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Carrozzi A, Jin R, Monginot S, Puts M, Alibhai SMH. Defining an Abnormal Geriatric Assessment: Which Deficits Matter Most? Cancers (Basel) 2023; 15:5776. [PMID: 38136321 PMCID: PMC10742229 DOI: 10.3390/cancers15245776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
At present, there is no clear definition of what constitutes an abnormal geriatric assessment (GA) in geriatric oncology. Various threshold numbers of abnormal GA domains are often used, but how well these are associated with treatment plan modification (TPM) and whether specific GA domains are more important in this context remains uncertain. A retrospective review of the geriatric oncology clinic database at Princess Margaret Cancer Centre in Toronto, Canada, including new patients seen for treatment decision making from May 2015 to June 2022, was conducted. Logistic regression modelling was performed to determine the association between various predictor variables (including the GA domains and numerical thresholds) and TPM. The study cohort (n = 736) had a mean age of 80.7 years, 46.1% was female, and 78.3% had a VES-13 score indicating vulnerability (≥3). In the univariable analysis, the best-performing threshold number of abnormal domains based on area under the curve (AUC) was 4 (AUC 0.628). The best-performing multivariable model (AUC 0.704) included cognition, comorbidities, and falls risk. In comparison, the multivariable model with the sole addition of the threshold of 4 had an AUC of 0.689. Overall, an abnormal GA may be best defined as one with abnormalities in the domains of cognition, comorbidities, and falls risk. The optimal numerical threshold to predict TPM is 4.
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Affiliation(s)
- Anthony Carrozzi
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Rana Jin
- Department of Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Susie Monginot
- Department of Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Shabbir M. H. Alibhai
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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Lee S, Bennett AV, Zhou X, Betof Warner A, Trogdon JG, Kent EE, Lund JL. Real-world treatment patterns and outcomes for patients with advanced melanoma treated with immunotherapy or targeted therapy. Pharmacoepidemiol Drug Saf 2023; 32:988-1000. [PMID: 37095605 DOI: 10.1002/pds.5630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/17/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To identify real-world patterns of first line treatment, treatment sequence and outcomes for older adults diagnosed with advanced melanoma who received immunotherapy or targeted therapy. METHODS The study population included older adults (ages 65+) diagnosed with unresectable or metastatic melanoma between 2012 and 2017 and who received first line immunotherapy or targeted therapy. Using the linked surveillance, epidemiology, and end results-medicare data, we described patterns of first line treatment and treatment sequence through 2018. We used descriptive statistics to report patient and provider characteristics by first line treatment receipt and changes in first line therapy use over calendar time. We also described overall survival (OS) and time to treatment failure (TTF) by first line treatment using the Kaplan-Meier method. For patterns of treatment sequence, we reported commonly observed treatment switch patterns by treatment sub-category and calendar year. RESULTS The analyses included 584 patients (mean age = 76.3 years). A majority (n = 502) received first line immunotherapy. There was a sustained increase in immunotherapy uptake, most notably from 2015 to 2016. The estimated median OS and TTF were longer with first line immunotherapy than with targeted therapy. Individuals treated with CTLA-4 + PD-1 inhibitors had the longest median OS (28.4 months). The most common treatment switch pattern was from a first line CTLA-4 inhibitor to a second line PD-1 inhibitor. CONCLUSIONS Our findings inform understanding of treatment patterns of currently used immunotherapies and targeted therapies in older adults with advanced melanoma. Immunotherapy use has increased steadily with PD-1 inhibitors becoming a dominant treatment option since 2015.
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Affiliation(s)
- Sejin Lee
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Antonia V Bennett
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Xi Zhou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Justin G Trogdon
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin E Kent
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer L Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Hamid M, Hannan M, Myo Oo N, Lynch P, Walsh DJ, Matthews T, Madden S, O’Connor M, Calvert P, Horgan AM. Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative Analysis. Curr Oncol 2022; 29:6167-6176. [PMID: 36135053 PMCID: PMC9498117 DOI: 10.3390/curroncol29090484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
The Comprehensive Geriatric Assessment (CGA) is recommended to guide treatment choices in older patients with cancer. Patients ≥ 70 years referred to our oncology service with a new cancer diagnosis are screened using the G-8. Patients with a score of ≤14 are eligible to attend the Geriatric Oncology and Liaison (GOAL) Clinic in our institution, with referral based on physician discretion. Referred patients undergo multidimensional assessments at baseline. CGA domains assessed include mobility, nutritional, cognitive, and psychological status. Chemotherapy toxicity risk is estimated using the Cancer Aging and Research Group (CARG) calculator. We undertook a retrospective analysis of patients attending the GOAL clinic over a 30-month period to April 2021. The objective was to determine rates of treatment dose modifications, delays, discontinuation, and unscheduled hospitalizations as surrogates for cytotoxic therapy toxicity in these patients. These data were collected retrospectively. Ninety-four patients received chemotherapy; the median age was 76 (70-87) and 45 were female (48%). Seventy-five (80%) had an ECOG PS of 0-1. Seventy-two (77%) had gastrointestinal cancer, and most had stage III (47%) or IV (40%) disease. Chemotherapy with curative intent was received by 51% (n = 48) and 51% received monotherapy. From the CGA, the median Timed Up and Go was 11 s (7.79-31.6), and 90% reported no falls in the prior 6 months. The median BMI was 26.93 (15.43-39.25), with 70% at risk or frankly malnourished by the Mini Nutritional Assessment. Twenty-seven (29%) patients had impaired cognitive function. Forty-three (46%) had a high risk of toxicity based on the baseline CARG toxicity calculator. Twenty-six (28%) required dose reduction, 55% (n = 52) required a dose delay, and 36% (n = 34) had a hospitalization due to toxicity. Thirty-nine patients (42%) discontinued treatment due to toxicity. Despite intensive assessment, clinical optimization and personalized treatment decisions, older adults with cancer remain at high risk of chemotherapy toxicity.
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Affiliation(s)
- Munzir Hamid
- Oncology Department, University Hospital Waterford, X91 ER8E Waterford, Ireland
| | - Michelle Hannan
- Oncology Department, University Hospital Waterford, X91 ER8E Waterford, Ireland
| | - Nay Myo Oo
- Oncology Department, University Hospital Waterford, X91 ER8E Waterford, Ireland
| | - Paula Lynch
- Oncology Department, University Hospital Waterford, X91 ER8E Waterford, Ireland
| | - Darren J. Walsh
- Oncology Department, University Hospital Waterford, X91 ER8E Waterford, Ireland
| | - Tara Matthews
- Oncology Department, University Hospital Waterford, X91 ER8E Waterford, Ireland
| | - Stephen Madden
- Data Science Centre, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Miriam O’Connor
- Oncology Department, University Hospital Waterford, X91 ER8E Waterford, Ireland
| | - Paula Calvert
- Oncology Department, University Hospital Waterford, X91 ER8E Waterford, Ireland
| | - Anne M. Horgan
- Oncology Department, University Hospital Waterford, X91 ER8E Waterford, Ireland
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Zuccarino S, Monacelli F, Antognoli R, Nencioni A, Monzani F, Ferrè F, Seghieri C, Antonelli Incalzi R. Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review. Cancers (Basel) 2022; 14:3235. [PMID: 35805005 PMCID: PMC9265029 DOI: 10.3390/cancers14133235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives.
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Affiliation(s)
- Sara Zuccarino
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, 16132 Genoa, Italy; (F.M.); (A.N.)
- IRCSS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, 56126 Pisa, Italy;
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, 16132 Genoa, Italy; (F.M.); (A.N.)
- IRCSS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, 56126 Pisa, Italy;
| | - Francesca Ferrè
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
| | - Chiara Seghieri
- Management and Health Laboratory, Institute of Management–Department Embeds, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (C.S.)
