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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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Feyzioğlu Ö, Dinçer S, Özdemir AE, Öztürk Ö. Physical performance tests have excellent reliability in frail and non-frail patients with prostate cancer. Disabil Rehabil 2024:1-8. [PMID: 38613370 DOI: 10.1080/09638288.2024.2340703] [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: 08/11/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Our aim was to investigate the test-retest reliability of the 2-min walk test (2MWT), timed up and go test (TUG), and five times sit-to-stand test (FTSST) in prostate cancer (PC) patients. METHODS This study was conducted with 73 patients who were classified into two groups as frail and non-frail determined by the Geriatric-8 questionnaire. Patients performed the 2MWT, TUG, and FTSST tests for two times. The test-retest reliability of the 2MWT, TUG, and FTSST was assessed by calculating the intraclass correlation coefficient (ICC). The standard error of measurement (SEM95) and minimal detectable change (MDC95) values were calculated. RESULTS All tests showed excellent test-retest reliability for both groups (ICC(2.1) > 0.90). The SEM95 and MDC95 values of 2MWT were 3.09, 8.57, and 3.15 m, 8.73 m for frail and non-frail groups. The SEM95 and MDC95 values of TUG for the frail group were 0.6 and 1.66 and 0.43 and 1.19 for the non-frail group, respectively. The SEM95 and MDC95 values of FTST for the frail group were 0.68 and 1.88 and for the non-frail group 0.86 and 2.38. CONCLUSIONS The 2MWT, TUG, and FTSST showed excellent reliability in frail and non-frail older adults with PC which can be used to assess physical performance.
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Affiliation(s)
- Özlem Feyzioğlu
- Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Istanbul, Turkey
| | - Selvi Dinçer
- Department of Radiation Oncology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Ayşem Ecem Özdemir
- Department of Physiotherapy and Rehabilitation, Gelisim University, Faculty of Health Sciences, Istanbul, Turkey
| | - Özgül Öztürk
- Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Istanbul, Turkey
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Bech D, Lietzen LW, Meldgaard P, Ryltoft AK, Ørum M. Diagnostic accuracy of the geriatric screening tools G8 and modified G8 in older patients with lung cancer: A diagnostic performance study. J Geriatr Oncol 2024; 15:101645. [PMID: 37903667 DOI: 10.1016/j.jgo.2023.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/30/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Danny Bech
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark.
| | - Lone Winther Lietzen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark; Aarhus University, Aarhus, Denmark
| | - Peter Meldgaard
- Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marianne Ørum
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
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Chon J, Timilshina N, AlMugbel F, Jin R, Monginot S, Tejero I, Breunis H, Alibhai SMH. Validity of a self-administered G8 screening test for older patients with cancer. J Geriatr Oncol 2023; 14:101553. [PMID: 37379768 DOI: 10.1016/j.jgo.2023.101553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/03/2023] [Accepted: 06/02/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION The Geriatric 8 (G8) is a brief cancer-specific tool which screens for patients who require a comprehensive geriatric assessment (CGA). The G8 test assesses patients on eight domains such as mobility, polypharmacy, age, and self-rated health. However, the current G8 requires a healthcare professional (nurse or physician) present to conduct the test, which limits its usefulness. The Self-G8 questionnaire (S-G8) is an adaptation of the original G8 test, assessing all the same domains, with questions modified to be appropriate for patients to self-complete. Our objective was to evaluate the performance of S-G8 compared to the G8 and CGA. MATERIALS AND METHODS The initial S-G8 was designed by our team through review of the literature and questionnaire design principles, and was optimized through feedback from patients over the age of 70. The questionnaire subsequently underwent further refinement after undergoing pilot testing (N = 14). The diagnostic accuracy of the final iteration of the S-G8 was evaluated along with the standard G8 in a prospective cohort study (N = 52) in an academic geriatric oncology clinic at the Princess Margaret Cancer Centre, Toronto, Canada. Psychometric characteristics were evaluated including internal consistency, sensitivity, and specificity compared to the G8 and to the CGA. RESULTS There was strong correlation between the G8 and S-G8 scores, with a Spearman correlation co-efficient of 0.76 (p < 0.001). Internal consistency was acceptable at 0.60. The frequency of abnormality (<14 score) for the G8 and S-G8 was 82.7% and 61.5%, respectively. The mean score for the original G8 and S-G8 was 11.9 and 13.5, respectively. The cut-off of 14 for the S-G8 yielded the best combination of sensitivity of 0.70 ± 0.07 and specificity of 0.78 ± 0.14 when compared to the G8. When compared to two or more abnormal domains on the CGA, the S-G8 performed at least as well as the G8 with a sensitivity of 0.77, specificity of 0.85, and a Youden's index of 0.62. DISCUSSION The S-G8 questionnaire appears to be an acceptable alternative to the original G8 in identifying older adults with cancer who will benefit from a CGA. Large scale testing is warranted.
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Affiliation(s)
- Joseph Chon
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Fahad AlMugbel
- Department of Medicine, University Health Network, Toronto, Canada
| | - Rana Jin
- Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Susie Monginot
- Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Isabel Tejero
- Department of Medicine, University Health Network, Toronto, Canada
| | | | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Canada.
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Depoorter V, Vanschoenbeek K, Decoster L, Silversmit G, Debruyne PR, De Groof I, Bron D, Cornélis F, Luce S, Focan C, Verschaeve V, Debugne G, Langenaeken C, Van Den Bulck H, Goeminne JC, Teurfs W, Jerusalem G, Schrijvers D, Petit B, Rasschaert M, Praet JP, Vandenborre K, Milisen K, Flamaing J, Kenis C, Verdoodt F, Wildiers H. Long-term health-care utilisation in older patients with cancer and the association with the Geriatric 8 screening tool: a retrospective analysis using linked clinical and population-based data in Belgium. THE LANCET. HEALTHY LONGEVITY 2023; 4:e326-e336. [PMID: 37327806 DOI: 10.1016/s2666-7568(23)00081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Little evidence is available on the long-term health-care utilisation of older patients with cancer and whether this is associated with geriatric screening results. We aimed to evaluate long-term health-care utilisation among older patients after cancer diagnosis and the association with baseline Geriatric 8 (G8) screening results. METHODS For this retrospective analysis, we included data from three cohort studies for patients (aged ≥70 years) with a new cancer diagnosis who underwent G8 screening between Oct 19, 2009 and Feb 27, 2015, and who survived more than 3 months after G8 screening. The clinical data were linked to cancer registry and health-care reimbursement data for long-term follow-up. The occurrence of outcomes (inpatient hospital admissions, emergency department visits, use of intensive care, contacts with general practitioner [GP], contacts with a specialist, use of home care, and nursing home admissions) was assessed in the 3 years after G8 screening. We assessed the association between outcomes and baseline G8 score (normal score [>14] or abnormal [≤14]) using adjusted rate ratios (aRRs) calculated from Poisson regression and using cumulative incidence calculated as a time-to-event analysis with the Kaplan-Meier method. FINDINGS 7556 patients had a new cancer diagnosis, of whom 6391 patients (median age 77 years [IQR 74-82]) met inclusion criteria and were included. 4110 (64·3%) of 6391 patients had an abnormal baseline G8 score (≤14 of 17 points). In the first 3 months after G8 screening, health-care utilisation peaked and then decreased over time, with the exception of GP contacts and home care days, which remained high throughout the 3-year follow-up period. Compared with patients with a normal baseline G8 score, patients with an abnormal baseline G8 score had more hospital admissions (aRR 1·20 [95% CI 1·15-1·25]; p<0·0001), hospital days (1·66 [1·64-1·68]; p<0·0001), emergency department visits (1·42 [1·34-1·52]; p<0·0001), intensive care days (1·49 [1·39-1·60]; p<0·0001), general practitioner contacts (1·19 [1·17-1·20]; p<0·0001), home care days (1·59 [1·58-1·60]; p<0·0001), and nursing home admissions (16·7% vs 3·1%; p<0·0001) in the 3-year follow-up period. At 3 years, of the 2281 patients with a normal baseline G8 score, 1421 (62·3%) continued to live at home independently and 503 (22·0%) had died. Of the 4110 patients with an abnormal baseline G8 score, 1057 (25·7%) continued to live at home independently and 2191 (53·3%) had died. INTERPRETATION An abnormal G8 score at cancer diagnosis was associated with increased health-care utilisation in the subsequent 3 years among patients who survived longer than 3 months. FUNDING Stand up to Cancer, the Flemish Cancer Society.
