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Singh G, Morant L, Bedra M, Emel J, Harris K, Markan Y, de Borja C, Tong M, Downs P, Boutros C. Value of a multidisciplinary geriatric oncology committee on patient care in a community-based, academic cancer center. J Geriatr Oncol 2024; 15:101771. [PMID: 38615579 DOI: 10.1016/j.jgo.2024.101771] [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: 11/09/2023] [Revised: 03/14/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION The heterogeneity in health and functional ability among older patients makes the management of cancer a unique challenge. The Geriatric Oncology Program at the University of Maryland Baltimore Washington Medical Center (BWMC) was created to optimize cancer management for older patients. This study aimed to assess the benefits of the implementation of such a program at a community-based academic cancer center. MATERIALS AND METHODS We analyzed patients aged ≥80 years presenting to the Geriatric Oncology Program between 2017 and 2022. A multidisciplinary team of specialists collectively reviewed each patient using geriatric-specific domains and stratified each patient into one of three management groups- Group 1: those deemed fit to receive standard oncologic care (SOC); Group 2: those recommended to receive optimization services prior to reassessment for SOC; and Group 3: those deemed to be best suited for supportive care and/or hospice care. RESULTS The study cohort consisted of 233 patients, of which 76 (32.6%) received SOC, 43 (18.5%) were optimized, and 114 (49.0%) received supportive care or hospice referral. Among the optimized patients, 69.8% were deemed fit for SOC upon re-evaluation following their respective optimization services. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) score was implemented in 2019 (n = 90). Patients receiving supportive/hospice care only had an average score of 5.8, while the averages for those in the optimization and SOC groups were 4.6 and 4.1, respectively (p ≤0.001). Patients receiving SOC had the longest average survival of 2.71 years compared to the optimization (2.30 years) and supportive care groups (0.93 years) (p ≤0.001). For all patients that underwent surgical interventions post-operatively, 23 patients (85%) were discharged home and four (15%) were discharged to a rehabilitation facility. DISCUSSION The present study demonstrates the profound impact that the complexities in health status and frailty among older individuals can have during cancer management. The Geriatric Oncology Program at BWMC maximized treatment outcomes for older adults through the provision of SOC therapies and optimization services, while also minimizing unnecessary interventions on an individual patient-centric level.
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Affiliation(s)
- Gurbani Singh
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States; University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201, United States
| | - Lena Morant
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - McKenzie Bedra
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Jennifer Emel
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Kelly Harris
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Yudhishtra Markan
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Christopher de Borja
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Monica Tong
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Patrice Downs
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Cherif Boutros
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States; University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201, United States.
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Montroni I, Ugolini G, Saur NM, Rostoft S, Spinelli A, Van Leeuwen BL, De Liguori Carino N, Ghignone F, Jaklitsch MT, Kenig J, Garutti A, Zingaretti C, Foca F, Vertogen B, Nanni O, Wexner SD, Audisio RA. Predicting Functional Recovery and Quality of Life in Older Patients Undergoing Colorectal Cancer Surgery: Real-World Data From the International GOSAFE Study. J Clin Oncol 2023; 41:5247-5262. [PMID: 37390383 DOI: 10.1200/jco.22.02195] [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: 10/04/2022] [Revised: 03/10/2023] [Accepted: 05/09/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE The GOSAFE study evaluates risk factors for failing to achieve good quality of life (QoL) and functional recovery (FR) in older patients undergoing surgery for colon and rectal cancer. METHODS Patients age 70 years and older undergoing major elective colorectal surgery were prospectively enrolled. Frailty assessment was performed and outcomes, including QoL (EQ-5D-3L) recorded (3/6 months postoperatively). Postoperative FR was defined as a combination of Activity of Daily Living ≥5 + Timed Up & Go test <20 seconds + MiniCog >2. RESULTS Prospective complete data were available for 625/646 consecutive patients (96.9%; 435 colon and 190 rectal cancer), 52.6% men, and median age was 79.0 years (IQR, 74.6-82.9 years). Surgery was minimally invasive in 73% of patients (321/435 colon; 135/190 rectum). At 3-6 months, 68.9%-70.3% patients experienced equal/better QoL (72.8%-72.9% colon, 60.1%-63.9% rectal cancer). At logistic regression analysis, preoperative Flemish Triage Risk Screening Tool ≥2 (3-month odds ratio [OR], 1.68; 95% CI, 1.04 to 2.73; P = .034, 6-month OR, 1.71; 95% CI, 1.06 to 2.75; P = .027) and postoperative complications (3-month OR, 2.03; 95% CI, 1.20 to 3.42; P = .008, 6-month OR, 2.56; 95% CI, 1.15 to 5.68; P = .02) are associated with decreased QoL after colectomy. Eastern Collaborative Oncology Group performance status (ECOG PS) ≥2 is a strong predictor of postoperative QoL decline in the rectal cancer subgroup (OR, 3.81; 95% CI, 1.45 to 9.92; P = .006). FR was reported by 254/323 (78.6%) patients with colon and 94/133 (70.6%) with rectal cancer. Charlson Age Comorbidity Index ≥7 (OR, 2.59; 95% CI, 1.26 to 5.32; P = .009), ECOG ≥2 (OR, 3.12; 95% CI, 1.36 to 7.20; P = .007 colon; OR, 4.61; 95% CI, 1.45 to 14.63; P = .009 rectal surgery), severe complications (OR, 17.33; 95% CI, 7.30 to 40.8; P < .001), fTRST ≥2 (OR, 2.71; 95% CI, 1.40 to 5.25; P = .003), and palliative surgery (OR, 4.11; 95% CI, 1.29 to 13.07; P = .017) are risk factors for not achieving FR. CONCLUSION The majority of older patients experience good QoL and stay independent after colorectal cancer surgery. Predictors for failing to achieve these essential outcomes are now defined to guide patients' and families' preoperative counseling.
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Affiliation(s)
- Isacco Montroni
- U.O. Department of Surgery, Colorectal Surgery Unit Ospedale S. Maria delle Croci, Ravenna, AUSL Romagna, Italy
| | - Giampaolo Ugolini
- U.O. Department of Surgery, Colorectal Surgery Unit Ospedale S. Maria delle Croci, Ravenna, AUSL Romagna, Italy
| | - Nicole M Saur
- University of Pennsylvania, Perelman School of Medicine, Department of Surgery, Division of Colon and Rectal Surgery, Philadelphia, PA
| | - Siri Rostoft
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Barbara L Van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Federico Ghignone
- U.O. Department of Surgery, Colorectal Surgery Unit Ospedale S. Maria delle Croci, Ravenna, AUSL Romagna, Italy
| | - Michael T Jaklitsch
- Division of Surgery, Division of Aging, Brigham and Women's Hospital, Boston, MA
| | - Jakub Kenig
- Department of General, Oncologic and Geriatric Surgery Jagiellonian University Medical College, Krakov, Poland
| | - Anna Garutti
- U.O. Department of Surgery, Colorectal Surgery Unit Ospedale S. Maria delle Croci, Ravenna, AUSL Romagna, Italy
| | - Chiara Zingaretti
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori," Meldola, Italy
| | - Flavia Foca
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori," Meldola, Italy
| | - Bernadette Vertogen
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori," Meldola, Italy
| | - Oriana Nanni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori," Meldola, Italy
| | - Steven D Wexner
- Cleveland Clinic Florida, Department of Colorectal Surgery, Weston, FL
| | - Riccardo A Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
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Osaki T, Tatebe S, Orihara J, Uchinaka E, Ashida K, Hirooka Y, Fujiwara Y. Impact of Frailty and Sarcopenia on Short- and Long-Term Outcomes in Elderly Patients Undergoing Radical Gastrectomy for Gastric Cancer. World J Surg 2023; 47:3250-3261. [PMID: 37777671 DOI: 10.1007/s00268-023-07200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The impact of frailty and sarcopenia in patients with gastric cancer is unclear. This study aimed to comprehensively examine the impact of frailty and sarcopenia on the short- and long-term outcomes in elderly patients undergoing radical gastrectomy for gastric cancer. METHODS We retrospectively assessed 246 patients aged ≥ 65 years who underwent radical gastrectomy. Frailty and sarcopenia were assessed using the modified frailty index (mFI) and psoas muscle mass index (PMI), respectively. RESULTS There were 30 (12.2%) and 60 (24.4%) patients with High-mFI and Low-PMI, respectively. As the age increased, both sexes showed significant correlations with PMI and mFI (r = - 0.238, 0.322, P = 0.003 and 0.002, respectively). High-mFI and Low-PMI did not affect the short-term outcomes. However, High-mFI was an independent risk factor for non-home discharge (P = 0.004) and was a significant predictor of 3- and 5-year overall survival (OS) (HR = 2.76 and 2.26; P = 0.002 and 0.005, respectively) and 1-, 3- and 5-year non-cancer-specific survival (non-CSS) (HR = 4.88, 8.05, and 4.01; P = 0.017, < 0.001, < 0.001, respectively). Low-PMI was a significant predictor of only 5-year OS (HR = 2.03, P = 0.003) and non-CSS (HR = 2.10, P = 0.020). CONCLUSIONS Frailty is significant predictor of non-home discharge and 1-, 3-, 5-year OS and 3- and 5-year non-CSS. Sarcopenia is a significant predictor of 5-year OS and non-CSS. Preoperative assessment of both frailty and sarcopenia can help surgeons to select adequate treatment strategies for the elderly population.
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Affiliation(s)
- Tomohiro Osaki
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan.
| | - Shigeru Tatebe
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Junpei Orihara
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Ei Uchinaka
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Keigo Ashida
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Yasuaki Hirooka
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine Graduate, Tottori, Japan
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Chen A, An E, Yan E, He D, Saripella A, Butris N, Tsang J, Englesakis M, Wong J, Alibhai S, Chung F. Incidence of preoperative instrumental activities of daily living (IADL) dependence and adverse outcomes in older surgical patients: A systematic review and meta-analysis. J Clin Anesth 2023; 89:111151. [PMID: 37210810 DOI: 10.1016/j.jclinane.2023.111151] [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: 02/09/2023] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
STUDY OBJECTIVE Instrumental activities of daily living (IADLs) are essential to patient function and quality of life after surgery. In older surgical patients, the incidence of preoperative IADL dependence has not been well characterized in the literature. This systematic review and meta-analysis aimed to determine the pooled incidence of preoperative IADL dependence and the associated adverse outcomes in the older surgical population. DESIGN Systematic review and meta-analysis. SETTING MEDLINE, MEDLINE Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations, Embase/Embase Classic, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews, ClinicalTrials.Gov, the WHO ICTRP (International Clinical Trials Registry Platform) were searched for relevant articles from 1969 to April 2022. PATIENTS Patients aged ≥60 years old undergoing surgery with preoperative IADL assessed by the Lawton IADL Scale. INTERVENTIONS Preoperative assessment. MEASUREMENT The primary outcome was the pooled incidence of preoperative IADL dependency. Additional outcomes included post-operative mortality, postoperative delirium [POD], functional status improvement, and discharge disposition. MAIN RESULTS Twenty-one studies (n = 5690) were included. In non-cardiac surgeries, the pooled incidence of preoperative IADL dependence was 37% (95% CI: 26.0%, 48.0%) among 2909 patients. Within cardiac surgeries, the pooled incidence of preoperative IADL dependence was 53% (95% CI: 24.0%, 82.0%) among 1074 patients. Preoperative IADL dependence was associated with an increased risk of postoperative delirium than those without IADL dependence (44.9% vs 24.4, OR 2.26; 95% CI: 1.42, 3.59; I2: 0%; P = 0.0005). CONCLUSIONS There is a high incidence of IADL dependence in older surgical patients undergoing non-cardiac and cardiac surgery. Preoperative IADL dependence was associated with a two-fold risk of postoperative delirium. Further work is needed to determine the feasibility of using the IADL scale preoperatively as a predictive tool for postoperative adverse outcomes.
