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Ramdany H, Lofaro T, Deplano S. The Haemato-Oncology Frailty (HOF) score to assess frailty in lymphoma. Eur J Haematol 2024; 112:611-620. [PMID: 38112247 DOI: 10.1111/ejh.14152] [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: 10/23/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
Morbidity and mortality during chemotherapy in older adults with haematological malignancy can be unpredictable. The Haemato-Oncology Frailty (HOF) score was previously found to predict outcomes in a cohort of patients with plasma cell myeloma. In this study, we assess its utility in assessing frailty in patients with lymphoma, and compare its performance to that of two other frailty scores. The HOF score was able to predict progression-free survival in this population, and was also shown to have potential in assessing the dynamism of frailty during chemotherapy. It performed well when compared to the Charlson Comorbidity Index (CCI) score and the Haematopoietic Cell Transplantation-Specific Comorbidity Index (HCTCI), although the study was not powered to assess for non-inferiority. The HOF score is a new score with the potential for application in different haematological malignancies.
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Affiliation(s)
- Hena Ramdany
- Imperial College London, Isle of Wight NHS Trust, Newport, UK
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Ioffe D, Bhatia-Patel SC, Gandhi S, Hamad EA, Dotan E. Cardiovascular Concerns, Cancer Treatment, and Biological and Chronological Aging in Cancer: JACC Family Series. JACC CardioOncol 2024; 6:143-158. [PMID: 38774000 PMCID: PMC11103051 DOI: 10.1016/j.jaccao.2024.02.001] [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: 10/10/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of death globally, particularly among the rapidly growing population of older adults (OAs). CVD is a leading cause of mortality among cancer survivors, often accelerated by cancer treatments associated with short- or long-term cardiotoxicity. Moreover, there is a dynamic relationship among CVD, cancer, and aging, characterized by shared risk factors and biological hallmarks, that plays an important role in caring for OAs, optimizing treatment approaches, and developing preventive strategies. Assessment of geriatric domains (eg, functional status, comorbidities, cognition, polypharmacy, nutritional status, social support, psychological well-being) is critical to individualizing treatment of OAs with cancer. The authors discuss considerations in caring for an aging population with cancer, including methods for the assessment of OAs with CVD and/or cardiovascular risk factors planned for cancer therapy. Multidisciplinary care is critical in optimizing patient outcomes and maintaining quality of life in this growing vulnerable population.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Sakshi Gandhi
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Eman A. Hamad
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Jackson EB, Curry L, Mariano C, Hsu T, Cook S, Pezo RC, Savard MF, Desautels DN, Leblanc D, Gelmon KA. Key Considerations for the Treatment of Advanced Breast Cancer in Older Adults: An Expert Consensus of the Canadian Treatment Landscape. Curr Oncol 2023; 31:145-167. [PMID: 38248095 PMCID: PMC10814011 DOI: 10.3390/curroncol31010010] [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: 10/25/2023] [Revised: 12/04/2023] [Accepted: 12/23/2023] [Indexed: 01/23/2024] Open
Abstract
The prevalence of breast cancer amongst older adults in Canada is increasing. This patient population faces unique challenges in the management of breast cancer, as older adults often have distinct biological, psychosocial, and treatment-related considerations. This paper presents an expert consensus of the Canadian treatment landscape, focusing on key considerations for optimizing selection of systemic therapy for advanced breast cancer in older adults. This paper aims to provide evidence-based recommendations and practical guidance for healthcare professionals involved in the care of older adults with breast cancer. By recognizing and addressing the specific needs of older adults, healthcare providers can optimize treatment outcomes and improve the overall quality of care for this population.
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Affiliation(s)
- Emily B. Jackson
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Lauren Curry
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Caroline Mariano
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Tina Hsu
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada (M.-F.S.)
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Sarah Cook
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
- Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Rossanna C. Pezo
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada;
- Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Marie-France Savard
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada (M.-F.S.)
