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Navarrete-Reyes AP, Mateos-Soria AS, Sánchez-Hernández JJ, Negrete-Najar JP. Frailty and Cancer Prognosis. Curr Oncol Rep 2024:10.1007/s11912-024-01558-x. [PMID: 38865004 DOI: 10.1007/s11912-024-01558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize the current evidence regarding the prognostic role of frailty in older patients diagnosed with cancer and to explore the evidence regarding its prognostic implications in cancer survivors. RECENT FINDINGS Frailty has been consistently associated with mortality/overall survival, postoperative complications, short- and long-term postoperative mortality, length of stay, among other adverse health-related outcomes in several oncological contexts. The possible association between frailty and treatment toxicity has been less explored, however most studies suggest frailty is a predictor of treatment induced toxicity. In addition, in cancer survivors, frailty is a risk factor for cardiovascular disease, incident type 2 diabetes mellitus, mortality, altered cognitive performance and increased symptom severity. Due to its usefulness in establishing prognosis and informing treatment decision making, it is expected that frailty screening and assessment will continue to gain popularity as part of the pretreatment evaluation of older patients with cancer.
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Affiliation(s)
- Ana Patricia Navarrete-Reyes
- Geriatric Medicine Department, Geriatric Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Abigail Samayoa Mateos-Soria
- Geriatric Medicine Department, Geriatric Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Internal Medicine Service, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Juan José Sánchez-Hernández
- Geriatric Medicine Department, Geriatric Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Internal Medicine Service, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juan Pablo Negrete-Najar
- Geriatric Medicine Service, Hospital General de Zona No. 35, Instituto Mexicano del Seguro Social, Ciudad Juárez, Mexico
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Yajima S, Masuda H. The significance of G8 and other geriatric assessments in urologic cancer management: A comprehensive review. Int J Urol 2024; 31:607-615. [PMID: 38402450 DOI: 10.1111/iju.15432] [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: 12/14/2023] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
In urologic oncology, which often involves older patients, it is important to consider how to manage their care appropriately. Geriatric assessment (GA) is a method that can address the specific needs of older cancer patients. The GA encompasses various assessment domains, but these domains exhibit variations across the literature. Some of the common items include functional ability, nutrition, comorbidities, cognitive ability, psychosocial disorders, polypharmacy, social and financial support, falls/imbalance, and vision/hearing. Despite the diversity of domains, there is limited consensus on reliable measurement methods. This review discusses the role of GA in managing urologic cancer in unique scenarios, such as those necessitating temporary or permanent urinary catheters or stomas due to urinary diversion. A comprehensive GA is time and human-resource-intensive in real-world clinical practice. Hence, simpler tools such as the Geriatric-8 (G8), capable of identifying high-risk patients requiring a detailed GA, are also under investigation in various contexts. Therefore, we conducted a systematic literature review on the G8. Our findings indicate that patients with low G8 scores encounter difficulties with stoma self-care after urinary diversion and have higher risks of urinary tract infections and ileus after radical cystectomy. The utilization of G8 as a screening tool for urologic cancer patients may facilitate the delivery of appropriate and personalized treatment and care.
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Affiliation(s)
- Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
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Massaro F, Andreozzi F, Vandevoorde C, Bron D. Supportive Care in Older Lymphoma Patients to Reduce Toxicity and Preserve Quality of Life. Cancers (Basel) 2023; 15:5381. [PMID: 38001641 PMCID: PMC10670135 DOI: 10.3390/cancers15225381] [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: 10/06/2023] [Revised: 10/23/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment paradigm in older patients with malignant hemopathies is the choice between an effective conservative treatment that preserves quality of life and an intensive, potentially curative treatment with more toxicities. For each patient, it is important to determine the risk/benefit ratio. The patient should be involved in the discussion, sufficiently informed and able to express himself and his expectations in terms of quality of life. However, this informed consent is conditioned by the ability of the patient to understand the risks and benefits of the treatment. Decline in quality of life is an important parameter for older patients with cancer and many prospective trials have now confirmed the impact of different side effects of treatment, such as recurrent hospitalization, loss of autonomy in daily activities, loss of contact with grandchildren and loss of cognitive functions. Interventions oriented to vulnerabilities detected in the older patients (by comprehensive geriatric assessment) and an optimal approach, including preventive measures to reduce treatment-related toxicity and mortality, are directly correlated to improvement in quality of life.
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Affiliation(s)
| | | | | | - Dominique Bron
- Department of Hematology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium; (F.M.); (F.A.); (C.V.)
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Baltussen JC, de Glas NA, van Holstein Y, van der Elst M, Trompet S, Uit den Boogaard A, van der Plas-Krijgsman W, Labots G, Holterhues C, van der Bol JM, Mammatas LH, Liefers GJ, Slingerland M, van den Bos F, Mooijaart SP, Portielje JEA. Chemotherapy-Related Toxic Effects and Quality of Life and Physical Functioning in Older Patients. JAMA Netw Open 2023; 6:e2339116. [PMID: 37870832 PMCID: PMC10594146 DOI: 10.1001/jamanetworkopen.2023.39116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/01/2023] [Indexed: 10/24/2023] Open
Abstract
Importance Although older patients are at increased risk of developing grade 3 or higher chemotherapy-related toxic effects, no studies, to our knowledge, have focused on the association between toxic effects and quality of life (QOL) and physical functioning. Objective To investigate the association between grade 3 or higher chemotherapy-related toxic effects and QOL and physical functioning over time in older patients. Design, Setting, and Participants In this prospective, multicenter cohort study, patients aged 70 years or older who were scheduled to receive chemotherapy with curative or palliative intent and a geriatric assessment were included. Patients were treated with chemotherapy between December 2015 and December 2021. Quality of life and physical functioning were analyzed at baseline and after 6 months and 12 months. Exposures Common Terminology Criteria for Adverse Events grade 3 or higher chemotherapy-related toxic effects. Main Outcomes and Measures The main outcome was a composite end point, defined as a decline in QOL and/or physical functioning or mortality at 6 months and 12 months after chemotherapy initiation. Associations between toxic effects and the composite end point were analyzed with multivariable logistic regression models. Results Of the 276 patients, the median age was 74 years (IQR, 72-77 years), 177 (64%) were male, 196 (71%) received chemotherapy with curative intent, and 157 (57%) had gastrointestinal cancers. Among the total patients, 145 (53%) had deficits in 2 or more of the 4 domains of the geriatric assessment and were classified as frail. Grade 3 or higher toxic effects were observed in 94 patients (65%) with frailty and 66 (50%) of those without frailty (P = .01). Decline in QOL and/or physical functioning or death was observed in 76% of patients with frailty and in 64% to 68% of those without frailty. Among patients with frailty, grade 3 or higher toxic effects were associated with the composite end point at 6 months (odds ratio [OR], 2.62; 95% CI, 1.14-6.05) but not at 12 months (OR, 1.09; 95% CI, 0.45-2.64) and were associated with mortality at 12 months (OR, 3.54; 95% CI, 1.50-8.33). Toxic effects were not associated with the composite end point in patients without frailty (6 months: OR, 0.76; 95% CI, 0.36-1.64; 12 months: OR, 1.06; 95% CI, 0.46-2.43). Conclusions and Relevance In this prospective cohort study of 276 patients aged 70 or older who were treated with chemotherapy, patients with frailty had more grade 3 or higher toxic effects than those without frailty, and the occurrence of toxic effects was associated with a decline in QOL and/or physical functioning or mortality after 1 year. Toxic effects were not associated with poor outcomes in patients without frailty. Pretreatment frailty screening and individualized treatment adaptions could prevent a treatment-related decline of remaining health.
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Affiliation(s)
- Joosje C. Baltussen
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nienke A. de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yara van Holstein
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Marjan van der Elst
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna Uit den Boogaard
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Geert Labots
- Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands
| | - Cynthia Holterhues
- Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands
| | | | | | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederiek van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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Feng G, Parthipan M, Breunis H, Timilshina N, Soto-Perez-de-Celis E, Mina DS, Emmenegger U, Finelli A, Krzyzanowska MK, Clarke H, Puts M, Alibhai SMH. Daily physical activity monitoring in older adults with metastatic prostate cancer on active treatment: Feasibility and associations with toxicity. J Geriatr Oncol 2023; 14:101576. [PMID: 37421787 DOI: 10.1016/j.jgo.2023.101576] [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: 04/09/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Physical activity may be associated with cancer treatment toxicity, but generalizability to geriatric oncology is unclear. As many older adults have low levels of physical activity and technology use, this area needs further exploration. We evaluated the feasibility of daily step count monitoring and the association between step counts and treatment-emergent symptoms. MATERIALS AND METHODS Adults aged 65+ starting treatment (chemotherapy, enzalutamide/abiraterone, or radium-223) for metastatic prostate cancer were enrolled in a prospective cohort study. Participants reported step counts (measured via smartphone) and symptoms (Edmonton Symptom Assessment Scale) daily for one treatment cycle (i.e., 3-4 weeks). Embedded semi-structured interviews were performed upon completion of the study. The feasibility of daily monitoring was evaluated with descriptive statistics and thematic analysis. The predictive validity of a decline in daily steps (compared to pre-treatment baseline) for the emergence of symptoms was examined using sensitivity and positive predictive value (PPV). Associations between a 15% decline in steps and the emergence of moderate (4-6/10) to severe (7-10/10) symptoms and pain in the next 24 h were assessed using logistic regression. RESULTS Of 90 participants, 47 engaged in step count monitoring (median age = 75, range = 65-88; 52.2% participation rate). Daily physical activity monitoring was found to be feasible (94% retention rate; 90.5% median response rate) with multiple patient-reported benefits including increased self-awareness and motivation to engage in physical activity. During the first treatment cycle, instances of a 15% decline in steps were common (n = 37, 78.7%), as was the emergence of moderate to severe symptoms overall (n = 40, 85.1%) and pain (n = 26, 55.3%). The predictive validity of a 15% decline in steps on the emergence of moderate to severe symptoms was good (sensitivity = 81.8%, 95% confidence interval [CI] = 68.7-95.0; PPV = 73.0%, 95% CI = 58.7-87.3), although the PPV for pain was poor (sensitivity = 77.8%, 95% CI = 58.6-97.0; PPV = 37.8%, 95% CI = 22.2-53.5). In the regression models, changes in daily physical activity were not associated with symptoms or pain. DISCUSSION Changes in physical activity had modest ability to predict moderate to severe symptoms overall. Although participation was suboptimal, daily activity monitoring in older adults with cancer appears feasible and may have other uses such as improving physical activity levels. Further studies are warranted.
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Affiliation(s)
- Gregory Feng
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Milothy Parthipan
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Henriette Breunis
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Narhari Timilshina
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Salvador Zubirán National Institute of Medical Science and Nutrition, Mexico City, Mexico
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia, Toronto General Hospital, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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Kravchenko G, Korycka-Bloch R, Stephenson SS, Kostka T, Sołtysik BK. Cardiometabolic Disorders Are Important Correlates of Vulnerability in Hospitalized Older Adults. Nutrients 2023; 15:3716. [PMID: 37686746 PMCID: PMC10490417 DOI: 10.3390/nu15173716] [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: 07/30/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
With an increasingly aging population worldwide, the concept of multimorbidity has attracted growing interest over recent years, especially in terms of frailty, which leads to progressive multisystem decline and increased adverse clinical outcomes. The relative contribution of multiple disorders to overall frailty index in older populations has not been established so far. This study aimed to assess the association between the vulnerable elders survey-13 (VES-13) score, which is acknowledged to be one of the most widely used measures of frailty, and the most common accompanying diseases amongst hospitalized adults aged 60 years old and more. A total of 2860 participants with an average age of 83 years were included in this study. Multiple logistic regression with adjustment for age and nutritional status was used to assess the independent impact of every particular disease on vulnerability. Diabetes mellitus type 2, coronary artery disease, atrial fibrillation, heart failure, chronic kidney disease, osteoarthritis, fractures, eyes disorders, depression, dementia, pressure ulcers, and urinary incontinence were associated with higher scores of VES-13. Hospital admission of older subjects with those conditions should primarily draw attention to the risk of functional decline, especially while qualifying older patients for further treatment in surgery and oncology. At the same time, lipid disorders, gastrointestinal diseases, higher body mass index, and albumins level were related to a lower risk of being vulnerable, which may be attributed to a younger age and better nutritional status of those patients.
