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Aldecoa KAT, Macaraeg CSL, Abougergi MS, Krishnamoorthy G, Arsene C. Palliative Care Utilization Among Hospitalized Patients With Hepatocellular Cancer: A Nationwide Study in the Pandemic Era (2019-2021). Am J Hosp Palliat Care 2024:10499091241271371. [PMID: 39138972 DOI: 10.1177/10499091241271371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
Background: Palliative care addresses a range of needs, from symptom management to providing support to patients with hepatocellular cancer (HCC) and their families throughout the illness. However, research on palliative care in HCC remains limited, particularly during the COVID-19 pandemic. This study investigates the healthcare utilization associated with palliative care referral among patients with HCC. Methods: This is a retrospective cross-sectional analysis conducted using the National Inpatient Sample (NIS) database from 2019 to 2021 among patients with HCC age ≥18 years. Results: Among the 35,220 hospitalizations with HCC as the principal diagnosis, 18.7% received inpatient palliative care referrals. Factors associated with increased palliative care referrals included age ≥65 years, Midwest region, Charlson Comorbidity Index (CCI) score ≥3, and end-of-life care, as reflected by discharge resulting in death. No racial or insurance disparities were observed. Palliative care consultations were associated with lower total hospital costs ($20,573 vs $26,035, <0.0001). A higher prevalence of "do-not-resuscitate" status was also found among patients with palliative care referrals. Conclusion: The study provides an understanding of palliative care utilization across pre-pandemic and pandemic periods. Factors such as advanced age, hospital region, and underlying comorbidities influenced the likelihood of referral, with no discernible racial or insurance disparities identified. Palliative care involvement has also been shown to provide cost-effective supportive care with lower hospital costs. These findings provide invaluable guidance for optimizing the integration of palliative care alongside HCC management.
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Affiliation(s)
- Kim Abbegail Tan Aldecoa
- Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA
- Wayne State University, Detroit, MI, USA
| | | | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, INOVA Fairfax Medical Campus, Great Falls, VA
- Catalyst Medical Consulting, Huntington Valley, PA, USA
| | - Geetha Krishnamoorthy
- Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA
- Wayne State University, Detroit, MI, USA
| | - Camelia Arsene
- Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA
- Wayne State University, Detroit, MI, USA
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2
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Patel R, Kwon D, Hovstadius M, Tiersten A. Patterns in use of palliative care in older patients with metastatic breast cancer: A National Cancer Database analysis. J Geriatr Oncol 2024:101840. [PMID: 39095312 DOI: 10.1016/j.jgo.2024.101840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 05/14/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Timely incorporation of palliative care (PC) during treatment of patients with metastatic cancers can improve symptom management and quality of life. Older age has been associated with lower PC use in patients with cancer. The frequency by which older patients with metastatic breast cancer (MBC) receive PC is unknown. The goal of this study was to use the National Cancer Database (NCDB) to describe national patterns in PC use in older adults over 75 years of age with MBC. MATERIALS AND METHODS Females with a diagnosis of MBC at age ≥ 75 years from 2010 to 2019 were identified from the NCDB. The NCDB defined PC as any surgery, radiation, systemic therapy, and/or pain management that was administered with noncurative intent. Multivariable logistic regression models were performed to assess associations between PC receipt and study covariates. RESULTS Of 17,325 eligible participants included in the final analysis, 39.4% were 75-79, 30.1% 80-84, and 30.4% ≥ 85 years of age. Overall, 22.1% (N = 3824) of patients utilized PC, of whom 14.3% received pain management, while the remainder received palliative intent surgery, radiation, and/or systemic therapy. Patients who were Hispanic were less likely to receive zzPC (AOR: 0.62, 95% CI: 0.48-0.79), p < 0.001). In the overall population, the use of PC increased from 19.2% in 2010 to 25.3% in 2019, though this was primarily driven by the statistically significant increase in the 75-79 age group (19.9% to 28.1%, p = 0.001). DISCUSSION In this patient population from the NCDB, we observed an increase in PC utilization over the last decade in older adults with MBC, though the increase was lowest in patients who were 85 years and older. Barriers to PC in older adults with cancer need to be further explored.
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Affiliation(s)
- Rima Patel
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA.
| | - Deukwoo Kwon
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Malin Hovstadius
- Frank H. Netter School of Medicine at Quinnipiac University, Hamden, CT, USA
| | - Amy Tiersten
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
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3
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Cook S, Alibhai S, Mehta R, Savard MF, Mariano C, LeBlanc D, Desautels D, Pezo R, Zhu X, Gelmon KA, Hsu T. Improving Care for Older Adults with Cancer in Canada: A Call to Action. Curr Oncol 2024; 31:3783-3797. [PMID: 39057151 PMCID: PMC11275828 DOI: 10.3390/curroncol31070279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/27/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Most patients diagnosed with and dying from cancer in Canada are older adults, with aging contributing to the large projected growth in cancer incidence. Older adults with cancer have unique needs, and on a global scale increasing efforts have been made to address recognized gaps in their cancer care. However, in Canada, geriatric oncology remains a new and developing field. There is increasing recognition of the value of geriatric oncology and there is a growing number of healthcare providers interested in developing the field. While there is an increasing number of dedicated programs in geriatric oncology, they remain limited overall. Developing novel methods to delivery geriatric care in the oncology setting and improving visibility is important. Formal incorporation of a geriatric oncology curriculum into training is critical to both improve knowledge and demonstrate its value to healthcare providers. Although a robust group of dedicated researchers exist, increased collaboration is needed to capitalize on existing expertise. Dedicated funding is critical to promoting clinical programs, research, and training new clinicians and leaders in the field. By addressing challenges and capitalizing on opportunities for improvement, Canada can better meet the unique needs of its aging population with cancer and ultimately improve their outcomes.