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Affiliation(s)
- Alisia Chen
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ekaterina An
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ellene Yan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David He
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nina Butris
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jinny Tsang
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Shabbir Alibhai
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network and University of Toronto, Toronto, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Raz DJ, Kim JY, Erhunwmunesee L, Hite S, Varatkar G, Sun V. The value of perioperative physical activity in older patients undergoing surgery for lung cancer. Expert Rev Respir Med 2023; 17:691-700. [PMID: 37668168 DOI: 10.1080/17476348.2023.2255133] [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: 04/02/2023] [Revised: 07/24/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION With a median age at diagnosis of 70, lung cancer represents an enormous public health problem among older Americans. An estimated 19,000 people age 65 and older undergo lung cancer surgery annually in the US. Older adults undergoing lung cancer surgery are often frail with limited physiologic reserves, multi-morbidities, and functional impairments. Physical function, dyspnea, and quality of life return to baseline slower in older adults compared with younger adults after lung surgery. AREAS COVERED In this review, we summarize available data about perioperative physical activity interventions that may improve outcomes for older adults undergoing lung cancer surgery. We also review the limitations of existing studies and discuss emerging data on the roles of telehealth and family caregiver inclusion in peri-operative physical activity interventions. EXPERT OPINION We propose that future perioperative physical activity interventions in older adults undergoing lung cancer surgery should include a comprehensive geriatric assessment to guide personalized interventions. Interventions should be conceptually based, with a focus on enhancing self-efficacy, motivation, and adherence through classic behavior change strategies that are proven to impact outcomes. Finally, interventions should be designed with attention to feasibility and scalability. Exercise programs delivered via telehealth (telephone or tele-video) may improve access and convenience for patients.
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Affiliation(s)
- Dan J Raz
- Department of Surgery, City of Hope, CA, USA
| | - Jae Y Kim
- Department of Surgery, City of Hope, CA, USA
| | - Loretta Erhunwmunesee
- Department of Surgery, City of Hope, CA, USA
- Department of Population Sciences, City of Hope, CA, USA
| | - Sherry Hite
- Department of Rehabilitation, City of Hope, CA, USA
| | | | - Virginia Sun
- Department of Surgery, City of Hope, CA, USA
- Department of Population Sciences, City of Hope, CA, USA
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Sharon CE, Strohl C, Saur NM. Frailty Assessment and Prehabilitation as Part of a PeRioperative Evaluation and Planning (PREP) Program for Patients Undergoing Colorectal Surgery. Clin Colon Rectal Surg 2023; 36:184-191. [PMID: 37113278 PMCID: PMC10125297 DOI: 10.1055/s-0043-1761151] [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: 04/29/2023]
Abstract
Frailty assessment and prehabilitation can be incrementally implemented in a multidisciplinary, multiphase pathway to improve patient care. To start, modifications can be made to a surgeon's practice with existing resources while adapting standard pathways for frail patients. Frailty screening can identify patients in need of additional assessment and optimization. Personalized utilization of frailty data for optimization through prehabilitation can improve postoperative outcomes and identify patients who would benefit from adapted care. Additional utilization of the multidisciplinary team can lead to improved outcomes and a strong business case to add additional members of the team.
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Affiliation(s)
- Cimarron E. Sharon
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Strohl
- Department of Geriatrics, University of Pennsylvania, Philadelphia, Pennsylvania
- Geriatric Surgery Program, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Nicole M. Saur
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Geriatric Surgery Program, Pennsylvania Hospital, Philadelphia, Pennsylvania
- Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Taffurelli G, Montroni I, Ghignone F, Zattoni D, Garutti A, Di Candido F, Mazzotti F, Frascaroli G, Tamberi S, Ugolini G. Frailty assessment can predict textbook outcomes in senior adults after minimally invasive colorectal cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:626-632. [PMID: 36396488 DOI: 10.1016/j.ejso.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/21/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
AIM Colorectal cancer (CRC) surgery can be associated with suboptimal outcomes in older patients. The aim was to identify the correlation between frailty and surgical variables with the achievement of Textbook Outcome (TO), a composite measure of the ideal postoperative course, by older patients with CRC. METHOD All consecutive patients ≥70years who underwent elective CRC-surgery between January 2017 and November 2021 were analyzed from a prospective database. To obtain a TO, all the following must be achieved: 90-day survival, Clavien-Dindo (CD) < 3, no reintervention, no readmission, no discharge to rehabilitation facility, no changes in the living situation and length of stay (LOS) ≤5days/≤14days for colon and rectal surgery respectively. Frailty and surgical variables were related to the achievement of TO. RESULTS Four-hundred-twenty-one consecutive patients had surgery (97.7% minimally invasive), 24.9% for rectal cancer, median age 80 years (range 70-92), median LOS of 4 days (range 1-96). Overall, 288/421 patients (68.4%) achieved a TO. CD 3-4 complications rate was 6.4%, 90-day mortality rate was 2.9%. At univariate analysis, frailty and surgical variables (ileostomy creation, p = 0.045) were related to. However, multivariate analysis showed that only frailty measures such as flemish Triage Risk Screening Tool≥2 (OR 1.97, 95%CI: 1.23-3.16; p = 0.005); Charlson Index>6 (OR 1.61, 95%CI: 1.03-2.51; p = 0.036) or Timed-Up-and-Go>20 s (OR 2.06, 95%CI: 1.01-4.19; p = 0.048) independently predicted an increased risk of not achieving a TO. CONCLUSION The association between frailty and comprehensive surgical outcomes offers objective data for guiding family counseling, managing expectations and discussing the possible loss of independence with patients and caregivers.
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Affiliation(s)
- Giovanni Taffurelli
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy.
| | - Isacco Montroni
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Federico Ghignone
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Davide Zattoni
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Anna Garutti
- Department of Medical Oncology, Ospedale per gli Infermi, Faenza, AUSL Romagna, Italy
| | - Francesca Di Candido
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Federico Mazzotti
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Giacomo Frascaroli
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Stefano Tamberi
- Department of Medical Oncology, Ospedale per gli Infermi, Faenza, AUSL Romagna, Italy
| | - Giampaolo Ugolini
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy; University of Bologna, Italy
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Impact of surgery and chemotherapy timing on outcomes in older versus younger epithelial ovarian cancer patients: A nationwide Danish cohort study. J Geriatr Oncol 2023; 14:101359. [PMID: 35989185 DOI: 10.1016/j.jgo.2022.08.008] [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: 04/05/2022] [Revised: 05/30/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To explore differences in surgical complexity, chemotherapy administration, and treatment delays between younger and older Danish patients with epithelial ovarian cancer (EOC). MATERIALS AND METHODS We included a nationwide cohort diagnosed with EOC from 2013 to 2018. We described surgical complexity and outcomes, the extent of chemotherapy and treatment delays stratified by age (<70 and ≥ 70 years), and surgical modality (primary, interval, or no debulking surgery). RESULTS In total, we included 2946 patients. For patients with advanced-stage disease, 52% of the older patients versus 25% of the younger patients did not undergo primary debulking surgery (PDS) or interval debulking surgery (IDS). For patients undergoing PDS or IDS, older patients underwent less extensive surgery and more often had residual disease after surgery >0 cm compared to younger patients. Furthermore, older patients were less often treated with chemotherapy. Older patients had PDS later than younger. We did not find any differences between age groups concerning treatment delays. Two-year cancer-specific survival differed significantly between age groups regardless of curatively intended treatment. DISCUSSION This study demonstrates that older patients are treated less actively concerning surgical and oncological treatment than younger patients, leading to worse cancer-specific survival. Older patients do not experience more treatment delays than younger ones.
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Magnuson A, Van der Walde N, McKoy JM, Wildes TM, Wong ML, Le-Rademacher J, Little RF, Klepin HD. Integrating Geriatric Assessment Measures into National Cancer Institute Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:142-150. [PMID: 36519816 PMCID: PMC9949568 DOI: 10.1093/jncimonographs/lgac021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022] Open
Abstract
To improve the care of older adults with cancer, the traditional approach to clinical trial design needs to be reconsidered. Older adults are underrepresented in clinical trials with limited or no information on geriatric-specific factors, such as cognition or comorbidities. To address this knowledge gap and increase relevance of therapeutic clinical trial results to the real-life population, integration of aspects relevant to older adults is needed in oncology clinical trials. Geriatric assessment (GA) is a multidimensional tool comprising validated measures assessing specific health domains that are more frequently affected in older adults, including aspects related to physical function, comorbidity, medication use (polypharmacy), cognitive and psychological status, social support, and nutritional status. There are several mechanisms for incorporating either the full GA or specific GA measures into oncology therapeutic clinical trials to contribute to the overarching goal of the trial. Mechanisms include utilizing GA measures to better characterize the trial population, define trial eligibility, allocate treatment receipt within the context of the trial, develop predictive models for treatment outcomes, guide supportive care strategies, personalize care delivery, and assess longitudinal changes in GA domains. The objective of this manuscript is to review how GA measures can contribute to the overall goal of a clinical trial, to provide a framework to guide the selection and integration of GA measures into clinical trial design, and ultimately enable accrual of older adults to clinical trials by facilitating the design of trials tailored to older adults treated in clinical practice.
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Affiliation(s)
- Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Noam Van der Walde
- Department of Radiation Oncology, West Cancer Center and Research Institute, University of Tennessee Health Science Center, Germantown, TN, USA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tanya M Wildes
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine, Omaha, NE, USA
| | - Melisa L Wong
- Divisions of Hematology and Oncology and Geriatrics, Department of Internal Medicine, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | | | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Heidi D Klepin
- Correspondence to: Heidi D. Klepin, MD, MS, Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA (e-mail: )
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Luzarraga-Aznar A, Teixeira N, Luna-Guibourg R, Español P, Soler-Moreno C, Rovira R. Surgical treatment in older patients with endometrial cancer: A retrospective study. Surg Oncol 2022; 44:101852. [PMID: 36126351 DOI: 10.1016/j.suronc.2022.101852] [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: 05/19/2022] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Older patients (OP) diagnosed with endometrial cancer (EC) are less likely to receive an optimal surgical treatment compared with non-older patients (NOP). This undertreatment along with the presence of more aggressive tumours at diagnosis can explain the worse prognosis of EC in OP. There is limited evidence comparing perioperative outcomes between OP and NOP, and the benefit of applying complex procedures to OP is still controversial. The primary objective of the study was to compare intraoperative and postoperative complications between NOP and OP with EC that underwent primary surgery. Secondary objectives were to compare surgical management and survival rates. METHODS This is a retrospective single-centre observational study including women undergoing surgery for EC between 2010 and 2019. Patients were classified according to age as NOP (younger than 75 years) or OP (75 years or older). Basal characteristics and surgical outcomes of groups were compared using Chi-square, Fisher's exact tests, student T-tests or Mann Whitney tests. Kaplan Meier analysis was used to evaluate survival. RESULTS In total 281 patients underwent primary surgery for EC between 2010 and 2019 in our centre. At diagnosis, 184 patients were younger than 75 years while 97 were 75 and older. No differences were found in disease characteristics. Most of our patients (83,3%) underwent laparoscopic surgery. Pelvic (58,2% vs. 37,1%, p = 0,001) and para-aortic (46,7% vs. 23,7%, p < 0,001) lymphadenectomies were performed more frequently in NOP compared with OP. Rates of intra-operative (6,5% vs. 12,4%, p = 0,116) and post-operative (13,0% vs. 20,6%, p = 0,120) complications were not statistically different between NOP and OP, and neither was the rate of severe complications according to Clavien-Dindo classification (5,4% vs. 8,2% of complications grade III-V respectively, p = 0,387). The 5-year disease-specific survival (DSS) rate tended to be lower in the OP than in the NOP (74,8% vs. 82,5%, p = 0,071). Considering only patients in whom complete surgical staging was performed, OP presented similar DSS to NOP, with comparable complication rate. CONCLUSIONS OP do not present a significantly higher rate of perioperative complications compared to NOP. However, they underwent fewer lymphadenectomies and tended to present poorer DSS. Further studies are needed to standardize the surgical management of these patients.