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Affiliation(s)
| | | | | | - Tomasz Kostka
- Department of Geriatrics, Healthy Aging Research Centre (HARC), Medical University of Lodz, Haller Sqr. No. 1, 90-647 Lodz, Poland; (G.K.); (R.K.-B.); (S.S.S.); (B.K.S.)
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Shivashankara, Banerjee J, Mehrotra R, Wildes TM. Improving care for older adults with hematological malignancies in India: Conquering the challenge. J Geriatr Oncol 2023; 14:101536. [PMID: 37258397 DOI: 10.1016/j.jgo.2023.101536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/27/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
In India, the number of older adults is steadily increasing and expected to reach around 200 million by 2030. Along with demographic change, India is experiencing a shift in family structure from multi-generational to nuclear families, affecting the social and psychological support available to older adults. The majority of hematological malignancies are diagnosed after the age of 60 years. Multiple issues associated with ageing, denoted as geriatric impairments, adversely affect the care of patients with cancer. Geriatric assessment and management is conspicuously underutilized and missing from the medical education curriculum in developing countries including India. Geriatric assessments may provide valuable information for the care of older adults with hematological malignancies, but incorporating geriatrics into the care of older patients with cancer in India will require knowledge of different approaches and consideration of the local healthcare context. In this article we will discuss the distinctive considerations in caring for older adults with hematological malignancies in India and to examine the unmet needs, challenges, and opportunities in improving the care of this population in the Indian context.
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Affiliation(s)
- Shivashankara
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Joyita Banerjee
- Department of Geriatric Medicine, AIIMS, Delhi, India; Venu Geriatric Care Centre, Sheikh Sarai, New Delhi, India
| | - Ravi Mehrotra
- Founder, Centre for Health, Innovation and Policy Foundation, Noida, India
| | - Tanya M Wildes
- Division of Oncology/Hematology, Department of Medicine, University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE, USA.
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Tagliaferri B, Mollica L, Palumbo R, Leli C, Malovini A, Terzaghi M, Quaquarini E, Teragni C, Maccarone S, Premoli A, Sottotetti F. Health-related quality of life and clinical complexity of a real-life cohort of patients with advanced HR +/HER2 - breast cancer treated with CDK4/6 inhibitors and endocrine therapy. Drugs Context 2023; 12:2023-1-7. [PMID: 37378079 PMCID: PMC10291968 DOI: 10.7573/dic.2023-1-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Background Advanced breast cancer (ABC) is characterized by multidimensional clinical complexity that is usually not considered in randomized clinical trials. In the present real-life study, we investigated the link between clinical complexity and quality of life of patients with HR+/HER2- ABC treated with CDK4/6 inhibitors. Methods We evaluated multimorbidity burden assessed with the Cumulative Illness Rating Scale (CIRS), polypharmacy and patient-reported outcomes (PROs). PROs were assessed at baseline (T0), after 3 months of therapy (T1), and at disease progression (T2) using EORTC QLC-C30 and QLQ-BR23 questionnaires. Baseline PROs and changes between T0 and T1 were evaluated amongst patients with different multimorbidity burden (CIRS <5 and ≥5) and polypharmacy (<2 or ≥2 drugs). Results From January 2018 to January 2022, we enrolled 54 patients (median age 66 years, IQR 59-74). The median CIRS score was 5 (IQR 2-7), whilst the median number of drugs taken by patients was 2 (IQR 0-4). No changes in QLQ-C30 final scoring between T0 and T1 were observed in the overall cohort (p=0.8944). At T2, QLQ-C30 global score deteriorated with respect to baseline (p=0.0089). At baseline, patients with CIRS ≥5 had worse constipation than patients without comorbidities (p<0.05) and a lower trend in the median QLQ-C30 global score. Patients on ≥2 drugs had lower QLQ-C30 final scores and worse insomnia and constipation (p<0.05). No change in QLQ-C30 final score from T0 to T1 was observed (p>0.05). Conclusion Multimorbidity and polypharmacy increase the clinical complexity of patients with ABC and may affect baseline PROs. The safety profile of CDK4/6 inhibitors seems to be maintained in this population. Further studies are needed to assess clinical complexity in patients with ABC.This article is part of the Tackling clinical complexity in breast cancer Special Issue: https://www.drugsincontext.com/special_issues/tackling-clinical-complexity-in-breast-cancer/.
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Affiliation(s)
| | - Ludovica Mollica
- Medical Oncology Unit, ICS Maugeri IRCCS, Pavia, Italy
- University of Pavia, Pavia, Italy
| | | | - Claudia Leli
- Medical Oncology Unit, ICS Maugeri IRCCS, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Alberto Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research, ICS Maugeri IRCCS, Pavia, Italy
| | - Matteo Terzaghi
- Laboratory of Informatics and Systems Engineering for Clinical Research, ICS Maugeri IRCCS, Pavia, Italy
| | | | | | - Stefano Maccarone
- Medical Oncology Unit, ICS Maugeri IRCCS, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Andrea Premoli
- Medical Oncology Unit, ICS Maugeri IRCCS, Pavia, Italy
- University of Pavia, Pavia, Italy
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Reale ML, Romano GD, Paolelli L, Leo S. Checkpoint inhibitors in older patients with advanced non-small cell lung cancer. Crit Rev Oncol Hematol 2023:104056. [PMID: 37301272 DOI: 10.1016/j.critrevonc.2023.104056] [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: 03/02/2023] [Revised: 05/27/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized lung cancer management improving overall survival and providing durable responses with a favorable toxicity profile. New questions have emerged regarding the efficacy and safety of immunotherapy among older adults, typically underrepresented in clinical trials. Several factors have to be taken into account in order to reduce the realistic risk of over or under-treatment of this growing subgroup of patients. In this perspective, geriatric assessment and screening tools should be implemented in clinical practice; moreover older patients' inclusion into adapted-designed clinical trials should be promoted. In this review, we discuss immunotherapy activity in advanced non-small cell lung cancer (NSCLC) older patients, the role of the comprehensive geriatric assessment, treatment toxicity and its management with a focus on future perspectives in this rapidly evolving scenario.
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Affiliation(s)
| | | | | | - Silvana Leo
- Medical Oncology Unit, Vito Fazzi Hospital, Lecce, Italy
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López-Gómez JJ, Cerezo-Martín JM, Gómez-Hoyos E, Jiménez-Sahagún R, Torres-Torres B, Ortolá-Buigues A, Delgado-García E, Pérez Mellen I, de Luis Román DA. Diagnosis of malnutrition and its relationship with prognosis in hospitalized patients with oncological pathology. ENDOCRINOL DIAB NUTR 2023:S2530-0180(23)00085-9. [PMID: 37225623 DOI: 10.1016/j.endien.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/15/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND AIMS Medical oncology inpatients are at a very high risk of malnutrition, and the presence of complications associated with malnutrition is significant in their evolution. It is necessary to have adequate tools in the diagnosis of malnutrition. OBJECTIVES This study is aimed to assess the nutritional status of cancer inpatients and compare the incidence of complications based on the nutritional diagnosis with different tools. METHODS An observational, longitudinal, and retrospective study was designed on 149 patients admitted to the Oncology Service who were requested nutritional and medical treatment between January 2014 and June 2017. Epidemiological, clinical, anthropometric, and nutritional data were collected. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), and the Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS The age of the patients was 61.61 (15.96) years. 67.8% of the patients were men. Most of the patients were in advanced tumor stages (stage III (15.3%); stage IV (77.1%)). The median of the MUST was 2 (0-3) (High risk: 83 (55.7%)). The median MNA was 17 (14-20) (poor nutritional status: 65 (43.6%); risk of malnutrition 71 (47.7%)). According to the GLIM criteria, 115 (77.2%) had malnutrition, and 97 (65.1%) had severe malnutrition. According to MNA, an increase in mortality was observed (MNA <17: 24.6% vs. MNA >17: 7.9%; pvalue <0.01). Multivariate analysis showed that poor nutritional status measured with MNA is related to an increased probability of mortality regardless of the stage of the disease and the patient's age OR: 4.19 95% CI (1.41-12.47); p-value = 0.02. CONCLUSIONS Malnutrition among cancer patients in whom a nutritional assessment is requested during admission is very high. In hospitalized patients with oncological pathology, it was observed that malnutrition measured by MNA acts as a mortality risk factor.
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Affiliation(s)
- Juan J López-Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición, Universidad de Valladolid (IENVA), Valladolid, Spain.
| | - Juan M Cerezo-Martín
- Servicio de Hematología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Emilia Gómez-Hoyos
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición, Universidad de Valladolid (IENVA), Valladolid, Spain
| | - Rebeca Jiménez-Sahagún
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición, Universidad de Valladolid (IENVA), Valladolid, Spain
| | - Beatriz Torres-Torres
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición, Universidad de Valladolid (IENVA), Valladolid, Spain
| | - Ana Ortolá-Buigues
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición, Universidad de Valladolid (IENVA), Valladolid, Spain
| | - Esther Delgado-García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición, Universidad de Valladolid (IENVA), Valladolid, Spain
| | - Isabel Pérez Mellen
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Daniel A de Luis Román
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición, Universidad de Valladolid (IENVA), Valladolid, Spain
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Gendarme S, Zebachi S, Corre R, Greillier L, Justeau G, Bylicki O, Decroisette C, Auliac JB, Guisier F, Geier M, Ricordel C, Frelaut M, Paillaud E, Chouaïd C, Canouï-Poitrine F. Predictors of three-month mortality and severe chemotherapy-related adverse events in patients aged 70 years and older with metastatic non-small-cell lung cancer: A secondary analysis of ESOGIA-GFPC-GECP 08-02 study. J Geriatr Oncol 2023:101506. [PMID: 37211514 DOI: 10.1016/j.jgo.2023.101506] [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: 11/22/2022] [Revised: 03/27/2023] [Accepted: 04/21/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Predictors for mortality and toxicity in older patients with cancer are mainly studied in cohorts with various cancers at different stages. This study aims to identify predictive geriatric factors (PGFs) for early death and severe chemotherapy related adverse events (CRAEs) in patients aged ≥70 years with metastatic non-small-cell lung cancer (mNSCLC). MATERIAL AND METHODS This is a secondary analysis of the multicenter, randomized, phase 3 ESOGIA trial that compared, for patients ≥70 years with mNSCLC, a treatment algorithm based on performance status and age to another algorithm based on geriatric assessment. To identify PGFs of three-month mortality and grade 3, 4, or 5 CRAEs, multivariate Cox models and logistic models, adjusted for treatment group and center, and stratified by randomization arm, were constructed. RESULTS Among 494 included patients, 145 (29.4%) had died at three months and 344 (69.6%) had severe chemotherapy toxicity. For three-month mortality, multivariate analyses retained mobility (Test Get up and Go), instrumental activity of daily living (IADL) dependence and weight loss as PGFs. The combined effect of IADL ≤2/4 and weight loss ≥3 kg was strongly associated with three-month mortality (adjusted hazard ratio: 5.71 [95% confidence interval [CI]: 2.64-12.32]). For chemotherapy toxicity, Charlson Comorbidity Index ≥2 was independently associated with grade3, 4, or 5 CRAEs (adjusted odds ratio [95% CI]: 1.94 [1.06-3.56]). DISCUSSION Mobility, IADL dependence, and weight loss were predictive of three-month mortality in a population aged ≥70 years treated for mNSCLC, while comorbidities were independently associated with severe chemotherapy toxicity.