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Medina HN, Liu Q, Cao C, Yang L. Balance and vestibular function and survival in US cancer survivors. Cancer 2021; 127:4022-4029. [PMID: 34265083 DOI: 10.1002/cncr.33787] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cancer and its treatment damage the musculoskeletal system and induce neurotoxicity, affecting the key sensory inputs for maintaining balance. The present study describes the pattern of balance impairment and evaluated its association with mortality among US cancer survivors. METHODS Data on a nationally representative sample of cancer survivors from the US National Health and Nutrition Examination Survey from 1999 to 2015 was analyzed. Sensory-specific balance impairment was measured at baseline by the modified Romberg test of standing balance on firm and compliant support surfaces. The linked mortality data were updated through December 31, 2015. RESULTS Among 511 cancer survivors, 282 (48.3%) had a balance impairment, predominantly attributing to vestibular dysfunction (251; 89.0% of 282 and 44.5% of 511). A higher prevalence of balance impairment was observed among cancer survivors with advanced age, lower socioeconomic status or educational attainment, body mass index <25 kg/m2 , and an inactive lifestyle. During up to 16.4 years of follow-up (median, 11.3 years; 5088 person-years), 253 cancer survivors had died. Cancer survivors with a balance impairment had a 63% higher risk of death from all causes (hazard ratio, 1.63; 95% confidence interval [CI], 1.12-2.38) after adjusting for sociodemographic factors, comorbidities, and cancer type. Specifically, those with vestibular dysfunctions had approximately 1.54 (95% CI, 1.05-2.27) times the risk of death compared to those without any balance impairment. These associations were stronger in males than in females. CONCLUSIONS In a US nationally representative sample of cancer survivors, balance impairment and vestibular dysfunctions were prevalent and associated with heightened all-cause mortality.
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Affiliation(s)
- Heidy N Medina
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Qinran Liu
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Chao Cao
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Bullock AF, Greenley SL, McKenzie GAG, Paton LW, Johnson MJ. Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis. Eur J Clin Nutr 2020; 74:1519-1535. [PMID: 32366995 PMCID: PMC7606134 DOI: 10.1038/s41430-020-0629-0] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 12/25/2022]
Abstract
Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03-4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03-3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.
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Affiliation(s)
- Alex F Bullock
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
| | - Sarah L Greenley
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | - Gordon A G McKenzie
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lewis W Paton
- Department of Health Sciences, University of York, York, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Farrington N, Richardson A, Bridges J. Interventions for older people having cancer treatment: A scoping review. J Geriatr Oncol 2020; 11:769-783. [DOI: 10.1016/j.jgo.2019.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/24/2019] [Accepted: 09/25/2019] [Indexed: 01/05/2023]
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Sourdet S, Brechemier D, Steinmeyer Z, Gerard S, Balardy L. Impact of the comprehensive geriatric assessment on treatment decision in geriatric oncology. BMC Cancer 2020; 20:384. [PMID: 32375695 PMCID: PMC7201727 DOI: 10.1186/s12885-020-06878-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 04/19/2020] [Indexed: 12/15/2022] Open
Abstract
Background The comprehensive geriatric assessment (CGA) is the gold standard in geriatric oncology to identify patients at high risk of adverse outcomes and optimize cancer and overall management. Many studies have demonstrated that CGA could modify oncologic treatment decision. However, there is little knowledge on which domains of the CGA are associated with this change. Moreover, the impact of frailty and physical performance on change in cancer treatment plan has been rarely assessed. Methods This is a cross-sectional study of older patients with solid or hematologic cancer referred by oncologists for a geriatric evaluation before cancer treatment. A comprehensive geriatric assessment was performed by a multidisciplinary team to provide guidance for treatment decision. We performed a multivariate analysis to identify CGA domains associated with change in cancer treatment plan. Results Four hundred eighteen patients, mean age 82.8 ± 5.5, were included between October 2011 and January 2016, and 384 of them were referred with an initial cancer treatment plan. This initial cancer treatment plan was changed in 64 patients (16.7%). In multivariate analysis, CGA domains associated with change in cancer treatment plan were cognitive impairment according to the MMSE score (p = 0.020), malnutrition according to the MNA score (p = 0.023), and low physical performance according to the Short Physical Performance Battery (p = 0.010). Conclusion Cognition, malnutrition and low physical performance are significantly associated with change in cancer treatment plan in older adults with cancer. More studies are needed to evaluate their association with survival, treatment toxicity and quality of life. The role of physical performance should be specifically explored.
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Affiliation(s)
- Sandrine Sourdet
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, TSA 60033, 31059, Toulouse, Cedex 9, France. .,UMR Inserm Unit 1027, University of Toulouse III, Toulouse, France.
| | - Delphine Brechemier
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, TSA 60033, 31059, Toulouse, Cedex 9, France
| | - Zara Steinmeyer
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, TSA 60033, 31059, Toulouse, Cedex 9, France
| | - Stephane Gerard
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, TSA 60033, 31059, Toulouse, Cedex 9, France
| | - Laurent Balardy
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, La Cité de la Santé, Hôpital La Grave, Place Lange, TSA 60033, 31059, Toulouse, Cedex 9, France
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Mongiat-Artus P, Paillaud E, Albrand G, Caillet P, Neuzillet Y. [Evaluation of the elderly patient with cancer]. Prog Urol 2019; 29:807-827. [PMID: 31771766 DOI: 10.1016/j.purol.2019.08.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To explain the notion of frailty, then to explain how crucial is the detection of frailty detection in the elderly patient, and, in cases of suspected frailty, how crucial is the need for geriatric assessment. To describe (i) how this assessment of the elderly cancer patient is performed, (ii) how the results of this geriatric assessment must drive the decision making, and (iii) the role of the geriatrician in the care pathway. METHOD Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific geriatric societies, from the National Cancer Institute using the following keywords: elderly, geriatrics, cancer, frailty, assessment, decision making. RESULTS The goal of frailty detection is to optimize care, to maintain the independence and the survival of the patient. The prevalence of frailty increases with the age and the diagnosis of cancer. Detection of frailty in the elderly patient with cancer is performed using the G8 questionnaire recommended by the INCa. In case of anomaly or clinical justification, the patient receives a geriatric assessment, which is a multidimensional and multidisciplinary procedure. The clinician can call on the UCOG of the region in which he practices. The relevance of medical decisions will be based on the results of this geriatric assessment. The geriatrician plays a crucial role and will be involved throughout the care. CONCLUSION The detection of frailty in the elderly patient with cancer is obligatory. Consecutive geriatric assessment can be performed by the UCOG of the region. The results of the geriatric assessment must serve as a basis for any therapeutic decision making and the preservation of the independence of the patient must remain the priority.