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Affiliation(s)
- Sarah Cook
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Shabbir Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Rajin Mehta
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Marie-France Savard
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Caroline Mariano
- BC Cancer Vancouver Centre, University of British Columbia, Vancouver, BC V5Z 4E6, Canada
| | - Dominique LeBlanc
- Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC G1V 0A6, Canada
| | - Danielle Desautels
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Rossanna Pezo
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Xiaofu Zhu
- Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Karen A. Gelmon
- BC Cancer Vancouver Centre, University of British Columbia, Vancouver, BC V5Z 4E6, Canada
| | - Tina Hsu
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H 8L6, Canada
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4
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Sánchez-Dávila JN, Verástegui EL, Peña-Nieves A, Allende-Pérez SR. Integration of the geriatric palliative care in oncological care of elderly patient with cancer. Palliat Support Care 2024:1-9. [PMID: 38621672 DOI: 10.1017/s1478951524000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVES The objective of this article is to describe the profile of the population attended to by the palliative geriatrics clinic and to evaluate the symptomatic control derived from the care provided. METHODS During 2017 a model based on a holistic approach was implemented, in this model the team geriatric palliative care plays a fundamental role by being part of the palliative care team and functioning as a liaison with the oncology team and other required services. We outlined the profile of 100 patients aged 70 and older seen between 2017 and 2019 at our geriatric palliative care clinic. Descriptive statistics were used. In addition, the symptoms and the care clinic model effect on the symptomatic control were analyzed, as well as the complexity of patients in palliative care with IDC-Pal. RESULTS The patients median age was 83.5 years. Patients were classified by type of management: 47% within the supportive care group and 53% with palliative care only; 58% had metastatic disease and 84% presented at least 1 comorbidity. Frailty was observed in 78% and a Karnofsky scale of 60 or less was observed in 59% of the overall population. SIGNIFICANCE OF RESULTS Elderly cancer patients have a complex profile and may have multiple needs. Integrating geriatric palliative care can help to provide better and personalized care along with symptomatic control. Further studies are required to establish the ideal care model for these patients. Importantly, a personalized treatment with a geriatric palliative care specialist is a key element.
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Affiliation(s)
| | - Emma L Verástegui
- Palliative Care Service, National Cancer Institute, Ciudad de México, México
| | - Adriana Peña-Nieves
- Palliative Care Service, National Cancer Institute, Ciudad de México, México
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5
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Castelo-Loureiro A, Perez-de-Acha A, Torres-Perez AC, Cunha V, García-Valdés P, Cárdenas-Reyes P, Soto-Perez-de-Celis E. Delivering Palliative and Supportive Care for Older Adults with Cancer: Interactions between Palliative Medicine and Geriatrics. Cancers (Basel) 2023; 15:3858. [PMID: 37568674 PMCID: PMC10417379 DOI: 10.3390/cancers15153858] [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: 07/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The world's population is aging rapidly, with projections indicating that by 2050 one in six people will be aged ≥65 years. As a result, the number of cancer cases in older people is expected to increase significantly. Palliative care is an essential component of cancer care with a direct impact on quality of life. However, older adults with cancer often suffer from multiple comorbidities, cognitive impairment, and frailty, posing unique challenges in the delivery of palliative care. The complex healthcare needs of older patients with cancer therefore require a comprehensive assessment, including a geriatric evaluation. Collaboration between geriatrics and palliative care can offer a solution to the challenges faced by older people with cancer, since this is a population with overlapping concerns for both disciplines. This review highlights the importance of palliative care for older adults with cancer and the benefits of a multidisciplinary approach. It also addresses the coordination of palliative care and geriatrics for specific symptom management and decision making.
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Affiliation(s)
| | - Andrea Perez-de-Acha
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Ana Cristina Torres-Perez
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Vanessa Cunha
- School of Medicine, University of Toronto, Toronto, ON M5S 3G5, Canada
| | - Paola García-Valdés
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Department of Palliative Care, Hospital Gea González, Mexico City 14080, Mexico
| | - Paula Cárdenas-Reyes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
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Goktas S, Akin S, Kosucu SN, Dogan P. Frailty in older Turkish cancer patients undergoing post-surgical adjuvant chemotherapy. Int J Palliat Nurs 2022; 28:590-599. [DOI: 10.12968/ijpn.2022.28.12.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Understanding the frailty levels of older patients undergoing surgery and chemotherapy will contribute to timely and reliable care practices and improve care outcomes. Aims: To determine the frailty of cancer patients who received chemotherapy treatment after surgery. Methods: This descriptive study included 192 Turkish patients aged over 60 years who received chemotherapy after surgery for cancer. Data were collected using a patient survey and the Edmonton Frailty Scale. Results: The average age of the participants was 66.3±5.3 years. Around 40% (40.6%) of the sample were diagnosed with breast cancer. The Edmonton Frailty Scale score of the group was 6.6 (SD±3.7). A quarter of the sample (22.9%) were at risk of frailty. Frailty levels were higher in older individuals with gastrointestinal cancers and other cancer groups compared with patients with breast cancer (p<0.001); patients with additional chronic diseases other than cancer (p=0.004); and in those with a history of falling and hospitalisation in the past year (p<0.001). Conclusions: Older patients with gastrointestinal cancer, additional chronic disease and a history of falling and hospitalisation within the past year should be evaluated closely for frailty before and during chemotherapy. It is crucial to consider the patient's vulnerability when making care and treatment decisions for older patients with cancer. Understanding the frailty levels of older patients who undergo surgery and receive chemotherapy can help health professionals to decide on timely and reliable care practices and improve care outcomes.
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Affiliation(s)
- Sonay Goktas
- University of Health Sciences, Hamidiye Faculty of Nursing; Department of Surgical Nursing, Turkey
| | - Semiha Akin
- University of Health Sciences, Hamidiye Faculty of Nursing, Department of Internal Medicine Nursing, Turkey
| | | | - Pinar Dogan
- Istanbul Medipol University, Department of Nursing, Turkey
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7
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Mota TA, Alves MB, Dantas ADO, de Moraes EB, de Sousa AR, da Silva RS. Basic Human Needs in the Elderly Receiving Palliative Care: A Scoping Review. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2022; 25:178-192. [PMID: 37674669 PMCID: PMC10179993 DOI: 10.14475/jhpc.2022.25.4.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 09/08/2023]
Abstract
Purpose This scoping review identified scientific evidence on basic human needs (BHNs) in the elderly receiving palliative care. Methods Systematic searches were conducted using six electronic databases (PubMed, CINAHL, Scopus, Lilacs, IBECS, and Web of Science). The initial search resulted in 1,227 articles, of which 104 were identified as potentially relevant. Fifty-three articles that met the inclusion criteria were identified and included in the final analysis. Results Using the three hierarchical dimensions of the BHN model, 17 needs were organised, with five in the psychobiological dimension, 10 in the psychosocial dimension, and two in the psychospiritual dimension. These needs reflect the importance of care with dignity and relief from suffering for the elderly in palliative care. Conclusion Recognising impaired BHNs in elderly people receiving palliative care will contribute to better care plans for the elderly, considering the multiple bio-psycho-social-spiritual dimensions of BHNs. This review points to a predominance of psychosocial needs.