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Danielle N. Desautels
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Paul Albrechtsen Research Institute, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Dominique Leblanc
- Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC G1V 0A6, Canada
| | - Karen A. Gelmon
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Zemp DD, Baschung Pfister P, Knols R, Quadri P, Bianchi G, Giunzioni D, Lavorato S, Giannini O, de Bruin E. A blended e-health intervention for improving functional capacity in elderly patients on haemodialysis: A feasibility study. Front Digit Health 2022; 4:1054932. [PMID: 36561924 PMCID: PMC9763896 DOI: 10.3389/fdgth.2022.1054932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Physical exercise showed to be beneficial for frail older adults on haemodialysis (HD). However, there are several obstacles hindering the regular practice of exercise, such as transportation difficulties, lack of time, fatigue and comorbidities. E-health in this regard has many potential advantages and could be useful for motivating HD patients to increase their level of physical activity. The aim of this study was to evaluate the feasibility of a blended e-health intervention for elderly HD patients who individually exercise at home while under remote supervision of a physiotherapist. Material and methods Patients over 60 years of age with sufficient cognitive and motoric resources to perform a simple physical test battery and to use a tablet-computer were recruited from four HD outpatient facilities. Following baseline assessment at home, the participants were visited by a physiotherapist (PT). The PT set an individual exercise programme and explained how to use the web-based interface. During the 12 weeks of training, the PTs remotely supervised the patients' progress. At 12 weeks follow-up a second assessment took place. Results Twenty-two patients were recruited to participate in the study. Seven patients dropped out of the blended programme and 15 patients concluded the programme. The average training frequency of the 15 participants concluding the study was 1.5 times a week [range 0.2-5.8]. The duration of a training session was between 20 and 40 min. The usability of the system was deemed positive. Regarding the efficacy of the intervention, no significant improvement of any measured parameter was found, and effect sizes were small to medium. Conclusion A blended e-health intervention supported by a web-based application for exercising at home under remote supervision of a PT is feasible in a HD population including older patients. However, before planning a randomized controlled trial, strategies to increase the recruitment rate and the adherence to such a blended intervention should be further developed, e.g., to improve the recruitment procedures and lower the expectable drop-out rate. Furthermore, the dosage of the blended programme should be adapted to the patients' physical performance levels in future trials.The study was registered on the website clinicaltrials.gov with ID NCT04076488.
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Affiliation(s)
- Damiano D. Zemp
- Geriatric Service, Ospedale Regionale di Mendrisio, EOC, Mendrisio, Switzerland,Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Pierrette Baschung Pfister
- Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland,Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, ZurichSwitzerland
| | - Ruud H. Knols
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland,Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, ZurichSwitzerland
| | - Pierluigi Quadri
- Geriatric Service, Ospedale Regionale di Mendrisio, EOC, Mendrisio, Switzerland,Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Giorgia Bianchi
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Davide Giunzioni
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Soraya Lavorato
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Olivier Giannini
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland,Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Eling D. de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden,OST – Eastern Swiss University of Applied Sciences, Department of Health, St. Gallen, Switzerland,Correspondence: Eling de Bruin
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Zemp DD, Giannini O, Quadri P, Tettamanti M, Berwert L, Lavorato S, Pianca S, Solcà C, de Bruin ED. A Pilot Observational Study Assessing Long-Term Changes in Clinical Parameters, Functional Capacity and Fall Risk of Patients With Chronic Renal Disease Scheduled for Hemodialysis. Front Med (Lausanne) 2022; 9:682198. [PMID: 35186984 PMCID: PMC8854975 DOI: 10.3389/fmed.2022.682198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/05/2022] [Indexed: 12/19/2022] Open
Abstract
BackgroundPatients with end-stage renal disease are known to be particularly frail, and the cause is still widely seen as being directly related to specific factors in renal replacement therapy. However, a closer examination of the transitional phase from predialysis to long-term hemodialysis leads to controversial explanations, considering that the frailty process is already well-described in the early stages of renal insufficiency. This study aims to describe longitudinally and multifactorially changes in the period extending from the decision to start the replacement therapy through to the end of 2 years of hemodialysis. We hypothesized that frailty is pre-existent in the predialysis phase and does not worsen with the beginning of the replacement therapy. Between 2015 and 2018 we recruited 25 patients (72.3 ± 5.7 years old) in a predialysis program, with the expectation that replacement therapy would begin within the coming few months.MethodsThe patients underwent a baseline visit before starting hemodialysis, with 4 follow-up visits in the first 2 years of treatment. Health status, physical performance, cognitive functioning, hematology parameters, and adverse events were monitored during the study period.ResultsAt baseline, our sample had a high variability with patients ranging from extremely frail to very fit. In the 14 participants that did not drop out of the study, out of 32 clinical and functional measures, a statistically significant worsening was only observed in the Short Physical Performance Battery (SPPB) score (p < 0.01, F = 8.50) and the number of comorbidities (p = 0.01, F = 3.94). A careful analysis, however, reveals a quite stable situation in the first year of replacement therapy, for both frail and fit participants and a deterioration in the second year that in frail participants could lead to death.ConclusionOur results should stimulate a reassessment about the role of a predialysis program in reducing complications during the transitional phase, but also about frailty prevention programs once hemodialysis has begun, for both frail and fit patients, to maintain satisfactory health status.
