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Gu YF, Lin FP, Epstein RJ. How aging of the global population is changing oncology. Ecancermedicalscience 2022; 15:ed119. [PMID: 35211208 PMCID: PMC8816510 DOI: 10.3332/ecancer.2021.ed119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Population aging is causing a demographic redistribution with implications for the future of healthcare. How will this affect oncology? First, there will be an overall rise in cancer affecting older adults, even though age-specific cancer incidences continue to fall due to better prevention. Second, there will be a wider spectrum of health functionality in this expanding cohort of older adults, with differences between “physiologically older” and “physiologically younger” patients becoming more important for optimal treatment selection. Third, greater teamwork with supportive care, geriatric, mental health and rehabilitation experts will come to enrich oncologic decision-making by making it less formulaic than it is at present. Success in this transition to a more nuanced professional mindset will depend in part on the development of user-friendly computational tools that can integrate a complex mix of quantitative and qualitative inputs from evidence-based medicine, functional and cognitive assessments, and the personal priorities of older adults.
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Affiliation(s)
- Yan Fei Gu
- New Hope Cancer Center, United Family Hospitals, 9 Jiangtai W Rd, Chaoyang, Beijing 100015, China
| | - Frank P Lin
- Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, Sydney 2010, Australia.,NH&MRC Clinical Trials Centre, 92 Parramatta Rd, Camperdown, Sydney 2050, Australia
| | - Richard J Epstein
- New Hope Cancer Center, United Family Hospitals, 9 Jiangtai W Rd, Chaoyang, Beijing 100015, China.,Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, Sydney 2010, Australia.,UNSW Clinical School, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney 2010, Australia.,https://orcid.org/0000-0002-4640-0195
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Nangia S, Gaikwad U, Roshan N. Geriatric assessment: A critical step to incorporate in day-to-day oncology practice! CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_138_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Santin Y, Resta J, Parini A, Mialet-Perez J. Monoamine oxidases in age-associated diseases: New perspectives for old enzymes. Ageing Res Rev 2021; 66:101256. [PMID: 33434685 DOI: 10.1016/j.arr.2021.101256] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/04/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022]
Abstract
Population aging is one of the most significant social changes of the twenty-first century. This increase in longevity is associated with a higher prevalence of chronic diseases, further rising healthcare costs. At the molecular level, cellular senescence has been identified as a major process in age-associated diseases, as accumulation of senescent cells with aging leads to progressive organ dysfunction. Of particular importance, mitochondrial oxidative stress and consequent organelle alterations have been pointed out as key players in the aging process, by both inducing and maintaining cellular senescence. Monoamine oxidases (MAOs), a class of enzymes that catalyze the degradation of catecholamines and biogenic amines, have been increasingly recognized as major producers of mitochondrial ROS. Although well-known in the brain, evidence showing that MAOs are also expressed in a variety of peripheral organs stimulated a growing interest in the extra-cerebral roles of these enzymes. Besides, the fact that MAO-A and/or MAO-B are frequently upregulated in aged or dysfunctional organs has uncovered new perspectives on their roles in pathological aging. In this review, we will give an overview of the major results on the regulation and function of MAOs in aging and age-related diseases, paying a special attention to the mechanisms linked to the increased degradation of MAO substrates or related to MAO-dependent ROS formation.
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Affiliation(s)
- Yohan Santin
- Institute of Metabolic and Cardiovascular Diseases (I2MC), INSERM, Université de Toulouse, Toulouse, France
| | - Jessica Resta
- Institute of Metabolic and Cardiovascular Diseases (I2MC), INSERM, Université de Toulouse, Toulouse, France
| | - Angelo Parini
- Institute of Metabolic and Cardiovascular Diseases (I2MC), INSERM, Université de Toulouse, Toulouse, France
| | - Jeanne Mialet-Perez
- Institute of Metabolic and Cardiovascular Diseases (I2MC), INSERM, Université de Toulouse, Toulouse, France.