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Affiliation(s)
| | | | - Lore Decoster
- Department of Medical Oncology, Vrije Universiteit Brussel, University Hospitals Brussels, Brussels, Belgium
| | | | - Philip R Debruyne
- Division of Medical Oncology, Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; Medical Technology Research Centre, School of Life Sciences, Anglia Ruskin University, Cambridge, UK; School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Inge De Groof
- Department of Geriatric Medicine, Iridium Network Antwerp, Sint-Augustinus Cancer Center, Wilrijk, Belgium
| | - Dominique Bron
- Department of Hematology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Frank Cornélis
- Department of Medical Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sylvie Luce
- Department of Medical Oncology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Christian Focan
- Department of Oncology, Clinique CHC MontLégia, Liège, Belgium
| | - Vincent Verschaeve
- Department of Medical Oncology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Gwenaëlle Debugne
- Department of Geriatric Medicine, Centre Hospitalier de Mouscron, Mouscron, Belgium
| | | | | | - Jean-Charles Goeminne
- Department of Medical Oncology, Centre Hospitalier Universitaire UCL-Namur, Namur, Belgium
| | - Wesley Teurfs
- Department of Medical Oncology, ZNA Stuivenberg, Antwerp, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, Centre Hospitalier Universitaire Sart Tilman, Liège University, Liège, Belgium
| | - Dirk Schrijvers
- Department of Medical Oncology, ZNA Middelheim, Antwerp, Belgium
| | - Bénédicte Petit
- Department of Medical Oncology, Centre Hospitalier Jolimont, La Louvière, Belgium
| | - Marika Rasschaert
- Department of Medical Oncology, University Hospital Antwerp, Edegem, Belgium
| | - Jean-Philippe Praet
- Department of Geriatric Medicine, Centre Hospitalier Universitaire St-Pierre, Free Universities Brussels, Brussels, Belgium
| | | | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Cindy Kenis
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Freija Verdoodt
- Research Department, Belgian Cancer Registry, Brussels, Belgium
| | - Hans Wildiers
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
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Zhao H, Lu X, Zheng S, Wei D, Zhao L, Wang Y, de Bock GH, Lu W. Comparison of two frailty screening tools in older patients with colorectal cancer. BMC Geriatr 2023; 23:295. [PMID: 37189055 DOI: 10.1186/s12877-023-03974-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Geriatric assessment (GA) is widely used to detect vulnerability in older patients. As this process is time-consuming, prescreening tools have been developed to identify patients at risk for frailty. We aimed to assess whether the Geriatric 8 (G8) or the Korean Cancer Study Group Geriatric Score (KG-7) shows better performance in identifying patients who are in need of full GA. MATERIALS AND METHODS A consecutive series of patients aged ≥ 60 years with colorectal cancer were included. The sensitivity, specificity, predictive value, and 95% confidence intervals (95% CI) were calculated for the G8 and the KG-7 using the results of GA as the reference standard. ROC(Receiver Operating Characteristic) was used to evaluate the accuracy of the G8 and the KG-7. RESULTS One hundred four patients were enrolled. A total of 40.4% of patients were frail according to GA, and 42.3% and 50.0% of patients were frail based on the G8 and the KG-7, respectively. The sensitivity and specificity of the G8 were 90.5% (95% CI: 77.4-97.3%) and 90.3% (95% CI: 80.1-96.4%), respectively. For the KG-7, the sensitivity and specificity were 83.3% (95% CI: 68.6-93.0%) and 72.6% (95% CI: 59.8-83.1%), respectively. Compared to the KG-7, the G8 had a higher predictive accuracy (AUC: (95% CI): 0.90 (0.83-0.95) vs. 0.78 (0.69-0.85); p < 0.01). By applying the G8 and the KG-7, 60 and 52 patients would not need a GA assessment, respectively. CONCLUSION Both the G8 and the KG-7 showed a great ability to detect frailty in older patients with colorectal cancer. In this population, compared to the KG-7, the G8 had a better performance in identifying those in need of a full Geriatric Assessment.
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Affiliation(s)
- Han Zhao
- Department of Epidemiology and Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xinlin Lu
- Department of Epidemiology and Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Senshuang Zheng
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Danmei Wei
- Department of Epidemiology and Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lizhong Zhao
- Department of Gastroenterology, Tianjin Union Medical Center, Tianjin, China
| | - Yuan Wang
- Department of Epidemiology and Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Geertruida H de Bock
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wenli Lu
- Department of Epidemiology and Statistics, School of Public Health, Tianjin Medical University, Tianjin, China.
- , 22 Qixiangtai Road, Tianjin, 300070, China.
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Hsu T, Elias R, Swartz K, Chapman A. Developing Sustainable Cancer and Aging Programs. Am Soc Clin Oncol Educ Book 2023; 43:e390980. [PMID: 37155945 DOI: 10.1200/edbk_390980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Geriatric assessment (GA) has been shown to decrease toxicity from systemic therapy, improve completion of chemotherapy, and reduce hospitalizations in older adults with cancer. Given the aging of the cancer population, this has the potential to have a positive impact on the care of a large swath of patients seen. Despite endorsement by several international societies, including the American Society of Clinical Oncology, uptake of GA has been low. Lack of knowledge, time, and resources has been cited as reasons for this. Although challenges to developing and implementing a cancer and aging program vary depending on the health care context, GA is adaptable to every health care context from low- to high-resource settings, as well as those in which geriatric oncology is a well-established or just emerging field. We provide an approach for clinicians and administrators to develop, implement, and sustain aging and cancer programs in a doable and sustainable way.
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Affiliation(s)
- Tina Hsu
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Rawad Elias
- Hartford HealthCare Cancer Institute, Hartford, CT
- University of Connecticut School of Medicine, Farmington, CT
| | - Kristine Swartz
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Jefferson Health, Philadelphia, PA
| | - Andrew Chapman
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Jefferson Health, Philadelphia, PA
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Yajima S, Nakanishi Y, Yasujima R, Hirose K, Umino Y, Okubo N, Kataoka M, Masuda H. Rapid geriatric screening tools predict inability to manage stoma by oneself after urinary diversion: G8 and IADL-modified G8. J Geriatr Oncol 2023; 14:101468. [PMID: 36870222 DOI: 10.1016/j.jgo.2023.101468] [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: 12/27/2022] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION This study aimed to evaluate whether functional screening, as assessed by the Geriatric-8 (G8) and the instrumental activities of daily living (IADL)-modified G8, are associated with the inability to manage a stoma by themselves in patients with bladder cancer who underwent robot-assisted radical cystectomy. MATERIALS AND METHODS We analyzed a total of 110 consecutive patients with bladder cancer who underwent robot-assisted radical cystectomy and were screened preoperatively using the G8 and the IADL-modified G8 at our institution between January 2020 and December 2022. Patients who could not undergo geriatric screening at the preoperative clinic before surgery and patients who underwent orthotopic neobladder construction were excluded. We evaluated the association between clinical factors, including scores of G8 and IADL-modified G8, and the inability to manage a stoma by oneself. For both G8 and IADL-modified G8, a cutoff value of ≤14 was set. RESULTS Of the 110 patients, the median age was 77 years, 92 (84%) patients were male and 47 (43%) patients were unable to manage a stoma by themselves. The geriatric assessment indicated that 64 patients (58%) were classified in the low G8 (≤14) group and 66 patients (60%) were classified in the low IADL-modified G8 (≤14) group. The values of area under the receiver operating characteristic curve for predicting inability to manage stoma by oneself were 0.725 for the G8 and 0.734 for the IADL-modified G8, respectively. Multivariate analysis including the G8 revealed that age ≥ 80, Charlson comorbidity index of ≥3, and G8 ≤ 14 (odds ratio [OR] = 4.9; 95% confidence interval [CI] = 1.8-13.0; P = 0.002) were independent risk factors for inability to manage a stoma by oneself. Likewise, multivariate analysis including the IADL-modified G8 revealed that age ≥ 80, Charlson comorbidity index of ≥3, and IADL-modified G8 ≤ 14 (OR = 5.4; 95% CI = 1.9-14.0; P = 0.001) were independent risk factors for inability to manage a stoma by oneself. DISCUSSION Screening using G8 and IADL-modified G8 may predict patients who have difficulty self-managing their stomas.
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Affiliation(s)
- Shugo Yajima
- National Cancer Center Hospital East, Chiba, Japan
| | | | | | - Kohei Hirose
- National Cancer Center Hospital East, Chiba, Japan
| | - Yosuke Umino
- National Cancer Center Hospital East, Chiba, Japan
| | - Naoya Okubo
- National Cancer Center Hospital East, Chiba, Japan
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Predictive value of the G8 and the IADL-modified G8 screening tools for postoperative delirium following major urological cancer surgery. J Geriatr Oncol 2022; 13:1188-1193. [PMID: 36038466 DOI: 10.1016/j.jgo.2022.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate whether the Geriatric-8 (G8) and the instrumental activities of daily living (IADL)-modified G8 are associated with the occurrence of postoperative delirium after major urological cancer surgery. MATERIALS AND METHODS We retrospectively analyzed a total of 415 consecutive patients who underwent major urologic cancer surgery and were screened preoperatively using the G8 and the IADL-modified G8 at our institution between January 2020 and July 2021. For both the G8 and the IADL-modified G8, a cut-off value of 14 was used. All patients underwent perioperative management according to the Enhanced Recovery After Surgery protocol formulated at our institution. Delirium was diagnosed using the Confusion Assessment Method. The relationship between these screening tests and clinical variables was examined. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC). To determine the risk factors for the occurrence of postoperative delirium, univariate and multivariate analyses were performed. RESULTS Of the 415 patients, 160 (39%) were assigned to the low G8 (score ≤ 14) group and 166 (40%) to the low IADL-modified G8 (score ≤ 14) group. The median age of the patients was 72 years. Postoperative delirium occurred in 31 patients (7%). The AUC values for predicting postoperative delirium were 0.69 for the G8 and 0.71 for the IADL-modified G8. Multivariate analysis for the G8 showed that G8 ≤ 14 (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.2-6.0; P = 0.02), preoperative use of benzodiazepine (OR = 3.8; 95% CI = 1.6-8.6; P = 0.002), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5-7.1; P = 0.003) were independent risk factors for postoperative delirium. Similarly, for the IADL-modified G8, IADL-modified G8 ≤ 14 (OR = 2.6; 95% CI = 1.1-5.8; P = 0.02), preoperative use of benzodiazepine (OR = 3.9; 95% CI = 1.7-8.8; P = 0.001), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5-7.2; P = 0.003) were independent risk factors for postoperative delirium. DISCUSSION The G8 and the IADL-modified G8 screening may allow for better identification of patients at risk of postoperative delirium.