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Affiliation(s)
- P Mongiat-Artus
- Inserm UMR_S1165, service d'urologie, unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université Paris Diderot, université de Paris, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
| | - E Paillaud
- EA 7376 épidémiologie clinique et vieillissement, service de gériatrie, unité d'onco-gériatrie et UCOG - Paris-Ouest, hôpital européen Georges-Pompidou, université René-Descartes, université de Paris, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - G Albrand
- Service de gériatrie et UCOG - IR, AuRA Ouest-Guyane, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - P Caillet
- Service de gériatrie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94000 Créteil, France
| | - Y Neuzillet
- Service d'urologie, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 92150 Suresnes, France
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Rowbottom L, Loucks A, Jin R, Breunis H, Syed AT, Watt S, Timilshina N, Puts M, Yokom D, Berger A, Alibhai SM. Performance of the Vulnerable Elders Survey 13 screening tool in identifying cancer treatment modification after geriatric assessment in pre-treatment patients: A retrospective analysis. J Geriatr Oncol 2019; 10:229-234. [DOI: 10.1016/j.jgo.2018.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/07/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022]
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Almodovar T, Teixeira E, Barroso A, Soares M, Queiroga H, Cavaco-Silva J, Barata F. Elderly patients with advanced NSCLC: The value of geriatric evaluation and the feasibility of CGA alternatives in predicting chemotherapy toxicity. Pulmonology 2019; 25:40-50. [DOI: 10.1016/j.pulmoe.2018.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/19/2018] [Indexed: 12/16/2022] Open
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Ørum M, Gregersen M, Jensen K, Meldgaard P, Damsgaard EMS. Frailty status but not age predicts complications in elderly cancer patients: a follow-up study. Acta Oncol 2018; 57:1458-1466. [PMID: 30280625 DOI: 10.1080/0284186x.2018.1489144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The purposes were to investigate the health status of elderly cancer patients by comprehensive geriatric assessment (CGA) and to compare the complications with respect to baseline CGA and to evaluate the need for geriatric interventions in an elderly cancer patients' population. MATERIAL Patients aged ≥70 years with lung cancer (LC), cancer of the head and neck (HNC), colorectal cancer (CRC), or upper gastro-intestinal cancer (UGIC) are referred to the Department of Oncology for cancer treatment. METHODS CGA was performed prior to cancer treatment and addressed the following domains: Activities of daily living (ADL), instrumental ADL (IADL), comorbidity, polypharmacy, nutrition, cognition, and depression. Complications, defined as dose reduction and discontinuation of treatment due to grade 3-4 toxicity, hospital admission, shift to palliative treatment, or death within 90 days, were identified from the medical files. Patients were classified as fit, vulnerable, or frail by CGA. PRINCIPAL RESULTS Patients (N = 217) with a median age of 75 years (range: 70-93 yeas) were included: 13% were fit, 35% vulnerable, and 52% frail. CGA significantly predicted admittance to hospital in frail and vulnerable patients compared to fit patients: risk ratio (RR) 2.12 (95% CI: 1.01; 4.46). Vulnerable and frail patients had higher absolute risk of death within 90 days compared to fit patients: 7% and 23% versus 0%. HR for death within 90 days in frail patients as compared to vulnerable patients was 3.50 (95% CI: 1.34; 9.15). More frail patients (88%) needed geriatric interventions than the vulnerable (46%) and fit patients (32%). Major conclusion: Few elderly cancer patients seem to be fit. CGA predicts admittance to hospital in a population of elderly patients with mixed cancer diseases. Frail and vulnerable patients have higher risk of death within 90 days as compared to fit patients.
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Affiliation(s)
- Marianne Ørum
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Kenneth Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Mohile SG, Dale W, Somerfield MR, Schonberg MA, Boyd CM, Burhenn PS, Canin B, Cohen HJ, Holmes HM, Hopkins JO, Janelsins MC, Khorana AA, Klepin HD, Lichtman SM, Mustian KM, Tew WP, Hurria A. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol 2018; 36:2326-2347. [PMID: 29782209 PMCID: PMC6063790 DOI: 10.1200/jco.2018.78.8687] [Citation(s) in RCA: 906] [Impact Index Per Article: 151.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To provide guidance regarding the practical assessment and management of vulnerabilities in older patients undergoing chemotherapy. Methods An Expert Panel was convened to develop clinical practice guideline recommendations based on a systematic review of the medical literature. Results A total of 68 studies met eligibility criteria and form the evidentiary basis for the recommendations. Recommendations In patients ≥ 65 years receiving chemotherapy, geriatric assessment (GA) should be used to identify vulnerabilities that are not routinely captured in oncology assessments. Evidence supports, at a minimum, assessment of function, comorbidity, falls, depression, cognition, and nutrition. The Panel recommends instrumental activities of daily living to assess for function, a thorough history or validated tool to assess comorbidity, a single question for falls, the Geriatric Depression Scale to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test to screen for cognitive impairment, and an assessment of unintentional weight loss to evaluate nutrition. Either the CARG (Cancer and Aging Research Group) or CRASH (Chemotherapy Risk Assessment Scale for High-Age Patients) tools are recommended to obtain estimates of chemotherapy toxicity risk; the Geriatric-8 or Vulnerable Elders Survey-13 can help to predict mortality. Clinicians should use a validated tool listed at ePrognosis to estimate noncancer-based life expectancy ≥ 4 years. GA results should be applied to develop an integrated and individualized plan that informs cancer management and to identify nononcologic problems amenable to intervention. Collaborating with caregivers is essential to implementing GA-guided interventions. The Panel suggests that clinicians take into account GA results when recommending chemotherapy and that the information be provided to patients and caregivers to guide treatment decision making. Clinicians should implement targeted, GA-guided interventions to manage nononcologic problems. Additional information is available at www.asco.org/supportive-care-guidelines .
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Affiliation(s)
- Supriya G Mohile
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - William Dale
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Mark R Somerfield
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Mara A Schonberg
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Cynthia M Boyd
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Peggy S Burhenn
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Beverly Canin
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Harvey Jay Cohen
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Holly M Holmes
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Judith O Hopkins
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Michelle C Janelsins
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Alok A Khorana
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Heidi D Klepin
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Stuart M Lichtman
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Karen M Mustian
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - William P Tew
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
| | - Arti Hurria
- Supriya G. Mohile, Michelle C. Janelsins, and Karen M. Mustian, University of Rochester Medical Center, Rochester; Beverly Canin, Breast Cancer Options, Kingston; Stuart M. Lichtman and William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; William Dale, Peggy S. Burhenn, and Arti Hurria, City of Hope, Duarte, CA; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Mara A. Schonberg, Beth Israel Deaconess Medical Center, Brookline, MA; Cynthia M. Boyd, Johns Hopkins University School of Medicine, Baltimore, MD; Harvey Jay Cohen, Duke University Medical Center, Durham; Judith O. Hopkins, Novant Health Oncology Specialists; Heidi D. Klepin, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC; Holly M. Holmes, McGovern Medical School, Houston, TX; and Alok A. Khorana, Cleveland Clinic, Cleveland, OH
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15
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Kates JM. Treatment-related Decisional Conflict, Quality of Life, and Comorbidity in Older Adults with Cancer. Asia Pac J Oncol Nurs 2018; 5:421-429. [PMID: 30271826 PMCID: PMC6103206 DOI: 10.4103/apjon.apjon_32_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: The present study aims to examine the relationships between and among cancer treatment-related decisional conflict, quality of life, and comorbidity in older adults with cancer. Methods: A convenience sample of 200 older adults was recruited from outpatient medical oncology and radiation oncology practices in the northeastern United States. A cross-sectional, descriptive, correlational study design was used employing a survey method. Survey instruments included the Decisional Conflict scale (DCS) (with five subscales, including informed, values clarity, support, uncertainty, and effective decision); Self-administered comorbidity questionnaire (SCQ); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (including five function scales, three symptom scales, a global health/quality of life scale, and six single items); and an investigator-developed demographic form. Results: The mean total DCS score was 22.1 (±12.5). The uncertainty subscale had the highest mean of the subscales (29.2 ± 18.2). The mean score for global health status/quality of life was 44.2 (±20.7). The mean score of the SCQ was low (9.6 ± 4.1). Significant positive relationships were identified between decisional conflict and quality of life (P = 0.009) and quality of life and comorbidity (P = 0.001). Multiple linear regression analysis found statistically significant relationships for total decisional conflict score and the five decisional conflict scale subscales. Conclusions: Results may suggest a relationship between decisional conflict and quality of life, as well as the quality of life and comorbidity. In addition, there are several physical, emotional, and spiritual factors that may positively or negatively impact decisional conflict.