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Detering KM, Sellars M, Kelly H, Clayton JM, Buck K, Nolte L. Prevalence of advance care planning documentation and self-reported uptake in older Australians with a cancer diagnosis. J Geriatr Oncol 2020; 12:274-281. [PMID: 32739354 DOI: 10.1016/j.jgo.2020.07.012] [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] [Received: 04/08/2020] [Revised: 05/26/2020] [Accepted: 07/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Advance care planning (ACP) and completion advance care directives (ACDs) is recommended for patients with cancer. Documentation needs to be available at the point of care. OBJECTIVE(S) To describe the prevalence of ACDs in health records and the self-reported awareness of and engagement in ACP as reported by older Australians with cancer, and to examine the concordance between self-reported completion of and presence of documentation in participants' health records. DESIGN/SETTING/PARTICIPANTS Prospective multi-center audit of health records, and a self-report survey of eligible participants in 51 Australian health and residential aged care services. The audit included 458 people aged ≥65 years with cancer. RESULTS 30% had ≥ ACD located in their record. 218 people were eligible for survey completion; 97 (44% response rate) completed it. Of these, 81% had a preference to limit some/all treatments, 10% wanted to defer decision-making to someone else, and 9% wanted all treatments. Fifty-eight percent of survey completers reported having completed an ACP document. Concordance between documentation in the participant's record and self-report of completion was 61% (k = 0.269), which is only fair agreement. CONCLUSION(S) Whilst 30% of participants had at least one ACD in their record, 58% self-reported document completion, and concordance between self-reported completion and presence in records was only fair. This is significant given most people had a preference for some/all limitation of treatment. Further ACP implementation strategies are required. These include a systematic approach to embedding ACP into routine care, workforce education, increasing community awareness, and looking at e-health solutions to improve accessibility at the point of care.
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Affiliation(s)
- Karen M Detering
- Advance Care Planning Australia, Austin Health, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, Victoria, Australia; Faculty of Health, Arts and Innovation, Swinburne University, Australia.
| | - Marcus Sellars
- Advance Care Planning Australia, Austin Health, Melbourne, Victoria, Australia
| | - Helana Kelly
- Advance Care Planning Australia, Austin Health, Melbourne, Victoria, Australia
| | - Josephine M Clayton
- Centre for Learning & Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kim Buck
- Advance Care Planning Australia, Austin Health, Melbourne, Victoria, Australia
| | - Linda Nolte
- Advance Care Planning Australia, Austin Health, Melbourne, Victoria, Australia
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Conde-Flores E, Dorantes-Heredia R, Motola-Kuba D, Grimaldo-Roque HJ, Martínez-Sámano JE, Ruiz-Morales JM. Epidemiological Profile of Patients of Aged 65 Years and Over in a University Private Hospital. Case Rep Oncol 2019; 12:113-118. [PMID: 31043948 PMCID: PMC6477496 DOI: 10.1159/000496812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives An increase in life expectancy is predicted for the general population and, by 2050, about one billion people will be older than 65 years. The Global Cancer Incidence, Mortality and Prevalence database estimates that 1.2 million people of this age will have cancer; this number represents 58% of new cases in the American population. This represents a challenge for diagnosis and treatment, given that some older people have multiple comorbidities and disabilities. Materials and Methods This was a retrospective descriptive study of 204 patients aged 65 years and over. All had a solid tumor that was diagnosed in a private hospital from January 2015 to December 2017. Results The median age was 72.2 years; the most frequent age group (48.5% of patients) was 65–75 years, and only a small percentage (4.4%) were aged > 85 years. The most common type of cancer was lung cancer (22.5%), followed by colorectal and urinary cancer. Most patients received cancer treatment after the disease diagnosis. Conclusion There are no epidemiological studies of the older oncology population in Mexico. We believe it is necessary to perform larger studies to understand this population and to undertake actions to facilitate greater attention to patient diagnosis, treatment, and alleviation.