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Su M, Yao N, Shang M, Shen Y, Qin T, Wang J, Sun X. Frailty and its association with health-related quality of life among older cancer patients: an evidence-based study from China. Health Qual Life Outcomes 2022; 20:124. [PMID: 35986354 PMCID: PMC9389706 DOI: 10.1186/s12955-022-02032-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background There is limited information about the population characteristics and adverse health outcomes of older cancer patients in China. This study aimed to describe the prevalence of frailty and examine the association between frailty and health-related quality of life (HRQoL) among older cancer patients. Methods This was a cross-sectional study involving older patients diagnosed with cancer in two tertiary hospitals in Shandong Province, China. Frailty was assessed using Geriatric 8 (G-8). HRQoL was measured using the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire. The Tobit regression model and logistic regression model was used to identify the relationship between frailty and HRQoL. Results Of the 229 older patients, 175 (76.4%) were frail. Frail patients had lower EQ-5D-5L utility scores than those who were non-frail (0.830 vs. 0.889; P = 0.004). After adjustments for sociodemographic and cancer-related variables, frailty was statistically associated with worse health-related quality of life (OR = 6.024; P = 0.001). Conclusion Frailty was associated with deteriorated HRQoL in older patients with cancer. Early frailty screening and preventive interventions are essential for improving quality of life through decision-making or pretreatment optimization in geriatric oncology. The majority of cancer cases and cancer mortality occur in older adults. Aging is a heterogenic process, which results in great diversity in older cancer patients concerning physical, psychological, and social status. There is limited information about the population characteristics and adverse health outcomes of older cancer patients in China, and the magnitude of this problem is unclear, creating challenges in understanding health disparities in geriatric cancer care. In this study, we have described the prevalence of frailty and explored the relationship between frailty and health-related quality of life (HRQoL). This study demonstrated that frailty, not being currently married, advanced cancer stage, and cancer site were significant factors influencing the lower HRQoL. Furthermore, frail individuals had a higher probability belonging to the lowest HRQoL quartile group. This study is considered as the first step in highlighting the importance of staging the aging and assessing quality of life among older cancer patients in China.
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Octavianus S, Handoko H, Permata TBM, Purwoto G, Adham M, Panigoro SS, Setiati S, Gondhowiardjo S. Characteristics and Assessment of Frailty as Risk Factor of Therapy-Related Acute Toxicities and Delayed Overall Treatment Time in Elderly Patients Treating with External Beam Radiation Therapy at Indonesia Top Referral Hospital. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Older patients are at a higher risk of being frail. Frailty implies that even a minor stressor can have major negative implications on physical, psychological domains. Geriatric-8 (G-8) screening tool shows good screening properties for identifying vulnerable elderly patients with cancer.
AIM: We, therefore, decided to investigate the utility of G-8 associated with acute toxicity and prolonged overall treatment time (OTT) in elderly cancer patients treated with radiotherapy (RT).
MATERIALS AND METHODS: A prospective observational cohort study is performed. Eligible subjects are patients aged ≥60 years and were referred for curative or palliative RT. We use the G-8 questionnaire for consecutive patients before starting RT. We recorded acute toxicity and OTT and identified potential predictors.
RESULTS: A total of 52 consecutive geriatric patients were included with an average age of 67 years. Of all those subjects, 21% had head-and-neck cancers, 29% gynecology cancers, 23% breast cancers, and 27% other cancers. According to the G-8, 65% of the patients were potentially frail. Toxicity Grade ≥3 was observed among 32% of subjects who were potentially frail according to the G-8 and 0% of the subject who was fit (p = 0.007). Prolonged OTT was observed in 61.8% of potentially frail and 27.8% of the subjects who were fit (p = 0.020). On multivariate analysis, only chemoradiation was strongly associated with acute toxicity Grade ≥3 odds ratio 11.1 (95% confidence interval 1.4–83.6; p = 0.019).
CONCLUSION: The utility of G-8 in daily practice seems to be limited. Only concurrent chemoradiation was associated with acute toxicity. Future prospective studies should investigate whether the G-8 is a good predictor for other relevant clinical outcomes and survival in our local settings.
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Traunero F, Claps F, Silvestri T, Mir MC, Ongaro L, Rizzo M, Piasentin A, Liguori G, Vedovo F, Celia A, Trombetta C, Pavan N. Reliable Prediction of Post-Operative Complications' Rate Using the G8 Screening Tool: A Prospective Study on Elderly Patients Undergoing Surgery for Kidney Cancer. J Clin Med 2022; 11:jcm11133785. [PMID: 35807070 PMCID: PMC9267910 DOI: 10.3390/jcm11133785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 01/20/2023] Open
Abstract
In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients (≥70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery.
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Affiliation(s)
- Fabio Traunero
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
- Correspondence: ; Tel.: +39-040-399-4293
| | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Tommaso Silvestri
- Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy; (T.S.); (A.C.)
| | - Maria Carmen Mir
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain;
| | - Luca Ongaro
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Michele Rizzo
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Andrea Piasentin
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Giovanni Liguori
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Francesca Vedovo
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy; (T.S.); (A.C.)
| | - Carlo Trombetta
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
| | - Nicola Pavan
- Urology Clinic, Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (F.C.); (L.O.); (M.R.); (A.P.); (G.L.); (F.V.); (C.T.); (N.P.)
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13
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The impact of the modified frailty index on clinical outcomes for patients with stage IV non-small cell lung cancer receiving chemotherapy. J Geriatr Oncol 2022; 13:654-661. [DOI: 10.1016/j.jgo.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 02/23/2022] [Indexed: 01/20/2023]
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Heudel PE, Delrieu L, Dumas E, Crochet H, Hodroj K, Charrier I, Chvetzoff G, Durand T, Blay JY. Impact of Limited E-Health Literacy on the Overall Survival of Patients With Cancer. JCO Clin Cancer Inform 2022; 6:e2100174. [PMID: 35213209 PMCID: PMC8887947 DOI: 10.1200/cci.21.00174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Digitalization of the health care system is transforming cancer patient care. Although many studies have investigated the determinants of a limited digital health literacy, the association between frailty factors and overall survival (OS) of these patients has never been assessed. METHODS A retrospective noninterventional study included 15,244 adult patients with cancer diagnosed between January 1, 2015, and December 31, 2017, and treated at the Centre Léon Bérard. Limited e-health literacy was defined as the absence of an e-mail address in the electronic patient record. An Inverse Probability of Treatment-Weighted Kaplan-Meier estimate and a multivariate Cox proportional hazards model including interaction terms were used to adjust for confounding on measured covariates. RESULTS In total, 15,244 adults with cancer were included: 55% women, with a median age of 62 years (19-103), and 35.5% had a metastatic disease. More than half (n = 8,771, 57.5%) had entered their e-mail address in their electronic patient record, and 4,020 (26.4%) opened their own patient portal. The median follow-up was 3.6 years (range: 0-6.8). Inverse Probability of Treatment-weighted Kaplan-Meier estimates showed a significantly better OS for patients with an e-mail address (P < .001). In multivariate analysis integrating interaction terms, male gender (hazard ratio [HR] = 1.27; 95% CI, 1.15 to 1.41; P < .001), older age (HR = 1.02; 95% CI, 1.02 to 1.03; P < .001), de novo metastatic setting (HR = 2.63; 95% CI, 2.47 to 2.79; P < .001), and no e-mail address (HR = 1.63; 95% CI, 1.33 to 2.00; P < .001) were significantly associated with worse OS. CONCLUSION Our results support a strong association between the limited level of literacy and OS. A more in-depth study integrating variables such as socioeconomic level and location of residence would enrich these results.
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Affiliation(s)
- Pierre E. Heudel
- Department of Medical Oncology, Center Léon Bérard, Lyon, France,Pierre E. Heudel, MD, MSc, LLM, Department of Medical Oncology, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France; e-mail:
| | - Lidia Delrieu
- Residual Tumor and Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, Paris, France
| | - Elise Dumas
- Residual Tumor and Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, Paris, France,MINES ParisTech, PSL Research University, CBIO-Center for Computational Biology, Paris, France,INSERM, U900, Paris, France
| | - Hugo Crochet
- Data and Artificial Intelligence Team, Center Léon Bérard, Lyon, France
| | - Khalil Hodroj
- Department of Medical Oncology, Center Léon Bérard, Lyon, France
| | | | - Gisèle Chvetzoff
- Departement of Supportive Care, Léon Bérard Cancer Center, Lyon, France
| | - Thierry Durand
- Department of Hospital Information, Léon Bérard Cancer Center, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Center Léon Bérard, Lyon, France
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Evolving Therapeutic Approaches for Older Patients with Acute Myeloid Leukemia in 2021. Cancers (Basel) 2021; 13:cancers13205075. [PMID: 34680226 PMCID: PMC8534216 DOI: 10.3390/cancers13205075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The better understanding of disease biology, the availability of new effective drugs and the increased awareness of patients’ heterogeneity in terms of fitness and personal expectations has made the current treatment paradigm of AML in the elderly very challenging. Here, we discuss the evolving criteria used to define eligibility for induction chemotherapy and transplantation, the introduction of new agents in the treatment of patients with very different clinical conditions, the implications of precision medicine and the importance of quality of life and supportive care, proposing a simplified algorithm that we follow in 2021. Abstract Acute myeloid leukemia (AML) in older patients is characterized by unfavorable prognosis due to adverse disease features and a high rate of treatment-related complications. Classical therapeutic options range from intensive chemotherapy in fit patients, potentially followed by allogeneic hematopoietic cell transplantation (allo-HCT), to hypomethylating agents or palliative care alone for unfit/frail ones. In the era of precision medicine, the treatment paradigm of AML is rapidly changing. On the one hand, a plethora of new targeted drugs with good tolerability profiles are becoming available, offering the possibility to achieve a prolonged remission to many patients not otherwise eligible for more intensive therapies. On the other hand, better tools to assess patients’ fitness and improvements in the selection and management of those undergoing allo-HCT will hopefully reduce treatment-related mortality and complications. Importantly, a detailed genetic characterization of AML has become of paramount importance to choose the best therapeutic option in both intensively treated and unfit patients. Finally, improving supportive care and quality of life is of major importance in this age group, especially for the minority of patients that are still candidates for palliative care because of very poor clinical conditions or unwillingness to receive active treatments. In the present review, we discuss the evolving approaches in the treatment of older AML patients, which is becoming increasingly challenging following the advent of new effective drugs for a very heterogeneous and complex population.