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Affiliation(s)
- Jeannette M Kates
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
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16
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[Geriatric assessment and prognostic scores in older cancer patient: Additional support to the therapeutic decision?]. Bull Cancer 2017; 104:946-955. [PMID: 29150094 DOI: 10.1016/j.bulcan.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/25/2017] [Accepted: 10/03/2017] [Indexed: 01/10/2023]
Abstract
Cancer is a disease of the elderly as demonstrated by the epidemiological evolution of Western countries. Indeed, two third of cancers newly diagnosed occur over 65 years. However, older cancer patients have been often excluded from clinical trials in oncology and the extrapolation of cancer treatments in this population remains difficult in practice. Scientific societies recommend that a comprehensive geriatric assessment (CGA) be performed in patients aged 70 and over and selected using screening tools for frailty such as the G8 index. The CGA allows to detect aging-related vulnerabilities in various domains (comorbidities, polypharmacy, autonomy, nutrition, mobility, cognition, mood, social) and associated with adverse outcomes during cancer treatment (reduced overall survival, perioperative complications, toxicity-related chemotherapy). The CGA is allow to elaborate a personalized treatment plan in geriatric oncology. However, to date, no algorithms based on CGA is validated to guide therapeutic decision in geriatric oncology. The collaboration between geriatrician and oncologist remains essential to elaborate an appropriate therapeutic strategy and limit the situations of over- and under-treatment. This article presents the set of tools and scores used in geriatric oncology to guide the therapeutic decision.
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Impaired mobility, depressed mood, cognitive impairment and polypharmacy are independently associated with disability in older cancer outpatients: The prospective Physical Frailty in Elderly Cancer patients (PF-EC) cohort study. J Geriatr Oncol 2017; 8:190-195. [DOI: 10.1016/j.jgo.2017.02.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/27/2016] [Accepted: 02/07/2017] [Indexed: 11/23/2022]
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Liuu E, Caillet P, Curé H, Anfasi N, De Decker L, Pamoukdjian F, Canouï-Poitrine F, Soubeyran P, Paillaud E. [Comprehensive geriatric assessment (CGA) in elderly with cancer: For whom?]. Rev Med Interne 2016; 37:480-8. [PMID: 26997159 DOI: 10.1016/j.revmed.2016.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/17/2015] [Accepted: 02/20/2016] [Indexed: 12/27/2022]
Abstract
Scientific societies recommend the implementation of a comprehensive geriatric assessment (CGA) in cancer patients aged 70 and older. The EGA is an interdisciplinary multidimensional diagnostic process seeking to assess the frail older person in order to develop a coordinated plan of treatment and long-term follow-up. Identification of comorbidities and age-induced physiological changes that may increase the risk of anticancer treatment toxicities is essential to better assess the risk-benefit ratio in elderly cancer patients. The systematic implementation of a CGA for each patient is difficult to perform in daily practice. Therefore, it is recommended to screen vulnerable patients who will benefit from a complete CGA. Our work presents the vulnerability screening tools validated by at least two independent studies in a cancer elderly population setting. Among seven screening tools, the G8 and the VES13 are the most effective, and have been validated specifically in older population with cancer. The G8 is recommended by scientific societies and the French National Cancer Institute (INCa) because of its easy implementation in daily clinical practice, its high sensitivity and fair specificity. Although studies are underway to improve its performance, the G8 is currently the simplest tool to routinely identify older cancer patients who should have a complete assessment in geriatric oncology.
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Affiliation(s)
- E Liuu
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France
| | - P Caillet
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France
| | - H Curé
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Medical oncology department, Grenoble university hospital, CS 10127 Grenoble, France
| | - N Anfasi
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - L De Decker
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Department of internal medicine and geriatrics, Nantes university hospital, 44093 Nantes, France
| | - F Pamoukdjian
- Unité de coordination en oncogériatrie, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - F Canouï-Poitrine
- CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Service de santé publique, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - P Soubeyran
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Institut Bergonié, université de Bordeaux, CS 61283 Bordeaux, France
| | - E Paillaud
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France.
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The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people. Br J Cancer 2015; 112:1435-44. [PMID: 25871332 PMCID: PMC4453673 DOI: 10.1038/bjc.2015.120] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/16/2015] [Accepted: 03/11/2015] [Indexed: 12/21/2022] Open
Abstract
Background: Although comorbidities are identified in routine oncology practice, intervention plans for the coexisting needs of older people receiving chemotherapy are rarely made. This study evaluates the impact of geriatrician-delivered comprehensive geriatric assessment (CGA) interventions on chemotherapy toxicity and tolerance for older people with cancer. Methods: Comparative study of two cohorts of older patients (aged 70+ years) undergoing chemotherapy in a London Hospital. The observational control group (N=70, October 2010–July 2012) received standard oncology care. The intervention group (N=65, September 2011–February 2013) underwent risk stratification using a patient-completed screening questionnaire and high-risk patients received CGA. Impact of CGA interventions on chemotherapy tolerance outcomes and grade 3+ toxicity rate were evaluated. Outcomes were adjusted for age, comorbidity, metastatic disease and initial dose reductions. Results: Intervention participants undergoing CGA received mean of 6.2±2.6 (range 0–15) CGA intervention plans each. They were more likely to complete cancer treatment as planned (odds ratio (OR) 4.14 (95% CI: 1.50–11.42), P=0.006) and fewer required treatment modifications (OR 0.34 (95% CI: 0.16–0.73), P=0.006). Overall grade 3+ toxicity rate was 43.8% in the intervention group and 52.9% in the control (P=0.292). Conclusions: Geriatrician-led CGA interventions were associated with improved chemotherapy tolerance. Standard oncology care should shift towards modifying coexisting conditions to optimise chemotherapy outcomes for older people.
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Versteeg KS, Konings IR, Lagaay AM, van de Loosdrecht AA, Verheul HMW. Prediction of treatment-related toxicity and outcome with geriatric assessment in elderly patients with solid malignancies treated with chemotherapy: a systematic review. Ann Oncol 2014; 25:1914-1918. [PMID: 24569912 DOI: 10.1093/annonc/mdu052] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION The number of older patients with cancer is increasing. Standard clinical evaluation of these patients may not be sufficient to determine individual treatment strategies and therefore Geriatric Assessment (GA) may be of clinical value. In this review, we summarize current literature that is available on GA in elderly patients with solid malignancies who receive chemotherapy. We focus on prediction of treatment toxicity, mortality and the role of GA in the decision-making process. DESIGN We conducted a systematic search in PubMed. Studied populations needed to fulfill the following criteria: 65 years or older, diagnosis of solid malignancy, treatment with chemotherapy, submission to GA, either designed to study prediction of treatment toxicity or mortality or to evaluate the role of GA in the decision-making process. RESULTS Our search provided 411 publications. Thirteen met the predefined criteria. These studies revealed: (i) up to 64% of elderly patients suffer from severe toxicity caused by polychemotherapy, (ii) Nutritional status, functionality and comorbidity are often associated with worse outcome, (iii) GA reveals (unknown) geriatric problems in more than 50% of elderly patients with cancer and (iv) 21%-53% of chemotherapy regimens are being modified based on GA. CONCLUSIONS In geriatric oncology, an accurate predictive test to guide anticancer treatment in order to prevent serious toxicity is needed. The value of GA in predicting toxicity and mortality in older patients with cancer undergoing treatment with chemotherapy has not been proven. It may be valuable in revealing geriatric problems but current evidence for its usefulness to guide treatment decisions in this setting is limited. However, we are convinced that GAs should be carried out to optimize treatment strategies in elderly patients with cancer to improve treatment efficacy and minimize toxicity.
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Affiliation(s)
- K S Versteeg
- Department of Medical Oncology, VU University Medical Center, Amsterdam
| | - I R Konings
- Department of Medical Oncology, VU University Medical Center, Amsterdam
| | - A M Lagaay
- Department of Internal Medicine, Spaarne Hospital, Hoofddorp
| | | | - H M W Verheul
- Department of Medical Oncology, VU University Medical Center, Amsterdam.