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Affiliation(s)
- Sébastien Gendarme
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France.
| | - Sonia Zebachi
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Santé Publique et Unité de Recherche Clinique, 1 Rue Gustave Eiffel, 94010 Créteil, France
| | - Romain Corre
- Centre Hospitalier Intercommunal de Cornouaille, Service de Pneumologie, 14 Av. Yves Thépot, 29000 Quimper, France
| | - Laurent Greillier
- Aix-Marseille Université, AP-HM, INSERM, CNRS, CRCM, Hôpital Nord, Service d'Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France
| | - Grégoire Justeau
- CHU d'Angers, Service de Pneumologie, 4 Rue Larrey, 49100 Angers, France
| | - Olivier Bylicki
- HIA Sainte-Anne, Service de Pneumologie, 2, boulevard Saint-Anne, 83000 Toulon, France
| | - Chantal Decroisette
- CH d'Annecy, Service de Pneumologie, 1, avenue de l'Hôpital, Metz-Tessy, 74374 Annecy, France
| | - Jean-Bernard Auliac
- Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France
| | - Florian Guisier
- Univ Rouen Normandie, LITIS Lab QuantIF team EA4108, CHU Rouen, France; Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care & CIC-CRB INSERM 1404 F, 76000, Rouen, France
| | - Margaux Geier
- CHU Morvan, Service de Pneumologie, 2, avenue Foch, 29200 Brest, France
| | - Charles Ricordel
- CHU Rennes, Service de Pneumologie, 2 Rue Henri le Guilloux, 35033 Rennes, France
| | - Maxime Frelaut
- Gustave Roussy, Département d'Oncologie Médicale, 39 rue Camille-Desmoulins, 94805 Villejuif Cedex, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service de Gériatrie, 20, rue Leblanc, 75908 Paris Cedex 15, France
| | - Christos Chouaïd
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, 40 avenue de Verdun, 94010 Créteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB (CEpiA Team), F-94010 Creteil, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Santé Publique et Unité de Recherche Clinique, 1 Rue Gustave Eiffel, 94010 Créteil, France
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12
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Association of frailty with chemotherapy toxicity in chemotherapy-naive older patients with cancer. Support Care Cancer 2022; 30:9975-9981. [DOI: 10.1007/s00520-022-07448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022]
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13
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[Consensus of Chinese Experts on Medical Treatment of Advanced Lung Cancer
in the Elderly (2022 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:363-384. [PMID: 35747916 PMCID: PMC9244502 DOI: 10.3779/j.issn.1009-3419.2022.101.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Akhtar OS, Huang LW, Tsang M, Torka P, Loh KP, Morrison VA, Cordoba R. Geriatric assessment in older adults with Non-Hodgkin lymphoma: A Young International Society of Geriatric Oncology (YSIOG) review paper. J Geriatr Oncol 2022; 13:572-581. [PMID: 35216939 DOI: 10.1016/j.jgo.2022.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022]
Abstract
Non-Hodgkin lymphoma (NHL) is a disease of older adults, with a median age at diagnosis of 67 years. Treatment in older adults with NHL is challenging. The aging process is associated with a decline in functional reserve that varies among individuals, and results in an increasing risk of treatment-related toxicity and mortality. Chronological age and performance status fail to capture the multidimensional and heterogeneous nature of the aging process. A geriatric assessment (GA) screens multiple geriatric domains and provides a more accurate assessment of functional reserve. Several abbreviated GA tools have been developed for use in oncology clinics and help identify patients at high risk for chemotherapy-related toxicity and mortality. In this review, we explore GA tools validated for use in patients with NHL. We discuss the evidence behind GA-guided treatment in NHL and present a suggested approach to assessing frailty in this patient population.
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Affiliation(s)
| | - Li-Wen Huang
- San Francisco VA Medical Center, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mazie Tsang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kah Poh Loh
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Vicki A Morrison
- Hennepin Healthcare/University of Minnesota, Minneapolis, MN, USA
| | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
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15
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Piras A, Boldrini L, Menna S, Venuti V, Pernice G, Franzese C, Angileri T, Daidone A. Hypofractionated Radiotherapy in Head and Neck Cancer Elderly Patients: A Feasibility and Safety Systematic Review for the Clinician. Front Oncol 2021; 11:761393. [PMID: 34868976 PMCID: PMC8633531 DOI: 10.3389/fonc.2021.761393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Radiotherapy (RT) in the head and neck (H&N) site are undoubtedly the most challenging treatments for patients. Older and frail patients are not always able to tolerate it, and there are still no clear guidelines on the type of treatments to be preferred for them. The recommendations for Risk-Adapted H&N Cancer Radiation Therapy during the coronavirus disease 2019 (COVID-19) pandemic provided by the ASTRO-ESTRO consensus statement achieved a strong agreement about hypofractionated RT (HFRT). A systematic literature review was conducted in order to evaluate the feasibility and safety of HFRT for older patients affected by H&N malignancies. Materials and Methods A systematic database search was performed on PubMed and Embase according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Original studies, case series, and case reports describing the use of HFRT (with at least 2.2 Gy fractions) in patients with mean age ≥65 years were included. The analysis was based on the type of study, number of patients, mean age, tumor site, histology, performance status (PS), RT details, concomitant chemotherapy (CT), and described clinical outcomes. All the reported doses have been calculated in equivalent dose in 2 Gy fractions (EQD2) and biologically effective dose (BED) using α/β = 10 Gy or α/β = 12 Gy. Results We selected 17 papers that met the inclusion criteria and divided them in 4 categories: 6 articles analyze HFRT performed twice daily in repeated cycles, 3 once a day in repeated cycles, 4 in alternative days, and the last 4 in consecutive days. Conclusion HFRT seems to be a good treatment with an acceptable prolonged disease control. In older patients fit for radical treatments, a 55 Gy in 20 fractions regimen can be proposed as a valid alternative to the standard fractionated RT, but there are a multitude of hypofractionated regimens, ranging from single fraction, quad shot, and 1-, 2-, 3-, 4-, and 5-week schedules that all may be appropriate. The correct regimen for a patient depends on many factors, and it represents the result of a more specific and complex decision.
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Affiliation(s)
- Antonio Piras
- UO Radioterapia Oncologica, Villa Santa Teresa, Palermo, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica-Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Sebastiano Menna
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica-Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Valeria Venuti
- Radioterapia Oncologica, Università degli Studi di Palermo, Palermo, Italy
| | | | - Ciro Franzese
- Radiotherapy Department, Humanitas Clinical and Research Hospital Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Biomedical Science Department, Humanitas University, Milan, Italy
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16
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Flannery MA, Culakova E, Canin BE, Peppone L, Ramsdale E, Mohile SG. Understanding Treatment Tolerability in Older Adults With Cancer. J Clin Oncol 2021; 39:2150-2163. [PMID: 34043433 PMCID: PMC8238902 DOI: 10.1200/jco.21.00195] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Marie A. Flannery
- University of Rochester Medical Center, School of Nursing, Rochester, NY
| | - Eva Culakova
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Beverly E. Canin
- SCOREboard Stakeholder Advisory Group, University of Rochester Medical Center, Rochester, NY
| | - Luke Peppone
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Erika Ramsdale
- Department of Medicine, University of Rochester, Rochester, NY
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17
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Irelli A, Sirufo MM, Scipioni T, Aielli F, Martella F, Ginaldi L, Pancotti A, De Martinis M. The VES-13 and G-8 tools as predictors of toxicity associated with aromatase inhibitors in the adjuvant treatment of breast cancer in elderly patients: A single-center study. Indian J Cancer 2021; 0:319470. [PMID: 34380841 DOI: 10.4103/0019-509x.319470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Adjuvant hormone treatment of postmenopausal breast cancer is mainly based on aromatase inhibitors. Adverse events associated with such class of drugs are particularly severe in elderly patients. Therefore, we investigated the possibility of ab initio predict which elderly patients could encounter toxicity. Methods In light of national and international oncological guidelines recommending the use of screening tests for multidimensional geriatric assessment in elderly patients aged ≥70 years and eligible for active cancer treatment, we assessed whether the Vulnerable Elder Survey (VES)-13 and the Geriatric (G)-8 could be predictors of toxicity associated with aromatase inhibitors. Seventy-seven consecutive patients aged ≥70 diagnosed with non-metastatic hormone-responsive breast cancer and therefore eligible for adjuvant hormone therapy with aromatase inhibitors, were screened with the VES-13 and the G-8, and underwent a six-monthly clinical and instrumental follow-up in our medical oncology unit, from September 2016 to March 2019 (30 months). Said patients were identified as vulnerable (VES-13 score ≥3 or G-8 score ≤14) and fit (VES-13 score <3 or G-8 score >14). The likelihood of experiencing toxicity is greater among vulnerable patients. Results The correlation between the VES-13 or the G-8 tools and the presence of adverse events is equal to 85.7% (p = 0.03). The VES-13 demonstrated 76.9% sensitivity, 90.2% specificity, 80.0% positive predictive value, 88.5% negative predictive value. The G-8 demonstrated 79.2% sensitivity, 88.7% specificity, 76% positive predictive value, 90.4% negative predictive value. Conclusion The VES-13 and the G-8 tools could be valuable predictors of the onset of toxicity associated with aromatase inhibitors in the adjuvant treatment of breast cancer in elderly patients aged ≥70.
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Affiliation(s)
- Azzurra Irelli
- Medical Oncology Unit, Department of Oncology, AUSL 04 Teramo, Italy
| | - Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, Italy
| | - Teresa Scipioni
- Medical Oncology Unit, Department of Oncology, AUSL 04 Teramo, Italy
| | - Federica Aielli
- Medical Oncology Unit, Department of Oncology, AUSL 04 Teramo, Italy
| | | | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, Italy
| | - Amedeo Pancotti
- Medical Oncology Unit, Department of Oncology, AUSL 04 Teramo, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, Italy
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18
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Bellieni A, Fusco D, Sanchez AM, Franceschini G, Di Capua B, Allocca E, Di Stasio E, Marazzi F, Tagliaferri L, Masetti R, Bernabei R, Colloca GF. Different Impact of Definitions of Sarcopenia in Defining Frailty Status in a Population of Older Women with Early Breast Cancer. J Pers Med 2021; 11:jpm11040243. [PMID: 33810556 PMCID: PMC8066315 DOI: 10.3390/jpm11040243] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022] Open
Abstract
Sarcopenia is a geriatric syndrome characterized by losses of quantity and quality of skeletal muscle, which is associated with negative outcomes in older adults and in cancer patients. Different definitions of sarcopenia have been used, with quantitative data more frequently used in oncology, while functional measures have been advocated in the geriatric literature. Little is known about the correlation between frailty status as assessed by comprehensive geriatric assessment (CGA) and sarcopenia in cancer patients. We retrospectively analyzed data from 96 older women with early breast cancer who underwent CGAs and Dual X-ray Absorptiometry (DXA) scans for muscle mass assessment before cancer treatment at a single cancer center from 2016 to 2019 to explore the correlation between frailty status as assessed by CGA and sarcopenia using different definitions. Based on the results of the CGA, 35 patients (36.5%) were defined as frail. Using DXA Appendicular Skeletal Mass (ASM) or the Skeletal Muscle Index (SMI=ASM/height^2), 41 patients were found to be sarcopenic (42.7%), with no significant difference in prevalence between frail and nonfrail subjects. Using the European Working Group on Sarcopenia in Older People (EWGSOP2) definition of sarcopenia (where both muscle function and mass are required), 58 patients were classified as "probably" sarcopenic; among these, 25 were sarcopenic and 17 "severely" sarcopenic. Only 13 patients satisfied both the requirements for being defined as sarcopenic and frail. Grade 3-4 treatment-related toxicities (according to Common Terminology Criteria for Adverse Events) were more common in sarcopenic and frail sarcopenic patients. Our data support the use of a definition of sarcopenia that includes both quantitative and functional data in order to identify frail patients who need tailored treatment.