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Karnakis T, Gattás-Vernaglia IF, Dos Santos Hughes SF, Aliberti MJR. Rapid geriatric risk screening and survival in older adults with cancer: Prognostic value of the IADL-modified G8. J Geriatr Oncol 2021; 13:381-383. [PMID: 34642095 DOI: 10.1016/j.jgo.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Theodora Karnakis
- Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Isabella Figaro Gattás-Vernaglia
- Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Márlon Juliano Romero Aliberti
- Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Partelli S, Sclafani F, Barbu ST, Beishon M, Bonomo P, Braz G, de Braud F, Brunner T, Cavestro GM, Crul M, Trill MD, Ferollà P, Herrmann K, Karamitopoulou E, Neuzillet C, Orsi F, Seppänen H, Torchio M, Valenti D, Zamboni G, Zins M, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Pancreatic Cancer. Cancer Treat Rev 2021; 99:102208. [PMID: 34238640 DOI: 10.1016/j.ctrv.2021.102208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Pancreatic cancer is an increasing cause of cancer mortality and has wide variation in treatment and care in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must be carried out only in pancreatic cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Stefano Partelli
- European Society of Surgical Oncology (ESSO); IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Sclafani
- European Organisation for Research and Treatment of Cancer (EORTC); Institut Jules Bordet, Brussels, Belgium
| | - Sorin Traian Barbu
- Pancreatic Cancer Europe (PCE); Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy
| | - Pierluigi Bonomo
- Flims Alumni Club (FAC); Careggi University Hospital, Florence, Italy
| | - Graça Braz
- European Oncology Nursing Society (EONS); Portuguese Oncology Institute, Porto, Portugal
| | - Filippo de Braud
- Organisation of European Cancer Institutes (OECI); IRCCS Foundation National Cancer Institute of Milan, Milan, Italy
| | - Thomas Brunner
- European Society for Radiotherapy and Oncology (ESTRO); Otto von Guericke University, Magdeburg, Germany
| | - Giulia Martina Cavestro
- European Hereditary Tumour Group (EHTG); IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mirjam Crul
- European Society of Oncology Pharmacy (ESOP); Amsterdam University Medical Centre, Netherlands
| | - Maria Die Trill
- International Psycho-Oncology Society (IPOS); ATRIUM: Psycho-Oncology & Clinical Psychology, Madrid, Spain
| | - Piero Ferollà
- International Neuroendocrine Cancer Alliance (INCA); Umbria Regional Cancer Network, Perugia, Italy
| | - Ken Herrmann
- European Association of Nuclear Medicine (EANM); University Hospital Essen, Essen, Germany
| | - Eva Karamitopoulou
- European Society of Pathology (ESP); Institute of Pathology, University of Bern, Bern, Switzerland
| | - Cindy Neuzillet
- International Society of Geriatric Oncology (SIOG), Institut Curie, Saint-Cloud, France
| | - Franco Orsi
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); European Institute of Oncology, Milan, Italy
| | - Hanna Seppänen
- Association of European Cancer Leagues (ECL); Helsinki University Hospital, Helsinki, Finland
| | - Martina Torchio
- Organisation of European Cancer Institutes (OECI); IRCCS Foundation National Cancer Institute of Milan, Milan, Italy
| | - Danila Valenti
- European Association for Palliative Care (EAPC); Palliative Care Network, AUSL Bologna, Bologna, Italy
| | - Giulia Zamboni
- European Society of Oncologic Imaging (ESOI); University Hospital Verona, Verona, Italy
| | - Marc Zins
- European Society of Radiology (ESR); Groupe hospitalier Paris Saint-Joseph, Paris, France
| | | | - Philip Poortmans
- European Cancer Organisation (ECCO); Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium
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Puts M, Soo WK, Szumacher E, Decoster L. Methods for frailty screening and geriatric assessment in older adults with cancer. Curr Opin Support Palliat Care 2021; 15:16-22. [PMID: 33507036 DOI: 10.1097/spc.0000000000000533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW This review highlights the latest development in the use of geriatric assessment(GA) and frailty assessment for older adults with cancer. RECENT FINDINGS From 2019, there were six large randomized controlled trials (RCTs) completed of GA for older adults with cancer, as well as several studies of frailty screening tools. SUMMARY The findings in this review highlight the benefits of implementing GA, followed by interventions to address the identified issues (GA -guided interventions). Four of six RCTs that implemented GA for older adults with cancer showed positive impact on various outcomes, including treatment toxicity and quality of life. GA implementation varied significantly between studies, from oncologist acting on GA summary, geriatrician comanagement, to full GA by a multidisciplinary team. However, there were several barriers reported to implementing GA for all older adults with cancer, such as access to geriatrics and resource issues. Future research needs to elucidate how to best operationalize GA in various cancer settings. The authors also reviewed frailty screening tools and latest evidence on their use and impact.
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Affiliation(s)
- Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Wee Kheng Soo
- Eastern Health Clinical School, Monash University
- Cancer Services, Eastern Health
- Aged Medicine Program, Eastern Health, Box Hill, Australia
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lore Decoster
- Department of Medical Oncology, Oncologisch Centrum, Universitair ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Oberic L, Peyrade F, Puyade M, Bonnet C, Dartigues-Cuillères P, Fabiani B, Ruminy P, Maisonneuve H, Abraham J, Thieblemont C, Feugier P, Salles G, Bijou F, Pica GM, Damaj G, Haioun C, Casasnovas RO, Farhat H, Le Calloch R, Waultier-Rascalou A, Malak S, Paget J, Gat E, Tilly H, Jardin F. Subcutaneous Rituximab-MiniCHOP Compared With Subcutaneous Rituximab-MiniCHOP Plus Lenalidomide in Diffuse Large B-Cell Lymphoma for Patients Age 80 Years or Older. J Clin Oncol 2021; 39:1203-1213. [PMID: 33444079 DOI: 10.1200/jco.20.02666] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The prognosis of elderly patients with diffuse large B-cell lymphoma (DLBCL) is worse than that of young patients. An attenuated dose of chemotherapy-cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (R-miniCHOP)-is a good compromise between efficacy and safety in very elderly patients. In combination with R-CHOP (R2-CHOP), lenalidomide has an acceptable level of toxicity and may mitigate the negative prognosis of the non-germinal center B-cell-like phenotype. The Lymphoma Study association conducted a multicentric, phase III, open-label, randomized trial to compare R-miniCHOP and R2-miniCHOP. PATIENTS AND METHODS Patients of age 80 years or older with untreated DLBCL were randomly assigned into the R-miniCHOP21 group or the R2-miniCHOP21 group for six cycles and stratified according to CD10 expression and age. The first cycle of rituximab was delivered by IV on D1 after a prephase and then delivered subcutaneously on D1 of cycles 2-6. Lenalidomide was delivered at a dose of 10 mg once daily on D1-D14 of each cycle. The primary end point was overall survival (OS). RESULTS A total of 249 patients with new DLBCL were randomly assigned (127 R-miniCHOP and 122 R2-miniCHOP). The median age was 83 years (range, 80-96), and 55% of the patients were classified as non-GCB. The delivered dose for each R-miniCHOP compound was similar in both arms. Over a median follow-up of 25.1 months, the intention-to-treat analysis revealed that R2-miniCHOP did not improve OS (2-year OS 66% in R-miniCHOP and 65.7% in R2-miniCHOP arm, P = .98) in the overall population or in the non-GCB population. Grade 3-4 adverse events occurred in 53% of patients with R-miniCHOP and in 81% of patients with R2-miniCHOP. CONCLUSION The addition of lenalidomide to R-miniCHOP does not improve OS. Rituximab delivered subcutaneously was safe in this population.
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Affiliation(s)
- Lucie Oberic
- Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse, France
| | - Frederic Peyrade
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Mathieu Puyade
- Department of Oncology-Haematology and Cell Therapy, CHU, Poitiers, INSERM, Inserm CIC 1402, Poitiers, France
| | - Christophe Bonnet
- Clinical Hematology Unit, CHU Liège, Liège Université, Campus Universitaire de Sart Tilman, Liège, Belgique
| | - Peggy Dartigues-Cuillères
- Anapath Research Unit (EA) EA4340 and Pathology Laboratory, Versailles University and APHP, Ambroise Paré Hospital, Boulogne, France
| | - Bettina Fabiani
- Department of Pathology, Hopital Saint-Antoine, APHP, Paris, France
| | | | - Hervé Maisonneuve
- Department of Clinical Hematology, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Julie Abraham
- Department of Hematology, CHU Dupuytren, Limoges, France
| | - Catherine Thieblemont
- APHP, Hopital Saint-Louis, Hemato-oncologie; Université de Paris, Paris Diderot, Paris, France
| | - Pierre Feugier
- Department of Haematology, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre Les Nancy, France
| | - Gilles Salles
- Department of Hematology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Benite, France
| | - Fontanet Bijou
- Department of Hematology, Hospital Bergonié, Bordeaux, France
| | - Gian-Matteo Pica
- Department of Hematology, Centre Hospitalier Métropole Savoie, Chambery, France
| | - Gandhi Damaj
- Department of Hematology, CHU Caen, Caen, France
| | - Corinne Haioun
- Department of Hematology, Henri Mondor University Hospital, UPEC, Creteil, France
| | | | - Hassan Farhat
- Department of Hematology, Centre Hospitalier de Versailles André Mignot, Versailles, France
| | - Ronan Le Calloch
- Centre hospitalier de Quimper Cornouaille/Université de Bretagne Occidentale, France
| | | | - Sandra Malak
- Department of Hematology, CLCC Rene Huguenin Institut Curie, Saint-Cloud, France
| | - Jerome Paget
- LYSARC, The Lymphoma Academic Research Organisation, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Elodie Gat
- LYSARC, The Lymphoma Academic Research Organisation, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, University of Normandy, INSERM U1245, Rouen, France
| | - Fabrice Jardin
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, University of Normandy, INSERM U1245, Rouen, France
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Sprangers B, Van der Veen A, Hamaker ME, Rostoft S, Latcha S, Lichtman SM, de Moor B, Wildiers H. Initiation and termination of dialysis in older patients with advanced cancer: providing guidance in a complicated situation. THE LANCET. HEALTHY LONGEVITY 2021; 2:e42-e52. [DOI: 10.1016/s2666-7568(20)30060-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/09/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023] Open
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Fusco D, Ferrini A, Pasqualetti G, Giannotti C, Cesari M, Laudisio A, Ballestrero A, Scabini S, Odetti PR, Colloca GF, Monzani F, Nencioni A, Antonelli Incalzi R, Monacelli F. Comprehensive geriatric assessment in older adults with cancer: Recommendations by the Italian Society of Geriatrics and Gerontology (SIGG). Eur J Clin Invest 2021; 51:e13347. [PMID: 32648990 DOI: 10.1111/eci.13347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/19/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Optimizing the approach to older adults with cancer is now a priority given the increasing frequency of new cancer diagnoses that are made in the older population. The comprehensive geriatric assessment (CGA) represents the gold-standard for (1) defining prognosis and ability to withstand cancer treatments, (2) exploring the multiple aspects that define the complexity of frail older persons, and (3) designing person-tailored interventions. MATERIALS AND METHODS In this document, based on a comprehensive revision of the literature, the Italian Society for Geriatrics and Gerontology proposes a CGA model (ONCOGER CGA) to be adopted by oncology centers for their routine approach to older patients with cancer. RESULTS AND DISCUSSION A widespread use of this standardized CGA format will facilitate comparisons across institutions, promote studies based on a multidimensional patient assessment, and foster the inclusion of geriatric endpoints in oncological clinical trials. Furthermore, we predict that the use of a standardized CGA approach will increase the integration of geriatricians into oncology care teams with the final result of improving therapeutic choices and clinical outcomes.