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Affiliation(s)
- Thaciane Alves Mota
- Postgraduate Programme in Nursing and Health at the School of Nursing, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Manuela Bastos Alves
- Postgraduate Programme in Nursing and Health at the School of Nursing, Federal University of Bahia, Salvador, Bahia, Brazil
- Nursing Collegiate, Bahia State University, Senhor do Bonfim, Bahia, Brazil
| | | | - Erica Brandão de Moraes
- School of Nursing, Federal Fluminense University, Niteroi, Rio de Janeiro, Brazil
- Brazilian Centre for Evidence-based Healthcare: JBI Centre of Excellence, São Paulo, São Paulo, Brazil
| | - Anderson Reis de Sousa
- Postgraduate Programme in Nursing and Health at the School of Nursing, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Rudval Souza da Silva
- Postgraduate Programme in Nursing and Health at the School of Nursing, Federal University of Bahia, Salvador, Bahia, Brazil
- Nursing Collegiate, Bahia State University, Senhor do Bonfim, Bahia, Brazil
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8
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Tsang M, Gan S, Boscardin J, Wong ML, Walter LC, Smith AK. The epidemiology of preexisting geriatric and palliative conditions in older adults with poor prognosis cancers. J Am Geriatr Soc 2022; 70:3402-3412. [PMID: 36259424 PMCID: PMC9772051 DOI: 10.1111/jgs.18039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/19/2022] [Accepted: 08/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Older patients with poor prognosis cancers have complex needs that can benefit from geriatrics and palliative care principles. Because they are not routinely assessed, the prevalence of preexisting geriatric and palliative conditions in this population is unknown. METHODS We used the nationally representative Health and Retirement Study (HRS) linked with Medicare claims (1998-2016) to identify adults aged ≥65 years diagnosed with poor prognosis cancers (cancers with a median survival ≤1 year). Using the HRS interview before the first Medicare cancer claim, we used survey-weighted descriptive statistics and modified Poisson regression analysis to examine the prevalence of the following clinically significant conditions: functional impairment, difficulty with mobility, falls and injurious falls, social support, cognition, advance care planning, use of pain or sleep medications, and presence of pain or breathlessness. RESULTS Of 2105 participants (mean age 76, 53% women, 34% lung cancer, 21% gastrointestinal cancer), the median survival was 9.6 months. Approximately 65% had difficulty climbing stairs (95% CI 63%-67%), 49% had no advance directive (95% CI 45%-54%), 35% lived alone (95% CI 33%-37%), 36% fell in the last 2 years (95% CI 34%-38%), and 32% rated their memory as poor (95% CI 29%-34%). After adjusting for gender, cancer type, and HRS survey time before the first Medicare claim for a poor prognosis cancer, functional impairment and falls were highest among adults aged 85+. Adults aged 65-74 years were less likely to have an advance directive. After adjusting for age, cancer type, and HRS survey time, women had a higher rate of pain and physical impairment. In exploratory analyses, race and socioeconomic status predicted difficulty with mobility and instrumental activities of daily living, living alone, and advance directive completion. CONCLUSIONS Due to a high prevalence across multiple domains, all older adults with poor prognosis cancers should be assessed for geriatric and palliative care conditions.
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Affiliation(s)
- Mazie Tsang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA
| | - Siqi Gan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Melisa L. Wong
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA
| | - Louise C. Walter
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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9
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Olivares-Hernández A, Figuero-Pérez L, Miramontes-González JP, Fonseca-Sánchez E. [Cancer and elderly: Two incompatible concepts for intensive care?]. Rev Esp Geriatr Gerontol 2022; 57:286. [PMID: 36089447 DOI: 10.1016/j.regg.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Alejandro Olivares-Hernández
- Servicio de Oncología Médica, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.
| | - Luis Figuero-Pérez
- Servicio de Oncología Médica, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - José Pablo Miramontes-González
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, España; Facultad de Medicina, Universidad de Valladolid, Valladolid, España
| | - Emilio Fonseca-Sánchez
- Servicio de Oncología Médica, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España; Facultad de Medicina, Universidad de Salamanca, Salamanca, España
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10
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Nipp RD, Temel B, Fuh CX, Kay P, Landay S, Lage D, Franco-Garcia E, Scott E, Stevens E, O'Malley T, Mohile S, Dale W, Traeger L, Hashmi AZ, Jackson V, Greer JA, El-Jawahri A, Temel JS. Pilot Randomized Trial of a Transdisciplinary Geriatric and Palliative Care Intervention for Older Adults With Cancer. J Natl Compr Canc Netw 2021; 18:591-598. [PMID: 32380460 DOI: 10.6004/jnccn.2019.7386] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/04/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Oncologists often struggle with managing the unique care needs of older adults with cancer. This study sought to determine the feasibility of delivering a transdisciplinary intervention targeting the geriatric-specific (physical function and comorbidity) and palliative care (symptoms and prognostic understanding) needs of older adults with advanced cancer. METHODS Patients aged ≥65 years with incurable gastrointestinal or lung cancer were randomly assigned to a transdisciplinary intervention or usual care. Those in the intervention arm received 2 visits with a geriatrician, who addressed patients' palliative care needs and conducted a geriatric assessment. We predefined the intervention as feasible if >70% of eligible patients enrolled in the study and >75% of eligible patients completed study visits and surveys. At baseline and week 12, we assessed patients' quality of life (QoL), symptoms, and communication confidence. We calculated mean change scores in outcomes and estimated intervention effect sizes (ES; Cohen's d) for changes from baseline to week 12, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. RESULTS From February 2017 through June 2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age, 72.3 years; cancer types: 56.5% gastrointestinal, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 79.6% attended both. Overall, 89.7% completed all study surveys. Compared with usual care, intervention patients had less QoL decrement (-0.77 vs -3.84; ES = 0.21), reduced number of moderate/severe symptoms (-0.69 vs +1.04; ES = 0.58), and improved communication confidence (+1.06 vs -0.80; ES = 0.38). CONCLUSIONS In this pilot trial, enrollment exceeded 55%, and >75% of enrollees completed all study visits and surveys. The transdisciplinary intervention targeting older patients' unique care needs showed encouraging ES estimates for enhancing patients' QoL, symptom burden, and communication confidence.