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Affiliation(s)
- Ana Luzarraga-Aznar
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Natalia Teixeira
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Rocío Luna-Guibourg
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain.
| | - Pia Español
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Cristina Soler-Moreno
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Ramon Rovira
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
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Montroni I, Ugolini G, Saur NM, Rostoft S, Spinelli A, Van Leeuwen BL, De Liguori Carino N, Ghignone F, Jaklitsch MT, Somasundar P, Garutti A, Zingaretti C, Foca F, Vertogen B, Nanni O, Wexner SD, Audisio RA. Quality of Life in Older Adults After Major Cancer Surgery: The GOSAFE International Study. J Natl Cancer Inst 2022; 114:969-978. [PMID: 35394037 PMCID: PMC9275771 DOI: 10.1093/jnci/djac071] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/11/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Accurate quality of life (QoL) data and functional results after cancer surgery are lacking for older patients. The international, multicenter Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) Study compares QoL before and after surgery and identifies predictors of decline in QoL. METHODS GOSAFE prospectively collected data before and after major elective cancer surgery on older adults (≥70 years). Frailty assessment was performed and postoperative outcomes recorded (30, 90, and 180 days postoperatively) together with QoL data by means of the three-level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L), including 2 components: an index (range = 0-1) generated by 5 domains (mobility, self-care, ability to perform the usual activities, pain or discomfort, anxiety or depression) and a visual analog scale. RESULTS Data from 26 centers were collected (February 2017-March 2019). Complete data were available for 942/1005 consecutive patients (94.0%): 492 male (52.2%), median age 78 years (range = 70-95 years), and primary tumor was colorectal in 67.8%. A total 61.2% of all surgeries were via a minimally invasive approach. The 30-, 90-, and 180-day mortality was 3.7%, 6.3%, and 9%, respectively. At 30 and 180 days, postoperative morbidity was 39.2% and 52.4%, respectively, and Clavien-Dindo III-IV complications were 13.5% and 18.7%, respectively. The mean EQ-5D-3L index was similar before vs 3 months but improved at 6 months (0.79 vs 0.82; P < .001). Domains showing improvement were pain and anxiety or depression. A Flemish Triage Risk Screening Tool score greater than or equal to 2 (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.13 to 2.21, P = .007), palliative surgery (OR = 2.14, 95% CI = 1.01 to 4.52, P = .046), postoperative complications (OR = 1.95, 95% CI = 1.19 to 3.18, P = .007) correlated with worsening QoL. CONCLUSIONS GOSAFE shows that older adults' preoperative QoL is preserved 3 months after cancer surgery, independent of their age. Frailty screening tools, patient-reported outcomes, and goals-of-care discussions can guide decisions to pursue surgery and direct patients' expectations.
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Affiliation(s)
- Isacco Montroni
- Colorectal surgery Unit, Ospedale “per gli Infermi”, AUSL Romagna, Faenza, Italy
| | - Giampaolo Ugolini
- Colorectal surgery Unit, Ospedale “per gli Infermi”, AUSL Romagna, Faenza, Italy
| | - Nicole M Saur
- Perelman School of Medicine, Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Barbara L Van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Federico Ghignone
- Colorectal surgery Unit, Ospedale “per gli Infermi”, AUSL Romagna, Faenza, Italy
| | - Michael T Jaklitsch
- Division of Thoracic Surgery and Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ponnandai Somasundar
- Department of Surgery, Roger Williams Medical Center, Boston University, Providence, RI, USA
| | - Anna Garutti
- Colorectal surgery Unit, Ospedale “per gli Infermi”, AUSL Romagna, Faenza, Italy
| | - Chiara Zingaretti
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Bernadette Vertogen
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Riccardo A Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
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12
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Sawaki M, Shimomura A, Shien T, Iwata H. Management of breast cancer in older patients. Jpn J Clin Oncol 2022; 52:682-689. [DOI: 10.1093/jjco/hyac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Japanese women have the highest life expectancy in the world and breast cancer is the most prevalent cancer among them. However, little data are available to support the evidence-based clinical management due to the fact that older adults are commonly excluded from most clinical trials. In Japan the rate of other cause of death in older patient was about a half, then we should consider whether or not breast cancer may affect the patient’s life expectancy to avoid either overtreatment or undertreatment. Although management principles in older patients may be similar with those of younger age, these differences would be caused by relatively short life expectancy, some comorbidity, drug interactions and low functional status. Then, their treatment needs to be individualized. To this end, employing a comprehensive geriatric assessment may be advantageous, which enables to evaluate patient vulnerability from several different aspects, to predict adverse events of chemotherapy and to identify geriatric problems in advance so that extra support and modified treatment can be provided. Before treatment we should assess the patient’s goals and values regarding the management of the cancer, especially on balancing survival benefit with immediate quality of life impairment due to anti-cancer therapy. In Japan Clinical Oncology Group (JCOG) , a randomized controlled trial for older patients with advanced stage HER2-positive breast cancer is ongoing as an inferiority design including geriatric assessment (JCOG1607, HARB TEA study). Best practice, current management and how to approach decision making in older patients with breast cancer are summarized.
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Affiliation(s)
- Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akihiko Shimomura
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Saur NM, Davis BR, Montroni I, Shahrokni A, Rostoft S, Russell MM, Mohile SG, Suwanabol PA, Lightner AL, Poylin V, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery. Dis Colon Rectum 2022; 65:473-488. [PMID: 35001046 DOI: 10.1097/dcr.0000000000002410] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nicole M Saur
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bradley R Davis
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Isacco Montroni
- Department of Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Armin Shahrokni
- Department of Medicine/Geriatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marcia M Russell
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Pasithorn A Suwanabol
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Amy L Lightner
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Vitaliy Poylin
- Division of Gastrointestinal and Oncologic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
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14
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Martinez-Cannon BA, Perez ACT, Hincapie-Echeverri J, Roy M, Marinho J, Buerba GA, Akagunduz B, Li D, Soto-Perez-de-Celis E. Anal cancer in older adults: A Young International Society of Geriatric Oncology review paper. J Geriatr Oncol 2022; 13:914-923. [DOI: 10.1016/j.jgo.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
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15
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Høydahl Ø, Edna TH, Xanthoulis A, Lydersen S, Endreseth BH. Octogenarian patients with colon cancer - postoperative morbidity and mortality are the major challenges. BMC Cancer 2022; 22:302. [PMID: 35313841 PMCID: PMC8939202 DOI: 10.1186/s12885-022-09384-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients. The present study aimed to evaluate the relative survival of octogenarian patients after a major resection of colon cancer with a curative intent. Methods All patients diagnosed with colon cancer at Levanger Hospital between 1980 and 2016 were included. We performed logistic regression to test for associations between 90-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival. Results Among 237 octogenarian patients treated with major resections with curative intent, the 90-day mortality was 9.3%. Among 215 patients that survived the first 90 days, the 5 year relative survival rate was 98.7%. The 90-day mortality of octogenarian patients was significantly higher than that of younger patients, but the long-term survival converged with that of younger patients. Among octogenarian patients, the incidence of colon cancer more than doubled during our 37-year observation period. The relative increase in patients undergoing surgery exceeded the increase in incidence; hence, more patients were selected for surgery over time. A high 90-day mortality was associated with older age, a high American Society of Anaesthesiologists (ASA) score, and emergency surgery. Moreover, worse long-term survival was associated with a high Charlson Comorbidity Index, a high ASA score, a worse TNM stage, emergency surgery and residual tumours. Both the 90-day and long-term survival rates improved over time. Conclusion Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 90-day mortality was high, but after surviving 90 days, the relative long-term survival rate was comparable to that of younger patients. Further improvements in survival will primarily require measures to reduce the 90-day mortality risk.
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Affiliation(s)
- Øystein Høydahl
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway. .,IKOM Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Tom-Harald Edna
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,IKOM Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Athanasios Xanthoulis
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,IKOM Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Department of Mental Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Birger Henning Endreseth
- IKOM Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Geriatric assessment-informed treatment decision making and downstream outcomes: what are the research priorities? Curr Opin Support Palliat Care 2022; 16:25-32. [DOI: 10.1097/spc.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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The Impact of Frailty Screening on Radiation Treatment Modification. Cancers (Basel) 2022; 14:cancers14041072. [PMID: 35205820 PMCID: PMC8870720 DOI: 10.3390/cancers14041072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. METHODS Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, completed the frailty G8 and estimated survival Charlson questionnaires. The cohort was stratified between G8 score ≤ 14 (fragile) or >14 (robust); the cutoff point for the Charlson index was established at five. RESULTS Of 161 patients; 69.4% were male, the median age was 75 years (range 65-91), and the prevailing performance status (PS) was 0-1 (83.1%). Overall, 28.7% of the cohort were frail based on G8 scores, while the estimated survival at 10 years was 2.25% based on the Charlson test. The treatment administered changed up to 21% after frailty analysis. The therapies prescribed were 5.8 times more likely to be modified in frail patients based on the G8 test. In addition, patients ≥ 85 years (p = 0.01), a PS ≥ 2 (p = 0.008), and limited mobility (p = 0.024) were also associated with a potential change. CONCLUSIONS CGAs remain the optimal assessment tool in oncogeriatry. However, we found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making.
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Fasano M, D’Onofrio I, Belfiore MP, Angrisani A, Caliendo V, Della Corte CM, Pirozzi M, Facchini S, Caterino M, Guida C, Nardone V, Reginelli A, Cappabianca S. Head and Neck Squamous Cell Carcinoma in Elderly Patients: Role of Radiotherapy and Chemotherapy. Cancers (Basel) 2022; 14:cancers14030472. [PMID: 35158740 PMCID: PMC8833743 DOI: 10.3390/cancers14030472] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 01/01/2023] Open
Abstract
Simple Summary The focus of this review deals with the management of elderly patients with head and neck squamous cell carcinoma, discussing the role of clinical management, geriatric evaluation and therapeutic approaches (radiation therapy and systemic therapies). Abstract Head and neck squamous cell carcinomas (HNSCC) constitute the sixth most common malignancy worldwide, with approximately 25–40% of the diagnosed patients older than 70 years. HNSCC patients are often frail and frequently have multiple comorbidities due to their unhealthy lifestyle, and evidence suggests that older patients may receive less aggressive and suboptimal treatment than younger patients with the same disease status. The aim of this review is to depict and summarize the evidence regarding the different strategies that can be used in the clinical management of elderly HNSCC patients. Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. This paper contains a narrative report and a critical discussion of clinical approaches in the context of elderly HNSCC.