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Kalsi T, Babic-Illman G, Fields P, Hughes S, Maisey N, Ross P, Wang Y, Harari D. The impact of low-grade toxicity in older people with cancer undergoing chemotherapy. Br J Cancer 2014; 111:2224-8. [PMID: 25268369 PMCID: PMC4264435 DOI: 10.1038/bjc.2014.496] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/24/2014] [Accepted: 08/16/2014] [Indexed: 12/27/2022] Open
Abstract
Background: Significant toxicity in chemotherapy trials is usually defined as grade ⩾3. In clinical practice, however, multiple lower grade toxicities are often considered meaningful. The purpose of this observational cohort study was to identify which level of toxicity triggers treatment modification and early discontinuation of chemotherapy in older people. Methods: Patients aged 65+ were recruited in a central London hospital. A total of 108 patients were recruited at the start of new chemotherapy treatment between October 2010 and July 2012. Results: Mean age was 72.1±5 years, median 72 and range 65–86 years. Of the patients, 50.9% (55) were male with gastrointestinal (49), gynaecological (18), lung (15) and other cancers (26). Chemotherapy was palliative in 59.3% (64/108), curative/ neoadjuvant/adjuvant in the others. Mean number of cycles completed was 4.2±3. Treatment modifications due to toxicity occurred in 60 (55.6%) patients, 35% (21/60) of whom had no greater than grade 2 toxicity. Early treatment discontinuation because of toxicity occurred in 23 patients (21.3%), 39.1% (9/23) of whom had no greater than grade 2 toxicity. Conclusions: Many older patients did not complete treatment as planned. Treatment was modified/discontinued even for one or two low-grade toxicities. Further work is required to clarify whether low-grade toxicity has a greater clinical impact in older people, or whether clinicians have a lower threshold for modifying/discontinuing treatment in older people.
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Affiliation(s)
- T Kalsi
- 1] POPS-GOLD, Department of Ageing & Health, Ground floor Bermondsey Wing, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK [2] Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London, SE1 3QD, UK
| | - G Babic-Illman
- POPS-GOLD, Department of Ageing & Health, Ground floor Bermondsey Wing, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - P Fields
- Department of Haematology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - S Hughes
- Department of Clinical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - N Maisey
- Department of Medical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - P Ross
- Department of Medical Oncology, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Y Wang
- Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London, SE1 3QD, UK
| | - D Harari
- 1] POPS-GOLD, Department of Ageing & Health, Ground floor Bermondsey Wing, Guys Hospital, Guys & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK [2] Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London, SE1 3QD, UK
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Caillet P, Laurent M, Bastuji-Garin S, Liuu E, Culine S, Lagrange JL, Canoui-Poitrine F, Paillaud E. Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment. Clin Interv Aging 2014; 9:1645-60. [PMID: 25302022 PMCID: PMC4189720 DOI: 10.2147/cia.s57849] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Cancer is common in older patients, who raise specific treatment challenges due to aging-related, organ-specific physiologic changes and the presence in most cases of comorbidities capable of affecting treatment tolerance and outcomes. Identifying comorbid conditions and physiologic changes due to aging allows oncologists to better assess the risk/benefit ratio and to adjust the treatment accordingly. Conducting a Comprehensive Geriatric Assessment (CGA) is one approach developed for this purpose. We reviewed the evidence on the usefulness of CGA for assessing health problems and predicting cancer treatment outcomes, functional decline, morbidity, and mortality in older patients with solid malignancies. Methods We searched Medline for articles published in English between January 1, 2000 and April 14, 2014, and reporting prospective observational or interventional studies of CGA feasibility or effectiveness in patients aged ≥65 years with solid malignancies. We identified studies with at least 100 patients, a multivariate analysis, and assessments of at least five of the following CGA domains: nutrition, cognition, mood, functional status, mobility and falls, polypharmacy, comorbidities, and social environment. Results All types of CGA identified a large number of unrecognized health problems capable of interfering with cancer treatment. CGA results influenced 21%–49% of treatment decisions. All CGA domains were associated with chemotoxicity or survival in at least one study. The abnormalities that most often predicted mortality and chemotoxicity were functional impairment, malnutrition, and comorbidities. Conclusion The CGA uncovers numerous health problems in elderly patients with cancer and can affect treatment decisions. Functional impairment, malnutrition, and comorbidities are independently associated with chemotoxicity and/or survival. Only three randomized published studies evaluated the effectiveness of CGA-linked interventions. Further research into the effectiveness of the CGA in improving patient outcomes is needed.
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Affiliation(s)
- Philippe Caillet
- Laboratoire d'Investigation Clinique (LIC), Faculté de Medecine, Université Paris Est Créteil (UPEC), Créteil, Paris ; Unité de Coordination d'Onco-Gériatrie, Département de Médecine Interne et Gériatrie, Hôpital Henri-Mondor, Assistance Publique - Hopitaux de Paris (AP-HP), Créteil, France
| | - Marie Laurent
- Laboratoire d'Investigation Clinique (LIC), Faculté de Medecine, Université Paris Est Créteil (UPEC), Créteil, Paris ; Unité de Coordination d'Onco-Gériatrie, Département de Médecine Interne et Gériatrie, Hôpital Henri-Mondor, Assistance Publique - Hopitaux de Paris (AP-HP), Créteil, France
| | - Sylvie Bastuji-Garin
- Laboratoire d'Investigation Clinique (LIC), Faculté de Medecine, Université Paris Est Créteil (UPEC), Créteil, Paris ; Service de Santé Publique, Hôpital Henri-Mondor, AP-HP, Créteil, France ; Unité de Recherche Clinique, Hôpital Henri-Mondor, AP-HP, Créteil, France
| | - Evelyne Liuu
- Unité de Coordination d'Onco-Gériatrie, Département de Médecine Interne et Gériatrie, Hôpital Henri-Mondor, Assistance Publique - Hopitaux de Paris (AP-HP), Créteil, France
| | - Stephane Culine
- Service d'Oncologie Médicale, Hôpital Saint-Louis, AP-HP, Paris
| | | | - Florence Canoui-Poitrine
- Laboratoire d'Investigation Clinique (LIC), Faculté de Medecine, Université Paris Est Créteil (UPEC), Créteil, Paris ; Unité de Coordination d'Onco-Gériatrie, Département de Médecine Interne et Gériatrie, Hôpital Henri-Mondor, Assistance Publique - Hopitaux de Paris (AP-HP), Créteil, France ; Service de Santé Publique, Hôpital Henri-Mondor, AP-HP, Créteil, France
| | - Elena Paillaud
- Laboratoire d'Investigation Clinique (LIC), Faculté de Medecine, Université Paris Est Créteil (UPEC), Créteil, Paris ; Unité de Coordination d'Onco-Gériatrie, Département de Médecine Interne et Gériatrie, Hôpital Henri-Mondor, Assistance Publique - Hopitaux de Paris (AP-HP), Créteil, France
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Mise au point du FRancilian Oncogeriatric Group (FROG) pour la prise en charge du cancer de vessie du sujet âgé. Bull Cancer 2014; 101:841-55. [DOI: 10.1684/bdc.2014.1939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Brugel L, Laurent M, Caillet P, Radenne A, Durand-Zaleski I, Martin M, Baron M, de Kermadec H, Bastuji-Garin S, Canouï-Poitrine F, Paillaud E. Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR). BMC Cancer 2014; 14:427. [PMID: 24923533 PMCID: PMC4081503 DOI: 10.1186/1471-2407-14-427] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/05/2014] [Indexed: 12/27/2022] Open
Abstract
Background Survival is poorer in elderly patients with head and neck squamous cell carcinomas [HNSCCs] than in younger patients. Possible explanations include a contribution of co-morbidities to mortality, frequent refusal of standard therapy, and the use of suboptimal treatments due to concern about toxicities. The Comprehensive Geriatric Assessment [CGA] is a multidimensional assessment of general health that can help to customise treatment and follow-up plans. The CGA has been proven effective in several health settings but has not been evaluated in randomised studies of patients with cancer. Our aim here was to assess the impact of the CGA on overall survival, function, and nutritional status of elderly patients with HNSCC. Methods/design EGeSOR is an open-label, multicentre, randomised, controlled, parallel-group trial in patients aged 70 years or older and receiving standard care for HNSCC. The intervention includes four components: the CGA conducted by a geriatrician before cancer treatment, participation of the same geriatrician in cancer treatment selection, a standardised geriatric therapeutic intervention designed by the same geriatrician; and geriatric follow-up for 24 months. The primary endpoint, assessed after 6 months, is a composite criterion including death, functional impairment [Activities of Daily Living score decrease ≥2], and weight loss ≥10%. Secondary endpoints include progression-free survival, unscheduled admissions, quality of life, treatment toxicities, costs, and completion of the planned cancer treatment. A centralised online system is used to perform 1:1 randomisation with a minimisation algorithm for centre, age, T and N stages, and tumour site [oral, oropharyngeal, hypopharyngeal, or laryngeal]. The estimated sample size is 704 patients, who are being recruited by 14 centres in 9 French cities. Discussion EGeSOR is the first randomised trial of the CGA in elderly cancer patients. We expect the CGA to have direct clinical benefits on the management of elderly patients with HNSCC. If this expectation is fulfilled, the trial may lead to modifications of the management model for elderly patients with cancer. Trial registration Trial registration:
NCT02025062
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Elena Paillaud
- AP-HP, hôpital Henri-Mondor, Département de Médecine Interne et Gériatrie, Unité d'Onco-Gériatrie, Créteil F-94010, France.