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Affiliation(s)
- Domenico Fusco
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital 'Agostino Gemelli', Rome, Italy
| | | | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa4, Pisa PI, Italy
| | - Chiara Giannotti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alice Laudisio
- Geriatric Unit, Campus Bio-Medico University, Rome, Italy
| | - Alberto Ballestrero
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Patrizio R Odetti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe F Colloca
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital 'Agostino Gemelli', Rome, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa4, Pisa PI, Italy
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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22
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Quoix E, Audigier-Valette C, Lavolé A, Molinier O, Westeel V, Barlesi F, Le Treut J, Pichon E, Dauba J, Otto J, Moreau L, Madelaine J, Dumont P, Margery J, Debieuvre D, Renault PA, Pujol JL, Langlais A, Morin F, Moro-Sibilot D, Souquet PJ. Switch maintenance chemotherapy versus observation after carboplatin and weekly paclitaxel doublet chemotherapy in elderly patients with advanced non-small cell lung cancer: IFCT-1201 MODEL trial. Eur J Cancer 2020; 138:193-201. [PMID: 32898792 DOI: 10.1016/j.ejca.2020.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Maintenance chemotherapy is a reasonable choice for patients with metastatic non-small cell lung carcinoma (NSCLC) not progressing after induction therapy with a platinum-based doublet. Nevertheless, there have been no studies dedicated to elderly patients. PATIENTS AND METHODS We conducted a randomised trial in patients aged 70-89 years, with advanced NSCLC (with neither EGFR mutation nor ALK rearrangement), who had not progressed after four cycles of monthly carboplatin and weekly paclitaxel in order to compare maintenance with either pemetrexed (500 mg/m2 d1, 22) in patients with non-squamous cell carcinoma or gemcitabine (1,150 mg/m2 d1, 8, 22) in squamous cell carcinoma to simple observation. The patients were required to have a performance status (PS) 0-2, mini-mental score >23, and creatinine clearance ≥45 mL/min. The primary end-point was overall survival (OS). RESULTS 632 patients were enrolled from May 2013 to October 2016. Of the 328 (52.3%) patients randomised after induction therapy, 166 patients were assigned to the observation arm, versus 162 to the switch maintenance arm, 119 of whom received pemetrexed and 43 gemcitabine. The median OS from randomisation was 14.1 months (95% confidence interval [CI]: 12.0-17.0) in the observation arm and 14 months (95% CI: 10.9-16.9) in the maintenance arm (p = 0.72). The median progression-free survival (PFS) from randomisation was 2.7 months (95% CI: 2.6-3.1) in the observation arm versus 5.7 months (95% CI: 4.8-7.1) in the maintenance arm (p < 0.001). CONCLUSION Switch maintenance therapy significantly prolonged PFS but not OS and, thus, should not be proposed to elderly patients with advanced NSCLC.
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Affiliation(s)
- Elisabeth Quoix
- Department of Pneumology, University Hospital of Strasbourg, Strasbourg, France.
| | | | | | | | - Virginie Westeel
- Department of Pneumology, University Hospital of Besançon, Besançon, France
| | - Fabrice Barlesi
- Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Jacques Le Treut
- Department of Pneumology, Pays D'Aix Hospital, Aix-en-Provence, France
| | - Eric Pichon
- Department of Pneumology, University Hospital of Tours, Tours, France
| | - Jérôme Dauba
- Department of Medical Oncology, Hospital Layné, Mont-de-Marsan, France
| | | | - Lionel Moreau
- Department of Pneumology, Louis Pasteur Hospital, Colmar, France
| | - Jeannick Madelaine
- Department of Pneumology, University Hospital of Caen Normandie, Caen, France
| | - Patrick Dumont
- Department of Pneumology, Hospital of Chauny, Chauny, France
| | - Jacques Margery
- Department of Pneumology, Hôpital D'Instruction des Armées Percy, Clamart, France
| | - Didier Debieuvre
- Department of Pneumology, GHRMSA, Emile Miller Hospital, Mulhouse, France
| | | | - Jean-Louis Pujol
- Department of Thoracic Oncology, Montpellier Regional University Hospital, Montpellier, France
| | | | - Franck Morin
- Intergroupe Francophone de Cancérologie Thoracique, Paris, France
| | - Denis Moro-Sibilot
- Thoracic Oncology Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pierre-Jean Souquet
- Department of Pneumology and Thoracic Oncology, Hospital of Lyon Sud, Lyon, France
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23
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Berghmans T, Lievens Y, Aapro M, Baird AM, Beishon M, Calabrese F, Dégi C, Delgado Bolton RC, Gaga M, Lövey J, Luciani A, Pereira P, Prosch H, Saar M, Shackcloth M, Tabak-Houwaard G, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer. Lung Cancer 2020; 150:221-239. [PMID: 33227525 DOI: 10.1016/j.lungcan.2020.08.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Lung cancer is the leading cause of cancer mortality and has a wide variation in treatment and outcomes in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must only be carried out in lung cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Thierry Berghmans
- European Organisation for Research and Treatment of Cancer (EORTC); Thoracic Oncology Clinic, Institut Jules Bordet, Brussels, Belgium
| | - Yolande Lievens
- European Society for Radiotherapy and Oncology (ESTRO); Radiation Oncology Department, Ghent University Hospital, Belgium
| | - Matti Aapro
- European Cancer Organisation; Genolier Cancer Center, Genolier, Switzerland
| | - Anne-Marie Baird
- European Cancer Organisation Patient Advisory Committee; Central Pathology Laboratory, St James's Hospital, Dublin, Ireland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Fiorella Calabrese
- European Society of Pathology (ESP); Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR); University of La Rioja, Logroño, La Rioja, Spain
| | - Mina Gaga
- European Respiratory Society (ERS); 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Andrea Luciani
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Ospedale S. Paolo, Milan, Italy
| | - Philippe Pereira
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Kliniken, Heilbronn, Germany
| | - Helmut Prosch
- European Society of Radiology (ESR); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Marika Saar
- European Society of Oncology Pharmacy (ESOP); Tartu University Hospital, Tartu, Estonia
| | - Michael Shackcloth
- European Society of Surgical Oncology (ESSO); Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Philip Poortmans
- European Cancer Organisation; Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium
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24
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Shahrokni A, Vishnevsky BM, Jang B, Sarraf S, Alexander K, Kim SJ, Downey R, Afonso A, Korc-Grodzicki B. Geriatric Assessment, Not ASA Physical Status, Is Associated With 6-Month Postoperative Survival in Patients With Cancer Aged ≥75 Years. J Natl Compr Canc Netw 2020; 17:687-694. [PMID: 31200361 DOI: 10.6004/jnccn.2018.7277] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The American Society of Anesthesiologists physical status (ASA PS) classification system is the most common method of assessing preoperative functional status. Comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool for preoperative assessment of older adults. The goal of this study was to assess the correlation between ASA classification and CGA deficits among oncogeriatric patients and to determine the association of each with 6-month survival. PATIENTS AND METHODS Oncogeriatric patients (aged ≥75 years) who underwent preoperative CGA in an outpatient geriatric clinic at a single tertiary comprehensive cancer center were identified. All patients underwent surgery, with a hospital length of stay (LOS) ≥1 day and at least 6 months of follow-up. ASA classifications were obtained from preoperative anesthesiology notes. Preoperative CGA scores ranged from 0 to 13. Six-month survival was assessed using the Social Security Death Index. RESULTS In total, 81 of the 980 patients (8.3%) included in the study cohort died within 6 months of surgery. Most patients were classified as ASA PS III (85.4%). The mean number of CGA deficits for patients with PS II was 4.03, PS III was 5.15, and PS IV was 6.95 (P<.001). ASA classification was significantly associated with age, preoperative albumin level, hospital LOS, and 30-day intensive care unit (ICU) admissions. On multivariable analysis, 6-month mortality was associated with number of CGA deficits (odds ratio [OR], 1.14 per each unit increase in CGA score; P=.01), 30-day ICU admissions (OR, 2.77; P=.003), hospital LOS (OR, 1.03; P=.02), and preoperative albumin level (OR, 0.36; P=.004). ASA classification was not associated with 6-month mortality. CONCLUSIONS Number of CGA deficits was strongly associated with 6-month mortality; ASA classification was not. Preoperative CGA elicits critical information that can be used to enhance the prediction of postoperative outcomes among older patients with cancer.