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Affiliation(s)
- Emilio Conde-Flores
- Internal Medicine Research Unit, Médica Sur Hospital and Clinical Foundation, Mexico City, Mexico
| | - Rita Dorantes-Heredia
- Anatomic Pathology Research Unit, Médica Sur Hospital and Clinical Foundation, Mexico City, Mexico
| | - Daniel Motola-Kuba
- Oncology Research Unit, Médica Sur Hospital and Clinical Foundation, Mexico City, Mexico
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Addressing communication challenges in older patients with cancer and geriatric syndromes: a communication skills training module for health care providers. Eur Geriatr Med 2019; 10:319-326. [PMID: 34652754 DOI: 10.1007/s41999-018-00157-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Older adults frequently suffer from functional decline and sensory changes which, in turn, may trigger ageism, i.e., stereotyping and discriminating against individuals based on their age. Ageism commonly interferes with medical care. Communication strategies can be used to counteract ageism and to engage in optimal patient-centered care. This study describes the development, application, and evaluation of a communication skills training (CST) module (Geriatrics 101) designed to familiarize health care providers (HCPs) with the concept of ageism, and the frequent sensory and physical impairments in older patients with cancer, and to teach practical communication skills to effectively communicate with these patients. METHODS Geriatrics 101 is one of three modules in a 1-day CST program for HCPs, intended to improve the outcome of consultations through utilization of a set of clinically meaningful strategies. Study measures included post-training module evaluation, self-efficacy measured pre- and post-training, and communication skills uptake assessed pre- and post-training. RESULTS 97 clinicians participated over 2 years. Over 90% of participants rated the module favorably. Participants' self-efficacy to communicate efficiently with older patients with impairments improved significantly from pre- (M = 3.52, SD 0.85) to post-module training (M = 4.26, SD 0.50). Participants also demonstrated significant uptake of three skills-invite agenda, transition, and normalize. CONCLUSION The successful development and application of our program paves the way for future research that focuses on the evaluation of such geriatric-focused communication training in clinical settings, assessing patient-reported outcomes.
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Kim SH, Chong JU, Lim JH, Chung MJ, Park JY, Bang SM, Park SW, Hwang HK, Kang CM, Lee WJ, Kim KS. Oncologic outcomes after radical surgery for periampullary cancer in octogenarians. Ann Hepatobiliary Pancreat Surg 2018; 22:128-135. [PMID: 29896573 PMCID: PMC5981142 DOI: 10.14701/ahbps.2018.22.2.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/21/2022] Open
Abstract
Backgrounds/Aims Interest in treatments for elderly patients has increased with life expectancy, and various studies have reported on the safety and feasibility of radical surgery in elderly patients with cancer. Here, we investigated oncologic outcomes of periampullary cancer in octogenarians. Methods We retrospectively reviewed medical records of 68 patients over 80 years of age who were diagnosed with periampullary cancer and were eligible for surgery; we analyzed overall survival (OS) and immediate postoperative complications and mortality. Results There were no significant differences in mean age, disease type, oncologic features, comorbidities, or nutritional status between the patients who had surgery and those who did not. Five patients (20.0%) had major postoperative complications, but there was no immediate postoperative mortality. Patients who had surgery (n=25) had better OS (29.3 months; 95% confidence interval [CI]: 5.6–53.0) than did those who did not (n=43, OS: 7.6 months; 95% CI: 3.2–12.0 months; p<0.001). Similarly, patients with distal common bile duct cancer who underwent surgery had better OS than those who did not (surgery group: n=13, OS: 29.3 months, 95% CI: 8.9–49.7; non-surgery group: n=15, OS: 5.7 months, 95% CI: 4.2–7.2 months; p=0.002). Conclusions Radical surgery for octogenarian patients with periampullary cancer is safe, feasible, and expected to result in better survival outcomes, especially for patients with common bile duct cancer.