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Affiliation(s)
- Andrea Bellieni
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.B.); (B.D.C.)
| | - Domenico Fusco
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.B.); (B.D.C.)
- Correspondence: ; Tel.: +39-063-0151
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.M.S.); (G.F.); (R.M.)
| | - Gianluca Franceschini
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.M.S.); (G.F.); (R.M.)
| | - Beatrice Di Capua
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.B.); (B.D.C.)
| | - Elena Allocca
- Istituto per la Sicurezza Sociale, 47890 Cailungo, Città di San Marino, San Marino;
| | - Enrico Di Stasio
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.M.); (L.T.); (G.F.C.)
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.M.); (L.T.); (G.F.C.)
| | - Riccardo Masetti
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.M.S.); (G.F.); (R.M.)
| | | | - Giuseppe Ferdinando Colloca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.M.); (L.T.); (G.F.C.)
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19
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Almugbel FA, Timilshina N, AlQurini N, Loucks A, Jin R, Berger A, Romanovsky L, Puts M, Alibhai SMH. Role of the vulnerable elders survey-13 screening tool in predicting treatment plan modification for older adults with cancer. J Geriatr Oncol 2020; 12:786-792. [PMID: 33342723 DOI: 10.1016/j.jgo.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Vulnerable Elders Survey (VES-13) is commonly used to identify older patients who may benefit from Comprehensive Geriatric Assessment (CGA) prior to cancer treatment. The optimal cut point of the VES-13 to identify those whose final oncologic treatment plan would change after CGA is unclear. We hypothesized that patients with high positive VES-13 scores (7-10)have a higher likelihood of a change in treatment compared to low positive scores (3-6). METHODS Retrospective review of a customized database of all patients seen for pre-treatment assessment in an academic geriatric oncology clinic from June 2015 to June 2019. Various VES-13 cut points were analyzed to identify those individuals whose treatment was modified after CGA. Area under the curve (AUC) was calculated and subgroups of patients treated locally or systemically were also examined to determine if performance varied by treatment modality. RESULTS We included 386 patients with mean age 81, 58% males. Gastrointestinal cancer was the most common site (31%) and 60% were planned to receive curative treatment. The final treatment plan was modified in 59% overall, with 52.7% modified with VES-13 scores 7-10, 50.8% with scores 3-6 and 28.1% with scores <3 (P = 0.002). VES-13 performance in predicting treatment modification was similar for cut points 3 (AUC 0.58), 4 (0.59), 5 (0.59), and 6 (0.59) and in those considering local treatment vs. chemotherapy. CONCLUSIONS A positive VES-13 score was associated with final oncologic treatment plan modification. A high positive score was not superior to the conventional cut point of ≥3.
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Affiliation(s)
- Fahad A Almugbel
- Medical Oncology Section, King Abdullah Center for Oncology and Liver Disease, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Naser AlQurini
- Fellowship Program, Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Canada
| | - Allison Loucks
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - Rana Jin
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - Arielle Berger
- Department of Medicine, University Health Network, Canada; Department of Medicine, University of Toronto, Canada
| | - Lindy Romanovsky
- Department of Medicine, University Health Network, Canada; Department of Medicine, University of Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Canada; Department of Medicine, University of Toronto, Canada.
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20
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Kadambi S, Loh KP, Dunne R, Magnuson A, Maggiore R, Zittel J, Flannery M, Inglis J, Gilmore N, Mohamed M, Ramsdale E, Mohile S. Older adults with cancer and their caregivers - current landscape and future directions for clinical care. Nat Rev Clin Oncol 2020; 17:742-755. [PMID: 32879429 PMCID: PMC7851836 DOI: 10.1038/s41571-020-0421-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 12/13/2022]
Abstract
Despite substantial improvements in the outcomes of patients with cancer over the past two decades, older adults (aged ≥65 years) with cancer are a rapidly increasing population and continue to have worse outcomes than their younger counterparts. Managing cancer in this population can be challenging because of competing health and ageing-related conditions that can influence treatment decision-making and affect outcomes. Geriatric screening tools and comprehensive geriatric assessment can help to identify patients who are most at risk of poor outcomes from cancer treatment and to better allocate treatment for these patients. The use of evidence-based management strategies to optimize geriatric conditions can improve communication and satisfaction between physicians, patients and caregivers as well as clinical outcomes in this population. Clinical trials are currently underway to further determine the effect of geriatric assessment combined with management interventions on cancer outcomes as well as the predictive value of geriatric assessment in the context of treatment with contemporary systemic therapies such as immunotherapies and targeted therapies. In this Review, we summarize the unique challenges of treating older adults with cancer and describe the current guidelines as well as investigational studies underway to improve the outcomes of these patients.
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Affiliation(s)
- Sindhuja Kadambi
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
| | - Kah Poh Loh
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Richard Dunne
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Allison Magnuson
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Ronald Maggiore
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Jason Zittel
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Marie Flannery
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Julia Inglis
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Nikesha Gilmore
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Mostafa Mohamed
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Erika Ramsdale
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
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21
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Jespersen E, Winther SB, Minet LR, Möller S, Pfeiffer P. Frailty screening for predicting rapid functional decline, rapid progressive disease, and shorter overall survival in older patients with gastrointestinal cancer receiving palliative chemotherapy - a prospective, clinical study. J Geriatr Oncol 2020; 12:578-584. [PMID: 33830020 DOI: 10.1016/j.jgo.2020.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES A growing number of older patients with cancer require well-founded clinical decision-making. Frailty screening is suggested as a service to improve outcomes in vulnerable older patients with cancer. This prospective study examined the value of frailty screening to predict rapid functional decline, rapid progressive disease (PD) and shorter overall survival (OS) in older patients with gastrointestinal cancer receiving palliative chemotherapy. MATERIALS AND METHODS Patients aged ≥70 years were screened for frailty in an oncologic department after clinical decision but before starting palliative chemotherapy. Screening was repeated at first response evaluation after approximately two months of chemotherapy. Frailty screening tools included performance status (PS), Charlson Comorbidity Index, G-8 using two different cut-offs (G814,G811), VES-13, Timed-Up-and-Go, Handgrip strength and falls. RESULTS A total of 170 patients were included, median age was 75.5 (70-88) years and 65.9% were male. The frequency of frailty varied from 14% to 74% according to the chosen frailty tool. In multivariate analysis G814 predicted OS (HR 1.5; 95%CI 1.0-2.4), whereas G811 predicted PD (OR 2.4; 1.1-5.6) and OS (HR 2.1; 1.4-2.9). VES-13 predicted functional decline (OR 3.5; 1.0-11.6), PD (OR 3.5; 1.5-8.4) and OS (HR 1.7; 1.2-2.4). Timed-Up-and-Go predicted OS (HR 1.8; 1.1-2.7). Handgrip strength and falls predicted functional decline (OR 4.5; 1.1-19 and OR 6.1; 1.4-25.8, respectively). PS predicted PD (OR 6.2; 2.6-14.7) and OS (HR 2.2; 1.5-3.2). CONCLUSION VES-13 was useful for predicting all three endpoints of interest. Frailty tools covering domains of functioning and nutrition are suggested for older patients with advanced gastrointestinal cancer.
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Affiliation(s)
- Eva Jespersen
- Research Unit of Rehabilitation, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Stine Braendegaard Winther
- Department of Oncology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lisbeth Rosenbek Minet
- Research Unit of Rehabilitation, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Health Science Research Centre, UCL University College, Odense, Denmark
| | - Sören Möller
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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The Association between Prehospital Vulnerability, ARDS Development, and Mortality among At-Risk Adults. Results from the LIPS-A Clinical Trial. Ann Am Thorac Soc 2020; 16:1399-1404. [PMID: 31453722 DOI: 10.1513/annalsats.201902-116oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Rationale: No previous studies have examined the role of prehospital vulnerability in acute respiratory distress syndrome (ARDS) development and mortality in an acutely ill adult population.Objectives: To describe the association between prehospital vulnerability and 1) the development of ARDS, 2) 28-day mortality, and 3) 1-year mortality.Methods: This was a longitudinal prospective cohort study nested within the multicenter LIPS-A (Lung Injury Prevention Study-Aspirin) trial. We analyzed 301 participants who completed Vulnerable Elders Survey (VES) at baseline. Multivariable logistic regression and Cox regression analyses were used to describe the association between vulnerability and short-term outcomes (ARDS and 28-day mortality) and long-term outcomes (1-year mortality), respectively.Results: The VES score ranged from 0 to 10 (median [interquartile range], 2.0 [0-6]); 143 (47.5%) fit criteria for prehospital vulnerability (VES ≥ 3). Vulnerability was not significantly associated with ARDS development (10 [7.0%] vulnerable patients developed ARDS as per LIPS-A study criteria vs. 20 [12.7%] without vulnerability; P = 0.10; adjusted odds ratio [95% confidence interval (CI)], 0.54 [0.24-1.24]; P = 0.15). Nor was vulnerability associated with 28-day mortality (15 [10.5%] vulnerable patients were dead by Day 28 vs. 11 [7.0%] nonvulnerable patients; P = 0.28; adjusted odds ratio [95% CI], 0.95 [0.39-2.26]; P = 0.90). Vulnerability was significantly associated with 1-year mortality in hospital survivors (35 [26.9%] vs. 13 [9.3%]; adjusted hazard ratio [95% CI], 2.20 [1.10-4.37]; P = 0.02).Conclusions: In a population of adults recruited for their high risk of ARDS, prehospital vulnerability, measured by VES, was highly prevalent and strongly associated with 1-year mortality.
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Dottorini L, Turati L, Mattei L, Formenti P. Definition and assessment of frailty in older patients: the surgical, anaesthesiological and oncological perspective. Ecancermedicalscience 2020; 14:1105. [PMID: 33082855 PMCID: PMC7532028 DOI: 10.3332/ecancer.2020.1105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Indexed: 01/08/2023] Open
Abstract
The number of oncology, surgery and anaesthesia procedures in older patients has greatly increased in recent years due to ageing populations. Older patients are typically characterised by physical changes such as comorbidities, decline in physiological activities and cognitive impairment. All these factors, together with polypharmacological therapies, may substantially impact perioperative outcome, quality of recovery and, more in general, quality of life. A comprehensive multidisciplinary approach to perioperative care is thus needed. The assessment of frailty has a central role in the pre-operative evaluation of older patients and, with a multidisciplinary approach. The best surgical procedures and oncologic therapies can be accurately discussed in the pre- and post-operative periods. All clinicians involved in this scenario should be proactive in multidisciplinary care to achieve better outcomes.