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Affiliation(s)
- Ryan D Nipp
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Brandon Temel
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Charn-Xin Fuh
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Paul Kay
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Sophia Landay
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Daniel Lage
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Esteban Franco-Garcia
- 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erin Scott
- 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erin Stevens
- 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Terrence O'Malley
- 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.,3Partners Continuing Care, Partners HealthCare System, Boston, Massachusetts
| | - Supriya Mohile
- 4Department of Medicine, Division of Hematology and Oncology, University of Rochester Medical Center, Rochester, New York
| | - William Dale
- 5Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Lara Traeger
- 6Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Ardeshir Z Hashmi
- 7Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio
| | - Vicki Jackson
- 2Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph A Greer
- 6Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Areej El-Jawahri
- 1Department of Medicine, Division of Hematology and Oncology, and
| | - Jennifer S Temel
- 1Department of Medicine, Division of Hematology and Oncology, and
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11
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Hubbard TJE, Pringle H, Bethune R, McDermott FD. Survival outcomes of elderly patients referred to the lower gastrointestinal 2-week wait service. Colorectal Dis 2021; 23:1434-1443. [PMID: 33742557 DOI: 10.1111/codi.15620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 02/08/2023]
Abstract
AIM The benefit to elderly patients (≥80 years old) of referral to the resource-intensive lower gastrointestinal 2-week wait (LGI-2WW) pathway is unknown. The aim of this study was to investigate the survival outcome of elderly patients referred to a LGI-2WW service. METHOD This study comprised a retrospective analysis of a prospectively gathered database of patients referred to a single-centre LGI-2WW service and conformed to STROBE guidelines. The primary outcome was all-cause mortality. Statistical analysis was performed with the chi-square test and Kaplan-Meier survival curves compared with the generalized log-rank test. RESULTS A total of 10 155 patients referred to the LGI-2WW service between 1 January 2015 and 31 December 2018 were analysed; median follow-up was 37.0 months (range 0-66 months). Six hundred and ninety one cancers were diagnosed (6.8% detection rate); 551 (80%) of these were lower GI cancers (LGICas) [517 (75%) colorectal; 34 (5%) anal]. Forty per cent of LGICas were diagnosed via the LGI-2WW service. Patients aged ≥80 years with LGICa were more likely to be treated with palliative intent [age <80 years, 92/360 (26%) vs. age ≥80 years, 105/191 (55%); p < 0.001]. LGICa patients aged <85 years had a survival difference between those treated with curative intent (LGICa-Cur) or palliative intent (LGICa-Pal) (median survival for patients aged 80-84 years: LGICa-Cur 57 months vs. LGICa-Pal 15 months; p < 0.001). Patients aged ≥85 years did not have any survival difference by treatment intent (median survival for patients aged 85-89 years: LGICa-Cur 31 months vs. LGICa-Pal 16 months; p = 0.062; median survival for patients aged ≥90 years: LGICa-Cur 14 months vs. LGICa-Pal 16 months; p = 0.703). CONCLUSION Patients with LGICa aged ≥85 years have similar survival whether treated with curative or palliative intent. This can inform management discussions with patients and LGI-2WW referral pathway prioritization approaches.
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Affiliation(s)
- Thomas J E Hubbard
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.,Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK
| | - Heather Pringle
- Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK
| | - Robert Bethune
- Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK
| | - Frank D McDermott
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.,Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK
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12
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Li SY. The relationships among self-efficacy, social support, and self-care behavior in the elderly patients with chronic pain (a STROBE-compliant article). Medicine (Baltimore) 2021; 100:e24554. [PMID: 33655921 PMCID: PMC7939190 DOI: 10.1097/md.0000000000024554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/13/2021] [Indexed: 01/04/2023] Open
Abstract
The relationships among the self-efficacy, social support and self-care behavior in the elderly patients with chronic pain has not been reported. Therefore, we explored the relationships among self-efficacy, social support and self-care behavior in the elderly patients with chronic pain.General data questionnaire, self-efficacy scale, social support scale and self-care behavior scale were performed in 1032 elderly patients with chronic pain from Shenyang city between February and December 2017. The relationships among self-efficacy, social support and self-care behavior, and self-efficacy as a mediator between the social support and self-care behavior were analyzed by Pearson correlation analysis and Bootstrap method.In these elderly patients with chronic pain, the total scores of the self-efficacy, social support and self-care behavior were 35.59 ± 12.38, 65.64 ± 19.68 and 50.52 ± 15.26, respectively. The self-efficacy was positively correlated with the self-care behavior (r = 0.414, P < .001), the self-efficacy was positively correlated with the social support (r = 0.293, P < .001) and the social support was positively correlated with the self-care behavior (r = 0.322, P < .001). The mediating effect of self-efficacy was 0.121 which accounted for 27.31% of the total effects.The self-efficacy plays a mediating effect between social support and self-care behavior in the elderly patients with chronic pain.
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Abstract
PURPOSE OF REVIEW Despite established benefits of palliative care in the oncology population, it remains an underutilized resource particularly among older adults. The illness trajectory and needs of an older adult with cancer are unique. The purpose of this paper is to review the current literature on providing comprehensive palliative and end-of-life care for the older adult with cancer. RECENT FINDINGS Though the difficulties of applying traditional palliative care principles in the older patients with cancer have been discussed, this review reveals a clear gap in the literature in discussing the provision of comprehensive palliative and end-of-life care in this population. Very few articles have been published in this domain with even fewer published within the past 18 months. SUMMARY As such, this article reviews key aspects of palliative and geriatric medicine that need to be considered and integrated in order to provide comprehensive palliative care to the older adult with cancer. This includes a discussion of proper pain and symptoms assessment, performance status assessment, advance care planning, and end-of-life care while considering the nuances of geriatric syndromes.