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Affiliation(s)
- Armin Shahrokni
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brian Jang
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Saman Sarraf
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Koshy Alexander
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Soo Jung Kim
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Anoushka Afonso
- Department of Anesthesiology & Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Beatriz Korc-Grodzicki
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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25
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van Winden MEC, Garcovich S, Peris K, Colloca G, de Jong EMGJ, Hamaker ME, van de Kerkhof PCM, Lubeek SFK. Frailty screening in dermato-oncology practice: a modified Delphi study and a systematic review of the literature. J Eur Acad Dermatol Venereol 2020; 35:95-104. [PMID: 32403174 PMCID: PMC7818261 DOI: 10.1111/jdv.16607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
Abstract
Background Appropriate management and prevention of both under‐ and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato‐oncology care, since frailty is associated with adverse health outcomes. Objectives This study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato‐oncology practice and to select the best existing FST(s) for this purpose. Methods A modified two‐round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5‐point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure. Results Consensus was achieved on evaluation of comorbidities (4.3 ± 0.7), polypharmacy (4.0 ± 0.9) and cognition (4.1 ± 0.8). The FST should have appropriate measurement properties (4.0 ± 1.0), be quickly executed (4.2 ± 0.7), clinically relevant (4.3 ± 0.7), and both easily understandable (4.1 ± 1.2) and interpretable (4.3 ± 0.7). Of the 26 identified FSTs, four evaluated the content‐related domains: the Geriatric‐8 (G8), the modified Geriatric‐8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool. Of these, the G8 was the most extensively studied FST, with the best psychometric properties and execution within 5 min. Conclusions The G8 appears the most suitable FST for assessing frailty in older adults with skin cancer, although clinical studies assessing its use in a dermato‐oncology population are needed to further assess whether or not frailty in this particular patient group is associated with relevant outcomes (e.g. complications and mortality), as seen in previous studies in other medical fields.
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Affiliation(s)
- M E C van Winden
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Garcovich
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - K Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Colloca
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M E Hamaker
- Department of Geriatrics, Diakonessenhuis, Zeist, The Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S F K Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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26
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Pothuri B, Alvarez Secord A, Armstrong DK, Chan J, Fader AN, Huh W, Kesterson J, Liu JF, Moore K, Westin SN, Naumann RW. Anti-cancer therapy and clinical trial considerations for gynecologic oncology patients during the COVID-19 pandemic crisis. Gynecol Oncol 2020; 158:16-24. [PMID: 32386911 PMCID: PMC7177100 DOI: 10.1016/j.ygyno.2020.04.694] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has consumed considerable resources and has impacted the delivery of cancer care. Patients with cancer may have factors which place them at high risk for COVID 19 morbidity or mortality. Highly immunosuppressive chemotherapy regimens and possible exposure to COVID-19 during treatment may put patients at additional risk. The Society of Gynecologic Oncology convened an expert panel to address recommendations for best practices during this crisis to minimize risk to patients from deviations in cancer care and from COVID-19 morbidity. METHODS An expert panel convened to develop initial consensus guidelines regarding anti-neoplastic therapy during the COVID-19 pandemic with respect to gynecologic cancer care and clinical trials. RESULTS COVID-19 poses special risks to patients who are older, have medical co-morbidities, and cancer. In addition, this pandemic will likely strain resources, making delivery of cancer care or conduct of clinical trials unpredictable. Recommendations are to limit visits and contact with health care facilities by using telemedicine when appropriate, and choosing regimens which require less frequent visits and which are less immunosuppressive. Deviations will occur in clinical trials as a result of limited resources, and it is important to understand regulatory obligations to trial sponsors as well as to the IRB to ensure that clinical trial and patient safety oversight are maintained. CONCLUSIONS The ongoing crisis will strain resources needed to deliver cancer care. When alterations to the delivery of care are mandated, efforts should be taken to minimize risks and maximize safety while approximating standard practice.
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Affiliation(s)
- Bhavana Pothuri
- NYU Langone Health, Perlmutter Cancer Center, New York University School of Medicine, New York, NY, United States.
| | | | - Deborah K Armstrong
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - John Chan
- California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco, CA, United States
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Warner Huh
- University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Joyce F Liu
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Kathleen Moore
- University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Shannon N Westin
- University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - R Wendel Naumann
- Levine Cancer Center, Atrium Health, Charlotte, NC, United States
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27
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Biganzoli L, Cardoso F, Beishon M, Cameron D, Cataliotti L, Coles CE, Delgado Bolton RC, Trill MD, Erdem S, Fjell M, Geiss R, Goossens M, Kuhl C, Marotti L, Naredi P, Oberst S, Palussière J, Ponti A, Rosselli Del Turco M, Rubio IT, Sapino A, Senkus-Konefka E, Skelin M, Sousa B, Saarto T, Costa A, Poortmans P. The requirements of a specialist breast centre. Breast 2020; 51:65-84. [PMID: 32217457 PMCID: PMC7375681 DOI: 10.1016/j.breast.2020.02.003] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022] Open
Abstract
This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Laura Biganzoli
- European Society of Breast Cancer Specialists (EUSOMA); Breast Centre, AUSL Toscana Centro, Prato, Italy.
| | - Fatima Cardoso
- European Society of Medical Oncology (ESMO); Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal
| | | | - David Cameron
- European Cancer Concord (ECC); University of Edinburgh Cancer Centre, IGMM, Western General Hospital, Edinburgh, UK
| | - Luigi Cataliotti
- European Society of Breast Cancer Specialists (EUSOMA), Senonetwork Italia and Breast Centres Certification, Florence, Italy
| | - Charlotte E Coles
- European Society for Radiotherapy and Oncology (ESTRO); University of Cambridge, Cambridge, UK
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Maria Die Trill
- International Psycho-Oncology Society (IPOS); ATRIUM: Psycho-Oncology & Clinical Psychology, Madrid, Spain
| | - Sema Erdem
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); Europa Donna, Milan, Italy
| | - Maria Fjell
- European Oncology Nursing Society (EONS); Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Romain Geiss
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Hôpital René Huguenin - Institut Curie, St. Cloud, France
| | - Mathijs Goossens
- European Cancer League (ECL); Centre for Cancer Detection (CvKO), Brussels, Belgium
| | - Christiane Kuhl
- European Society of Radiology (ESR); Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - Lorenza Marotti
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | - Peter Naredi
- European Cancer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Oberst
- Organisation of European Cancer Institutes (OECI); Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Jean Palussière
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Department of Imaging, Institut Bergonié, Bordeaux, France
| | - Antonio Ponti
- European Society of Breast Cancer Specialists (EUSOMA), Centre for Epidemiology and Prevention in Oncology (CPO) Piemonte, AOU Citta' Della Salute e Della Scienza, Turin, Italy
| | | | - Isabel T Rubio
- European Society of Surgical Oncology (ESSO); Breast Surgical Oncology, Clinica Universidad de Navarra Madrid, Spain
| | - Anna Sapino
- European Society of Pathology (ESP); Department of Medical Sciences, University of Turin, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Elzbieta Senkus-Konefka
- European Organisation for Research and Treatment of Cancer (EORTC); Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Marko Skelin
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, General Hospital Sibenik, Sibenik, Croatia
| | - Berta Sousa
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, General Hospital Sibenik, Sibenik, Croatia
| | - Tiina Saarto
- Flims Alumni Club (FAC); Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal
| | | | - Philip Poortmans
- Iridium Kankernetwerk, University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Wilrijk-Antwerp, Belgium
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28
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Brausi M, Hoskin P, Andritsch E, Banks I, Beishon M, Boyle H, Colecchia M, Delgado-Bolton R, Höckel M, Leonard K, Lövey J, Maroto P, Mastris K, Medeiros R, Naredi P, Oyen R, de Reijke T, Selby P, Saarto T, Valdagni R, Costa A, Poortmans P. ECCO Essential Requirements for Quality Cancer Care: Prostate cancer. Crit Rev Oncol Hematol 2020; 148:102861. [PMID: 32151466 DOI: 10.1016/j.critrevonc.2019.102861] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND ECCO Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give oncology teams, patients, policymakers and managers an overview of essential care throughout the patient journey. PROSTATE CANCER Prostate cancer is the second most common male cancer and has a wide variation in outcomes in Europe. It has complex diagnosis and treatment challenges, and is a major healthcare burden. Care must only be a carried out in prostate/urology cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Maurizio Brausi
- European Association of Urology; Department of Urology, B. Ramazzini Hospital, Carpi-Modena, Italy
| | - Peter Hoskin
- European Society for Radiotherapy and Oncology (ESTRO); Mount Vernon Cancer Centre; University of Manchester, Manchester, United Kingdom
| | - Elisabeth Andritsch
- International Psycho-Oncology Society (IPOS); Clinical Department of Oncology, University Medical Centre of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ian Banks
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); European Men's Health Forum, Belgium
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Helen Boyle
- International Society of Geriatric Oncology (SIOG); Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | - Maurizio Colecchia
- European Society of Pathology (ESP); Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Delgado-Bolton
- European Association for Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Michael Höckel
- European Society of Oncology Pharmacy (ESOP); Kliniken Kassel, Gesundheit Nordhessen Holding, Kassel, Germany
| | - Kay Leonard
- European Oncology Nursing Society (EONS); Saint Luke's Radiation Oncology Centre, St James's Hospital, Dublin, Ireland
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Pablo Maroto
- European Organisation for Research and Treatment of Cancer (EORTC); Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ken Mastris
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); Europa Uomo
| | - Rui Medeiros
- Association of European Cancer Leagues (ECL); Portuguese Cancer League, Instituto Portugues de Oncologia, Porto, Portugal
| | - Peter Naredi
- European Cancer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Raymond Oyen
- European Society of Radiology (ESR); Department of Radiology, KU Leuven, Leuven, Belgium
| | - Theo de Reijke
- European Society of Surgical Oncology (ESSO); Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Selby
- European Cancer Concord (ECC); Leeds Institute of Cancer and Pathology, University of Leeds; St James' University Hospital, Leeds, United Kingdom
| | - Tiina Saarto
- European Association for Palliative Care (EAPC); Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Riccardo Valdagni
- European School of Oncology (ESO); Prostate Cancer Programme and Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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van Walree IC, Scheepers E, van Huis-Tanja L, Emmelot-Vonk MH, Bellera C, Soubeyran P, Hamaker ME. A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer. J Geriatr Oncol 2019; 10:847-858. [DOI: 10.1016/j.jgo.2019.04.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 12/13/2022]
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Banks I, Weller D, Ungan M, Selby P, Aapro M, Beishon M, Bolt M, Bonanno F, Champeix C, Dégi C, Eneqvist LJ, Kazmierska J, Kolacinska A, Malas S, Moine S, Pavlic DR, Price R, Walter F, Wyld L. ECCO Essential Requirements for Quality Cancer Care: Primary care. Crit Rev Oncol Hematol 2019; 142:187-199. [PMID: 31445441 DOI: 10.1016/j.critrevonc.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/03/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND ECCO Essential Requirements for Quality Cancer Care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to cancer patients. They are written by European experts representing all disciplines involved in cancer care. This paper concerns the integration of primary care into care for all cancers in Europe. Primary care integration.