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Affiliation(s)
- Morena Fasano
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Ida D’Onofrio
- Unit of Radiation Oncology, Ospedale del Mare, ASL Napoli 1 Centro, 80147 Naples, Italy; (I.D.); (C.G.)
| | - Maria Paola Belfiore
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Antonio Angrisani
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Valentina Caliendo
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Carminia Maria Della Corte
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Mario Pirozzi
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Sergio Facchini
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Marianna Caterino
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Cesare Guida
- Unit of Radiation Oncology, Ospedale del Mare, ASL Napoli 1 Centro, 80147 Naples, Italy; (I.D.); (C.G.)
| | - Valerio Nardone
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
- Correspondence: ; Tel.: +39-0815-664-179
| | - Alfonso Reginelli
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
| | - Salvatore Cappabianca
- Department of Precision Medicine, Faculty of Medicine and Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.F.); (M.P.B.); (A.A.); (V.C.); (C.M.D.C.); (M.P.); (S.F.); (M.C.); (A.R.); (S.C.)
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OUP accepted manuscript. Br J Surg 2022; 109:595-602. [DOI: 10.1093/bjs/znac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/14/2021] [Accepted: 12/30/2021] [Indexed: 11/14/2022]
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Lee ST, Kim JW. Factors to consider for surgical in elderly patients with oral cancer. J Korean Assoc Oral Maxillofac Surg 2021; 47:388-393. [PMID: 34713814 PMCID: PMC8564093 DOI: 10.5125/jkaoms.2021.47.5.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022] Open
Abstract
At present, in Korea, due to developments in medicine and technology and an increasing mean lifespan, the expected lifetime for elderly people is increasing (at 70 years, the expected additional lifespan is 14.8 years for males and 18.3 years for females). However, among all causes of death, malignant neoplasm is ranked first for all ages. Further, the incidence rate of oral cancer tends to increase with age. Thus, oral and maxillofacial surgeons have increased opportunity to experience the ‘oldest old’ patients with oral cancer. Elderly patients commonly have several comorbidities, poor general condition, limited socioeconomic support, fear of various postoperative complications, and perception of short for the rest of their life. In this situation, the patient, caregiver, and surgeon often choose undergraded treatment rather than standard treatment for oral squamous cell carcinoma owing to patient age. In elderly patients with oral cancer, ablation of tumor or reconstructive surgery is challenging for surgeons. Oral and maxillofacial surgeons must evaluate carefully the patient’s medical condition and make a decision regarding treatment plans after sufficient discussion with patient and caregivers. We review the literature to consider the factors involved for deciding on a treatment plan regarding surgery in elderly patients with oral cancer.
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Affiliation(s)
- Sung-Tak Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Jin-Wook Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
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Tweed TTT, Sier MAT, Van Bodegraven AA, Van Nie NC, Sipers WMWH, Boerma EJG, Stoot JHMB. Feasibility and Efficiency of the BEFORE (Better Exercise and Food, Better Recovery) Prehabilitation Program. Nutrients 2021; 13:nu13103493. [PMID: 34684494 PMCID: PMC8538645 DOI: 10.3390/nu13103493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 12/11/2022] Open
Abstract
Prehabilitation has been postulated as an effective preventive intervention to reduce postoperative complications, particularly for elderly patients with a relatively high risk of complications. To date, it remains to be determined whether prehabilitation increases physical capacity and reduces postoperative complications. The aim of this study was to assess the feasibility of a 4-week multimodal prehabilitation program consisting of a personalized, supervised training program and nutritional intervention with daily fresh protein-rich food for colorectal cancer patients aged over 64 years prior to surgery. The primary outcome was the feasibility of this prehabilitation program defined as ≥80% compliance with the exercise training program and nutritional intervention. The secondary outcomes were the organizational feasibility and acceptability of the prehabilitation program. A compliance rate of ≥80% to both the exercise and nutritional intervention was accomplished by 6 patients (66.7%). Attendance of ≥80% at all 12 training sessions was achieved by 7 patients (77.8%); all patients (100%) attended ≥80% of the available training sessions. Overall, compliance with the training was 91.7%. Six patients (66.7%) accomplished compliance of ≥80% with the nutritional program. The median protein intake was 1.2 (g/kg/d). No adverse events occurred. This multimodal prehabilitation program was feasible for the majority of patients.
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Affiliation(s)
- Thaís T. T. Tweed
- Department of Surgery, Zuyderland Medical Center, Dr. H van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands; (M.A.T.S.); (N.C.V.N.); (E.-J.G.B.); (J.H.M.B.S.)
- Correspondence: ; Tel.: +31-6-47596097
| | - Misha A. T. Sier
- Department of Surgery, Zuyderland Medical Center, Dr. H van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands; (M.A.T.S.); (N.C.V.N.); (E.-J.G.B.); (J.H.M.B.S.)
| | - Ad A. Van Bodegraven
- Department of Gastroenterology, Zuyderland Medical Center, Dr. H van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands;
| | - Noémi C. Van Nie
- Department of Surgery, Zuyderland Medical Center, Dr. H van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands; (M.A.T.S.); (N.C.V.N.); (E.-J.G.B.); (J.H.M.B.S.)
| | - Walther M. W. H. Sipers
- Department of Geriatric Medicine, Zuyderland Medical Center, Dr. H van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands;
| | - Evert-Jan G. Boerma
- Department of Surgery, Zuyderland Medical Center, Dr. H van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands; (M.A.T.S.); (N.C.V.N.); (E.-J.G.B.); (J.H.M.B.S.)
| | - Jan H. M. B. Stoot
- Department of Surgery, Zuyderland Medical Center, Dr. H van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands; (M.A.T.S.); (N.C.V.N.); (E.-J.G.B.); (J.H.M.B.S.)
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22
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Ruiz M, Peña M, Cohen A, Ehsani H, Joseph B, Fain M, Mohler J, Toosizadeh N. Physical and Cognitive Function Assessment to Predict Postoperative Outcomes of Abdominal Surgery. J Surg Res 2021; 267:495-505. [PMID: 34252791 DOI: 10.1016/j.jss.2021.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/27/2021] [Accepted: 05/07/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Current evaluation methods to assess physical and cognitive function are limited and often not feasible in emergency settings. The upper-extremity function (UEF) test to assess physical and cognitive performance using wearable sensors. The purpose of this study was to examine the (1) relationship between preoperative UEF scores with in-hospital outcomes; and (2) association between postoperative UEF scores with 30-d adverse outcomes among adults undergoing emergent abdominal surgery. METHODS We performed an observational, longitudinal study among adults older than 40 y who presented with intra-abdominal symptoms. The UEF tests included a 20-sec rapid repetitive elbow flexion (physical function), and a 60-sec repetitive elbow flexion at a self-selected pace while counting backwards by threes (cognitive function), administered within 24-h of admission and within 24-h prior to discharge. Multiple logistic regression models assessed the association between UEF and outcomes. Each model consisted of the in-hospital or 30-d post-discharge outcome as the dependent variable, preoperative UEF physical and cognitive scores as hypothesis covariates, and age and sex as adjuster covariates. RESULTS Using UEF physical and cognitive scores to predict in-hospital outcomes, an area under curve (AUC) of 0.76 was achieved, which was 17% more sensitive when compared to age independently. For 30-d outcomes, the AUC increased to 0.89 when UEF physical and cognitive scores were included in the model with age and sex. DISCUSSION Sensor-based measures of physical and cognitive function enhance outcome prediction providing an objective practicable tool for risk stratification in emergency surgery settings among aging adults presenting with intra-abdominal symptoms.
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Affiliation(s)
- Martha Ruiz
- Department of Public Health, University of Arizona, Tucson, Arizona
| | - Miguel Peña
- Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, Arizona
| | - Audrey Cohen
- Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, Arizona
| | - Hossein Ehsani
- Kinesiology Department, University of Maryland, College Park, Maryland
| | - Bellal Joseph
- Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Mindy Fain
- Arizona Center on Aging, University of Arizona, Tucson, Arizona; Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Jane Mohler
- Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, Arizona
| | - Nima Toosizadeh
- Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, Arizona; Arizona Center on Aging, University of Arizona, Tucson, Arizona; Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, Arizona.
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23
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Cushman T, Waisel DB, Treggiari MM. The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective. Anesth Analg 2021; 133:663-675. [PMID: 34014183 DOI: 10.1213/ane.0000000000005559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
No patient arrives at the hospital to undergo general anesthesia for its own sake. Anesthesiology is a symbiont specialty, with the primary mission of preventing physical and psychological pain, easing anxiety, and shepherding physiologic homeostasis so that other care may safely progress. For most elective surgeries, the patient-anesthesiologist relationship begins shortly before and ends after the immediate perioperative period. While this may tempt anesthesiologists to defer goals of care discussions to our surgical or primary care colleagues, we have both an ethical and a practical imperative to share this responsibility. Since the early 1990s, the American College of Surgeons (ACS), the American Society of Anesthesiologists (ASA), and the Association of Perioperative Registered Nurses (AORN) have mandated a "required reconsideration" of do-not-resuscitate (DNR) orders. Key ethical considerations and guiding principles informing this "required reconsideration" have been extensively discussed in the literature and include respect for patient autonomy, beneficence, and nonmaleficence. In this article, we address how well these principles and guidelines are translated into daily clinical practice and how often anesthesiologists actually discuss goals of care or potential limitations to life-sustaining medical treatments (LSMTs) before administering anesthesia or sedation. Having done so, we review how often providers implement goal-concordant care, that is, care that reflects and adheres to the stated patient wishes. We conclude with describing several key gaps in the literature on goal-concordance of perioperative care for patients with limitations on LSMT and summarize novel strategies and promising efforts described in recent literature to improve goal-concordance of perioperative care.
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Affiliation(s)
- Tera Cushman
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - David B Waisel
- Department of Anesthesiology, Yale University, New Haven, Connecticut
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24
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Keyes AM, Kelly ME, McInerney N, Khan MF, Bolger JC, McCormack E, Grundy J, McCormack O, MacHale J, Conneely J, Brennan D, Cahill R, Shields C, Moran B, Mulsow J. Short-term outcomes in older patients with peritoneal malignancy treated with cytoreductive surgery and HIPEC: Experience with 245 patients from a national centre. Eur J Surg Oncol 2021; 47:2358-2362. [PMID: 33895028 DOI: 10.1016/j.ejso.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cytoreductive Surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the optimal management of selected patients with peritoneal malignancy. There is limited published evidence on outcomes in older patients treated by this complex therapeutic strategy. METHODS A retrospective review of a prospective database of all patients who underwent CRS with HIPEC in a single institution over seven years. A comparative analysis of outcomes in patients under 65 undergoing CRS and HIPEC with patients ≥65 years was performed. The key endpoints were morbidity, mortality, reintervention rate and length of stay in the high dependency/intensive care (HDU/ICU) units. RESULTS Overall, 245 patients underwent CRS and HIPEC during the study period, with 76/245 (31%) ≥65 years at the time of intervention. Tumour burden measured by the peritoneal carcinomatosis index (PCI) score was a median of 11 for both groups. Median length of hospital stay in the ≥65-year-old group was 14.5 days versus 13 days in the <65-year-old group (∗p = 0.01). Patients aged ≥65-years spent a median of one more day in the critical care unit ∗(p = 0.001). Significant morbidity (Clavien-Dindo ≥ Grade IIIa) was higher in the ≥65-year than the <65-year group (18.4% versus 11.2%). There were no perioperative deaths in the ≥65-year group. CONCLUSION This study demonstrates higher perioperative major morbidity in ≥65-year group, but with low mortality in patients undergoing CRS/HIPEC for disseminated intraperitoneal malignancy. This increased morbidity does not translate into higher rates of re-interventions and highlights the importance of optimal patient selection.