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Affiliation(s)
- Lise Huynh
- Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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14
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Chen J, Xiao H, Chen Y, Sun H, Chen S, Zheng J. Effect of reminiscence therapy based on positive psychology theory (RTBPPT) on the positive feelings of the spousal caregivers of elderly patients with advanced cancer in China. Eur J Cancer Care (Engl) 2020; 29:e13324. [PMID: 32885518 DOI: 10.1111/ecc.13324] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/21/2020] [Accepted: 08/07/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Elderly patients with advanced cancer often experience various symptoms and need a great amount of care. However, their spousal caregivers are prone to negative emotions because of old age, poor health and the heavy burden of care. OBJECTIVE To examine the effect of a reminiscence therapy (RT) intervention on the spousal caregivers of elderly patients with advanced cancer. METHODS This study was a randomised controlled trial. Fifty-six spousal caregivers were randomly assigned to the control group (N = 29) receiving usual care and the experimental group (N = 27) receiving the RT intervention. The caregivers' caregiving burden, positive feelings towards caregiving and hope were measured before and immediately after the intervention. RESULTS The experimental group showed a significant reduction in the burden of spousal care compared to the control group (p < .01). The experimental group also had higher levels of positive feelings and hope than did the control group (p < .01). CONCLUSION RT is an effective approach to reducing the care burden of spouses of elderly patients with advanced cancer and enhancing the spouses' positive feelings and hope.
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Affiliation(s)
- Jingjing Chen
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Huimin Xiao
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ying Chen
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Haiyan Sun
- Department of Oncology, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shaohua Chen
- School of Nursing, Capital Medical University, Beijing, China
| | - Jianjing Zheng
- Department of Oncology, Fujian Provincial Hospital, Fuzhou, China
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15
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Lolli C, Altavilla A, Conteduca V, Farolfi A, Casadei C, Schepisi G, Banna GL, De Giorgi U. A comprehensive review of the role of immune checkpoint inhibitors in elderly patients affected by renal cell carcinoma. Crit Rev Oncol Hematol 2020; 153:103036. [DOI: 10.1016/j.critrevonc.2020.103036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/22/2020] [Accepted: 06/22/2020] [Indexed: 12/22/2022] Open
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16
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Perceptions of medical status and treatment goal among older adults with advanced cancer. J Geriatr Oncol 2020; 11:937-943. [DOI: 10.1016/j.jgo.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/20/2019] [Accepted: 11/18/2019] [Indexed: 01/26/2023]
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17
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Leus AJG, Frie M, Haisma MS, Terra JB, Plaat BEC, Steenbakkers RJHM, Halmos GB, Rácz E. Treatment of keratinocyte carcinoma in elderly patients - a review of the current literature. J Eur Acad Dermatol Venereol 2020; 34:1932-1943. [PMID: 32030838 PMCID: PMC7496368 DOI: 10.1111/jdv.16268] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022]
Abstract
A large percentage of the patients with keratinocyte carcinoma (KC, formerly known as non‐melanoma skin cancer) is of advanced age and often too frail for standard therapies. However, no specific treatment recommendations are given for this population. This review aimed to give an overview of the current literature on the best practice for the treatment of elderly patients with KC. A literature search was performed in MEDLINE, using ‘keratinocyte carcinoma’, ‘elderly’, ‘treatment’ and various synonyms. Case reports, reviews, comments, non‐English literature and studies with a sample size <15 were excluded. After selection, a total of 47 studies were reviewed. Two types of studies were identified, focusing on (I) the effect of age on treatment outcomes and (II) alternative treatment schedules for elderly patients. Studies on surgery, the gold standard, describe larger lesions and defect size in the elderly population. Recurrence rate, complication rate and disease‐specific survival were not affected by age. Depending on the expected morbidity of a suggested (re‐)excision and patient preferences, a conservative watchful waiting policy can be agreed upon as a shared decision. Other common treatment modalities, such as adjuvant radiotherapy, photodynamic therapy and systemic therapy for basal cell carcinoma (BCC), show comparable results in the elderly and younger population. Alternative treatment schedules for elderly patients include primary hypofractionated radiotherapy, which seems effective and well‐tolerated, although research is limited to case series. Additionally, localized and topical treatments seem safe and effective especially for low‐risk tumours. Data are lacking on the efficacy of systemic therapies of metastatic KC in elderly patients. Efficacy of most treatments (with the exception of photodynamic therapy) is not dependent on age. There is need for more research on the efficacy of adjusted treatment modalities, such as hypofractionated radiotherapy and palliative or curative systemic treatment.
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Affiliation(s)
- A J G Leus
- Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - M Frie
- Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - M S Haisma
- Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - J B Terra
- Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - B E C Plaat
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - R J H M Steenbakkers
- Department of Radiotherapy, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - G B Halmos
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - E Rácz
- Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
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Ku JY, Roh JL, Kim SB, Choi SH, Nam SY, Kim SY. Prognostic value of neutrophil-to-lymphocyte ratio in older patients with head and neck cancer. J Geriatr Oncol 2019; 11:417-422. [PMID: 31257164 DOI: 10.1016/j.jgo.2019.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/20/2019] [Accepted: 06/19/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Neutrophil-to-lymphocyte ratio (NLR), may predict treatment response and outcomes in some human malignancies. However, NLR has rarely been examined in older patients with head and neck squamous cell carcinoma (HNSCC). This study evaluated factors, including pre-treatment evaluation tests, predictive of mortality in older patients with HNSCC. METHODS This study prospectively enrolled 233 consecutive HNSCC patients aged 65 years or older. Pre-treatment evaluations included patient demographics, comorbidity, body weight loss, voice handicap index, dysphagia, Beck's depression inventory, comprehensive geriatric assessment, and circulating biomarkers. Cumulative incidence and cause-specific hazard functions were used to analyse the risk factors for overall mortality (OM), cancer mortality (CM), and non-cancer mortality (NCM). RESULTS Multivariate analyses showed that age, performance scale, NLR, and nodal stage were independent predictors of OM and CM (all P < .05). Age, body weight loss, frailty, and NLR were independent predictors of NCM (all P < .05). Older age ≥ 75 years and NLR showed strong association with all OM, CM, and NCM (all P < .05). NLR >2.5 was related to a higher risk of OM (hazard ratio [HR] = 1.77, 95% confidence interval [CI]: 1.05-2.97, P = .031), CM (HR = 1.89, 95% CI: 1.09-3.29, P = .023), and NCM (HR = 6.29, 95% CI: 2.16-18.37, P = .001). CONCLUSION Cancer and non-cancer mortalities among older patients with HNSCC may be predicted by several clinical and haematological data. NLR might be used as a circulating prognostic marker for mortality in older patients with HNSCC.