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Affiliation(s)
- Damiano D. Zemp
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Service of Geriatrics, EOC, Ospedale Regionale di Mendrisio EOC, Mendrisio, Switzerland
| | - Olivier Giannini
- Department of Medicine, EOC, Bellinzona, Switzerland
- Division of Nephrology, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Pierluigi Quadri
- Service of Geriatrics, EOC, Ospedale Regionale di Mendrisio EOC, Mendrisio, Switzerland
- Department of Medicine, EOC, Bellinzona, Switzerland
| | - Mauro Tettamanti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Lorenzo Berwert
- Department of Medicine, EOC, Bellinzona, Switzerland
- Division of Nephrology, EOC, Lugano, Switzerland
| | | | | | - Curzio Solcà
- Service of Nephrology, Centro Dialisi Nefrocure e Clinica Luganese Moncucco, Lugano, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- *Correspondence: Eling D. de Bruin
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Martinez-Recio S, Perez-Wert JP, Martinez-Fdez S, Jimenez-Bou D, Ruiz-Gutierrez I, Peña J, Pertejo A, Espinosa E, Pinto A. COMPARISON OF 2-WEEKLY AND 3-WEEKLY DOSING OF DOCETAXEL IN METASTATIC PROSTATE CANCER. Clin Genitourin Cancer 2022; 20:363-370. [DOI: 10.1016/j.clgc.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 12/20/2022]
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7
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Bessems SAM, Konsten JLM, Vogelaar JFJ, Csepán-Magyar R, Maas HAAM, van de Wouw YAJ, Janssen-Heijnen MLG. Frailty screening by Geriatric-8 and 4-meter gait speed test is feasible and predicts postoperative complications in elderly colorectal cancer patients. J Geriatr Oncol 2020; 12:592-598. [PMID: 33158771 DOI: 10.1016/j.jgo.2020.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/29/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Identification of frail older colorectal cancer patients might help to select those prone to adverse events and may lead to adjustment of treatment plans. However, the prognostic validity of screening for frailty is unknown. METHODS This retrospective study evaluates colorectal cancer patients ≥70 years who underwent elective surgery between May 2016 and December 2018. The Geriatric-8 (G8) and 4-m gait speed test (4MGST) were used as frailty screening tools. According to hospital guidelines, patients were referred to a geriatrician when screening was indicative for frailty (G8 ≤ 14 and/or 4MGST < 1 m/s). Patients were categorized as fit, vulnerable or frail by comprehensive geriatric assessment (CGA). The clinical implications and prognostic validity of frailty screening and CGA were evaluated. RESULTS 149 patients were included, of whom 132 (89%) were screened for frailty. Frailty was suspected in 40% of screened patients (n = 53) of whom 89% (n = 47) was referred for CGA. A higher complication rate was seen in patients with G8 ≤ 14 and/or 4MGST < 1 m/s compared to those with G8 > 14 and 4MGST ≥1 m/s (respectively 62% versus 28%,p < 0.001). Pneumonia (21% versus 6%, p = 0.013) and cardiac complications (11% versus 4%, p = 0.093) were more prevalent in patients with G8 ≤ 14 and/or 4MGST < 1 m/s. CGA identified frail patients as a group with a high complication rate of 68%. CONCLUSION Screening for frailty with subsequent referral for CGA is feasible in older colorectal cancer patients. Our study suggests that screening for frailty by G8 + 4MGST can identify patients with higher risk for postoperative complications.
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Affiliation(s)
- Stan A M Bessems
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands.
| | - Joop L M Konsten
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Reka Csepán-Magyar
- Department of Geriatric Medicine, VieCuri Medical Centre, Venlo, the Netherlands
| | - Huub A A M Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Yes A J van de Wouw
- Department of Medical Oncology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
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Real-world outcomes treating patients with advanced cutaneous squamous cell carcinoma with immune checkpoint inhibitors (CPI). Br J Cancer 2020; 123:1535-1542. [PMID: 32868898 PMCID: PMC7653959 DOI: 10.1038/s41416-020-01044-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background Immunotherapy has revolutionised the treatment of advanced cutaneous squamous cell carcinoma (cSCC). It is important to understand both safety and efficacy in a real-world and trial-ineligible cSCC population. We aimed to evaluate safety, efficacy and molecular insights among a broader cSCC population, including immunosuppressed patients, treated with immune checkpoint inhibitors (CPI). Methods We present a cohort of advanced cSCC patients (n = 61) treated from 2015 to 2020 evaluating the best overall response (BOR) (RECISTv1.1) to CPI therapy, immune-related adverse events (irAEs) and tumour mutational burden (TMB) to correlate with outcomes. A validated geriatric scoring index (CIRS-G) was utilised to assess comorbidities among patients ≥75. These data were compared with published clinical trial results among the broader cSCC population. Results BOR to CPI was lower among the entire cohort when compared with trial data (31.5 vs. 48%, P < 0.01), with higher rates of progression (59 vs. 16.5%, P < 0.01), regardless of immunosuppression history or age. Grade 3+ irAEs were more common among responders (P = 0.02), while pre-treatment lymphocyte count and TMB predicted response (P = 0.02). Conclusions We demonstrate comparatively lower response rates to CPI among real-world cSCC patients not explained by older age or immunosuppression history alone. Immune-related toxicity, absolute lymphocyte count and TMB predicted CPI response.