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Affiliation(s)
- Lorenzo Dottorini
- Oncology Unit, Medical Sciences Department, ASST Bergamo Est, Alzano Lombardo (BG), 24022, Italy
| | - Luca Turati
- Surgical Oncology Unit, Treviglio Hospital, Treviglio (BG), 24047, Italy
| | - Luca Mattei
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, 20100, Italy
| | - Paolo Formenti
- SC Anestesia e Rianimazione, Ospedale San Paolo-Polo Universitario, ASST Santi Paolo e Carlo, Milan, 20100, Italy
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24
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Oral metronomic cyclophosphamide in advanced ovarian cancer: long-lasting clinical response in an elderly frailty patient. Anticancer Drugs 2020; 30:964-968. [PMID: 31305269 DOI: 10.1097/cad.0000000000000815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Elderly patients with ovarian cancer are an increasing population and many of them are frailty with an increased risk of postoperative complications, chemotherapy intolerance and mortality. Metronomic chemotherapy is the chronic administration of low, equally spaced, doses of antineoplastic drugs with therapeutic efficacy and low toxicity. Oral metronomic cyclophosphamide has gained increasing interest in recent years in the treatment of patients with recurrent ovarian cancer. We report the case of a 87-year-old and -frailty woman with advanced ovarian cancer, not eligible for surgery or standard first-line intravenous chemotherapy. The patient has received oral metronomic cyclophosphamide with a long-lasting clinical response and improved performance status. Oral metronomic cyclophosphamide is a promising treatment for elderly and frailty advanced ovarian cancer patients and should be further investigated.
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25
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Abd Allah ES, Gad HMM, Abdel-Aziz HR. Nutritional Status and Its Contributing Factors among Older Adults with Cancer Receiving Chemotherapy. Clin Nurs Res 2020; 29:650-658. [PMID: 32755230 DOI: 10.1177/1054773820947953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study aimed to assess nutritional status and its contributing factors among older adults with cancer receiving chemotherapy so, a descriptive study design was used. The study was conducted at Zagazig University Hospitals, Egypt. The study's sample was selected purposively which composed of 194 older adults. Nutritional status was measured by the Arabic version of the Mini-Nutritional Assessment (MNA). Contributing factors were identified by examining the relationship of nutritional status with demographic and clinical variables. Study results revealed that 33% of the older patients were malnourished and 51.5% were at risk for malnutrition. Statistically significant relations were found between nutritional status and advanced age, illiteracy, insufficient monthly income, comorbidities, cancer stage four at diagnosis, and receiving ≥4 chemotherapy cycles. High prevalence of malnutrition and many contributing factors were identified among older patients with cancer receiving chemotherapy. So, continuous malnutrition screening along chemotherapy courses with special concern for contributing factors assessed in this study is recommended.
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Affiliation(s)
- Eman Shokry Abd Allah
- Professor of Community Health Nursing and Gerontological Nursing, Gerontological Nursing Department, Faculty of Nursing, Zagazig University, Egypt
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Frailty and Vulnerability as Predictors of Chemotherapy Toxicity in Older Adults: A Longitudinal Study in Peru. J Nutr Health Aging 2020. [DOI: 10.1007/s12603-020-1504-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Mohile S, Dumontier C, Mian H, Loh KP, Williams GR, Wildes TM, Boyd K, Ramsdale E, Pyne S, Magnuson A, Tew W, Klepin HD, Dale W, Shahrokni A. Perspectives from the Cancer and Aging Research Group: Caring for the vulnerable older patient with cancer and their caregivers during the COVID-19 crisis in the United States. J Geriatr Oncol 2020; 11:753-760. [PMID: 32340908 PMCID: PMC7172832 DOI: 10.1016/j.jgo.2020.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Supriya Mohile
- University of Rochester Medical Center, Rochester, NY, United States of America.
| | - Clark Dumontier
- Brigham and Women's Hospital, Marcus Institute for Aging Research, Boston, MA, United States of America
| | | | - Kah Poh Loh
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Grant R Williams
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Tanya M Wildes
- Washington University School of Medicine, St Louis, MO, United States of America
| | - Kevin Boyd
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Erika Ramsdale
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Sonia Pyne
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Allison Magnuson
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - William Tew
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Heidi D Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, United States of America
| | - William Dale
- City of Hope National Cancer Center, Duarte, CA, United States of America
| | - Armin Shahrokni
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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Feliu J, Jiménez-Munárriz B, Basterretxea L, Paredero I, Llabrés E, Antonio-Rebollo M, Losada B, Espinosa E, Gironés R, Custodio AB, Del Mar Muñoz M, Díaz-Almirón M, Gómez-Mediavilla J, Pinto A, Torregrosa MD, Soler G, Cruz P, Higuera O, Molina-Garrido MJ. Predicting Chemotherapy Toxicity in Older Patients with Cancer: A Multicenter Prospective Study. Oncologist 2020; 25:e1516-e1524. [PMID: 32329131 DOI: 10.1634/theoncologist.2019-0701] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Standard oncology tools are inadequate to distinguish which older patients are at higher risk of developing chemotherapy-related complications. MATERIALS AND METHODS Patients over 70 years of age starting new chemotherapy regimens were prospectively included in a multicenter study. A prechemotherapy assessment that included sociodemographics, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and the development of grade 3-5 toxicity was examined by using logistic regression. RESULTS A total of 551 patients were accrued. Chemotherapy doses (odds ratio [OR] 1.834; 95% confidence interval [CI] 1.237-2.719) and creatinine clearance (OR 0.989; 95% CI 0.981-0.997) were the only factors independently associated with toxicity. Only 19% of patients who received reduced doses of chemotherapy and had a creatinine clearance ≥40 mL/minute had grade 3-4 toxicity, compared with 38% of those who received standard doses or had a creatinine clearance <40 mL/minute (p < .0001). However, no satisfactory multivariate model was obtained using different selection approaches. CONCLUSION Chemotherapy doses and renal function were identified as the major risk factors for developing severe toxicity in the older patient. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up in these patients. IMPLICATIONS FOR PRACTICE Older patients are more vulnerable to chemotherapy toxicity. However, standard tools are inadequate to identify who is at higher risk of developing chemotherapy-related complications. Chemotherapy doses (standard vs. reduced) and renal function were identified as the major risk factors for developing severe toxicity in the elderly. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up.
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Affiliation(s)
- Jaime Feliu
- Oncology Department, Hospital Universitario La Paz, Cátedra UAM-AMGEN, CIBERONC, Madrid, Spain
| | | | | | - Irene Paredero
- Oncology Department, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Elisenda Llabrés
- Oncology Department, Hospital Universitario Insular de Gran Canarias, Las Palmas, Spain
| | - Maite Antonio-Rebollo
- Oncohematogeriatrics Unit, Institut Català d'Oncologia, IDIBELL Hospitalet, Barcelona, Spain
| | - Beatriz Losada
- Oncology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Enrique Espinosa
- Oncology Department, Hospital Universitario La Paz, Cátedra UAM-AMGEN, CIBERONC, Madrid, Spain
| | - Regina Gironés
- Oncology Department, Hospital Lluis Alcanyis de Xátiva, Valencia, Spain
| | - Ana Belén Custodio
- Oncology Department, Hospital Universitario La Paz, Cátedra UAM-AMGEN, CIBERONC, Madrid, Spain
| | | | - Mariana Díaz-Almirón
- Biostatistics Department, Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Alvaro Pinto
- Oncology Department, Hospital Universitario La Paz, Cátedra UAM-AMGEN, CIBERONC, Madrid, Spain
| | | | - Gema Soler
- Oncohematogeriatrics Unit, Institut Català d'Oncologia, IDIBELL Hospitalet, Barcelona, Spain
| | - Patricia Cruz
- Oncology Department, Hospital Universitario La Paz, Cátedra UAM-AMGEN, CIBERONC, Madrid, Spain
| | - Oliver Higuera
- Oncology Department, Hospital Universitario La Paz, Cátedra UAM-AMGEN, CIBERONC, Madrid, Spain
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Nagl L, Koinig K, Hofer F, Stauder R. Comorbidities cluster with impaired functional capacities and depressive mood and predict adverse outcome in older patients with hematological malignancies. Leuk Lymphoma 2020; 61:1954-1964. [PMID: 32281446 DOI: 10.1080/10428194.2020.1747063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study evaluates prevalence of comorbidities and their association with impairments in older patients with hematological malignancies at initial diagnosis (n = 209). At least one comorbidity was present in 62.2%, 68.5% and 93.8% as defined by CCI (Charlson Comorbidity Index), Cumulative Illness Rating Scale-Geriatric (CIRS-G) and HCT-Comorbidity Index, respectively. Severe comorbidities (CIRS-G Grade 3/4) were present in 57.9%. The mean number of affected organ systems was 3.6 (CIRS-G categories), with diabetes (18.2%), congestive heart failure and prior solid tumors (each 17.7%) detected most frequently. Comorbidities were significantly correlated with reduced functional and objective physical capacities, impaired performance and depressive mood. Both CCI and CIRS-G were found to be prognostic factors for OS (p < 0.05). CCI scoring of comorbidities, diagnosis MDS/AML and a body mass index <23kg/m2 were independent adverse predictors for OS. This first prospective analysis reveals a prognostic significance of comorbidities. Clustering of comorbidities with impairments suggests common mechanisms.
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Affiliation(s)
- Laurenz Nagl
- Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - Karin Koinig
- Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Hofer
- Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
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Nipp RD, Thompson LL, Temel B, Fuh CX, Server C, Kay PS, Landay S, Lage DE, Traeger L, Scott E, Jackson VA, Horick NK, Greer JA, El-Jawahri A, Temel JS. Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes. J Natl Compr Canc Netw 2020; 18:305-313. [PMID: 32135520 DOI: 10.6004/jnccn.2019.7355] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 09/03/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oncologists often struggle with managing the complex issues unique to older adults with cancer, and research is needed to identify patients at risk for poor outcomes. METHODS This study enrolled patients aged ≥70 years within 8 weeks of a diagnosis of incurable gastrointestinal cancer. Patient-reported surveys were used to assess vulnerability (Vulnerable Elders Survey [scores ≥3 indicate a positive screen for vulnerability]), quality of life (QoL; EORTC Quality of Life of Cancer Patients questionnaire [higher scores indicate better QoL]), and symptoms (Edmonton Symptom Assessment System [ESAS; higher scores indicate greater symptom burden] and Geriatric Depression Scale [higher scores indicate greater depression symptoms]). Unplanned hospital visits within 90 days of enrollment and overall survival were evaluated. We used regression models to examine associations among vulnerability, QoL, symptom burden, hospitalizations, and overall survival. RESULTS Of 132 patients approached, 102 (77.3%) were enrolled (mean [M] ± SD age, 77.25 ± 5.75 years). Nearly half (45.1%) screened positive for vulnerability, and these patients were older (M, 79.45 vs 75.44 years; P=.001) and had more comorbid conditions (M, 2.13 vs 1.34; P=.017) compared with nonvulnerable patients. Vulnerable patients reported worse QoL across all domains (global QoL: M, 53.26 vs 66.82; P=.041; physical QoL: M, 58.95 vs 88.24; P<.001; role QoL: M, 53.99 vs 82.12; P=.001; emotional QoL: M, 73.19 vs 85.76; P=.007; cognitive QoL: M, 79.35 vs 92.73; P=.011; social QoL: M, 59.42 vs 82.42; P<.001), higher symptom burden (ESAS total: M, 31.05 vs 15.00; P<.001), and worse depression score (M, 4.74 vs 2.25; P<.001). Vulnerable patients had a higher risk of unplanned hospitalizations (hazard ratio, 2.38; 95% CI, 1.08-5.27; P=.032) and worse overall survival (hazard ratio, 2.26; 95% CI, 1.14-4.48; P=.020). CONCLUSIONS Older adults with cancer who screen positive as vulnerable experience a higher symptom burden, greater healthcare use, and worse survival. Screening tools to identify vulnerable patients should be integrated into practice to guide clinical care.