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Somana-Ehrminger S, Dabakuyo TS, Manckoundia P, Ouédraogo S, Marilier S, Arveux P, Quipourt V. Influence of geriatric oncology consultation on the management of breast cancer in older women: A French population-based study. Geriatr Gerontol Int 2014; 15:111-9. [DOI: 10.1111/ggi.12240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Sophie Somana-Ehrminger
- Department of Geriatric Internal Medicine; Hospital of Champmaillot; University Hospital; Dijon Cedex France
| | - Tienhan S Dabakuyo
- Côte d'Or Breast and Gynecological Cancer Registry; Center George François Leclerc; Dijon Cedex France
| | - Patrick Manckoundia
- Department of Geriatric Internal Medicine; Hospital of Champmaillot; University Hospital; Dijon Cedex France
- National Institute of Health and Medical Research INSERM U1093; Motricity-Plasticity: Performance, Dysfunction, Aging and Technology Optimization; University of Burgundy, Faculty of Sport Sciences; Dijon Cedex France
| | - Samiratou Ouédraogo
- Côte d'Or Breast and Gynecological Cancer Registry; Center George François Leclerc; Dijon Cedex France
| | - Sophie Marilier
- Department of Geriatric Internal Medicine; Hospital of Champmaillot; University Hospital; Dijon Cedex France
- Coordination Unit in Geriatric Oncology in Burgundy; Hospital of Champmaillot, University Hospital; Dijon Cedex France
| | - Patrick Arveux
- Côte d'Or Breast and Gynecological Cancer Registry; Center George François Leclerc; Dijon Cedex France
| | - Valérie Quipourt
- Department of Geriatric Internal Medicine; Hospital of Champmaillot; University Hospital; Dijon Cedex France
- Coordination Unit in Geriatric Oncology in Burgundy; Hospital of Champmaillot, University Hospital; Dijon Cedex France
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Blanc M, Dialla O, Manckoundia P, Arveux P, Dabakuyo S, Quipourt V. Influence of the geriatric oncology consultation on the final therapeutic decision in elderly subjects with cancer: analysis of 191 patients. J Nutr Health Aging 2014; 18:76-82. [PMID: 24402393 DOI: 10.1007/s12603-013-0377-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Evaluate the impact of the Geriatric Oncology Consultation on the final therapeutic management of cancer in elderly patients aged 70 and older. DESIGN Retrospective study. SETTING The Pilot Coordination Unit in Geriatric Oncology of Côte d'Or, Burgundy, France. PARTICIPANTS From January 2010 to December 2010, 191 patients with cancer aged 70 and older. MEASUREMENTS The concordance between the treatments proposed following the Tumor Board, those proposed following the Geriatric Evaluation (GE) and those actually given to the patients was evaluated using the Kappa agreement test. RESULTS One hundred and ninety-one patients were included. Mean age was 81.5. The most frequent cancer locations were breast (31.9%), colon-rectum (14.1%) and lung (10.5%). Concordance between the cancer treatments proposed by the Tumor Board and those suggested after the GE was excellent except for chemotherapy and targeted therapy, which were recommended less frequently by the geriatrician (Kappa = 0.67), and support care, which was more often proposed after the GE (Kappa = 0.61). However, concordance between treatments proposed by the geriatrician and treatment actually given was not so good for chemotherapy (Kappa = 0.58), and surgery (Kappa = 0.61), since both were often replaced by a less aggressive treatment. CONCLUSION Concordance between the therapies proposed during the Tumor Board or after the Geriatric Oncology Consultation and the treatment actually given was satisfactory. However, the role of the oncologist remains determinant in the final choice, especially for chemotherapy.
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Affiliation(s)
- M Blanc
- V. Quipourt, Coordination Unit in Geriatric Oncology in Burgundy, Hospital of Champmaillot, University Hospital, 2 rue Jules Violle, 21079 Dijon Cedex, France, phone number: (33)0380295284, fax number: (33)0380295285, e-mail address:
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Abstract
With a large, aging population in the USA and continued prolongation of life expectancy, treatment of cancer in the elderly will continue to be of importance. The most common cancer in men is prostate cancer, which is most often diagnosed in those over the age of 65 years. Initial therapies for prostate cancer are local treatments in those with localized disease and for whom definitive therapy is appropriate. Optimal treatment of an older patient with recurrent prostate cancer now involves more of a decision process than treatment has in the past, with the recent approval of several new medical agents for advanced prostate cancer. Through this article we will focus on treatment options for recurrent prostate cancer, keeping in mind the unique characteristics of the elderly population. A majority of the discussion will focus on many of the newly approved agents used to treat castration-resistant prostate cancer, and exciting agents currently under investigation. Improved androgen blockade has improved overall survival in patients with metastatic disease but carries many of the same adverse effects as previous agents. Newer approaches with immunotherapy, radiopharmaceuticals, or second-generation androgen receptor blockers introduce a different adverse-effect profile for older patients. As data matures, these too may improve survival for patients with metastatic disease. Throughout all stages of disease, one must keep in mind the unique needs of an older patient population.
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Serra-Rexach JA, Jimenez AB, García-Alhambra MA, Pla R, Vidán M, Rodríguez P, Ortiz J, García-Alfonso P, Martín M. Differences in the therapeutic approach to colorectal cancer in young and elderly patients. Oncologist 2012; 17:1277-85. [PMID: 22923453 DOI: 10.1634/theoncologist.2012-0060] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To analyze differences in the therapeutic approach to and tumor-related mortality of young and elderly colorectal cancer (CRC) patients. PATIENTS AND METHODS This was a descriptive study of a retrospective cohort, based on administrative databases, of all patients with CRC diagnosed or treated in our institution. We extracted data on sociodemographic characteristics, comorbidity, type of cancer, type of treatment received, survival time, and cause of death. We compared differences between a young group (YG) (age <75 years) and an older group (OG) (age ≥75 years) and assessed the variables associated with receiving different therapeutic options (multivariate analysis) and with survival time (Cox proportional hazards models). RESULTS The study included 503 patients (YG, 320; OG, 183), with mean ages of 63.1 years in the YG and 81.8 years in the OG. No differences were observed between the groups in degree of differentiation, extension, tumor stage, or comorbidity. After adjustment for gender, comorbidity, and tumor localization and extension, YG patients were more likely than OG patients to receive surgery, radiotherapy, and chemotherapy and less likely to receive palliative care. After a median follow-up of 36.5 months, YG patients had a longer tumor-specific survival time than OG patients (36.41 months vs 26.05 months). After further adjustment, the YG had a lower tumor-specific mortality risk (hazard ratio, 0.66) than the OG. CONCLUSION In comparison with younger patients, elderly CRC patients are undertreated, mainly because of their age and not because of their tumor type or comorbidity. Elderly patients have a significantly shorter tumor-specific survival time, partially because of this undertreatment.