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Affiliation(s)
- Alan Martin Keyes
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Michael Eamon Kelly
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Niall McInerney
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Mohammad Faraz Khan
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Jarlath Christopher Bolger
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Emilie McCormack
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Josh Grundy
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Orla McCormack
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John MacHale
- Department of Anaesthesiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John Conneely
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Donal Brennan
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Ronan Cahill
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor Shields
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Brendan Moran
- Basingstoke and North Hampshire Hospital, Peritoneal Malignancy Institute, Basingstoke, UK
| | - Jürgen Mulsow
- National Centre for Peritoneal Malignancy, Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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Chesney TR, Haas B, Coburn N, Mahar AL, Davis LE, Zuk V, Zhao H, Wright F, Hsu AT, Hallet J. Association of frailty with long-term homecare utilization in older adults following cancer surgery: Retrospective population-based cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:888-895. [PMID: 32980211 DOI: 10.1016/j.ejso.2020.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/09/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Frailty is an important prognostic factor, and the association with postoperative dependence is important outcome to older adults. We examined the association of frailty with long-term homecare utilization for older adults following cancer surgery. METHODS In this population-based cohort study, we determined frailty status in all older adults (≥70 years old) undergoing cancer resection (2007-2017). Outcomes were receipt of homecare and intensity of homecare (days per month) over 5 years. We estimated the adjusted association of frailty with outcomes, and assessed interaction with age. RESULTS Of 82,037 patients, 6443 (7.8%) had frailty. Receipt and intensity of homecare was greater with frailty, but followed similar trajectories over 5 years between groups. Homecare receipt peaked in the first postoperative month (51.4% frailty, 43.1% no frailty), and plateaued by 1 year until 5 years (28.5% frailty, 12.8% no frailty). After 1 year, those with frailty required 4 more homecare days per month than without frailty (14 vs 10 days/month). After adjustment, frailty was associated with increased homecare receipt (hazard ratio 1.40; 95%CI 1.35-1.45), and increasing intensity each year (year 1 incidence rate ratio [IRR] 1.22, 95%CI 1.18-1.27 to year 5 IRR 1.47, 95%CI 1.35-1.59). The magnitude of the association of frailty with homecare receipt decreased with age (pinteraction <0.001). CONCLUSION While the trajectory of homecare receipt and intensity is similar between those with and without frailty, frailty is associated with increased receipt of homecare and increased intensity of homecare after cancer surgery across all age groups.
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Affiliation(s)
- Tyler R Chesney
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Barbara Haas
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Davis
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Victoria Zuk
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Frances Wright
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
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26
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Garcia MV, Agar MR, Soo WK, To T, Phillips JL. Screening Tools for Identifying Older Adults With Cancer Who May Benefit From a Geriatric Assessment: A Systematic Review. JAMA Oncol 2021; 7:616-627. [PMID: 33443547 DOI: 10.1001/jamaoncol.2020.6736] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Older adults with cancer are at risk of overtreatment or undertreatment when decision-making is based solely on chronological age. Although a geriatric assessment is recommended to inform care, the time and expertise required limit its feasibility for all patients. Screening tools offer the potential to identify those who will benefit most from a geriatric assessment. Consensus about the optimal tool to use is lacking. Objective To appraise the evidence on screening tools used for older adults with cancer and identify an optimal screening tool for older adults with cancer who may benefit from geriatric assessment. Evidence Review Systematic review of 4 databases (MEDLINE, Embase, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and PubMed) with narrative synthesis from January 1, 2000, to March 14, 2019. Studies reporting on the diagnostic accuracy and use of validated screening tools to identify older adults with cancer who need a geriatric assessment were eligible for inclusion. Data were analyzed from March 14, 2019, to March 23, 2020. Findings Seventeen unique studies were included, reporting on the use of 12 screening tools. Most studies were prospective cohort studies (n = 11) with only 1 randomized clinical trial. Not all studies reported time taken to administer the screening tools. The Geriatric-8 (G8) (n = 12) and the Vulnerable Elders Survey-13 (VES-13) (n = 9) were the most frequently evaluated screening tools. The G8 scored better in sensitivity and the VES-13 in specificity. Other screening tools evaluated include the Groningen Frailty Index, abbreviated comprehensive geriatric assessment, and Physical Performance Test in 2 studies each. All other screening tools were evaluated in 1 study each. Conclusions and Relevance To date, the G8 and VES-13 have the most evidence to recommend their use to inform the need for geriatric assessment. When choosing a screening tool, clinicians will need to weigh the tradeoffs between sensitivity and specificity. Future research needs to further validate or improve current screening tools and explore other factors that can influence their use, such as ease of use and resourcing.
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Affiliation(s)
- Maja V Garcia
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Meera R Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Wee-Kheng Soo
- Eastern Health Clinical School, Monash University, Melbourne, Australia.,Cancer Services, Eastern Health, Melbourne, Australia.,Department of Aged Medicine, Eastern Health, Victoria, Australia
| | - Timothy To
- Division of Rehabilitation, Aged Care and Palliative Care, Flinders Medical Centre, Bedford Park, Australia.,Flinders University College of Nursing and Health Sciences, Bedford Park, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Zattoni D, Montroni I, Saur NM, Garutti A, Bacchi Reggiani ML, Ghignone F, Taffurelli G, Ugolini G. Prediction of functional loss in emergency surgery is possible with a simple frailty screening tool. World J Emerg Surg 2021; 16:12. [PMID: 33736667 PMCID: PMC7977323 DOI: 10.1186/s13017-021-00356-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/26/2021] [Indexed: 12/25/2022] Open
Abstract
Background Senior adults fear postoperative loss of independence the most, and this might represent an additional burden for families and society. The number of geriatric patients admitted to the emergency room requiring an urgent surgical treatment is rising, and the presence of frailty is the main risk factor for postoperative morbidity and functional decline. Frailty assessment in the busy emergency setting is challenging. The aim of this study is to verify the effectiveness of a very simple five-item frailty screening tool, the Flemish version of the Triage Risk Screening Tool (fTRST), in predicting functional loss after emergency surgery among senior adults who were found to be independent before surgery. Methods All consecutive individuals aged 70 years and older who were independent (activity of daily living (ADL) score ≥5) and were admitted to the emergency surgery unit with an urgent need for abdominal surgery between December 2015 and May 2016 were prospectively included in the study. On admission, individuals were screened using the fTRST and additional metrics such as the age-adjusted Charlson Comorbidity Index (CACI) and the ASA score. Thirty- and 90-day complications and postoperative decline in the ADL score where recorded. Regression analysis was performed to identify preoperative predictors of functional loss. Results Seventy-eight patients entered the study. Thirty-day mortality rate was 12.8% (10/78), and the 90-day overall mortality was 15.4% (12/78). One in every four patients (17/68) experienced a significant functional loss at 30-day follow-up. At 90-day follow-up, only 3/17 patients recovered, 2 patients died, and 12 remained permanently dependent. On the regression analysis, a statistically significant correlation with functional loss was found for fTRST, CACI, and age≥85 years old both at 30 and 90 days after surgery. fTRST≥2 showed the highest effectiveness in predicting functional loss at 90 days with AUC 72 and OR 6.93 (95% CI 1.71–28.05). The institutionalization rate with the need to discharge patients to a healthcare facility was 7.6% (5/66); all of them had a fTRST≥2. Conclusion fTRST is an easy and effective tool to predict the risk of a postoperative functional decline and nursing home admission in the emergency setting.
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Affiliation(s)
- Davide Zattoni
- Department of General Surgery, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy. .,Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy.
| | - Isacco Montroni
- Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy
| | - Nicole Marie Saur
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, 800 Walnut Street 20th floor, Philadelphia, PA, USA
| | - Anna Garutti
- Department of Geriatrics, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy
| | | | - Federico Ghignone
- Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy
| | - Giovanni Taffurelli
- Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy
| | - Giampaolo Ugolini
- Department of General Surgery, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy.,Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy
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Dammeyer K, Alfonso AR, Diep GK, Kantar RS, Berman ZP, Daar DA, Ramly EP, Sosin M, Ceradini DJ. Predicting postoperative complications following mastectomy in the elderly: Evidence for the 5-factor frailty index. Breast J 2021; 27:509-513. [PMID: 33650221 DOI: 10.1111/tbj.14208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/11/2021] [Accepted: 02/10/2021] [Indexed: 01/01/2023]
Abstract
Understanding the risk factors that contribute to post-mastectomy complications can better inform preoperative discussions. Here, we assess the impact of the 5-Factor Frailty Index Score (mFI-5) in predicting 30-day postoperative complications in patients undergoing mastectomy. A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data base was conducted for patients older than 65 undergoing mastectomy between 2010 and 2015. We assessed each patient's Frailty Index Score using the mFI-5. Primary outcomes included wound complications and overall complications. Multivariate logistic and linear regression analyses were used to determine the ability of the mFI-5 to predict postoperative outcomes. A total of 13,783 patients were analyzed. The rate of wound complications was 3.0%, while the rate of overall complications was 6.0%. An mFI-5 score greater than 2 was an independent risk factor for wound complications and overall complications. Overall, patients undergoing mastectomy with an mFI-5 of 2 or greater experienced higher rates of postoperative complications. The mFI-5 is an accessible tool that can be used to risk-stratify patients undergoing mastectomy and can positively contribute to the informed consent and shared decision-making process.
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Affiliation(s)
- Kristen Dammeyer
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Gustave K Diep
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - David A Daar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Michael Sosin
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Daniel J Ceradini
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
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Morgan JL, Holmes G, Ward S, Martin C, Burton M, Walters SJ, Cheung KL, Audisio RA, Reed MW, Wyld L. Observational cohort study to determine the degree and causes of variation in the rate of surgery or primary endocrine therapy in older women with operable breast cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:261-268. [PMID: 33046279 PMCID: PMC7526638 DOI: 10.1016/j.ejso.2020.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/18/2020] [Accepted: 09/09/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND In the UK there is variation in the treatment of older women with breast cancer, with up to 40% receiving primary endocrine therapy (PET), which is associated with inferior survival. Case mix and patient choice may explain some variation in practice but clinician preference may also be important. METHODS A multicentre prospective cohort study of women aged >70 with operable breast cancer. Patient characteristics (health status, age, tumour characteristics, treatment allocation and decision-making preference) were analysed to identify whether treatment variation persisted following case-mix adjustment. Expected case-mix adjusted surgery rates were derived by logistic regression using the variables age, co-morbidity, tumour stage and grade. Concordance between patients' preferred and actual decision-making style was assessed and associations between age, treatment and decision-making style calculated. RESULTS Women (median age 77, range 70-102) were recruited from 56 UK breast units between 2013 and 2018. Of 2854/3369 eligible women with oestrogen receptor positive breast cancer, 2354 were treated with surgery and 500 with PET. Unadjusted surgery rates varied between hospitals, with 23/56 units falling outside the 95% confidence intervals on funnel plots. Adjusting for case mix reduced, but did not eliminate, this variation between hospitals (10/56 units had practice outside the 95% confidence intervals). Patients treated with PET had more patient-centred decisions compared to surgical patients (42.2% vs 28.4%, p < 0.001). CONCLUSIONS This study demonstrates variation in treatment selection thresholds for older women with breast cancer. Health stratified guidelines on thresholds for PET would help reduce variation, although patient preference should still be respected.