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Affiliation(s)
- Ryan D Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Leah L Thompson
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Brandon Temel
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Charn-Xin Fuh
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | | | - Paul S Kay
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Sophia Landay
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Daniel E Lage
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | | | - Erin Scott
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Vicki A Jackson
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Nora K Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Areej El-Jawahri
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Temel
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
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Sena GR, Lima TPF, Mello MJG, Thuler LCS, Lima JTO. Developing Machine Learning Algorithms for the Prediction of Early Death in Elderly Cancer Patients: Usability Study. JMIR Cancer 2019; 5:e12163. [PMID: 31573896 PMCID: PMC6787529 DOI: 10.2196/12163] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/14/2019] [Accepted: 07/31/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The importance of classifying cancer patients into high- or low-risk groups has led many research teams, from the biomedical and bioinformatics fields, to study the application of machine learning (ML) algorithms. The International Society of Geriatric Oncology recommends the use of the comprehensive geriatric assessment (CGA), a multidisciplinary tool to evaluate health domains, for the follow-up of elderly cancer patients. However, no applications of ML have been proposed using CGA to classify elderly cancer patients. OBJECTIVE The aim of this study was to propose and develop predictive models, using ML and CGA, to estimate the risk of early death in elderly cancer patients. METHODS The ability of ML algorithms to predict early mortality in a cohort involving 608 elderly cancer patients was evaluated. The CGA was conducted during admission by a multidisciplinary team and included the following questionnaires: mini-mental state examination (MMSE), geriatric depression scale-short form, international physical activity questionnaire-short form, timed up and go, Katz index of independence in activities of daily living, Charlson comorbidity index, Karnofsky performance scale (KPS), polypharmacy, and mini nutritional assessment-short form (MNA-SF). The 10-fold cross-validation algorithm was used to evaluate all possible combinations of these questionnaires to estimate the risk of early death, considered when occurring within 6 months of diagnosis, in a variety of ML classifiers, including Naive Bayes (NB), decision tree algorithm J48 (J48), and multilayer perceptron (MLP). On each fold of evaluation, tiebreaking is handled by choosing the smallest set of questionnaires. RESULTS It was possible to select CGA questionnaire subsets with high predictive capacity for early death, which were either statistically similar (NB) or higher (J48 and MLP) when compared with the use of all questionnaires investigated. These results show that CGA questionnaire selection can improve accuracy rates and decrease the time spent to evaluate elderly cancer patients. CONCLUSIONS A simplified predictive model aiming to estimate the risk of early death in elderly cancer patients is proposed herein, minimally composed by the MNA-SF and KPS. We strongly recommend that these questionnaires be incorporated into regular geriatric assessment of older patients with cancer.
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Affiliation(s)
- Gabrielle Ribeiro Sena
- Department of Geriatric Oncology, Instituto de Medicina Integral Prof Fernando Figueira, Recife, Brazil
| | - Tiago Pessoa Ferreira Lima
- Department of Geriatric Oncology, Instituto de Medicina Integral Prof Fernando Figueira, Recife, Brazil.,Instituto Federal de Pernambuco - IFPE, Department os Computational Science, Recife, Brazil
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Prospective comparison of the value of CRASH and CARG toxicity scores in predicting chemotherapy toxicity in geriatric oncology. Oncol Lett 2019; 18:4947-4955. [PMID: 31612006 PMCID: PMC6781512 DOI: 10.3892/ol.2019.10840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/26/2019] [Indexed: 01/25/2023] Open
Abstract
Predicting the risk of severe adverse reactions to chemotherapy is of great clinical significance for proper selection of effective and safe treatment for elderly cancer patients. The present study aimed to verify and compare the value of two evaluation models of chemotherapy risk prediction for elderly cancer patients through prospective analysis. The two evaluation models assessed were the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) and Cancer Aging Research Group (CARG) toxicity scores. Elderly patients aged ≥70 with cancer were recruited at two participating hospitals in China and completed an assessment prior to starting chemotherapy. CRASH and CARG toxicity scores of each participant were calculated. Chemotherapy-related toxicity was recorded through each cycle of chemotherapy. A total of 106 participants were recruited between September 2015 and August 2018. The CRASH and CARG toxicity scores were positively correlated (r=0.689; P<0.01). Of the participants, 54 (50.9%) participants underwent a grade 3-5 chemotherapy-related toxicity and 21 (19.8%) experienced grade 3-5 nonhematological toxicity in the process of treatment. CRASH and CARG toxicity scores predicted severe chemotherapy-related toxicity and had a high discriminatory value based on receiver operating characteristic curve analysis (area under the curve of 0.772 and 0.760, respectively; P<0.001). The results of the present study indicate that the CRASH and CARG toxicity scores are helpful tools for the prediction of severe chemotherapy-related toxicity, and are recommended for routine oncology practice.
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Rosati G, Addeo R, Aprile G, Avallone A, Bilancia D, Brugnatelli S, Buccafusca G, Carlomagno C, Cordio S, Delfanti S, Dell'Aquila E, Di Bisceglie M, Di Donato S, Di Stasi A, Germano D, Giuliani F, Granetto C, Latiano TP, Leo S, Tralongo P, Stroppolo ME, Venturini F, Bianco S. Italian survey on cetuximab-based therapy of elderly patients with metastatic colorectal cancer. Cancer Chemother Pharmacol 2019; 84:1089-1096. [PMID: 31493178 DOI: 10.1007/s00280-019-03943-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/24/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE There is no consensus on the use of cetuximab in elderly patients with metastatic colorectal cancer. To this end, a survey was carried in 17 Italian oncology centers. METHODS The centers answered a 29-item questionnaire structured as follows: (i) demographic characteristics; (ii) medical history; (iii) assessment of RAS/BRAF mutations and DPD/UGT polymorphism before treatment; (iv) treatment schemes and side effects; (v) geriatric assessment and customization of treatment. RESULTS One-third of patients are over 80 years old. The RAS/BRAF mutational status is not primarily evaluated by 17.6% of the centers, while DPD and UGT polymorphism is not evaluated by 82.4% and 76.5% of the centers. The most common therapeutic scheme is cetuximab/FOLFIRI and diarrhea is the main cause of suspension/reduction of treatment. The 70% of centers use systemic tetracyclines for skin toxicity. The 23.5% of the centers do not carry out any geriatric evaluation before the start of the therapy and those who perform it prefer the G8 (70.6%) and VES-13 (29.4%) scales. CONCLUSIONS Greater efforts should be made to improve the evaluation of the patient both about mutational and genetic procedures with geriatric evaluation. As for cetuximab in elderly patients, randomized studies are needed to provide guidance to physicians.
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Affiliation(s)
- Gerardo Rosati
- U.O. Oncologia Medica, Azienda Ospedaliera S. Carlo, Potenza, Italy.
| | - Raffaele Addeo
- U.O. Oncologia Medica, Ospedale "San Giovanni di Dio", ASL NA 2 NORD, Frattamaggiore, Italy
| | - Giuseppe Aprile
- Dipartimento di Oncologia Clinica, Ospedale San Bortolo, AULSS8, Vicenza, Italy
| | - Antonio Avallone
- Unità Oncologia Clinica Sperimentale Addome, Dipartimento Assistenziale e di Ricerca dei Percorsi Oncologici del Distretto Addominale, INT Fondazione 'G. Pascale', Naples, Italy
| | | | - Silvia Brugnatelli
- S.C. Oncologia Medica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Chiara Carlomagno
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Naples, Italy
| | - Stefano Cordio
- S.C. Oncologia Medica, Ospedale Garibaldi, Catania, Italy
| | - Sara Delfanti
- S.C. Oncologia Medica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | | | | | | | | | | | - Tiziana Pia Latiano
- Dipartimento di Oncologia Medica, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | | | - Paolo Tralongo
- U.O. Oncologia Medica, Ospedale Umberto I - RAO, Siracusa, Italy
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Mariano C, Jamal R, Bains P, Hejazi S, Chao L, Wan J, Ho J. Utility of a chemotherapy toxicity prediction tool for older patients in a community setting. ACTA ACUST UNITED AC 2019; 26:234-239. [PMID: 31548802 DOI: 10.3747/co.26.4869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Expert groups have recommended incorporation of a geriatric assessment into clinical practice for older patients starting oncologic therapy. However, that practice is not standard primarily because of resource limitations. In the present study, we evaluated the effect on treatment decisions by oncologists in the community oncology setting of a brief geriatric assessment tool that estimates risk of toxicity. Methods This prospective longitudinal study in 5 community oncology practices in British Columbia involved patients 70 years of age and older starting a new cytotoxic chemotherapy regimen. Clinical personnel completed a brief validated geriatric assessment tool-the Cancer and Aging Research Group chemotherapy toxicity tool (carg-tt)-that estimates the risk of grade 3 or greater toxicity in older patients. Physicians were asked if the carg-tt changed their treatment plan or prompted extra supports. Patients were followed to assess the incidence of toxicity during treatment. Results The study enrolled 199 patients between July 2016 and February 2018. Mean age was 77 years. Treatment was palliative in 61.4% of the group. Compared with physician judgment, the carg-tt predicted higher rates of toxicity. In 5 patients, treatment was changed based on the carg-tt. In 38.5% of the patients, data from the tool prompted extra supports. Within the first 3 cycles of treatment, 21.3% of patients had experienced grade 3 or greater toxicity. Conclusions This study demonstrates that use of a brief geriatric assessment tool is possible in a broad community oncology practice. The tool modified the oncologist's supportive care plan for a significant number of older patients undertaking cytotoxic chemotherapy.
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Affiliation(s)
- C Mariano
- Department of Medicine and Medical Oncology, Royal Columbian Hospital, New Westminster, BC
| | - R Jamal
- University of British Columbia, Vancouver, BC
| | - P Bains
- Department of Medicine and Medical Oncology, Lions Gate Hospital, North Vancouver, BC
| | - S Hejazi
- Department of Evaluation and Research Services, Fraser Health Authority, Surrey, BC
| | - L Chao
- Department of Medicine and Medical Oncology, Lions Gate Hospital, Richmond, BC
| | - J Wan
- Department of Pharmacy, Royal Columbian Hospital, New Westminster, BC
| | - J Ho
- Department of Medicine and Medical Oncology, Lions Gate Hospital, Richmond, BC
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Feliu J, Heredia-Soto V, Gironés R, Jiménez-Munarriz B, Saldaña J, Guillén-Ponce C, Molina-Garrido MJ. Management of the toxicity of chemotherapy and targeted therapies in elderly cancer patients. Clin Transl Oncol 2019; 22:457-467. [PMID: 31240462 DOI: 10.1007/s12094-019-02167-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/16/2019] [Indexed: 12/22/2022]
Abstract
The elderly form a very heterogeneous group in relation to their general health state, degree of dependence, comorbidities, performance status, physical reserve and geriatric situation, so cancer treatment in the older patient remains a therapeutic challenge. The physiological changes associated with aging increase the risk of developing a serious toxicity induced by chemotherapy treatment, as well as other undesirable consequences as hospitalizations, dependence and non-compliance with treatment, that can negatively affect survival, quality of life and treatment efficacy. The use of hematopoietic growth factors and other active supportive interventions in the elderly can help prevent and/or alleviate these toxicities. However, we have little data on the efficacy and tolerance of support treatments in the older patient. The objective of this work is to review the most frequent toxicities of oncological treatments in the elderly and their management.