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Affiliation(s)
- Ja Yoon Ku
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Sung-Bae Kim
- Department of Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Fjose M, Eilertsen G, Kirkevold M, Grov EK. "Non-palliative care" - a qualitative study of older cancer patients' and their family members' experiences with the health care system. BMC Health Serv Res 2018; 18:745. [PMID: 30268149 PMCID: PMC6162914 DOI: 10.1186/s12913-018-3548-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/18/2018] [Indexed: 12/26/2022] Open
Abstract
Background Among all cancer patients in the palliative phase, ¾ have reached the age of 65. An aging population will increase the number of people afflicted with cancer, and create challenges for patients, family members and health services. Nevertheless, limited research has focused explicitly on the experiences and needs of older cancer patients in the palliative phase and their families. Therefore, the aim of this study is to explore what older home dwelling cancer patients in the palliative phase and their close family members, as individuals and as a family, experience as important and difficult when facing the health services. Methods We used a qualitative descriptive design. Data was collected through family group interviews with 26 families. Each interview consisted of an older home dwelling cancer patient and one to four family members with different relationships to the patient (e.g. spouse, adult children and/or children-in-law). Data was analysed by qualitative content analysis. Results The main theme is “Non-palliative care” – health care services in the palliative phase not tailored to family needs. Three themes are revealed: 1) exhausting cancer follow-up, 2) a cry for family involvement, and 3) fragmented care. Conclusion The health services seem poorly organised for meeting the demands of palliative care for older home dwelling cancer patients in the palliative phase and their family members. Close family members would like to contribute but health services lack systems for involving them in the follow-up of the patient.
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Affiliation(s)
- Marianne Fjose
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Postboks 7030, 5020, Bergen, Norway.
| | - Grethe Eilertsen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Marit Kirkevold
- Faculty of Medicine, Department of Nursing Science, University of Oslo, Oslo, Norway
| | - Ellen Karine Grov
- Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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20
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Cheng KKF, Nicholson C. Prioritizing the integration of geriatric oncology and palliative care. J Geriatr Oncol 2018; 9:690-692. [PMID: 30025820 DOI: 10.1016/j.jgo.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Karis Kin-Fong Cheng
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.
| | - Caroline Nicholson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London/ St. Christopher's Hospice London, United Kingdom; St Christopher's Hospice, 51-59 Lawrie Park Road, London, SE26 6DZ, United Kingdom.
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21
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Sourrouille I, Macovei R, Faron M, Le Péchoux C, Mir O, Adam J, Dumont S, Terrier P, Le Cesne A, Honoré C. Long-Term Outcome After Surgery for a Localized Retroperitoneal Soft Tissue Sarcoma in Elderly Patients: Results from a Retrospective, Single-Center Study. Ann Surg Oncol 2018; 25:2201-2208. [DOI: 10.1245/s10434-018-6529-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 11/18/2022]
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22
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Arcanjo SP, Saporetti LA, Curiati JAE, Jacob-Filho W, Avelino-Silva TJ. Clinical and laboratory characteristics associated with referral of hospitalized elderly to palliative care. ACTA ACUST UNITED AC 2018; 16:eAO4092. [PMID: 29694607 PMCID: PMC5968794 DOI: 10.1590/s1679-45082018ao4092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022]
Abstract
Objective To investigate clinical and laboratory characteristics associated with referral of acutely ill older adults to exclusive palliative care. Methods A retrospective cohort study based on 572 admissions of acutely ill patients aged 60 years or over to a university hospital located in São Paulo, Brazil, from 2009 to 2013. The primary outcome was the clinical indication for exclusive palliative care. Comprehensive geriatric assessments were used to measure target predictors, such as sociodemographic, clinical, cognitive, functional and laboratory data. Stepwise logistic regression was used to identify independent predictors of palliative care. Results Exclusive palliative care was indicated in 152 (27%) cases. In the palliative care group, in-hospital mortality and 12 month cumulative mortality amounted to 50% and 66%, respectively. Major conditions prompting referral to palliative care were advanced dementia (45%), cancer (38%), congestive heart failure (25%), stage IV and V renal dysfunction (24%), chronic obstructive pulmonary disease (8%) and cirrhosis (4%). Major complications observed in the palliative care group included delirium (p<0.001), infections (p<0.001) and pressure ulcers (p<0.001). Following multivariate analysis, male sex (OR=2.12; 95%CI: 1.32-3.40), cancer (OR=7.36; 95%CI: 4.26-13.03), advanced dementia (OR=12.6; 95%CI: 7.5-21.2), and albumin levels (OR=0.25; 95%CI: 0.17-0.38) were identified as independent predictors of referral to exclusive palliative care. Conclusion Advanced dementia and cancer were the major clinical conditions associated with referral of hospitalized older adults to exclusive palliative care. High short-term mortality suggests prognosis should be better assessed and discussed with patients and families in primary care settings.