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Affiliation(s)
- Jenna L Morgan
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.
| | - Geoff Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sue Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charlene Martin
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Stephen J Walters
- Clinical Trials Research Unit, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Kwok Leung Cheung
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
| | - Riccardo A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, 41345, Göteborg, Sweden
| | | | - Lynda Wyld
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
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Saur NM, Montroni I, Audisio RA. Considerations in Surgical Management of Gastrointestinal Cancer in Older Patients. Curr Oncol Rep 2021; 23:8. [PMID: 33387059 DOI: 10.1007/s11912-020-00991-y] [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] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The goal of this manuscript is to present new and thought-provoking information related to the surgical care of older patients. We focused on four main areas including communication, surgical pathways, the care of emergency surgery patients, and functional recovery and quality of life. We sought to answer how these areas have evolved, affecting the care of older patients. RECENT FINDINGS Older patients with cancer present particular challenges in relation to communication, goals, surgical treatment, and post-surgical outcomes. Communication should be clear early and during the treatment course. A multidisciplinary, multimodality, multi-phase pathway can be utilized to improve the postoperative outcomes of older patients with cancer. Functional recovery and quality of life can and should be measured in this population. Communication is complicated in cancer patients, which is made more complex with advancing age. Communication is the cornerstone of the treatment of older patients. Future research should focus on interventions to improve communication and measure quality of life and functional recovery metrics.
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Affiliation(s)
- Nicole M Saur
- Department of Surgery, University of Pennsylvania, 800 Walnut Street 20th floor, Philadelphia, PA, 19107, USA.
| | - Isacco Montroni
- Department of General Surgery, Ospedale per gli Infermi, Viale Stradone 9, 48018, Faenza, RA, Italy
| | - Riccardo A Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Blå Stråket 5, 413 45, Göteborg, Sweden
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Dworsky JQ, Shellito AD, Childers CP, Copeland TP, Maggard-Gibbons M, Tan HJ, Saliba D, Russell MM. Association of Geriatric Events With Perioperative Outcomes After Elective Inpatient Surgery. J Surg Res 2020; 259:192-199. [PMID: 33302219 DOI: 10.1016/j.jss.2020.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/14/2020] [Accepted: 11/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Older adults undergoing surgery are at risk for geriatric events (GEs: delirium, dehydration, falls or fractures, failure to thrive, and pressure ulcers). The prevalence and association of GEs with clinical outcomes after elective surgery is unclear. MATERIALS AND METHODS Using the 2013-2014 National Inpatient Sample, we analyzed hospital admissions for the five most common elective procedures (total knee arthroplasty, right hemicolectomy, carotid endarterectomy, aortic valve replacement, and radical prostatectomy) in older adults (age ≥ 65). Our primary variable of interest was presence of any GE. Logistic regression estimated the association of GEs with (1) age group and (2) perioperative outcomes (mortality, postoperative complications, prolonged length of stay, and discharge to skilled nursing facility). RESULTS Of 1,255,120 admissions, 66.5% were aged ≥65. The overall rate of any GE was 2.4% and increased with age (55-64 y: 1.5%; 65-74: 2.2%; ≥75: 4.1%; P < 0.001). After adjustment, the probability of any GE increased with age (P < 0.001). Rates of GEs varied by procedure (P < 0.001). In comparison with admissions with no GEs, one or more GE was associated with higher probability of worse outcomes including mortality, postoperative complications, prolonged length of stay, and discharge to skilled nursing facility (all P < 0.001). In addition, there was a dose-dependent relationship between GEs and these poor perioperative outcomes. CONCLUSIONS GEs are strongly associated with poor perioperative outcomes. Efforts should focus on mutable factors responsible for GEs to optimize surgical care for older adults.
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Affiliation(s)
- Jill Q Dworsky
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.
| | - Adam D Shellito
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance California.
| | | | - Timothy P Copeland
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | | | - Hung-Jui Tan
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Debra Saliba
- Los Angeles VA GRECC & UCLA Borun Center, Los Angeles, California
| | - Marcia M Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
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VanderWalde NA, Williams GR. Developing an electronic geriatric assessment to improve care of older adults with cancer receiving radiotherapy. Tech Innov Patient Support Radiat Oncol 2020; 16:24-29. [PMID: 33385071 PMCID: PMC7769846 DOI: 10.1016/j.tipsro.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 01/02/2023] Open
Abstract
Older adults make up a substantial proportion of patients diagnosed with cancer. Gaps in evidence of care for older adults with cancer leads to treatment heterogeneity and poor outcomes. Medical and Surgical Oncology clinics throughout the world are increasingly using Geriatric Assessment (GA) based approaches to treatment that are beginning to improve care through treatment decision-making communication, health-related quality of life outcomes, and reducing chemotherapy toxicities. Yet, GA based approaches are not often used in radiation oncology clinics. This manuscript aims to describe the ongoing development of an electronic patient-reported GA with real-time data interpretation and recommendation delivery to help increase the use of a personalized GA based approach to the care of older adults within radiation oncology clinics. Future studies demonstrating the utility and benefit of GA based approaches to help older adults undergoing radiotherapy for their cancers are still sorely needed.
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Affiliation(s)
- Noam A. VanderWalde
- Department of Radiation Oncology, West Cancer Center and Research Institute, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Grant R. Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama Birmingham, Birmingham, AL, United States
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Belgrano V, Ramello M, Montroni I, Audisio RA. Surgical oncology in the elderly. Acta Chir Belg 2020; 120:401-403. [PMID: 31328639 DOI: 10.1080/00015458.2019.1642598] [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: 10/26/2022]
Abstract
Poor cancer-specific outcomes in the elderly group are primarily a surgical failure. Surgeons are insufficiently trained to draw a line between fit and frail patients; this results in over-treatment of the frail patient, as well as under-treatment of the fit one. Communication skills should be improved to better understand the patient's requests. The timing of the surgical procedure is crucially important; all efforts should be put in place to optimize the patient's conditions before the surgery takes place.
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Affiliation(s)
- Valerio Belgrano
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Policlinico San Martino, University General Hospital, University of Genoa, Genoa, Italy
| | - Monica Ramello
- Department of Medical Oncology, Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale Maggiore, Trieste, Italy
| | - Isacco Montroni
- Colorectal Surgery and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Riccardo A. Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
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Pata G, Bianchetti L, Rota M, Marengoni A, Chiesa D, Cassinotti E, Palmisano S, Colombi M, Del Zotto G, Romanelli G, Calza S, Boni L, De Manzini N, Fumagalli Romario U. Multidimensional Prognostic Index (MPI) score has the major impact on outcome prediction in elderly surgical patients with colorectal cancer: The FRAGIS study. J Surg Oncol 2020; 123:667-675. [PMID: 33238052 DOI: 10.1002/jso.26314] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study aims (I) to evaluate whether the Multidimensional Prognostic Index (MPI) score is associated with postoperative outcomes and (II) to develop a prognostic model for individual complication-risk prediction following colorectal cancer (CRC) surgery. METHOD This is a prospective multicentric cohort study. Consecutive ≥75-year-old candidates for elective CRC surgery were enrolled from October 2017 to August 2019. Patients underwent standardized preoperative geriatric assessment including the MPI. Patients with MPI score > 0.33 were classified as frail. Logistic regression models were employed to evaluate variables associated with major postoperative complications and mortality, using 10-fold cross-validated LASSO (least absolute shrinkage and selection operator) for model selection. RESULTS In all, 104 patients were included, 34 (33%) had MPI score > 0.33. Major postoperative complications occurred in 52% of frail versus 16% of fit (MPI score ≤ 0.33) patients (p < .01). Both 30-day (9% vs. 0%; p = .033) and 90-day mortality (18% vs. 1%; p < .01) were higher among frail patients. In multivariate analysis, MPI score was associated with adverse outcomes. A final postoperative complication predictive model was created, including MPI score, gait-speed test, ASA (American Society of Anesthesiology) score, surgical approach, and stoma creation. CONCLUSION MPI score is strongly associated with postoperative major complications in CRC elderly patients and it is a primary component of an individual prediction model.
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Affiliation(s)
- Giacomo Pata
- General Surgery 2 Unit, University Hospital ASST Spedali Civili of Brescia, Brescia, Italy
| | - Luca Bianchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Deborah Chiesa
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS-Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Silvia Palmisano
- Department of Surgery, Ospedali Riuniti, University of Trieste, Trieste, Italy
| | - Marta Colombi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulio Del Zotto
- Department of Surgery, Ospedali Riuniti, University of Trieste, Trieste, Italy
| | - Giuseppe Romanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Big and Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS-Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nicolò De Manzini
- Department of Surgery, Ospedali Riuniti, University of Trieste, Trieste, Italy
| | - Uberto Fumagalli Romario
- General Surgery 2 Unit, University Hospital ASST Spedali Civili of Brescia, Brescia, Italy.,Digestive Surgery Unit, European Institute of Oncology (IEO), IRCCS, Milan, Italy
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The impact of frailty in older women undergoing pelvic floor reconstructive surgery. Menopause 2020; 28:332-336. [PMID: 33177412 DOI: 10.1097/gme.0000000000001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
IMPORTANCE AND OBJECTIVE Women ≥ 65 years old commonly undergo pelvic surgery but are often not screened for coexisting frailty, the presence of which increases the risk of postoperative complications. In the absence of a current consensus, the objective of this review is to discuss the incorporation of a frailty assessment into the work-up of women undergoing pelvic floor reconstructive surgery. METHODS This is a review of the literature, focusing on measurements of frailty including the Edmonton Frail Scale, FRAIL scale, Groningen Frailty Indicator, frailty phenotype, Tilburg Frailty Indicator, a 70-item frailty index, Mini-Cog score, Charlson comorbidity index, timed up and go test, and life-space assessment. Their use in the perioperative management of older women undergoing pelvic floor reconstructive surgery will be discussed. DISCUSSION AND CONCLUSION Understanding the concept of frailty and how it may affect surgical decisions and outcomes is essential. The timed up and go test, life space assessment and Mini-Cog assessment at a minimum should be considered preoperatively in patients over the age of 65 years old planning pelvic floor or elective surgery.
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Abstract
Ovarian cancer is the third most common gynecologic malignancy worldwide but accounts for the highest mortality rate among these cancers. A stepwise approach to assessment, diagnosis, and treatment is vital to appropriate management of this disease process. An integrated approach with gynecologic oncologists as well as medical oncologists, pathologists, and radiologists is of paramount importance to improving outcomes. Surgical cytoreduction to R0 is the mainstay of treatment, followed by adjuvant chemotherapy. Genetic testing for gene mutations that affect treatment is the standard of care for all women with epithelial ovarian cancer. Nearly all women will have a recurrence, and the treatment of recurrent ovarian cancer continues to be nuanced and requires extensive review of up to date modalities that balance efficacy with the patient's quality of life. Maintenance therapy with poly ADP-ribose polymerase inhibitors, bevacizumab, and/or drugs targeting homologous recombination deficiency is becoming more widely used in the treatment of ovarian cancer, and the advancement of immunotherapy is further revolutionizing treatment targets.
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Affiliation(s)
- Lindsay Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO, USA
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Care of the Geriatric Colorectal Surgical Patient and Framework for Creating a Geriatric Program: A Compendium From the 2019 American Society of Colon and Rectal Surgeons Annual Meeting. Dis Colon Rectum 2020; 63:1489-1495. [PMID: 32947418 PMCID: PMC7547896 DOI: 10.1097/dcr.0000000000001793] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Supplemental Digital Content is available in the text.
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Abstract
Curative-intent surgery is the treatment of choice for thoracic malignancies, including lung cancer. There is significant complexity and uncertainty associated with the diagnosis, prognosis, and surgical treatment decision-making in thoracic surgery. From a patient point of view, this complexity and uncertainty can be overwhelming. Therefore, for high-quality cancer care, an emphasis on patient-centered care-including the improvement in quality of life (QOL) through symptom and functional monitoring-is essential. Using the current literature and our previous research, the purpose of this paper is to: (I) review the current evidence on symptom and functional monitoring in surgery; (II) describe strategies to monitor symptoms and functional recovery in surgery; and (III) describe a model of patient-centered care in thoracic surgery.