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Gordon MJ, Huang J, Chan RJ, Bhargava P, Danilov AV. Medical comorbidities in patients with chronic lymphocytic leukaemia treated with idelalisib: analysis of two large randomised clinical trials. Br J Haematol 2020; 192:720-728. [PMID: 32599655 DOI: 10.1111/bjh.16879] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 12/18/2022]
Abstract
Comorbidities influence survival in patients with chronic lymphocytic leukaemia (CLL) treated with chemo-immunotherapy or ibrutinib. While idelalisib has been studied in patients with comorbidities, their impact has not been investigated. We analysed 481 patients treated with idelalisib on two randomised trials (NCT01659021 and NCT01539512). Comorbidities were assessed using the Cumulative Illness Risk Scale (CIRS). Patients received idelalisib + anti-CD20 (rituximab or ofatumumab; n = 284) or anti-CD20 alone (n = 197). The median age was 69 years. We found that comorbidities did not significantly affect outcomes of idelalisib therapy. The objective response rate (ORR) was 79·3% versus 85·8%, the median progression-free survival (PFS) was 16·3 versus 19·1 months, and the median overall survival (OS) was 39·8 versus 49·8 months in patients treated with idelalisib who had a CIRS score of >6 versus ≤6, correspondingly. Treatment with idelalisib + anti-CD20 was associated with superior PFS and ORR when compared to anti-CD20 monotherapy in patients who had high comorbidities (CIRS score of >6) or at least one severe comorbidity (median PFS 16·3 vs. 6·9 months and 16·6 vs. 6·5 months; odds ratio 20·1 and 33·2; P < 0·0001). Thus, comorbidities do not portend inferior outcomes in patients with CLL treated with idelalisib in combination with anti-CD20 therapy.
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Affiliation(s)
- Max J Gordon
- Oregon Health and Science University, Portland, OR, USA
| | | | | | | | - Alexey V Danilov
- Oregon Health and Science University, Portland, OR, USA.,City of Hope National Medical Center, Duarte, CA, USA
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Markovic DZ, Jevtovic-Stoimenov T, Stojanovic M, Vukovic AZ, Dinic V, Markovic-Zivkovic BZ, Jankovic RJ. Cardiac biomarkers improve prediction performance of the combination of American Society of Anesthesiologists physical status classification and Americal College of Surgeons National Surgical Quality Improvement Program calculator for postoperative mortality in elderly patients: a pilot study. Aging Clin Exp Res 2019; 31:1207-1217. [PMID: 30456501 DOI: 10.1007/s40520-018-1072-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Our previous research has shown American Society of Anaesthesiologists physical status classification (ASA) score and Americal College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator to have the most accuracy in the prediction of postoperative mortality. AIMS The aim of our research was to define the most reliable combination of cardiac biomarkers with ASA and ACS NSQIP. METHODS We have included a total of 78 patients. ASA score has been determined in standard fashion, while we used the available interactive calculator for the ACS NSQIP score. Biomarkers BIRC5, H-FABP, and hsCRP have been measured in specialized laboratories. RESULTS All of the deceased patients had survivin (BIRC5) > 4.00 pg/ml, higher values of H-FABP and hsCRP and higher estimated levels of ASA and ACS NSQIP (P = 0.0001). ASA and ACS NSQIP alone had AUC of, respectively, 0.669 and 0.813. The combination of ASA and ACS NSQIP had AUC = 0.841. Combination of hsCRP with the two risk scores had AUC = 0.926 (95% CI 0.853-1.000, P < 0.0001). If we add three cardiac biomarkers to this model, we get AUC as high as 0.941 (95% CI 0.876-1.000, P < 0.0001). The correction of statistical models with comorbidities (CIRS-G score) did not change the accuracy of prediction models that we have provided. DISCUSSION Addition of ACS NSQIP and biomarkers adds to the accuracy of ASA score, which has already been proved by other authors. CONCLUSION Cardiac biomarker hsCRP can be used as the most reliable cardiac biomarker; however, the "multimarker approach" adds the most to the accuracy of the combination of clinical risk scores.