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Affiliation(s)
- Ian Banks
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); European Men's Health Forum
| | - David Weller
- World Organization of Family Doctors (WONCA Europe); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mehmet Ungan
- World Organization of Family Doctors (WONCA Europe); Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Peter Selby
- European Cancer Concord (ECC); Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | - Matti Aapro
- European Cancer Organisation (ECCO); Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Marije Bolt
- Council of Occupational Therapists for European Countries (COTEC)
| | - Fiona Bonanno
- European Society of Oncology Pharmacy (ESOP); Sir Anthony Mamo Oncology Centre, Malta
| | | | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Lisa Jelf Eneqvist
- European Oncology Nursing Society (EONS); Regional Cancercenter Stockholm-Gotland, Sweden
| | - Joanna Kazmierska
- European Society of Radiotherapy and Oncology (ESTRO); Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland
| | - Agnieszka Kolacinska
- European Society of Surgical Oncology (ESSO); Department of Head and Neck Cancer Surgery and Surgical Oncology, Medical University of Lodz, Lodz, Poland
| | - Simon Malas
- Association of European Cancer Leagues (ECL); Oncology Clinic, Limassol General Hospital, Limassol, Cyprus
| | - Sébastien Moine
- European Association of Palliative Care (EAPC); Education and Health Practices Laboratory, University of Paris, France
| | | | | | - Fiona Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Lynda Wyld
- European Society of Breast Cancer Specialists (EUSOMA); Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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Kim JW, Kim SH, Lee YG, Hwang IG, Kim JY, Koh SJ, Ko YH, Shin SH, Woo IS, Hong S, Kim TY, Baek JY, Kim HJ, Kim HJ, Lee MA, Kwon JH, Hong YS, Ryoo HM, Lee KH, Kim JH. Prospective Validation of The Korean Cancer Study Group Geriatric Score (KG)-7, a Novel Geriatric Screening Tool, in Older Patients with Advanced Cancer Undergoing First-line Palliative Chemotherapy. Cancer Res Treat 2019; 51:1249-1256. [PMID: 30653746 PMCID: PMC6639235 DOI: 10.4143/crt.2018.451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/30/2018] [Indexed: 12/27/2022] Open
Abstract
Purpose The purpose of this study was to prospectively validate the Korean Cancer Study Group Geriatric Score (KG)-7, a novel geriatric screening tool, in older patients with advanced cancer planned to undergo first-line palliative chemotherapy. Materials and Methods Participants answered the KG-7 questionnaire before undergoing geriatric assessment (GA) and first-line palliative chemotherapy. The performance of KG-7 was evaluated by calculating the sensitivity (SE), specificity (SP), positive and negative predictive value (PPV and NPV), balanced accuracy (BA), and area under the curve (AUC). Results The baseline GA and KG-7 results were collected from 301 patients. The median age was 75 years (range, 70 to 93 years). Abnormal GA was documented in 222 patients (73.8%). Based on the ≤ 5 cut-off value of KG-7 for abnormal GA, abnormal KG-7 score was shown in 200 patients (66.4%). KG-7 showed SE, SP, PPV, NPV, and BA of 75.7%, 59.7%, 84.4%, 46.0%, and 67.7%, respectively; AUC was 0.745 (95% confidence interval, 0.687 to 0.803). Furthermore, patients with higher KG-7 scores showed significantly longer survival (p=0.006). Conclusion KG-7 appears to be adequate in identifying patients with abnormal GA prospectively. Hence, KG-7 can be a useful screening tool for Asian countries with limited resources and high patient volume.
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Affiliation(s)
- Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Gyu Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Young Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yoon Ho Ko
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - In Sook Woo
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soojung Hong
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeon Baek
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Myung Ah Lee
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hun-Mo Ryoo
- Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Kyung Hee Lee
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Russo C, Giannotti C, Signori A, Cea M, Murialdo R, Ballestrero A, Scabini S, Romairone E, Odetti P, Nencioni A, Monacelli F. Predictive values of two frailty screening tools in older patients with solid cancer: a comparison of SAOP2 and G8. Oncotarget 2018; 9:35056-35068. [PMID: 30416679 PMCID: PMC6205549 DOI: 10.18632/oncotarget.26147] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/01/2018] [Indexed: 12/27/2022] Open
Abstract
Objectives Comprehensive Geriatric Assessment (CGA), the gold standard for detecting frailty in elderly cancer patients, is time-consuming and hard to apply in routine clinical practice. Here we compared the performance of two screening tools for frailty, G8 and SAOP2 for their accuracy in identifying vulnerable patients. Material and Methods We tested G8 and SAOP2 in 282 patients aged 65 or older with a diagnosis of solid cancer and candidate to undergo surgical, medical and/or radiotherapy treatment. CGA, including functional and cognitive status, depression, nutrition, comorbidity, social status and quality of life was used as reference. ROC curves were used to compare two screening tools. Results Mean patient age was 79 years and 54% were female. Colorectal and breast cancer were the most common types cancer (49% and 24%). Impaired CGA, G8, and SAOP2 were found in 62%, 89%, and 94% of the patients, respectively. SAOP2 had a better sensitivity (AUC 0.85, p<0.032) than G8 (AUC 0.79), with higher performance in breast cancer patients (AUC 0.93) and in patients aged 70-80 years (AUC 0.87). Conclusions G8 and SAOP2 both showed good screening capacity for frailty in the cancer patient population we examined with SAOP2 showing a slightly better performance than G8.
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Affiliation(s)
- Chiara Russo
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Chiara Giannotti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Alessio Signori
- DISSAL, Section of Biostatistics, Department of Health Sciences, University of Genova, Genoa, Italy
| | - Michele Cea
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Roberto Murialdo
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Alberto Ballestrero
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Stefano Scabini
- Hospital Policlinic San Martino, Oncological Surgery and Implantable Systems, Genoa, Italy
| | - Emanuele Romairone
- Hospital Policlinic San Martino, Oncological Surgery and Implantable Systems, Genoa, Italy
| | - Patrizio Odetti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, Italy
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, Genoa, 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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Pease DF, Morrison VA. Treatment of mantle cell lymphoma in older adults. J Geriatr Oncol 2018; 9:308-314. [DOI: 10.1016/j.jgo.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/27/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
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Bron D, Soubeyran P, Fulop T. Innovative approach to older patients with malignant hemopathies. Haematologica 2018; 101:893-5. [PMID: 27478198 DOI: 10.3324/haematol.2016.142810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dominique Bron
- Department of Clinical and Experimental Hematology, Institut Jules Bordet (ULB), Brussels, Belgium
| | - Pierre Soubeyran
- Hematological Research Group, Bergonié Cancer Institut, Bordeaux, France
| | - Tamas Fulop
- Department Geriatry, Centre Hospitalier Universitaire du Sherbrooke, Quebec, Canada
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Allum W, Lordick F, Alsina M, Andritsch E, Ba-Ssalamah A, Beishon M, Braga M, Caballero C, Carneiro F, Cassinello F, Dekker JW, Delgado-Bolton R, Haustermans K, Henning G, Hutter B, Lövey J, Netíková IŠ, Obermannová R, Oberst S, Rostoft S, Saarto T, Seufferlein T, Sheth S, Wynter-Blyth V, Costa A, Naredi P. ECCO essential requirements for quality cancer care: Oesophageal and gastric cancer. Crit Rev Oncol Hematol 2018; 122:179-193. [PMID: 29458786 DOI: 10.1016/j.critrevonc.2017.12.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 12/31/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. OESOPHAGEAL AND GASTRIC ESSENTIAL REQUIREMENTS FOR QUALITY CARE: CONCLUSION: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality OG cancer service. The ERQCC expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary units or centres must be guaranteed for all those with OG cancer.