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Affiliation(s)
- Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Jae Kim
- Division of Thoracic Surgery, Department of Surgery, City of Hope, Duarte, CA, USA
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Hellman K, Holmberg E, Bjurberg M, Borgfeldt C, Dahm-Kähler P, Flöter Rådestad A, Hjerpe E, Högberg T, Marcickiewicz J, Rosenberg P, Stålberg K, Tholander B, Kjølhede P, Åvall-Lundqvist E. Primary treatment and relative survival by stage and age in vulvar squamous cell carcinoma: A population-based SweGCG study. Gynecol Oncol 2020; 159:663-671. [PMID: 32988623 DOI: 10.1016/j.ygyno.2020.09.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Vulvar cancer affects mainly elderly women and with an ageing population the incidence has increased. We explored the primary treatment patterns and relative survival of patients with vulvar squamous cell carcinoma (VSCC) by stage and age-group. METHODS A population-based nationwide study on women diagnosed with VSCC between 2012 and 2016 and registered in the Swedish Quality Registry for Gynecologic Cancer (SQRGC). Main outcome was 5-year relative survival (RS) estimated by the Pohar Perme method. The relative risk of excess mortality (EMRR) between different groups was analyzed by Poisson regression. The age-standardized relative survival (AS-RS) was estimated for the total cohort. RESULTS Median follow-up time was 41 months. The study population included 657 women; 33% were ≥ 80 years old. FIGO stage I was most common (55%). Primary surgery was performed in 96% stage I, 65% stage II, 80% stage III and 28% stage IV. In women ≥80 years, exploration of the groins and chemoradiotherapy was less often performed. They also received lower mean doses of radiation than younger women. The 5-year AS-RS was 74%. 5-year RS was 84% for stage I, 60% for stage II, 54% for stage III and 35% for stage IV. The EMRR for women ≥80 years compared with women <60 years was 4.3 (p < 0.001); 4.9 (p < 0.001) for stages I-II and 3.5(p = 0.007) for stage III. CONCLUSIONS In general, primary treatment of patients with vulvar squamous cell carcinoma in Sweden adhered to guidelines. Areas of improvement include treatment for stage II and for the very old.
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Affiliation(s)
- Kristina Hellman
- Department of Gynecologic Cancer, Theme Cancer, Karolinska University Hospital, SE-17176 Stockholm, Sweden.
| | - Erik Holmberg
- Region Västra Götaland, Regional Cancer Centre West, SE-41345 Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, SE-41345 Gothenburg, Sweden
| | - Maria Bjurberg
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Department of Clinical Sciences, Lund University, SE-22185 Lund, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital and Lund University, SE-22185 Lund, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden
| | - Angelique Flöter Rådestad
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Elisabet Hjerpe
- Department of Obstetrics and Gynecology, Visby Hospital, SE-62155 Visby, Sweden
| | - Thomas Högberg
- Department of Cancer Epidemiology, Lund University, SE-22100 Lund, Sweden
| | - Janusz Marcickiewicz
- Department of Obstetrics and Gynecology, Halland Hospital, SE-43281 Varberg, Sweden
| | - Per Rosenberg
- Department of Oncology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-58185 Linköping, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, SE-75185 Uppsala, Sweden
| | - Bengt Tholander
- Department of Oncology, Uppsala University Hospital, SE-75185 Uppsala, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, SE-58185 Linköping, Sweden
| | - Elisabeth Åvall-Lundqvist
- Department of Oncology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-58185 Linköping, Sweden
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Chavarri-Guerra Y, Slavin TP, Longoria-Lozano O, Weitzel JN. Genetic cancer predisposition syndromes among older adults. J Geriatr Oncol 2020; 11:1054-1060. [PMID: 31980412 PMCID: PMC7937543 DOI: 10.1016/j.jgo.2020.01.001] [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: 09/05/2019] [Revised: 11/27/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Abstract
Earlier age at onset is one characteristic of hereditary cancer syndromes, so most studies of genetic testing have focused on young patients with cancer. However, recent studies of multigene panel tests in unselected cancer populations have detected a considerable proportion of older patients with germline pathogenic variants (PVs) in cancer susceptibility genes. As the number of older patients with cancer continues to rise, clinicians should be aware of genetic/genomic cancer risk assessment (GCRA) criteria in both young and older adults. Identifying individuals with a germline PV in a cancer susceptibility gene may be important for precision therapy of current cancers and screening and prevention of new primary cancers, as well as cascade testing to identify high cancer risks for family members. Typically, hereditary predisposition germline genetic testing has been recommended for patients with early onset cancers and/or a family history of cancer. However, more recently international guidelines recommend testing for potential therapeutic intervention regardless of age for some tumors frequently seen in older patients, such as epithelial ovarian, pancreatic, and metastatic prostate and breast cancers. GCRA in older patients may present challenges including: clonal hematopoiesis (CH) confounding test interpretation, ethical aspects (autonomy, nonmaleficence, beneficence), patient health status, comorbidities, as well as lack of insurance coverage. These factors should be considered during genetic counseling and when considering cancer screening and risk reduction procedures. This manuscript reviews available data on common hereditary cancer syndromes in older patients and provides tools to help providers perform GCRA in this population.
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Affiliation(s)
- Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Thomas P Slavin
- Department of Medical Oncology, Division of Clinical Cancer Genomics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ossian Longoria-Lozano
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jeffrey N Weitzel
- Department of Medical Oncology, Division of Clinical Cancer Genomics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Shahrokni A, Vishnevsky BM, Jang B, Sarraf S, Alexander K, Kim SJ, Downey R, Afonso A, Korc-Grodzicki B. Geriatric Assessment, Not ASA Physical Status, Is Associated With 6-Month Postoperative Survival in Patients With Cancer Aged ≥75 Years. J Natl Compr Canc Netw 2020; 17:687-694. [PMID: 31200361 DOI: 10.6004/jnccn.2018.7277] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The American Society of Anesthesiologists physical status (ASA PS) classification system is the most common method of assessing preoperative functional status. Comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool for preoperative assessment of older adults. The goal of this study was to assess the correlation between ASA classification and CGA deficits among oncogeriatric patients and to determine the association of each with 6-month survival. PATIENTS AND METHODS Oncogeriatric patients (aged ≥75 years) who underwent preoperative CGA in an outpatient geriatric clinic at a single tertiary comprehensive cancer center were identified. All patients underwent surgery, with a hospital length of stay (LOS) ≥1 day and at least 6 months of follow-up. ASA classifications were obtained from preoperative anesthesiology notes. Preoperative CGA scores ranged from 0 to 13. Six-month survival was assessed using the Social Security Death Index. RESULTS In total, 81 of the 980 patients (8.3%) included in the study cohort died within 6 months of surgery. Most patients were classified as ASA PS III (85.4%). The mean number of CGA deficits for patients with PS II was 4.03, PS III was 5.15, and PS IV was 6.95 (P<.001). ASA classification was significantly associated with age, preoperative albumin level, hospital LOS, and 30-day intensive care unit (ICU) admissions. On multivariable analysis, 6-month mortality was associated with number of CGA deficits (odds ratio [OR], 1.14 per each unit increase in CGA score; P=.01), 30-day ICU admissions (OR, 2.77; P=.003), hospital LOS (OR, 1.03; P=.02), and preoperative albumin level (OR, 0.36; P=.004). ASA classification was not associated with 6-month mortality. CONCLUSIONS Number of CGA deficits was strongly associated with 6-month mortality; ASA classification was not. Preoperative CGA elicits critical information that can be used to enhance the prediction of postoperative outcomes among older patients with cancer.
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Affiliation(s)
- Armin Shahrokni
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brian Jang
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Saman Sarraf
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Koshy Alexander
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Soo Jung Kim
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Anoushka Afonso
- Department of Anesthesiology & Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Beatriz Korc-Grodzicki
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Dogrul RT, Dogrul AB, Konan A, Caglar O, Sumer F, Caliskan H, Kizilarslanoglu MC, Kilic MK, Balci C, Arik G, Aycicek GS, Ozsurekci C, Halil M, Cankurtaran M, Yavuz BB. Does Preoperative Comprehensive Geriatric Assessment and Frailty Predict Postoperative Complications? World J Surg 2020; 44:3729-3736. [PMID: 32737555 DOI: 10.1007/s00268-020-05715-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The influence of preoperative comprehensive geriatric assessment and frailty on postoperative morbidity, mortality, delirium were examined. METHODS A total of 108 patients were evaluated. The Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Brody Instrumental Activities of Daily Living Scale (IADL), the Mini-Nutrition Assessment test (MNA), the Mini-Mental State Examination (MMSE), Yesavage Geriatric Depression Scale (GDS) were performed. Fried Criteria were used to assess physical frailty. We used the Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity score (POSSUM), the American Society of Anesthesiologists Score (ASA), and the Charlson Comorbidity Index (CCI) to determine the risk of postoperative morbidity and mortality. Assessment Test for Delirium (4AT) was applied for detection of delirium. RESULTS The median age was 71 years (min-max: 65-84). IADL (p = 0.032), MNA (p = 0.01), MMSE scores (p = 0.026) were found to be significantly lower in patients with morbidity. POSSUM physiology score (p = 0.005), operative score (p = 0.015) and CCI (p = 0.029) were significantly higher in the patients with morbidity. Patients developed morbidity were found to be more frail (p < 0.001). The patients with delirium were found to have lower IADL (p = 0.049) and MMSE scores (p = 0.004), higher POSSUM physiology score (p = 0.005) and all of them were frail. It was found that frailty (OR = 23.695 95% CI: 6.912-81.231 p < 0.001), POSSUM operative score (OR:1.118 95% CI: 1.021-1.224 p = 0.016) and preoperative systolic blood pressure (OR:0.937%95 CI: 0.879-0.999 p = 0.048) were independently related factors for postoperative morbidity. CONCLUSION In our study, CGA and frailty in preoperative period were found to be indicators for postoperative morbidity and delirium.
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Affiliation(s)
- Rana Tuna Dogrul
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey.
| | - Ahmet Bulent Dogrul
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Konan
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Omur Caglar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Sumer
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Hatice Caliskan
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Muhammet Cemal Kizilarslanoglu
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Mustafa Kemal Kilic
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Cafer Balci
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Gunes Arik
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Gozde Sengul Aycicek
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Cemile Ozsurekci
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Meltem Halil
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Burcu Balam Yavuz
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Perceptions of medical status and treatment goal among older adults with advanced cancer. J Geriatr Oncol 2020; 11:937-943. [DOI: 10.1016/j.jgo.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/20/2019] [Accepted: 11/18/2019] [Indexed: 01/26/2023]
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Lee JY, Kim KJ, Kim CO, Lee KH. Relationship of the pre-operative comprehensive geriatric assessment to length of stay in Korean older adults undergoing spinal surgery. Aging Clin Exp Res 2020; 32:1137-1143. [PMID: 31429002 DOI: 10.1007/s40520-019-01300-9] [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: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although pre-operative, Comprehensive Geriatric Assessment has been used widely, its impact on the health status of older adults has not been fully examined. AIMS This study aimed to investigate the relationships between subcomponents of a Comprehensive Geriatric Assessment and length of hospital stay in older adults undergoing spinal surgery. METHODS Participants were 133 older adults in neurosurgical department. The Comprehensive Geriatric Assessment included nutrition, physical activity, functional status, cognition, depression, the Timed Up and Go test, self-rated health, and frailty. Length of stay was replaced by excessive number of days, because expected length of stay varied depending on the type of surgery. RESULTS Excessive lengths of stay were associated with pre-frailty (p = 0.02), frailty (p = 0.02), risk of depression (p < 0.01), and post-operative complications (p < 0.01). More specifically, frailty and risk of depression played as moderators as interacting post-operative complications. The effect of interaction was greatest in the older adults who were frail and depressed (p < 0.001). DISCUSSION Among the subcomponent of Comprehensive Geriatric Assessment, frailty and depression were significant predictors of excessive length of stay. The interrelationship between frailty and depression better explained excessive length of stay rather than considered as individual variable. CONCLUSIONS Clinicians are encouraged to pay attention to depression and frailty, and its interaction to improve the health status of surgical elderly patients.