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Kim KH, Lee JJ, Kim J, Zhou JM, Gomes F, Sehovic M, Extermann M. Association of multidimensional comorbidities with survival, toxicity, and unplanned hospitalizations in older adults with metastatic colorectal cancer treated with chemotherapy. J Geriatr Oncol 2019; 10:733-741. [PMID: 30765268 DOI: 10.1016/j.jgo.2019.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies of older patients with colorectal cancer(CRC) have found inconsistent results about the correlation of various comorbidities with overall survival(OS) and treatment tolerance. To refine our understanding, we evaluated this correlation using the Cumulative Illness Rating Scale-Geriatric(CIRS-G) and heat maps to identify subgroups with the highest impact. METHODS We retrospectively reviewed 153 patients aged 65 years and older with stage IV CRC undergoing chemotherapy. We calculated CIRS-G scores, and a Total Risk Score(TRS) derived from a previous heat map study. The association between CIRS-G scores/TRS and OS, unplanned hospitalizations, and chemotoxicity was examined by the Cox proportional hazards model. RESULTS Median age was 71 years. Median MAX2 score of chemotherapies was 0.134(0.025-0.231). The most common comorbidities were vascular(79.8%), eye/ear/nose/throat(68%), and respiratory disease(52.4%). Median OS was 25.1 months(95% confidence interval: 21.2-27.6). In univariate analysis, ECOG PS ≥ 2(HR 1.86(1.1-3.17), p = 0.019), poorly differentiated histology(HR 2.03(1.27-3.25), p = 0.003), primary site(rectum vs colon)(HR 0.58 (0.34-0.98), p = 0.04), age at diagnosis(HR per 5y 1.20 (1.04-1.39), p = 0.012), and number of CIRS-G grade 4 comorbidities(HR 1.86 (1.1-3.17), p = 0.019) were associated with OS. In multivariate analysis, the number of CIRS-G grade 4 comorbidities lost significance, although it retained it in the subgroup of patients with colon cancer. Conversely, the TRS was associated with OS in patients with rectal cancer. No association of comorbidity with unplanned hospitalization or chemotoxicity was observed. CONCLUSIONS In older adults with metastatic CRC, the number of CIRS-G grade 4 comorbidities was associated with worse OS but no specific CIRS-G category was independently associated with OS, unplanned hospitalization, or toxicities.
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Affiliation(s)
- Ki Hyang Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea; Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jae Jin Lee
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Division of Medical Oncology and Hematology, Department of Internal Medicine, Yonsei Noble Hospital, Seoul, South Korea
| | - Jongphil Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jun-Min Zhou
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Fabio Gomes
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Marina Sehovic
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Martine Extermann
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Miot S, Akbaraly T, Michelon C, Couderc S, Crepiat S, Loubersac J, Picot MC, Pernon É, Gonnier V, Jeandel C, Blain H, Baghdadli A. Comorbidity Burden in Adults With Autism Spectrum Disorders and Intellectual Disabilities-A Report From the EFAAR (Frailty Assessment in Ageing Adults With Autism Spectrum and Intellectual Disabilities) Study. Front Psychiatry 2019; 10:617. [PMID: 31607957 PMCID: PMC6761800 DOI: 10.3389/fpsyt.2019.00617] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Autism spectrum disorder (ASD) is an early-onset and lifelong neurodevelopmental condition frequently associated with intellectual disability (ID). Although emerging studies suggest that ASD is associated with premature ageing and various medical comorbidities, as described for ID, data are scarce. Objectives: To determine the comorbidity burden and its association with distinct clinical presentation in terms of ASD severity, adaptive skills, level of autonomy, and drug exposure in a well-phenotyped sample of individuals with ASD-ID-the EFAAR (Frailty Assessment in Ageing Adults with Autism Spectrum and Intellectual Disabilities) cohort. Methods: A total of 63 adults with ASD-ID, with a mean age of 42.9 ± 15.1 years, were recruited from 2015 to 2017 from nine specialized institutions. They underwent detailed clinical examinations, including screening for comorbidities, ASD severity [Childhood Autism Rating Scale (CARS)], adaptive functioning [Vineland Adaptive Behavior Scale II (VABS-II)], autonomy [activities of daily living (ADLs)], and drug use [polypharmacy and the Drug Burden Index (DBI)]. The comorbidity burden was evaluated using the Cumulative Illness Rating Scale (CIRS-G) and its sub-scores [the severity index (CIRS-SI) and severe comorbidity (CIRS-SC)]. Results: We found a large range of comorbidities, including gastrointestinal disorders and mental and neurological diseases. Overall, 25% of our ASD-ID sample had chronic kidney disease with the associated increased cardiovascular risk factors. The comorbidity burden was high (mean CIRS-G total score of 10.6 ± 4.8), comparable with that observed among patients older than those in our population hospitalized in geriatric departments. Furthermore, the comorbidity burden positively correlated with age, decreased autonomy, and polypharmacy. Conclusion: The severity of the comorbidity burden associated with premature ageing in adults with ASD and ID highlight their crucial need of personalized medical care.