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Affiliation(s)
- Suelen Pereira Arcanjo
- Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luis Alberto Saporetti
- Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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Nipp RD, El-Jawahri A, Traeger L, Jacobs JM, Gallagher ER, Park ER, Jackson VA, Pirl WF, Temel JS, Greer JA. Differential effects of early palliative care based on the age and sex of patients with advanced cancer from a randomized controlled trial. Palliat Med 2018; 32:757-766. [PMID: 29323617 PMCID: PMC6467298 DOI: 10.1177/0269216317751893] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early palliative care interventions enhance patient outcomes, including quality of life, mood, and coping, but it remains unclear whether certain subgroups of patients are more likely to benefit from early palliative care. We explored whether age and sex moderate the improved outcomes seen with early palliative care. METHODS We performed a secondary analysis of data from a randomized trial of 350 patients with advanced lung and non-colorectal gastrointestinal cancer. Patients received an early palliative care intervention integrated with oncology care or usual oncology care alone. We used linear regression to determine if age (older or younger than 65) and sex moderated the effects of the intervention on quality of life (Functional Assessment of Cancer Therapy-General (FACT-G)), depression symptoms (Patient Health Questionnaire 9 (PHQ-9)), and coping (Brief COPE) within lung and gastrointestinal subgroups. RESULTS At 24 weeks, younger patients with lung cancer receiving early palliative care reported increased use of active coping ( B = 1.74; p = 0.02) and decreased use of avoidant coping ( B = -0.97; p = 0.02), but the effects of early palliative care on these outcomes were not significant for older patients. Male patients with lung cancer assigned to early palliative care reported better quality of life (FACT-G: B = 9.31; p = 0.01) and lower depression scores (PHQ-9: B = -2.82; p = 0.02), but the effects of early palliative care on these outcomes were not significant for female patients. At 24 weeks, we found no age or sex moderation effects within the gastrointestinal cancer subgroup. CONCLUSION Age and sex moderate the effects of early palliative care for patients with advanced lung cancer. Early palliative care may need to be tailored to individuals' unique sociodemographic and clinical characteristics.
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Affiliation(s)
- Ryan D Nipp
- 1 Division of Hematology & Oncology, Department of Medicine, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Areej El-Jawahri
- 1 Division of Hematology & Oncology, Department of Medicine, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lara Traeger
- 2 Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jamie M Jacobs
- 2 Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily R Gallagher
- 1 Division of Hematology & Oncology, Department of Medicine, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- 2 Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vicki A Jackson
- 3 Division of Palliative Care & Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William F Pirl
- 4 Department of Psychiatry, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Jennifer S Temel
- 1 Division of Hematology & Oncology, Department of Medicine, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph A Greer
- 2 Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Runzer-Colmenares FM, Urrunaga-Pastor D, Aguirre LG, Reategui-Rivera CM, Parodi JF, Taype-Rondan A. Fragilidad y vulnerabilidad como predictores de radiotoxicidad en adultos mayores: un estudio longitudinal en Perú. Med Clin (Barc) 2017; 149:325-330. [DOI: 10.1016/j.medcli.2017.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 02/07/2023]
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Koll T, Pergolotti M, Holmes HM, Pieters HC, van Londen GJ, Marcum ZA, MacKenzie AR, Steer CB. Supportive Care in Older Adults with Cancer: Across the Continuum. Curr Oncol Rep 2016; 18:51. [PMID: 27342609 PMCID: PMC5504916 DOI: 10.1007/s11912-016-0535-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supportive care is an essential component of anticancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anticancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent.
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Affiliation(s)
- Thuy Koll
- Internal Medicine Division of Geriatric Medicine, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, 68198-6155, NE, USA
| | - Mackenzi Pergolotti
- Cancer Outcomes Research Group, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, UTHealth, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin, MSB 5.116, Houston, 77030, TX, USA
| | | | - G J van Londen
- University of Pittsburgh, S. 140 Cooper Pavilion, 5115 Centre Ave., Pittsburgh, 15232, PA, USA
| | - Zachary A Marcum
- University of Washington, 1959 NE Pacific Ave, H375G, Box 357630, Seattle, 98195, WA, USA
| | - Amy R MacKenzie
- Department of Medical Oncology, Division of Regional Cancer Care, Thomas Jefferson University, 925 Chestnut St., 4th floor, Philadelphia, 9107, PA, USA
| | - Christopher B Steer
- Border Medical Oncology, Suite 1, 69 Nordsvan Drive, Wodonga, 3690, VIC, Australia.
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Tan A, Chung S, Ducasse V, Laganier J, Teixeira A. What is the diagnosis? A mass of the breast in an old man. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sharma N, Sharma AM, Wojtowycz MA, Wang D, Gajra A. Utilization of palliative care and acute care services in older adults with advanced cancer. J Geriatr Oncol 2016; 7:39-46. [PMID: 26769146 DOI: 10.1016/j.jgo.2015.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 10/31/2015] [Accepted: 12/07/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVES There is a gap in knowledge regarding the rates of utilization of palliative care services (PCS) and acute care services (ACS) among older patients with advanced cancer close to end of life. We analyzed the utilization of these services among older adults (65 years and older) and compared them to those in younger adults (40-64 years) with advanced cancer. MATERIALS AND METHODS A retrospective chart review of 567 veterans who died with advanced cancer between 2002 and 2009 and utilized PCS and ACS prior to death was conducted after IRB approval. To assess PCS utilization, we studied the mean duration between day of hospice referral and time of death (DOR) and the mean length of stay with hospice (LoS). The frequency of emergency room visits (ERVLM), hospital admissions (HALM), and ICU admissions (ICULM) in the last month of life was used as a measure for ACS. The differences among older and younger patients were compared using two sample t-tests. RESULTS Older adults had earlier referral to PCS [mean DOR: 47.3 versus 34.5 days, p=0.015], longer stay with hospice [mean LoS: 32.5 versus 20.2 days, p=0.007], fewer hospital [HALM: 0.7 versus 0.9, p=0.043], and ICU admissions [ICULM: 0.1 versus 0.2, p=0.030] per patient. The proportion of patients utilizing ER visits [53.5 % versus 59.5%, p=0.173] and hospital admissions [58.6% versus 65.1%, p=0.13] in the last month of life was similar in both age groups with fewer older adults utilizing ICU care [13.2% versus 19.5%, p=0.047]. CONCLUSION Older patients with cancer are likely to be referred to PCS earlier than younger patients and spend a longer duration with PCS prior to death. However, there continues to be significant utilization of ACS in all patients with advanced cancer. Better understanding of the goals of care in older adults with cancer and education of oncology providers regarding the need to utilize and integrate palliative care services earlier in the course of disease is imperative.
