared these scores in patients with or without postoperative complications. We assessed the relationship between these scores, clinicopathological features and postoperative mortality. RESULTS Postoperative complications developed in 78 patients (33%). American Society of Anesthesiologists score, performance status, PNI score, PRS, SSS, and CRS were significantly higher in patients with postoperative complications than in those without postoperative complications (p < 0.05). The area under the receiver operating characteristic curve (AUC) was highest for E-PASS [E-PASS (PRS, 0.74; SSS, 0.62; CRS, 0.78), PNI (0.62), CR-POSSUM (PS, 0.57; OSS, 0.52)]. Multivariate logistic analysis identified CRS ≥ 0.2 as a significant determinant of postoperative complications (p < 0.01; hazard ratio, 4.84). Overall survival was significantly better in the CRS < 0.2 group than in the CRS > 0.2 group (p < 0.01). CONCLUSIONS The E-PASS score system was a useful predictor of postoperative complications and mortality, especially in patients with advanced age.
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Millan M, Merino S, Caro A, Feliu F, Escuder J, Francesch T. Treatment of colorectal cancer in the elderly. World J Gastrointest Oncol 2015; 7:204-20. [PMID: 26483875 PMCID: PMC4606175 DOI: 10.4251/wjgo.v7.i10.204] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/30/2015] [Accepted: 08/30/2015] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer has a high incidence, and approximately 60% of colorectal cancer patients are older than 70, with this incidence likely increasing in the near future. Elderly patients (> 70-75 years of age) are a very heterogeneous group, ranging from the very fit to the very frail. Traditionally, these patients have often been under-treated and recruited less frequently to clinical trials than younger patients, and thus are under-represented in publications about cancer treatment. Recent studies suggest that fit elderly patients can be treated in the same way as their younger counterparts, but the treatment of frail patients with comorbidities is still a matter of controversy. Many factors should be taken into account, including fitness for treatment, the wishes of the patient and family, and quality of life. This review will focus on the existing evidence for surgical, oncologic, and palliative treatment in patients over 70 years old with colorectal cancer. Careful patient assessment is necessary in order to individualize treatment approach, and this should rely on a multidisciplinary process. More well-designed controlled trials are needed in this patient population.
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Cohan JN, Bacchetti P, Varma MG, Finlayson E. Outcomes after ileoanal pouch surgery in frail and older adults. J Surg Res 2015; 198:327-33. [DOI: 10.1016/j.jss.2015.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/27/2015] [Accepted: 04/02/2015] [Indexed: 12/21/2022]
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Affiliation(s)
- Rob Bethune
- Association of Coloproctology of Great Britain, Ireland and ICENI Centre for Surgical Research, Colchester, UK
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Tominaga T, Takeshita H, Arai J, Takagi K, Kunizaki M, To K, Abo T, Hidaka S, Nanashima A, Nagayasu T, Sawai T. Short-term outcomes of laparoscopic surgery for colorectal cancer in oldest-old patients. Dig Surg 2015; 32:32-8. [PMID: 25678189 DOI: 10.1159/000373897] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/31/2014] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIMS Oldest-old patients generally have several comorbidities, and laparoscopic-assisted colectomy (LAC) has not been performed on these patients. However, the surgical technique of LAC has improved, and its indications have been extended. The aim of this study was to evaluate the safety and effectiveness of LAC for patients over 85 years old. METHODS Fifty-eight patients over 85 years old who underwent colectomy were retrospectively analyzed. The patients were divided into two groups (LAC group n = 15; open surgery group (Open group) n = 43), and clinicopathological features, surgical characteristics, and outcomes were compared. RESULTS There were no significant differences in clinical background characteristics between the groups. The LAC group had longer operation time and greater lymph node dissection (both p < 0.01). Postoperatively, the use of analgesics (p = 0.01) was less and the start of oral liquid intake (p = 0.03) was faster in the LAC group. Postoperative complications occurred in 3 patients (20%) in the LAC group and 13 patients (30%) in the Open group (p = 0.66); delirium (n = 6) and sub-ileus (n = 4) developed only in the Open group. CONCLUSION After LAC, elderly patients tended to have less postoperative pain and started oral liquid intake earlier. LAC can be safe and effective, preventing postoperative complications that occur specifically in oldest-old patients.
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Affiliation(s)
- Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
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