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Affiliation(s)
- José A Serra-Rexach
- Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.
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Deschler B, Ihorst G, Platzbecker U, Germing U, März E, de Figuerido M, Fritzsche K, Haas P, Salih HR, Giagounidis A, Selleslag D, Labar B, de Witte T, Wijermans P, Lübbert M. Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome. Haematologica 2012; 98:208-16. [PMID: 22875615 DOI: 10.3324/haematol.2012.067892] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Myelodysplastic syndromes and acute myeloid leukemia exemplify the complexity of treatment allocation in older patients as options range from best supportive care, non-intensive treatment (e.g. hypomethylating agents) to intensive chemotherapy/hematopoietic cell transplantation. Novel metrics for non-disease variables are urgently needed to help define the best treatment for each older patient. We investigated the feasibility and prognostic value of geriatric/quality of life assessments aside from established disease-specific variables in 195 patients aged 60 years or over with myelodysplastic syndromes/acute myeloid leukemia. These patients were grouped according to treatment intensity and assessed. Assessment consisted of eight instruments evaluating activities of daily living, depression, mental functioning, mobility, comorbidities, Karnofsky Index and quality of life. Patients with a median age of 71 years (range 60-87 years) with myelodysplastic syndromes (n=63) or acute myeloid leukemia (n=132) were treated either with best supportive care (n=47), hypomethylating agents (n=73) or intensive chemotherapy/hematopoietic cell transplantation (n=75). After selection of variables, pathological activities of daily living and quality of life/fatigue remained highly predictive for overall survival in the entire patient group beyond disease-related risk factors adverse cytogenetics and blast count of 20% or over. In 107 patients treated non-intensively activities of daily living of less than 100 (hazard ratio, HR 2.94), Karnofsky Index below 80 (HR 2.34) and quality of life/'fatigue' of 50 or over (HR 1.77) were significant prognosticators. Summation of adverse features revealed a high risk of death (HR 9.36). In-depth evaluation of older patients prior to individual treatment allocation is feasible and provides additional information to standard assessment. Patients aged 60 years or over with newly diagnosed myelodysplastic syndromes/acute myeloid leukemia and impairments in activities of daily living, Karnofsky Index below 80%, quality of life/'fatigue' of 50 or over, are likely to have poor outcomes.
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Puts MTE, Hardt J, Monette J, Girre V, Springall E, Alibhai SMH. Use of geriatric assessment for older adults in the oncology setting: a systematic review. J Natl Cancer Inst 2012; 104:1133-63. [PMID: 22851269 PMCID: PMC3413614 DOI: 10.1093/jnci/djs285] [Citation(s) in RCA: 240] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 05/14/2012] [Accepted: 05/17/2012] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Geriatric assessment is a multidisciplinary diagnostic process that evaluates the older adult's medical, psychological, social, and functional capacity. No systematic review of the use of geriatric assessment in oncology has been conducted. The goals of this systematic review were: 1) to provide an overview of all geriatric assessment instruments used in the oncology setting; 2) to examine the feasibility and psychometric properties of those instruments; and 3) to systematically evaluate the effectiveness of geriatric assessment in predicting or modifying outcomes (including the impact on treatment decision making, toxicity of treatment, and mortality). METHODS We searched Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library for articles published in English, French, Dutch, or German between January 1, 1996, and November 16, 2010, reporting on cross-sectional, longitudinal, interventional, or observational studies that assessed the feasibility or effectiveness of geriatric assessment instruments. The quality of articles was evaluated using relevant quality assessment frameworks. RESULTS We identified 83 articles that reported on 73 studies. The quality of most studies was poor to moderate. Eleven studies examined psychometric properties or diagnostic accuracy of the geriatric assessment instruments used. The assessment generally took 10-45 min. Geriatric assessment was most often completed to describe a patient's health and functional status. Specific domains of geriatric assessment were associated with treatment toxicity in 6 of 9 studies and with mortality in 8 of 16 studies. Of the four studies that examined the impact of geriatric assessment on the cancer treatment decision, two found that geriatric assessment impacted 40%-50% of treatment decisions. CONCLUSION Geriatric assessment in the oncology setting is feasible, and some domains are associated with adverse outcomes. However, there is limited evidence that geriatric assessment impacted treatment decision making. Further research examining the effectiveness of geriatric assessment on treatment decisions and outcomes is needed.
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Affiliation(s)
- M T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
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Gironés R, Torregrosa D, Maestu I, Gómez-Codina J, Tenias JM, Costa RR. Comprehensive Geriatric Assessment (CGA) of elderly lung cancer patients: A single-center experience. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2011.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Tremblay D, Charlebois K, Terret C, Joannette S, Latreille J. Integrated oncogeriatric approach: a systematic review of the literature using concept analysis. BMJ Open 2012; 2:bmjopen-2012-001483. [PMID: 23220777 PMCID: PMC3533132 DOI: 10.1136/bmjopen-2012-001483] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The purpose of this study was to provide a more precise definition of an integrated oncogeriatric approach (IOGA) through concept analysis. DATA SOURCES The literature was reviewed from January 2005 to April 2011 integrating three broad terms: geriatric oncology, multidisciplinarity and integrated care delivery models. STUDY ELIGIBILITY CRITERIA Citation selection was based on: (1) elderly cancer patients as the study population; (2) disease management and (3) case studies, intervention studies, assessments, evaluations and studies. Inclusion and exclusion criteria were refined in the course of the literature search. INTERVENTIONS Initiatives in geriatric oncology that relate to oncology services, social support services and primary care services for elderly cancer patients. PARTICIPANTS Elderly cancer patients aged 70 years old or more. STUDY APPRAISAL AND SYNTHESIS METHODS Rodgers' concept analysis method was used for this study. The analysis was carried out according to thematic analysis based on the elements of the Chronic Care Model. RESULTS The search identified 618 citations. After in-depth appraisal of 327 potential citations, 62 articles that met our inclusion criteria were included in the analysis. Three IOGA main attributes were identified, which constitute IOGA's core aspects: geriatric assessment (GA), comorbidity burden and treatment outcomes. The IOGA concept comprises two broad antecedents: coordinated healthcare delivery and primary supportive care services. Regarding the consequents of an integrated approach in geriatric oncology, the studies reviewed remain inconclusive. CONCLUSIONS Our study highlights the pioneering character of the multidimensional IOGA concept, for which the relationship between clinical and organisational attributes, on the one hand, and contextual antecedents, on the other, is not well understood. We have yet to ascertain IOGA's consequents. IMPLICATIONS OF KEY FINDINGS: There is clearly a need for a whole-system approach to change that will provide direction for multilevel (clinical, organisational, strategic) interventions to support interdisciplinary practice, education and research.