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Affiliation(s)
- Stéphanie Miot
- CESP, INSERM U1178, Centre de recherche en Epidemiologie et Santé des Populations, Paris, France.,Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France.,Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Tasnime Akbaraly
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France.,MMDN, Univ. Montpellier, EPHE, INSERM, U1198, Montpellier, France.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Cecile Michelon
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Sylvie Couderc
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Sophie Crepiat
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Julie Loubersac
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Biostatistic Department, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Éric Pernon
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Véronique Gonnier
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Claude Jeandel
- Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Hubert Blain
- Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Amaria Baghdadli
- CESP, INSERM U1178, Centre de recherche en Epidemiologie et Santé des Populations, Paris, France.,Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
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Dreyer J, Bremer M, Henkenberens C. Comorbidity indexing for prediction of the clinical outcome after stereotactic body radiation therapy in non-small cell lung cancer. Radiat Oncol 2018; 13:213. [PMID: 30390700 PMCID: PMC6215615 DOI: 10.1186/s13014-018-1156-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose To determine the prognostic impact of comorbidity and age in medically inoperable early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT) using the age-adjusted Charlson Comorbidity Index (aCCI). Patients and methods Between November 2008 and January 2015, 196 consecutive patients with medically inoperable NSCLC were treated with SBRT at a single institution. The prescribed isocenter dose was either 60.0 Gray (Gy) in six fractions for central lung cancer or 56.25 Gy in three fractions for peripheral lung cancer. Baseline comorbidities were retrospectively retrieved according to available outclinic medical records as well as the hospital information system. The aCCI was scored for each patient and subjected according to outcome and toxicity as well as all of the single items of the aCCI and other clinical parameters using univariate and multivariate analysis. Results Thirty-one point 6 % (62/196) of patients were deceased, of whom 17.3% (34/196) died due to lung cancer and 14.3% (28/196) due to comorbidities. The median overall survival (OS) was 15.0 months (95% CI [11.9–18.1]), whereas the median cancer-specific survival (CSS) was not reached. An aCCI ≥7 compared with an aCCI ≤6 was significantly associated with an increased risk of death (HR 1.79, 95% CI [1.02–2.80], p = 0.04) and cancer-specific death (HR 9.26, 95% CI [4.83–24.39], p < 0.001), respectively. Neither OS nor CCS were significantly associated with age, sex, side (left vs. right), lobe, localization (central vs. peripheral), packyears, TNM, or any item of the aCCI. Considering the 14.3% (28/196) of deceased patients who died due to comorbidities, aCCI ≥9 was significantly associated with non-cancer-related death (HR 3.12, 95% CI [1.22–8.33], p = 0.02). The observed cumulative rate of radiation pneumonitis (RP) ≥2 was 12.7% (25/196). The aCCI had no statistical association with RP. Conclusion Advanced age and numerous comorbidities characterizing this patient population were successfully assessed using the aCCI in terms of survival. Therefore, we recommend that age and comorbidity be indexed using the aCCI as a simple scoring system for all patients treated with SBRT for lung cancer.
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Affiliation(s)
- Julia Dreyer
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael Bremer
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christoph Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Samples LS, Graf SA. On the front line: first choice pharmacotherapeutics for chronic lymphocytic leukemia. Expert Opin Pharmacother 2018; 19:1675-1684. [PMID: 30222470 DOI: 10.1080/14656566.2018.1524874] [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: 10/28/2022]
Abstract
INTRODUCTION Chronic lymphocytic leukemia (CLL) is a common hematologic malignancy with a highly variable clinical course. Frontline treatments include cytotoxic chemotherapies, immunotherapies, and small molecule inhibitors. Clinical and molecular factors guide treatment initiation and selection. Over the last decade, refinement of CLL risk stratification tools and growth of the arsenal of effective therapeutics have profoundly improved outcomes. These advances have concurrently increased the complexity of managing the early phases of treatment. AREAS COVERED This review describes the factors considered in the determination of first-line treatment of CLL. Areas of emphasis include assessment of patient fitness, disease classification and risk stratification, and the mechanisms, efficacy, and toxicities associated with available pharmacotherapeutics. EXPERT OPINION Multiple different treatments may be appropriate for a specific clinical scenario, and selection among them requires discussion of relative risks and benefits. Advances in frontline CLL treatment will continue to shift the treatment paradigm toward prioritizing quality of life alongside survival, limiting treatment and toxicity, and the development of biologically rational synergistic drug combinations and sequences.