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Affiliation(s)
- Namita Sharma
- SUNY Upstate University, Department of Medicine, Syracuse, NY 13210, USA; VA Medical Center, Syracuse, NY, USA
| | - Amit M Sharma
- SUNY Upstate University, Department of Medicine, Syracuse, NY 13210, USA; VA Medical Center, Syracuse, NY, USA
| | - Martha A Wojtowycz
- SUNY Upstate University, Department of Public Health and Preventive Medicine, Syracuse, NY 13210, USA
| | - Dongliang Wang
- SUNY Upstate University, Department of Public Health and Preventive Medicine, Syracuse, NY 13210, USA
| | - Ajeet Gajra
- SUNY Upstate University, Department of Medicine, Syracuse, NY 13210, USA; VA Medical Center, Syracuse, NY, USA.
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Nipp RD, Greer JA, El-Jawahri A, Traeger L, Gallagher ER, Park ER, Jackson VA, Pirl WF, Temel JS. Age and Gender Moderate the Impact of Early Palliative Care in Metastatic Non-Small Cell Lung Cancer. Oncologist 2015; 21:119-26. [PMID: 26621041 PMCID: PMC4709206 DOI: 10.1634/theoncologist.2015-0232] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/28/2015] [Indexed: 12/25/2022] Open
Abstract
This study analyzed data from a randomized controlled trial of patients with metastatic non-small cell lung cancer who received either early palliative care (EPC) integrated with oncology care or oncology care alone. Males and younger patients who received EPC had better quality of life and mood than those who received oncology care alone. However, these outcomes did not differ significantly between treatment groups for females or older patients. Background. Studies demonstrate that early palliative care (EPC) improves advanced cancer patients’ quality of life (QOL) and mood. However, it remains unclear whether the role of palliative care differs based upon patients’ demographic characteristics. We explored whether age and gender moderate the improvements in QOL and mood seen with EPC. Methods. We performed a secondary analysis of data from a randomized controlled trial of patients with metastatic non-small cell lung cancer. Patients received either EPC integrated with oncology care or oncology care alone. We assessed the degree to which QOL (Trial Outcome Index [TOI]) and mood (Hospital Anxiety and Depression Scale [HADS] and Patient Health Questionnaire 9 [PHQ-9]) outcomes at week 12 varied by patient age (<65) and gender. The week 12 data of 107 patients are included in this analysis. Results. At 12 weeks, younger patients receiving EPC reported better QOL (TOI mean = 62.04 vs. 49.43, p = .001) and lower rates of depression (HADS–Depression = 4.0% vs. 52.4%, p < .001; PHQ-9 = 0.0% vs. 28.6%, p = .006) than younger patients receiving oncology care alone. Males receiving EPC reported better QOL (TOI mean = 58.81 vs. 48.30, p = .001) and lower rates of depression (HADS–Depression = 18.5% vs. 60.9%, p = .002; PHQ-9 = 3.8% vs. 34.8%, p = .008) than males receiving oncology care alone. At 12 weeks, QOL and mood did not differ between study groups for females and older patients. Conclusion. Males and younger patients who received EPC had better QOL and mood than those who received oncology care alone. However, these outcomes did not differ significantly between treatment groups for females or older patients. Implications for Practice: This study found that early palliative care improves patients’ quality of life and mood differentially based on their age and gender. Specifically, males and younger patients receiving early palliative care experienced better quality of life and mood than those receiving oncology care alone. Conversely, females and older patients did not experience this treatment effect. Thus, palliative care interventions may need to be tailored to patients’ age- and gender-specific care needs. Studying how patients’ demographic characteristics affect their experience with palliative care will enable the development of interventions targeted to the distinct supportive care needs of patients with cancer.
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Affiliation(s)
- Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Emily R Gallagher
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Abstract
OBJECTIVES To describe how the Advanced Practice Nurse (APN) is uniquely suited to meet the needs of older adults throughout the continuum of cancer, to explore the progress that APNs have made in gero-oncology care, and make suggestions for future directions. DATA SOURCE Google Scholar, PubMed, and CINAHL. Search terms included: "gero-oncology," "geriatric oncology," "Advanced Practice Nurse," "Nurse Practitioner," "older adult," "elderly," and "cancer." CONCLUSION Over the last decade, APNs have made advances in caring for older adults with cancer by playing a role in prevention, screening, and diagnosis; through evidence-based gero-oncology care during cancer treatment; and in designing tailored survivorship care models. APNs must combat ageism in treatment choice for older adults, standardize comprehensive geriatric assessments, and focus on providing person-centered care, specifically during care transitions. IMPLICATIONS FOR NURSING PRACTICE APNs are well-positioned to help understand the complex relationship between risk factors, geriatric syndromes, and frailty and translate research into practice. Palliative care must expand beyond specialty providers and shift toward APNs with a focus on early advanced care planning. Finally, APNs should continue to establish multidisciplinary survivorship models across care settings, with a focus on primary care.
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Millan M, Merino S, Caro A, Feliu F, Escuder J, Francesch T. Treatment of colorectal cancer in the elderly. World J Gastrointest Oncol 2015; 7:204-20. [PMID: 26483875 PMCID: PMC4606175 DOI: 10.4251/wjgo.v7.i10.204] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/30/2015] [Accepted: 08/30/2015] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer has a high incidence, and approximately 60% of colorectal cancer patients are older than 70, with this incidence likely increasing in the near future. Elderly patients (> 70-75 years of age) are a very heterogeneous group, ranging from the very fit to the very frail. Traditionally, these patients have often been under-treated and recruited less frequently to clinical trials than younger patients, and thus are under-represented in publications about cancer treatment. Recent studies suggest that fit elderly patients can be treated in the same way as their younger counterparts, but the treatment of frail patients with comorbidities is still a matter of controversy. Many factors should be taken into account, including fitness for treatment, the wishes of the patient and family, and quality of life. This review will focus on the existing evidence for surgical, oncologic, and palliative treatment in patients over 70 years old with colorectal cancer. Careful patient assessment is necessary in order to individualize treatment approach, and this should rely on a multidisciplinary process. More well-designed controlled trials are needed in this patient population.
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Hong JF, Zhang W, Song YX, Xie LF, Wang WL. Psychological distress in elderly cancer patients. Int J Nurs Sci 2015. [DOI: 10.1016/j.ijnss.2015.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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