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Affiliation(s)
- William Allum
- European Society of Surgical Oncology (ESSO); Department of Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - Florian Lordick
- European Society for Medical Oncology (ESMO); University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Leipzig, Germany
| | - Maria Alsina
- Association of European Cancer Leagues (ECL); Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisabeth Andritsch
- International Psycho-Oncology Society (IPOS); Clinical Department of Oncology, University Medical Centre of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ahmed Ba-Ssalamah
- European Society of Radiology (ESR); Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | | | - Marco Braga
- European Society for Clinical Nutrition and Metabolism (ESPEN); Department of Surgery, San Raffaele University Hospital, Milan, Italy
| | - Carmela Caballero
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Fatima Carneiro
- European Society of Pathology (ESP); Faculty of Medicine of the University of Porto, Centro Hospitalar de São João and Ipatimup/i3S, Porto, Portugal
| | - Fernando Cassinello
- European Society of Anaesthesiology (ESA); Anaesthesia Department, Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Jan Willem Dekker
- European CanCer Organisation (ECCO) Oncopolicy Committee; Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Roberto Delgado-Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro University Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Karin Haustermans
- European Society for Radiotherapy and Oncology (ESTRO); Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Geoffrey Henning
- European CanCer Organisation (ECCO) Patient Advisory Committe, EuropaColon, Salisbury, UK
| | - Bettina Hutter
- European Society of Anaesthesiology (ESA); Anaesthesia Department, Hirslanden Clinic Zurich, Zurich, Switzerland
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Irena Štenglová Netíková
- European Society of Oncology Pharmacy (ESOP); Department of Clinical Pharmacology and Pharmacy, General Teaching Hospital, Prague, Czech Republic
| | - Radka Obermannová
- European Organisation for Research and Treatment of Cancer (EORTC); Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Simon Oberst
- Organisation of European Cancer Institutes (OECI); Cambridge Cancer Centre, Cambridge, UK
| | - Siri Rostoft
- International Society of Geriatric Oncology (SIOG); Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Tiina Saarto
- European Association for Palliative Care (EAPC); Comprehensive Cancer Center, Department of Palliative Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Thomas Seufferlein
- United European Gastroenterology (UEG); Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Sapna Sheth
- European CanCer Organisation, Brussels, Belgium
| | - Venetia Wynter-Blyth
- European Oncology Nursing Society (EONS); Imperial College Healthcare NHS Trust, London, UK
| | | | - Peter Naredi
- European CanCer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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[Geriatric assessment and prognostic scores in older cancer patient: Additional support to the therapeutic decision?]. Bull Cancer 2017; 104:946-955. [PMID: 29150094 DOI: 10.1016/j.bulcan.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/25/2017] [Accepted: 10/03/2017] [Indexed: 01/10/2023]
Abstract
Cancer is a disease of the elderly as demonstrated by the epidemiological evolution of Western countries. Indeed, two third of cancers newly diagnosed occur over 65 years. However, older cancer patients have been often excluded from clinical trials in oncology and the extrapolation of cancer treatments in this population remains difficult in practice. Scientific societies recommend that a comprehensive geriatric assessment (CGA) be performed in patients aged 70 and over and selected using screening tools for frailty such as the G8 index. The CGA allows to detect aging-related vulnerabilities in various domains (comorbidities, polypharmacy, autonomy, nutrition, mobility, cognition, mood, social) and associated with adverse outcomes during cancer treatment (reduced overall survival, perioperative complications, toxicity-related chemotherapy). The CGA is allow to elaborate a personalized treatment plan in geriatric oncology. However, to date, no algorithms based on CGA is validated to guide therapeutic decision in geriatric oncology. The collaboration between geriatrician and oncologist remains essential to elaborate an appropriate therapeutic strategy and limit the situations of over- and under-treatment. This article presents the set of tools and scores used in geriatric oncology to guide the therapeutic decision.
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Abstract
A growing majority of people with cancer is composed of older patients. For many such patients, independence and quality of life are as important as prolongation of survival, emphasizing the need for treatments that are not only effective but also well-tolerated. Given age-related decline in organ function and the prevalence of comorbidities and polypharmacy, optimum management is complex and requires collaboration between oncologists and geriatricians. Advances in surgery now include preoperative assessment and, when indicated, prehabilitation of the patient, as well as the enhanced recovery after surgery approach. Medical treatment is benefiting from the advent of highly effective novel immunomodulatory agents that join the tumor-targeted small molecule tyrosine kinase inhibitors and monoclonal antibodies in modifying the tolerability of therapy. Improved tolerability is evident with radiotherapy (RT). The adoption of stereotactic body RT in community oncology practice is increasing the proportion of elderly patients with comorbidities who can receive curative treatment. A further aspect of precision medicine as it relates to the older cancer patient is the tailoring of intervention to the robustness or frailty and life expectancy of the individual. Quantitative and validated tools for comprehensive geriatric assessment are playing an important role in this process.
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Maggiore R, Zumsteg ZS, BrintzenhofeSzoc K, Trevino KM, Gajra A, Korc-Grodzicki B, Epstein JB, Bond SM, Parker I, Kish JA, Murphy BA, VanderWalde NA. The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment. Int J Radiat Oncol Biol Phys 2017; 98:868-883. [PMID: 28602414 DOI: 10.1016/j.ijrobp.2017.02.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/23/2017] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
Older adults with head and neck squamous cell carcinoma (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced disease, for which combined-modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and a higher risk of functional impairments remains challenging and is exacerbated by the paucity of studies involving older adults. The purpose of this article is to identify knowledge gaps in the evaluation and management of older adults with HNSCC-particularly those undergoing concurrent chemoradiation therapy-and their caregivers through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with locoregionally advanced HNSCC. On the basis of our findings, we prioritize these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.
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Affiliation(s)
- Ronald Maggiore
- Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, New York
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Kelly M Trevino
- Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Ajeet Gajra
- Division of Hematology/Oncology, Department of Medicine, SUNY Upstate Medical University Cancer Center, Syracuse, New York
| | | | - Joel B Epstein
- Department of Oral Medicine and Diagnostic Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stewart M Bond
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Ira Parker
- University of California, San Diego School of Medicine, La Jolla, California
| | - Julie A Kish
- Division of Hematology/Oncology, Department of Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Barbara A Murphy
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Noam A VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Science Center-West Cancer Center, Memphis, Tennessee.
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Schulkes KJG, Souwer ETD, van Elden LJR, Codrington H, van der Sar-van der Brugge S, Lammers JWJ, Portielje JEA, van den Bos F, Hamaker ME. Prognostic Value of Geriatric 8 and Identification of Seniors at Risk for Hospitalized Patients Screening Tools for Patients With Lung Cancer. Clin Lung Cancer 2017; 18:660-666.e1. [PMID: 28320638 DOI: 10.1016/j.cllc.2017.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/08/2017] [Accepted: 02/21/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Because of the time-consuming aspect of geriatric assessments, cancer specialists are seeking shorter screening tools to distinguish fit and frail patients. We analyzed the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) in elderly patients with lung cancer. PATIENTS AND METHODS From January 2014 to April 2016, the data from patients with lung cancer aged > 70 years at 2 teaching hospitals in the Netherlands were included in a database. The patients were classified as potentially frail if they had a G8 of ≤ 14 or ISAR-HP of ≥ 2. RESULTS Of the 142 included patients (median age, 77 years; interquartile range, 73-82 years), 108 (76%) were potentially frail. After correction for possible confounders, the potentially frail patients had a significantly greater risk of 1-year mortality (hazard ratio [HR], 4.08; 95% confidence interval [CI] 1.67-9.99; P = .02). Higher disease stage (HR, 1.72; 95% CI, 1.40-2.12; P < .001) was also a significant predictor of mortality; however, initial treatment (standard or otherwise) and age were not. When using both screening instruments separately, an impaired score on the G8 and higher disease stage were the variables remaining in the regression analyses (HR for impaired G8, 3.01; 95% CI, 1.35-6.72; P < .001). Patients with impaired scores on the ISAR-HP and G8 had more geriatric impairments than did patients with only an impaired G8 score. CONCLUSION G8 screening is useful for the prognostication of elderly patients with lung cancer and could be used in combination with ISAR-HP to increase specificity at the cost of sensitivity. Using the ISAR-HP as the only screening tool would be insufficient.
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Affiliation(s)
- Karlijn J G Schulkes
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, Netherlands.
| | | | | | - Henk Codrington
- Department of Pulmonology, Haga Hospital, The Hague, Netherlands
| | | | - Jan-Willem J Lammers
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, Netherlands
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44
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Ip E, Pokorny AMJ, Della-Fiorentina S, Beale P, Bray V, Kiely BE, Blinman P. Use of palliative chemotherapy in patients aged 80 years and over with incurable cancer: experience at three Sydney cancer centres. Intern Med J 2016; 47:75-81. [PMID: 27749003 DOI: 10.1111/imj.13296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/23/2016] [Accepted: 10/11/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Octogenarians represent a growing population reviewed in medical oncology clinics, yet there is a paucity of data on how chemotherapy is tolerated in this age group. AIM To describe the use of palliative first-line chemotherapy in patients 80 years and over and factors associated with its use. METHODS We identified all new patients aged 80 years or older diagnosed with incurable advanced solid organ cancer and seen in one of three Sydney medical oncology outpatient clinics between January 2009 and December 2013. Patient, disease and treatment details were summarised and factors associated with chemotherapy use explored. RESULTS Of 420 eligible patients, 100 (24%) started first-line chemotherapy. Younger age at diagnosis was the only factor associated with receiving chemotherapy (median 82.9 vs 84.1 years, P = 0.002). A total of 78% of patients had single-agent chemotherapy, and 41% received a full dose for the first cycle. During treatment, 54% experienced toxicity, necessitating dose reduction, delay or omission, and 32% were hospitalised. These events were associated with receipt of combination chemotherapy (OR 5.1; P = 0.04) and full-dose chemotherapy for cycle 1 (OR 3.5; P = 0.02). Radiological disease control was achieved in 60%. Chemotherapy was stopped because of progressive disease (48%), toxicity (37%) or completion of planned course (17%). CONCLUSION A quarter of patients 80 years and older received first-line palliative chemotherapy. Despite most receiving a modified dose, one third were hospitalised during treatment. These findings highlight the need for careful clinical assessment and selection of older cancer patients for chemotherapy.
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Affiliation(s)
- E Ip
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - A M J Pokorny
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - S Della-Fiorentina
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - P Beale
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - V Bray
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - B E Kiely
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - P Blinman
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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