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Affiliation(s)
- Laura S Samples
- a Department of Medicine , University of Washington School of Medicine , Seattle , WA , USA
| | - Solomon A Graf
- a Department of Medicine , University of Washington School of Medicine , Seattle , WA , USA.,b Clinical Research Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA.,c Department of Hematology and Oncology , Veterans Affairs Puget Sound Health Care System , Seattle , WA , USA
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Comprehensive Geriatric Assessment in the Older Adult with Cancer: A Review. Eur Urol Focus 2018; 3:330-339. [PMID: 29331624 DOI: 10.1016/j.euf.2017.10.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/19/2017] [Accepted: 10/21/2017] [Indexed: 01/21/2023]
Abstract
CONTEXT The number of older adults with cancer is expected to increase rapidly in the upcoming decades. Aging is heterogeneous and chronological age is often not reflective of biological age. A comprehensive geriatric assessment (CGA) is an in-depth assessment of multiple domains of health that results in better assessment of a patient's overall health and fitness and allows directed intervention to improve patient outcomes. OBJECTIVE To review the value of CGA for older adults with cancer, CGA composition and tools that can be utilized, and the feasibility of including CGA in oncologic practice. EVIDENCE ACQUISITION The currently available evidence on CGA for older adults with cancer was reviewed. EVIDENCE SYNTHESIS A CGA can highlight unidentified health problems and identify patients at higher risk of mortality, functional decline, surgical complications, chemotherapy intolerance, and chemotherapy toxicity. It has been shown that CGA is feasible in the oncology clinic, but geriatric screening tools may be useful to specifically identify patients who would benefit from a full CGA. CONCLUSIONS CGA is feasible and can identify patients at higher risk of adverse events such as mortality, functional decline, surgical complications, and chemotherapy toxicity. Clinicians should consider incorporating CGA when assessing and caring for older adults with cancer. PATIENT SUMMARY In this report, we review the benefits of a comprehensive geriatric assessment (CGA), a detailed in-depth assessment that identifies health problems not typically identified during routine assessments, for older adults with cancer. We describe the different domains of the CGA and suggest tools to utilize, as well as ways to incorporate CGA into the cancer care setting.
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Comorbidity in Lung Cancer: A Prospective Cohort Study of Self-Reported versus Register-Based Comorbidity. J Thorac Oncol 2018; 13:54-62. [DOI: 10.1016/j.jtho.2017.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/18/2017] [Accepted: 10/03/2017] [Indexed: 12/23/2022]
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Markovic D, Jevtovic-Stoimenov T, Stojanovic M, Vukovic A, Dinic V, Markovic-Zivkovic B, Jankovic RJ. Addition of clinical risk scores improves prediction performance of American Society of Anesthesiologists (ASA) physical status classification for postoperative mortality in older patients: a pilot study. Eur Geriatr Med 2017; 9:51-59. [DOI: 10.1007/s41999-017-0002-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 10/12/2017] [Indexed: 12/20/2022]
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Droz JP, Albrand G, Gillessen S, Hughes S, Mottet N, Oudard S, Payne H, Puts M, Zulian G, Balducci L, Aapro M. Management of Prostate Cancer in Elderly Patients: Recommendations of a Task Force of the International Society of Geriatric Oncology. Eur Urol 2017; 72:521-531. [PMID: 28089304 DOI: 10.1016/j.eururo.2016.12.025] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/29/2016] [Indexed: 12/27/2022]
Abstract
CONTEXT Prostate cancer is the most frequent male cancer. Since the median age of diagnosis is 66 yr, many patients require both geriatric and urologic evaluation if treatment is to be tailored to individual circumstances including comorbidities and frailty. OBJECTIVE To update the 2014 International Society of Geriatric Oncology (SIOG) guidelines on prostate cancer in men aged >70 yr. The update includes new material on health status evaluation and the treatment of localised, advanced, and castrate-resistant disease. DATA ACQUISITION A multidisciplinary SIOG task force reviewed pertinent articles published during 2013-2016 using search terms relevant to prostate cancer, the elderly, geriatric evaluation, local treatments, and castration-refractory/resistant disease. Each member of the group proposed modifications to the previous guidelines. These were collated and circulated. The final manuscript reflects the expert consensus. DATA SYNTHESIS Elderly patients should be managed according to their individual health status and not according to age. Fit elderly patients should receive the same treatment as younger patients on the basis of international recommendations. At the initial evaluation, screening for cognitive impairment is mandatory to establish patient competence in making decisions. Initial evaluation of health status should use the validated G8 screening tool. Abnormal scores on the G8 should lead to a simplified geriatric assessment that evaluates comorbid conditions (using the Cumulative Illness Score Rating-Geriatrics scale), dependence (Activities of Daily Living) and nutritional status (via estimation of weight loss). When patients are frail or disabled or have severe comorbidities, a comprehensive geriatric assessment is needed. This may suggest additional geriatric interventions. CONCLUSIONS Advances in geriatric evaluation and treatments for localised and advanced disease are contributing to more appropriate management of elderly patients with prostate cancer. A better understanding of the role of active surveillance for less aggressive disease is also contributing to the individualisation of care. PATIENT SUMMARY Many men with prostate cancer are elderly. In the physically fit, treatment should be the same as in younger patients. However, some elderly prostate cancer patients are frail and have other medical problems. Treatment in the individual patient should be based on health status and patient preference.