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Affiliation(s)
- Sung Hyun Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Uk Chong
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hong Lim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Jae Chung
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Youp Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Bang
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Woo Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Kyung Hwang
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Moo Kang
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jung Lee
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Expression alterations define unique molecular characteristics of spinal ependymomas. Oncotarget 2016; 6:19780-91. [PMID: 25909290 PMCID: PMC4637320 DOI: 10.18632/oncotarget.3715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/11/2015] [Indexed: 12/18/2022] Open
Abstract
Ependymomas are glial tumors that originate in either intracranial or spinal regions. Although tumors from different regions are histologically similar, they are biologically distinct. We therefore sought to identify molecular characteristics of spinal ependymomas (SEPN) in order to better understand the disease biology of these tumors. Using gene expression profiles of 256 tumor samples, we identified increased expression of 1,866 genes in SEPN when compared to intracranial ependymomas. These genes are mainly related to anterior/posterior pattern specification, response to oxidative stress, glial cell differentiation, DNA repair, and PPAR signalling, and also significantly enriched with cellular senescence genes (P = 5.5 × 10-03). In addition, a high number of significantly down-regulated genes in SEPN are localized to chromosome 22 (81 genes from chr22: 43,325,255 - 135,720,974; FDR = 1.77 × 10-23 and 22 genes from chr22: 324,739 - 32,822,302; FDR = 2.07 × 10-09) including BRD1, EP300, HDAC10, HIRA, HIC2, MKL1, and NF2. Evaluation of NF2 co-expressed genes further confirms the enrichment of chromosome 22 regions. Finally, systematic integration of chromosome 22 genes with interactome and NF2 co-expression data identifies key candidate genes. Our results reveal unique molecular characteristics of SEPN such as altered expression of cellular senescence and chromosome 22 genes.
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Pallis AG, Hatse S, Brouwers B, Pawelec G, Falandry C, Wedding U, Lago LD, Repetto L, Ring A, Wildiers H. Evaluating the physiological reserves of older patients with cancer: the value of potential biomarkers of aging? J Geriatr Oncol 2013; 5:204-18. [PMID: 24495695 DOI: 10.1016/j.jgo.2013.09.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/11/2013] [Accepted: 09/05/2013] [Indexed: 12/19/2022]
Abstract
Aging of an individual entails a progressive decline of functional reserves and loss of homeostasis that eventually lead to mortality. This process is highly individualized and is influenced by multiple genetic, epigenetic and environmental factors. This individualization and the diversity of factors influencing aging result in a significant heterogeneity among people with the same chronological age, representing a major challenge in daily oncology practice. Thus, many factors other than mere chronological age will contribute to treatment tolerance and outcome in the older patients with cancer. Clinical/comprehensive geriatric assessment can provide information on the general health status of individuals, but is far from perfect as a prognostic/predictive tool for individual patients. On the other hand, aging can also be assessed in terms of biological changes in certain tissues like the blood compartment which result from adaptive alterations due to past history of exposures, as well as intrinsic aging processes. There are major signs of 'aging' in lymphocytes (e.g. lymphocyte subset distribution, telomere length, p16INK4A expression), and also in (inflammatory) cytokine expression and gene expression patterns. These result from a combination of the above two processes, overlaying genetic predispositions which contribute significantly to the aging phenotype. These potential "aging biomarkers" might provide additional prognostic/predictive information supplementing clinical evaluation. The purpose of the current paper is to describe the most relevant potential "aging biomarkers" (markers that indicate the biological functional age of patients) which focus on the biological background, the (limited) available clinical data, and technical challenges. Despite their great potential interest, there is a need for much more (validated) clinical data before these biomarkers could be used in a routine clinical setting. This manuscript tries to provide a guideline on how these markers can be integrated in future research aimed at providing such data.
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Affiliation(s)
- Athanasios G Pallis
- European Organization for Research and Treatment of Cancer Elderly Task Force, Brussels, Belgium.
| | - Sigrid Hatse
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Barbara Brouwers
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Graham Pawelec
- Center for Medical Research, ZMF, University of Tübingen Medical School, Waldhörnlestr. 22, D-72072 Tübingen, Germany
| | - Claire Falandry
- Geriatrics Unit, Lyon Sud University Hospital, Pierre-Benite, France; Laboratoire de Biologie Moléculaire de la Cellule, Lyon Sud Medicine Faculty, Lyon University, Lyon, France
| | - Ulrich Wedding
- Jena University Hospital, Department of Internal Medicine, Erlanger Allee 101, 07747 Jena, Germany
| | - Lissandra Dal Lago
- Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Lazzaro Repetto
- Dipartimento Oncologia, Ospedale di Sanremo, Via G Borea, 56, 18038 Sanremo, Italy
| | | | - Hans Wildiers
- European Organization for Research and Treatment of Cancer Elderly Task Force, Brussels, Belgium; Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, and Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
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