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Affiliation(s)
- Dominique Tremblay
- Centre de recherche CSSS Champlain-Charles-Le Moyne, Université de Sherbrooke, École des Sciences infirmières, Longueuil, Québec, Canada
| | - Kathleen Charlebois
- Centre de recherche CSSS Champlain-Charles Le Moyne, Longueuil,Québec, Canada
| | - Catherine Terret
- Programme d'oncologie gériatrie, Département d'oncologie, Centre Leon-Bérard, Claude-Bernard Lyon-1 Université Lyon, Lyon, France
| | - Sonia Joannette
- Centre de recherche CSSS Champlain-Charles-Le Moyne, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Jean Latreille
- Centre intégré de cancérologie de la Montérégie, Greenfield Park, Québec,Canada, Université de Sherbrooke, Faculté de médecine et des sciences de la santé, Longueuil. Québec, Canada
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Caillet P, Canoui-Poitrine F, Vouriot J, Berle M, Reinald N, Krypciak S, Bastuji-Garin S, Culine S, Paillaud E. Comprehensive Geriatric Assessment in the Decision-Making Process in Elderly Patients With Cancer: ELCAPA Study. J Clin Oncol 2011; 29:3636-42. [DOI: 10.1200/jco.2010.31.0664] [Citation(s) in RCA: 315] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose To identify Comprehensive Geriatric Assessment (CGA) components independently associated with changes in planned cancer treatment. Patients and Methods We prospectively included 375 consecutive elderly patients with cancer (ELCAPA01 study) assessed by geriatricians using the CGA. Multivariate analysis was used to identify factors associated with changes in the cancer treatment (intensification, decrease, or delayed > 2 weeks). Change was defined as a difference between the initial treatment proposal and the final treatment selected in a multidisciplinary meeting. Results Mean age was 79.6 years (standard deviation [SD], 5.6 years), and 197 (52.5%) were women. The most common tumor location was the digestive system (58.7%). The mean number of comorbidities was 4.2 (SD, 2.7) per patient, and the mean Cumulative Illness Rating Scale for Geriatrics score was 11.8 (SD, 5.3). After the CGA, the initial cancer treatment plan was modified for 78 (20.8%) of 375 patients (95% CI, 16.8 to 25.3), usually to decrease treatment intensity (63 [80.8%] of 78 patients). By univariate analysis, cancer treatment changes were associated with Eastern Cooperative Oncology Group performance status ≥ 2 (73.3% in the group with changes v 41.1% in the in the group without changes; P < .001), dependency for one or more activities of daily living (ADL; 59.0% v 24.2%; P < .001), malnutrition (81.8% v 51.2%; P < .001), cognitive impairment (38.5% v 24.9%; P = .023), depression (52.6% v 21.7%; P < .001), and greater number of comorbidities (mean, 4.8 [SD, 2.9] v 4.0 [SD, 2.6]; P = .02). By multivariate analysis, factors independently associated with cancer treatment changes were a lower ADL score (odds ratio [OR], 1.25 per 0.5-point decrease; CI, 1.04 to 1.49; P = .016) and malnutrition (OR, 2.99; CI, 1.36 to 6.58; P = .007). Conclusion Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment.
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Affiliation(s)
- Philippe Caillet
- From the University of Paris Est Creteil, Laboratoire d'Investigation Clinicque EA 4393; Assitance Publique-Hôpitaux de Paris Henri Mondor, Créteil, France
| | - Florence Canoui-Poitrine
- From the University of Paris Est Creteil, Laboratoire d'Investigation Clinicque EA 4393; Assitance Publique-Hôpitaux de Paris Henri Mondor, Créteil, France
| | - Johanna Vouriot
- From the University of Paris Est Creteil, Laboratoire d'Investigation Clinicque EA 4393; Assitance Publique-Hôpitaux de Paris Henri Mondor, Créteil, France
| | - Muriel Berle
- From the University of Paris Est Creteil, Laboratoire d'Investigation Clinicque EA 4393; Assitance Publique-Hôpitaux de Paris Henri Mondor, Créteil, France
| | - Nicoleta Reinald
- From the University of Paris Est Creteil, Laboratoire d'Investigation Clinicque EA 4393; Assitance Publique-Hôpitaux de Paris Henri Mondor, Créteil, France
| | - Sebastien Krypciak
- From the University of Paris Est Creteil, Laboratoire d'Investigation Clinicque EA 4393; Assitance Publique-Hôpitaux de Paris Henri Mondor, Créteil, France
| | - Sylvie Bastuji-Garin
- From the University of Paris Est Creteil, Laboratoire d'Investigation Clinicque EA 4393; Assitance Publique-Hôpitaux de Paris Henri Mondor, Créteil, France
| | - Stephane Culine
- From the University of Paris Est Creteil, Laboratoire d'Investigation Clinicque EA 4393; Assitance Publique-Hôpitaux de Paris Henri Mondor, Créteil, France
| | - Elena Paillaud
- From the University of Paris Est Creteil, Laboratoire d'Investigation Clinicque EA 4393; Assitance Publique-Hôpitaux de Paris Henri Mondor, Créteil, France
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Lazarovici C, Khodabakhshi R, Leignel D, Fabre-Guillevin E, Minard A, Gisselbrecht M. Factors leading oncologists to refer elderly cancer patients for geriatric assessment. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2011.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Comorbidity and polypharmacy in elderly cancer patients: The significance on treatment outcome and tolerance. J Geriatr Oncol 2010. [DOI: 10.1016/j.jgo.2010.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Komorbiditätsorientierte Onkologie – ein Überblick. Wien Klin Wochenschr 2010; 122:203-18. [DOI: 10.1007/s00508-010-1363-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 03/23/2010] [Indexed: 12/27/2022]
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Clough-Gorr KM, Stuck AE, Thwin SS, Silliman RA. Older breast cancer survivors: geriatric assessment domains are associated with poor tolerance of treatment adverse effects and predict mortality over 7 years of follow-up. J Clin Oncol 2009; 28:380-6. [PMID: 20008637 DOI: 10.1200/jco.2009.23.5440] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate geriatric assessment (GA) domains in relation to clinically important outcomes in older breast cancer survivors. METHODS Six hundred sixty women diagnosed with primary breast cancer in four US geographic regions (Los Angeles, CA; Minnesota; North Carolina; and Rhode Island) were selected with disease stage I to IIIA, age >or= 65 years at date of diagnosis, and permission from attending physician to contact. Data were collected over 7 years of follow-up from consenting patients' medical records, telephone interviews, physician questionnaires, and the National Death Index. Outcomes included self-reported treatment tolerance and all-cause mortality. Four GA domains were described by six individual measures, as follows: sociodemographic by adequate finances; clinical by Charlson comorbidity index (CCI) and body mass index; function by number of physical function limitations; and psychosocial by the five-item Mental Health Index (MHI5) and Medical Outcomes Study Social Support Survey (MOS-SSS). Associations were evaluated using t tests, chi(2) tests, and regression analyses. RESULTS In multivariable regression including age and stage, three measures from two domains (clinical and psychosocial) were associated with poor treatment tolerance; these were CCI >or= 1 (odds ratio [OR] = 2.49; 95% CI, 1.18 to 5.25), MHI5 score less than 80 (OR = 2.36; 95% CI, 1.15 to 4.86), and MOS-SSS score less than 80 (OR = 3.32; 95% CI, 1.44 to 7.66). Four measures representing all four GA domains predicted mortality; these were inadequate finances (hazard ratio [HR] = 1.89; 95% CI, 1.24 to 2.88; CCI >or= 1 (HR = 1.38; 95% CI, 1.01 to 1.88), functional limitation (HR = 1.40; 95% CI, 1.01 to 1.93), and MHI5 score less than 80 (HR = 1.34; 95% CI, 1.01 to 1.85). In addition, the proportion of women with these outcomes incrementally increased as the number of GA deficits increased. CONCLUSION This study provides longitudinal evidence that GA domains are associated with poor treatment tolerance and predict mortality at 7 years of follow-up, independent of age and stage of disease.
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Affiliation(s)
- Kerri M Clough-Gorr
- Section of Geriatrics, Boston University School of Medicine, Boston, MA, USA.
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