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Affiliation(s)
- Jean-Pierre Droz
- Cancer-Environment Research Unit, Centre Léon-Bérard and Claude-Bernard Lyon 1 University, Lyon, France.
| | - Gilles Albrand
- Groupement Hospitalier Sud des Hospices Civils de Lyon, Hôpital Antoine Charial, Francheville, France
| | - Silke Gillessen
- Department of Oncology/Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Simon Hughes
- Oncology Management Offices, Guy's Hospital, London, UK
| | - Nicolas Mottet
- Department of Urology, Saint-Etienne University Hospital, Saint-Priest en Jarez, France
| | - Stéphane Oudard
- Oncology Department, Georges Pompidou Hospital, René-Descartes Faculty, Paris 5 University, Paris, France
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Gilbert Zulian
- Hôpital de Bellerive, Geneva University Hospitals, Geneva, Switzerland
| | - Lodovico Balducci
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, FL, USA
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Halvorsen TO, Sundstrøm S, Fløtten Ø, Brustugun OT, Brunsvig P, Aasebø U, Bremnes RM, Kaasa S, Grønberg BH. Comorbidity and outcomes of concurrent chemo- and radiotherapy in limited disease small cell lung cancer. Acta Oncol 2016; 55:1349-1354. [PMID: 27549509 DOI: 10.1080/0284186x.2016.1201216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many patients with limited disease small cell lung cancer (LD SCLC) suffer from comorbidity. Not all patients with comorbidity are offered standard treatment, though there is little evidence for such a policy. The aim of this study was to investigate whether patients with comorbidity had inferior outcomes in a LD SCLC cohort. MATERIAL AND METHODS We analyzed patients from a randomized study comparing two three-week schedules of thoracic radiotherapy (TRT) plus standard chemotherapy in LD SCLC. Patients were to receive four courses of cisplatin/etoposide and TRT of 45 Gy/30 fractions (twice daily) or 42 Gy/15 fractions (once daily). Responders received prophylactic cranial irradiation (PCI). Comorbidity was assessed using the Charlson Comorbidity Index (CCI), which rates conditions with increased one-year mortality. RESULTS In total 157 patients were enrolled between May 2005 and January 2011. Median age was 63 years, 52% were men, 16% had performance status 2, and 72% stage III disease. Forty percent had no comorbidity; 34% had CCI-score 1; 15% CCI 2; and 11% CCI 3-5. There were no significant differences in completion rates of chemotherapy, TRT or PCI across CCI-scores; or any significant differences in the frequency of grade 3-5 toxicity (p = 0.49), treatment-related deaths (p = 0.36), response rates (p = 0.20), progression-free survival (p = 0.18) or overall survival (p = 0.09) between the CCI categories. CONCLUSION Patients with comorbidity completed and tolerated chemo-radiotherapy as well as other patients. There were no significant differences in response rates, progression-free survival or overall survival - suggesting that comorbidity alone is not a reason to withhold standard therapy in LD SCLC.
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Affiliation(s)
- Tarje Onsøien Halvorsen
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stein Sundstrøm
- Clinic of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øystein Fløtten
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Odd T. Brustugun
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Paal Brunsvig
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Ulf Aasebø
- Department of Pulmonology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Roy M. Bremnes
- Department of Clinical Medicine, Faculty of Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Stein Kaasa
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn H. Grønberg
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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