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Affiliation(s)
- J Feliu
- Medical Oncology Department, H. Universitario La Paz, CIBERONC, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - V Heredia-Soto
- Medical Oncology Department, H. Universitario La Paz, CIBERONC, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - R Gironés
- Medical Oncology Department, H. Lluís Alcanyís. Xàtiva, Valencia, Spain
| | - B Jiménez-Munarriz
- Medical Oncology Department, H. Universitario Clara Campal, Madrid, Spain
| | - J Saldaña
- Medical Oncology Department, Instituto Catalán de Oncología, Hospitalet, Barcelona, Spain
| | - C Guillén-Ponce
- Medical Oncology Department, H. Universitario Ramón Y Cajal, Madrid, Spain
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Adetunji Moses O, Khan MI, Fang Q, Qin L, Rehman ZU, Zhang Y, Deng Feng C, Ma Y, Tang X, Wu C, Adam ML, Huang D, Liu H, Song L. PVP intercalated metallic WSe 2 as NIR photothermal agents for efficient tumor ablation. NANOTECHNOLOGY 2019; 30:065102. [PMID: 30543196 DOI: 10.1088/1361-6528/aaf151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Transition metal dichalogenides (TMDCs) with unique layered structures hold promising potential as transducers for photothermal therapy. However, the low photothermal conversion efficiency and poor stability in some cases limit their practical applications. Herein, we demonstrate the fabrication of ultrathin homogeneous hybridized TMDC nanosheets and their use for highly efficient photothermal tumor ablation. In particular, the nanosheets were composed of metallic WSe2 intercalated with polyvinylpyrrolidone (PVP), which was facilely prepared through a solvothermal process from the mixture of selenourea crystals, WCl6 powder along with PVP polymeric nanogel. Our characterizations revealed that the obtained nanosheets exhibited excellent photothermal conversion efficiency, therapeutic demonstration with improved biocompatibility and physiological stability attributing to the combined merits of metallic phase of WSe2 and hydrophilic PVP insertion. Both the histological analysis of vital organs and in vitro/in vivo tests confirmed the nanosheets as actively effective and biologically safe in this phototherapeutic technique. Findings from this non-invasive experiment clearly emphasize the explorable therapeutic efficacy of the layered-based hybrid agents in future cancer treatment planning procedures.
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Affiliation(s)
- Oyawale Adetunji Moses
- National Synchrotron Radiation Laboratory, CAS Center for Excellence in Nanoscience, University of Science and Technology of China, Hefei, Anhui 230029, People's Republic of China
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Dottorini L, Catena L, Sarno I, Di Menna G, Marte A, Novelli E, Rusca C, Bajetta E. The role of Geriatric screening tool (G8) in predicting side effect in older patients during therapy with aromatase inhibitor. J Geriatr Oncol 2018; 10:356-358. [PMID: 30333087 DOI: 10.1016/j.jgo.2018.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/20/2018] [Accepted: 10/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endocrine therapy is the main treatment in hormonosensitive breast cancer; the most frequent side effects are arthralgia, osteoporosis, depression, dyslipidemia and hypertension. G8 is a simple test developed to identify older patients who could benefit from a comprehensive geriatric assessment (CGA). The aim of this study is to evaluate the possible role of G8 in predicting side effects from treatment with aromatase inhibitor in women ≥65 years old. MATHERIAL AND METHOD Women ≥65 years old affected by breast cancer about to start a therapy with an aromatase inhibitor, in the adjuvant setting, were evaluated with the G8 tool. Patients were classified as "fit" with G8 score > 14 or "vulnerable" with G8 score ≤ 14; they then started treatment and clinical-instrumentalfollow-up. RESULTS From April 2016 to February 2018, 50 consecutive patients were screened. Median age was 75.1 (range 65-86). G8 identified 30 patients (60%) as "fit" (score > 14) and 20 (40%) as "vulnerable" (score ≤ 14). The grade of concordance between G8 score and the appearance/absence of adverse events were statistically significant (41/50 patients, 82%, p = 0.0002); sensitivity resulted in 78% and specificity was 81%; positive predictive value was 70% and negative predictive value was 87%. The most frequent adverse event was arthromyalgia. CONCLUSION The G8 screening tool has a potential role in predicting side effects during a treatment with aromatase inhibitor. G8 could be very useful in everyday clinical practice for this population.
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Affiliation(s)
| | - Laura Catena
- Institute of Oncology, Policlinico di Monza, Monza, Italy
| | - Italo Sarno
- Institute of Oncology, Policlinico di Monza, Monza, Italy
| | | | | | | | - Carmen Rusca
- Psychologist Consultant, Policlinico di Monza, Monza, Italy
| | - Emilio Bajetta
- Institute of Oncology, Policlinico di Monza, Monza, Italy
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Bron D, Aurer I, André MPE, Bonnet C, Caballero D, Falandry C, Kimby E, Soubeyran P, Zucca E, Bosly A, Coiffier B. Unmet needs in the scientific approach to older patients with lymphoma. Haematologica 2018; 102:972-975. [PMID: 28566341 DOI: 10.3324/haematol.2017.167619] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dominique Bron
- Department of Hematology, Institut Jules Bordet (ULB), Brussels, Belgium
| | - Igor Aurer
- Hematological Malignancies Unit, University Hospital Centre Zagreb, Croatia
| | - Marc P E André
- Department of Hematology, CHU Dinant Godinne (CHU UCL Namur), Belgium
| | | | - Dolores Caballero
- Department of Hematology, Complejo Asistencial Universitario de Salamanca, Spain
| | - Claire Falandry
- Unité de Gériatrie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, France
| | - Eva Kimby
- Department of Hematology, Karolinska Institute Huddinge University Hospital Stockholm, Sweden
| | | | - Emanuele Zucca
- Lymphoma Unit-Division of Research - IOSI / Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Ferrero A, Villa M, Tripodi E, Fuso L, Menato G. Can Vulnerable Elders Survey-13 predict the impact of frailty on chemotherapy in elderly patients with gynaecological malignancies? Medicine (Baltimore) 2018; 97:e12298. [PMID: 30278504 PMCID: PMC6181619 DOI: 10.1097/md.0000000000012298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The management of gynaecological cancers in elderly women and high-risk patients is an even more relevant issue, because the increase in longevity and comorbidities. The assumption of frailty based on age alone may lead to inadequate and inappropriate treatment and frailty assessment is recommended. The aim of this study was to assess if Vulnerable Elders Survey-13 (VES-13), as indicator of frailty, can predict the toxicity of chemotherapy in gynaecological cancers.VES-13 was administered to patients aged ≥ 70 years with ovarian, endometrial and cervical cancers who underwent chemotherapy from 2010 to 2016.Eighty-four patients aged ≥ 70 years (mean age 74.6) were included, 36 patients (42.9%) resulted vulnerable (score ≥ 3). Thrombocytopenia and anaemia were more prevalent in the vulnerable subjects (81.3% versus 18.7%, P = .0005, and 81.8% versus 18.2%, P = .005, respectively), while neutropenia was similar between the 2 groups. Vulnerable women had higher risk of non-haematological toxicities. Most of the patients (77.4%) completed chemotherapy, but dose reductions and discontinuations were more common in the vulnerable group (66.7% versus 33.3%, P = .07 and 68.4% versus 31.6%, P = .01, respectively).To our knowledge, this is the first study to evaluate VES-13 exclusively in elderly women with gynaecological cancers. VES-13 may be useful to stratify this category of patients according to vulnerability in order to identify women at risk of toxicity and to prevent complications induced by chemotherapy.
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Can we avoid the toxicity of chemotherapy in elderly cancer patients? Crit Rev Oncol Hematol 2018; 131:16-23. [PMID: 30293701 DOI: 10.1016/j.critrevonc.2018.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/22/2018] [Indexed: 12/27/2022] Open
Abstract
Although approximately 50% of cancer patients are 70 years of age or older, cancer treatment in the elderly remains a therapeutic challenge. The elderly form a very heterogeneous group in relation to their general health state, degree of dependence, comorbidities, performance status, physical reserve and geriatric situation, for which therapeutic decisions must be made in an individualized manner. In addition, changes in pharmacokinetics and pharmacodynamics of the drugs occur with age, as well as the tolerance of the tissues, leading to a narrowing of the therapeutic margin and an increase in toxicity. In the general population, Performace Status (PS) has traditionally been used to estimate tolerance to chemotherapy, but in the elderly population it is not useful. In this review we summarize the current knowledge about the pharmacology of antineoplastic drugs in the elderly and the tools available to help us identify risk of chemotherapy toxicity in these patients.
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Shahrokni A, Alexander K, Wildes TM, Puts MTE. Preventing Treatment-Related Functional Decline: Strategies to Maximize Resilience. Am Soc Clin Oncol Educ Book 2018; 38:415-431. [PMID: 30231361 DOI: 10.1200/edbk_200427] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The majority of patients with cancer are older adults. A comprehensive geriatric assessment (CGA) will help the clinical team identify underlying medical and functional status issues that can affect cancer treatment delivery, cancer prognosis, and treatment tolerability. The CGA, as well as more abbreviated assessments and geriatric screening tools, can aid in the treatment decision-making process through improved individualized prediction of mortality, toxicity of cancer therapy, and postoperative complications and can also help clinicians develop an integrated care plan for the older adult with cancer. In this article, we will review the latest evidence with regard to the use of CGA in oncology. In addition, we will describe the benefits of conducting a CGA and the types of interventions that can be taken by the interprofessional team to improve the treatment outcomes and well-being of older adults.
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Affiliation(s)
- Armin Shahrokni
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Koshy Alexander
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tanya M Wildes
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Martine T E Puts
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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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 DOI: 10.1200/jco.2018.78.8687] [Citation(s) in RCA: 868] [Impact Index Per Article: 144.7] [Reference Citation Analysis] [Abstract] [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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Menjak IB, Jerzak KJ, Desautels DN, Pritchard KI. An update on treatment for post-menopausal metastatic breast cancer in elderly patients. Expert Opin Pharmacother 2018; 19:597-609. [PMID: 29601247 DOI: 10.1080/14656566.2018.1454431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Elderly patients make up a significant proportion of patients with metastatic breast cancer. With several options available in the metastatic setting for hormone positive breast cancer, these patients require an individualized approach to decision-making that considers multiple factors beyond performance status and chronologic age. AREAS COVERED The authors review the literature on endocrine monotherapy and combinations for hormone positive metastatic breast cancer, with specific commentary on the efficacy and toxicity for elderly patients. The authors describe the role of comprehensive geriatric assessment (CGA) and highlight the considerations for the use of bone modifying agents, and HER2-targeted therapy for hormone positive/HER2+ patients. EXPERT OPINION Evidence for elderly patients is largely based on subgroup analyses, which should be interpreted with caution. Nonetheless, elderly patients with metastatic hormone receptor positive breast cancer appear to derive similar benefit from treatments as younger patients. Similarly, for most drugs, these patients have no significant worsening of toxicity compared to younger patients. In addition to tumor biology, patient values and information from the CGA should be used to guide treatment decisions.
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Affiliation(s)
- Ines B Menjak
- a Department of Medicine , Sunnybrook Odette Cancer Centre , Toronto , Canada
| | - Katarzyna J Jerzak
- a Department of Medicine , Sunnybrook Odette Cancer Centre , Toronto , Canada
| | - Danielle N Desautels
- b Department of Medical Oncology and Haematology , CancerCare Manitoba , Winnipeg , Canada
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Significance of stereotactic body radiotherapy in older patients with early stage non-small cell lung cancer. J Geriatr Oncol 2018; 9:594-599. [PMID: 29573969 DOI: 10.1016/j.jgo.2018.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/21/2018] [Accepted: 03/06/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Our aim was to investigate long-term treatment outcomes in older patients with early stage non-small cell lung cancer (NSCLC) and the presence or absence of therapeutic benefits, using the G8 screening tool. METHODS We retrospectively studied 43 older patients (median age 78 years, range 65-89 years) with stage I lung tumors (T1 and T2 tumors in 34 and 9 patients, respectively), who underwent stereotactic body radiotherapy (SBRT). This study assessed outcomes in a cohort of patients who received geriatric assessments, performed between 2004 and 2011, before the start of their SBRT regimen. Any questions asked to patients before undergoing treatment were applied to the G8 screening tool. RESULTS G8 scores ranged from 8 to 16 (median, 12) in all patients (n = 43), while G8 scores in the T1 and T2 groups ranged from 9 to 16 (median, 13) and 8 to 15 (median, 12), respectively. In patients with G8 scores ≤12, the 2-year and 5-year survival rates were 56.1% and 28% respectively, while the rates were 94.1% and 68.4%, respectively, in patients with G8 scores ≥13 (P = 0.0014). During long-term follow-up, 25.9% of the patients (n = 43) died of the primary disease, NSCLC, and 34.9% of patients died of other diseases or other types of cancer. CONCLUSION SBRT may be effective, even in older adults. Regardless of age, SBRT improved the long-term survival of patients only with G8 scores ≥13. The G8 screening tool may aid in determining whether older patients with comorbidities would benefit from SBRT.