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Souwer ETD, Bastiaannet E, Steyerberg EW, Dekker JWT, van den Bos F, Portielje JEA. Risk prediction models for postoperative outcomes of colorectal cancer surgery in the older population - a systematic review. J Geriatr Oncol 2020; 11:1217-1228. [PMID: 32414672 DOI: 10.1016/j.jgo.2020.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/17/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND An increasing number of patients with Colorectal Cancer (CRC) is 65 years or older. We aimed to systematically review existing clinical prediction models for postoperative outcomes of CRC surgery, study their performance in older patients and assess their potential for preoperative decision making. METHODS A systematic search in Pubmed and Embase for original studies of clinical prediction models for outcomes of CRC surgery. Bias and relevance for preoperative decision making with older patients were assessed using the CHARMS guidelines. RESULTS 26 prediction models from 25 publications were included. The average age of included patients ranged from 61 to 76. Two models were exclusively developed for 65 and older. Common outcomes were mortality (n = 10), anastomotic leakage (n = 7) and surgical site infections (n = 3). No prediction models for quality of life or physical functioning were identified. Age, gender and ASA score were common predictors; 12 studies included intraoperative predictors. For the majority of the models, bias for model development and performance was considered moderate to high. CONCLUSIONS Prediction models are available that address mortality and surgical complications after CRC surgery. Most models suffer from methodological limitations, and their performance for older patients is uncertain. Models that contain intraoperative predictors are of limited use for preoperative decision making. Future research should address the predictive value of geriatric characteristics to improve the performance of prediction models for older patients.
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Affiliation(s)
- Esteban T D Souwer
- Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Ewout W Steyerberg
- Department of Biochemical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Frederiek van den Bos
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
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Jauhari Y, Gannon MR, Dodwell D, Horgan K, Clements K, Medina J, Tsang C, Robinson T, Tang SSK, Pettengell R, Cromwell DA. Construction of the secondary care administrative records frailty (SCARF) index and validation on older women with operable invasive breast cancer in England and Wales: a cohort study. BMJ Open 2020; 10:e035395. [PMID: 32376755 PMCID: PMC7223146 DOI: 10.1136/bmjopen-2019-035395] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/28/2020] [Accepted: 03/31/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Studies that use national datasets to evaluate the management of older women with breast cancer are often constrained by a lack of information on patient fitness. This study constructed a frailty index for use with secondary care administrative records and evaluated its ability to improve models of treatment patterns and overall survival in women with breast cancer. DESIGN Retrospective cohort study. PARTICIPANTS Women aged ≥50 years with oestrogen receptor (ER) positive early invasive breast cancer diagnosed between 2014 and 2017 in England. METHODS The secondary care administrative records frailty (SCARF) index was based on the cumulative deficit model of frailty, using International Statistical Classification of Diseases, Injuries and Causes of Death, 10th revision codes to define a set of deficits. The index was applied to administrative records that were linked to national cancer registry datasets. The ability of the SCARF index to improve the performance of regression models to explain observed variation in the rate of surgery and overall survival was evaluated using Harrell's c-statistic and decision curve analysis. External validation was performed on a dataset of similar women diagnosed in Wales. RESULTS The SCARF index captured 32 deficits that cover functional impairment, geriatric syndromes, problems with nutrition, cognition and mood, and medical comorbidities. In the English dataset (n=67 925), the prevalence of frailty in women aged 50-69, 70-79 and ≥80 years was 15%, 28% and 47%, respectively. Adding a frailty measure to regression models containing age, tumour characteristics and comorbidity improved their ability to: (1) discriminate between whether a woman was likely to have surgery and (2) predict overall survival. Similar results were obtained when the models were applied to the Welsh cohort (n=4 230). CONCLUSION The SCARF index provides a simple and consistent method to identify frailty in population level data and could help describe differences in breast cancer treatments and outcomes.
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Affiliation(s)
- Yasmin Jauhari
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Melissa Ruth Gannon
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Dodwell
- Nuffield Department of Population Health, Oxford University, Oxford, Oxfordshire, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, W Yorks, UK
| | - Karen Clements
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Carmen Tsang
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, Leicestershire, UK
| | | | | | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Huisman MG, Ghignone F, Ugolini G, Sidorenkov G, Montroni I, Vigano A, de Liguori Carino N, Farinella E, Cirocchi R, Audisio RA, de Bock GH, van Leeuwen BL. Long-Term Survival and Risk of Institutionalization in Onco-Geriatric Surgical Patients: Long-Term Results of the PREOP Study. J Am Geriatr Soc 2020; 68:1235-1241. [PMID: 32155289 PMCID: PMC7318670 DOI: 10.1111/jgs.16384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/30/2019] [Accepted: 01/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate long-term survival and institutionalization in onco-geriatric surgical patients, and to analyze the association between these outcomes and a preoperative risk score. DESIGN Prospective cohort study with long-term follow-up. SETTING International and multicenter locations. PARTICIPANTS Patients aged 70 years or older undergoing elective surgery for a malignant solid tumor at five centers (n = 229). MEASUREMENTS We assessed long-term survival and institutionalization using the Preoperative Risk Estimation for Onco-geriatric Patients (PREOP) score, developed to predict the 30-day risk of major complications. The PREOP score collected data about sex, type of surgery, and the American Society for Anesthesiologists classification, as well as the Timed Up & Go test and the Nutritional Risk Screening results. An overall score higher than 8 was considered abnormal. RESULTS We included 149 women and 80 men (median age = 76 y; interquartile range = 8). Survival at 1, 2, and 5 years postoperatively was 84%, 77%, and 56%, respectively. Moreover, survival at 1 year was worse for patients with a PREOP risk score higher than 8 (70%) compared with 8 or lower (91%). Of those alive at 1 year, 43 (26%) were institutionalized, and by 2 years, almost half of the entire cohort (46%) were institutionalized or had died. A PREOP risk score higher than 8 was associated with increased mortality (hazard ratio = 2.6; 95% confidence interval [CI] = 1.7-4.0), irrespective of stage and age, but not with being institutionalized (odds ratios = 1 y, 1.6 [95% CI = .7-3.8]; 2 y, 2.2 [95% CI = .9-5.5]). CONCLUSION A high PREOP score is associated with mortality but not with remaining independent. Despite acceptable survival rates, physical function may deteriorate after surgery. It is imperative to discuss treatment goals and expectations preoperatively to determine if they are feasible. Using the PREOP risk score can provide an objective measure on which to base decisions. J Am Geriatr Soc 68:1235-1241, 2020.
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Affiliation(s)
- Monique G Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Federico Ghignone
- Department of Colorectal and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Giampaolo Ugolini
- Department of Colorectal and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Grigory Sidorenkov
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isacco Montroni
- Department of Colorectal and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Antonio Vigano
- McGill Nutrition and Performance Laboratory, McGill University, Montreal, Canada
| | - Nicola de Liguori Carino
- Manchester Royal Infirmary, Department of Hepato-Pancreato-Biliary Surgery, Central Manchester University Hospitals, Manchester, UK
| | - Eriberto Farinella
- Department of General Surgery and Surgical Oncology, University of Perugia, Hospital of Terni, Terni, Italy
| | - Roberto Cirocchi
- Department of General Surgery and Surgical Oncology, University of Perugia, Hospital of Terni, Terni, Italy
| | - Riccardo A Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Michaan N, Park SY, Lim MC. Comprehensive geriatric assessment is correlated to overall survival among gynaecologic oncology patients. Jpn J Clin Oncol 2020; 50:276-281. [PMID: 31822898 DOI: 10.1093/jjco/hyz178] [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: 07/31/2019] [Revised: 09/16/2019] [Accepted: 10/25/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To investigate the correlation of comprehensive geriatric assessment to overall survival among older gynaecologic oncology patients. METHODS Between 2011 and 2017, patients >70 years had geriatric assessment before treatment. Geriatric assessment included the following tests: Old American resource and services, instrumental activities of daily living, modified Barthels index, mini-mental state examination, geriatric depression scale, mini-nutritional assessment, risk of falling and medication use. Overall survival was calculated for patients' groups below and above median tests scores. Univariate as well as multivariate analysis was done to evaluate the association between each variable and survival. RESULTS About 120 patients had geriatric assessment. Mean patients' age was 76.4 ± 5. A total of 78 Patients had ovarian cancer, 16 uterine cancer, 17 cervical cancer and 9 had other gynaecologic malignancies. No correlation was found between age, BMI (body mass index) and cancer type to overall survival. Patients with scores below cut-off values of modified Barthels index, instrumental activities of daily living, mini-nutritional assessment and mini-nutritional assessment had significantly shorter overall survival (P = 0.004, 0.031, 0.046 and 0.004, respectively). This remained significant in both univariate and multivariate analysis. CONCLUSIONS Gynaecologic oncology patients with lower geriatric assessment scores have significantly lower overall survival, irrespective of cancer type. Geriatric assessment tests allow objective assessment of older patients with worst prognosis before treatment planning.
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Affiliation(s)
- Nadav Michaan
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Center for Uterine Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Sang Yoon Park
- Center for Uterine Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
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Ramello M, Audisio RA. “Understanding older patients: Communication as the key step for a comprehensive approach”. Eur J Surg Oncol 2020; 46:301-304. [DOI: 10.1016/j.ejso.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/07/2019] [Accepted: 11/05/2019] [Indexed: 02/06/2023] Open
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Papis D, Vagliasindi A, Maida P. Hepatobiliary and pancreatic surgery in the elderly: Current status. Ann Hepatobiliary Pancreat Surg 2020; 24:1-5. [PMID: 32181422 PMCID: PMC7061045 DOI: 10.14701/ahbps.2020.24.1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 12/15/2022] Open
Abstract
Hepato-pancreatico-biliary (HPB) surgery includes major hepatic resection and pancreatic surgery, both procedures are complex and have a potentially high complication rate. The presence of centers of excellence with a high patients volume has lowered the complication and increased the resection rate. Increased life expectancy and improved general health status have increased the number of elderly patients eligible for major surgery. Since old patients have more co-morbidities and decreased life expectancy, the benefit of these procedures need to be critically evaluated in this group. Analysis of the literature related to this argument demonstrated that pancreatoduodenectomy can be performed safely in selected elderly patients (70 years of age or older), with morbidity and mortality rates comparable those observed in younger patients. This aspect was also confirmed by cost analysis studies that reported similar data in both groups. Similar findings are also reported for major hepatic resection in elderly patients with either hepatocellular carcinoma (HCC), Klatskin tumor or gallbladder carcinoma. More studies are needed regarding the subgroup of very elderly patients (80 years or older). Nevertheless, those elderly patients who will benefit from surgery must be adequatelly selected.
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Affiliation(s)
- Davide Papis
- General Surgery Unit, Del Mare Hospital, Naples, Italy
| | | | - Pietro Maida
- General Surgery Unit, Del Mare Hospital, Naples, Italy
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