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Antonio M, Saldaña J, Linares J, Ruffinelli JC, Palmero R, Navarro A, Arnaiz MD, Brao I, Aso S, Padrones S, Navarro V, González-Barboteo J, Borràs JM, Cardenal F, Nadal E. Geriatric assessment may help decision-making in elderly patients with inoperable, locally advanced non-small-cell lung cancer. Br J Cancer 2018; 118:639-647. [PMID: 29381689 PMCID: PMC5846066 DOI: 10.1038/bjc.2017.455] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/18/2017] [Accepted: 11/22/2017] [Indexed: 12/23/2022] Open
Abstract
Background: Although concurrent chemoradiotherapy (cCRT) increases survival in patients with inoperable, locally advanced non-small-cell lung cancer (NSCLC), there is no consensus on the treatment of elderly patients. The aim of this study was to determine the prognostic value of the comprehensive geriatric assessment (CGA) and its ability to predict toxicity in this setting. Methods: We enrolled 85 consecutive elderly (⩾75 years) participants, who underwent CGA and the Vulnerable Elders Survey (VES-13). Those classified as fit and medium-fit by CGA were deemed candidates for cCRT (platinum-based chemotherapy concurrent with thoracic radiation therapy), while unfit patients received best supportive care. Results: Fit (37%) and medium-fit (48%) patients had significantly longer median overall survival (mOS) (23.9 and 16.9 months, respectively) than unfit patients (15%) (9.3 months, log-rank P=0.01). In multivariate analysis, CGA groups and VES-13 were independent prognostic factors. Fit and medium-fit patients receiving cCRT (n=54) had mOS of 21.1 months (95% confidence interval: 16.2, 26.0). In those patients, higher VES-13 (⩾3) was associated with shorter mOS (16.33 vs 24.3 months, P=0.027) and higher risk of G3-4 toxicity (65 vs 32%, P=0.028). Conclusions: Comprehensive geriatric assessment and VES-13 showed independent prognostic value. Comprehensive geriatric assessment may help to identify elderly patients fit enough to be treated with cCRT.
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Affiliation(s)
- Maite Antonio
- Thoracic Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain.,Geriatric Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - Juana Saldaña
- Thoracic Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain.,Geriatric Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - Jennifer Linares
- Thoracic Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - José C Ruffinelli
- Thoracic Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - Ramón Palmero
- Thoracic Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - Arturo Navarro
- Thoracic Oncology Unit, Department of Radiation Oncology, Institut Català d'Oncologia. Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - Maria Dolores Arnaiz
- Thoracic Oncology Unit, Department of Radiation Oncology, Institut Català d'Oncologia. Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - Isabel Brao
- Thoracic Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - Samantha Aso
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Feixa Llarga, s/n, 08907. L'Hospitalet, Barcelona 08907, Spain
| | - Susana Padrones
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Feixa Llarga, s/n, 08907. L'Hospitalet, Barcelona 08907, Spain
| | - Valentí Navarro
- Clinical Research Unit, Institut Català d'Oncologia, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - Jesús González-Barboteo
- Palliative Care Unit, Institut Català d'Oncologia, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - Josep Maria Borràs
- Department of Clinical Sciences, IDIBELL, University of Barcelona, Feixa Llarga, s/n, 08908. L'Hospitalet, Barcelona 08907, Spain
| | - Felipe Cardenal
- Thoracic Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
| | - Ernest Nadal
- Thoracic Oncology Unit, Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain.,Clinical Research in Solid Tumors (CReST) Group, OncoBell Program, IDIBELL, Avinguda Gran via 199-203. L'Hospitalet, Barcelona 08908, Spain
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A contribution to the future of geriatric oncology training: The SIOG Treviso advanced course. J Geriatr Oncol 2017; 8:387-388. [DOI: 10.1016/j.jgo.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 11/18/2022]
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Antonio M, Carmona-Bayonas A, Saldaña J, Navarro V, Tebé C, Salazar R, Borràs JM. Factors Predicting Adherence to a Tailored-Dose Adjuvant Treatment on the Basis of Geriatric Assessment in Elderly People With Colorectal Cancer: A Prospective Study. Clin Colorectal Cancer 2017; 17:e59-e68. [PMID: 29054805 DOI: 10.1016/j.clcc.2017.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 09/20/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Selecting elderly people with colorectal cancer (CRC) for adjuvant chemotherapy is challenging. Comprehensive geriatric assessment (CGA) can help by classifying them according to their frailty profile. The supposed benefit of chemotherapy is on the basis of the rate of treatment adherence. In this study we evaluated tolerance and adherence to tailored-dose adjuvant therapy on the basis of CGA in a cohort of older patients with high-risk stage II and stage III CRC. PATIENTS AND METHODS This was a prospective study in 193 consecutive patients aged 75 years or older. On the basis of CGA results, we classified patients as fit, medium fit, or unfit, administering standard therapy, adjusted treatment, and best supportive care, respectively. We recorded planned chemotherapy, toxicity, and completion of the treatment. A logistic multivariate analysis was carried out. RESULTS Seventeen (15%) of the 141 candidates for chemotherapy (n = 86 fit and n = 55 medium fit) refused treatment; associated factors included polypharmacy (odds ratio [OR], 5.34; 95% confidence interval [CI], 1.55-18.40) and rectal location (OR, 5.61; 94% CI, 1.45-21.49). Of the 105 (74%) patients receiving chemotherapy, 20 (27%) fit and 4 (13%) medium fit patients experienced Grade 3 to 4 toxicity (P = .11) without association to explanatory variables. Approximately 55% of patients treated with chemotherapy received at least 80% of the planned dose (55% fit and 58% medium fit patients; P = .7). Factors associated with completion of chemotherapy were the absence of toxicity (OR, 7.67; 95% CI, 2.41-24.43) and social support (OR, 2.29; 95% CI, 0.08-1.04). CONCLUSION CGA is useful for selecting elderly patients for adjuvant chemotherapy, adapting the dose to their frailty profile, and identifying adherence-related factors amenable to modification through CGA-based interventions.
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Affiliation(s)
- Maite Antonio
- Medical Oncology Department, Institut d'Investigació Biomèdica de Bellvitge, Institut Català d'Oncologia-Hospital Duran i Reynals, University of Barcelona, Barcelona, Spain.
| | | | - Juana Saldaña
- Medical Oncology Department, Institut d'Investigació Biomèdica de Bellvitge, Institut Català d'Oncologia-Hospital Duran i Reynals, University of Barcelona, Barcelona, Spain
| | - Valentí Navarro
- Research Clinical Unit, Institut Català d'Oncologia-Hospital Duran I Reynals, Barcelona, Spain
| | - Cristian Tebé
- Statisical Assessment Service, Institut d'Investigació Biomèdica de Bellvitge and Universitat Rovira i Virgili, Barcelona, Spain
| | - Ramon Salazar
- Medical Oncology Department, Institut d'Investigació Biomèdica de Bellvitge, Institut Català d'Oncologia-Hospital Duran i Reynals, University of Barcelona, Barcelona, Spain
| | - Josep Maria Borràs
- Department of Clinical Sciences, University of Barcelona and Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
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Biganzoli L, Mislang AR, Di Donato S, Becheri D, Biagioni C, Vitale S, Sanna G, Zafarana E, Gabellini S, Del Monte F, Mori E, Pozzessere D, Brunello A, Luciani A, Laera L, Boni L, Di Leo A, Mottino G. Screening for Frailty in Older Patients With Early-Stage Solid Tumors: A Prospective Longitudinal Evaluation of Three Different Geriatric Tools. J Gerontol A Biol Sci Med Sci 2017; 72:922-928. [PMID: 28158486 DOI: 10.1093/gerona/glw234] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/07/2016] [Indexed: 01/09/2023] Open
Abstract
Background Frailty increases the risk of adverse health outcomes and/or dying when exposed to a stressor, and routine frailty assessment is recommended to guide treatment decision. The Balducci frailty criteria (BFC) and Fried frailty criteria (FFC) are commonly used, but these are time consuming. Vulnerable Elders Survey-13 (VES-13) score of ≥7, a simple and resource conserving function-based scoring system, may be used instead. This prospective study evaluates the performance of VES-13 in parallel with BFC and FFC, to identify frailty in elderly patients with early-stage cancer. Methods Patients aged ≥70 years with early-stage solid tumors were classified as frail/nonfrail based on BFC (≥1 criteria), FFC (≥3 criteria), and VES-13 (score ≥ 7). All patients were assessed for functional decline and death. Results We evaluated 185 patients. FFC had a 17% frailty rate, whereas BFC and VES-13 both had 25%, with poor concordance seen between the three geriatric tools. FFC (hazard ratio = 1.99, p = .003) and VES-13 (hazard ratio = 2.81, p < .001) strongly discriminated for functional decline, whereas BFC (hazard ratio = 3.29, p < .001) had the highest discriminatory rate for deaths. BFC and VES-13 remained prognostic for overall survival in multivariate analysis correcting for age, tumor type, stage, and systemic treatment. Conclusions A VES-13 score of ≥7 is a valuable discriminating tool for predicting functional decline or death and can be used as a frailty-screening tool among older cancer patients in centers with limited resources to conduct a comprehensive geriatric assessment.
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Affiliation(s)
- Laura Biganzoli
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Anna Rachelle Mislang
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Samantha Di Donato
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Dimitri Becheri
- Geriatric Medicine Unit, Nuovo Ospedale-Santo Stefano, Prato, Italy
| | - Chiara Biagioni
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Stefania Vitale
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.,Universita degli Studi di Siena, Toscana, Italy
| | - Giuseppina Sanna
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Elena Zafarana
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Stefano Gabellini
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Francesca Del Monte
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Elena Mori
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.,Universita degli Studi di Siena, Toscana, Italy
| | - Daniele Pozzessere
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Antonella Brunello
- Medical Oncology 1 Unit, Instituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Andrea Luciani
- Medical Oncology Unit, Ospedale S. Paolo-Polo Universitario, Milano, Italy
| | - Letizia Laera
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Luca Boni
- Clinical Trials Coordinating Center, Instituto Toscano Tumori, Firenze, Italy
| | - Angelo Di Leo
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy
| | - Giuseppe Mottino
- Geriatric Medicine Unit, Nuovo Ospedale-Santo Stefano, Prato, Italy
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Abstract
Pancreatic cancer is more common in older adults, who are underrepresented in clinical trials and frequently under treated. Chronological age alone should not deter clinicians from offering treatment to geriatric patients, as they are a heterogeneous population. Geriatric assessment, frailty assessment tools, and toxicity risk scores help clinicians select appropriate patients for therapy. For resectable disease, surgery can be safe but should be done at a high-volume center. Adjuvant therapy is important; though there remains controversy on the role of radiation, chemotherapy is well studied and efficacious. In locally advanced unresectable disease, chemoradiation or chemotherapy alone is an option. Neoadjuvant therapy improves the chances of resectability in borderline resectable disease. Chemotherapy extends survival in metastatic disease, but treatment goals and risk-benefit ratios have to be clarified. Adequate symptom management and supportive care are important. There are now many new treatment strategies and novel therapies for this disease.
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