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Pille A, Meillat H, Braticevic C, Lelong B, Rousseau F, Cecile M, Tassy L. How to compensate for frailty? The real life impact of geriatric co-management on morbi-mortality after colorectal cancer surgery in patients aged 70 years or older. Aging Clin Exp Res 2024; 36:163. [PMID: 39117915 PMCID: PMC11310235 DOI: 10.1007/s40520-024-02752-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/02/2024] [Indexed: 08/10/2024]
Abstract
In Europe, CRC is the second most common cause of cancer death, and surgery remains the mainstay curative treatment. Age and frailty are associated with an increased risk of postoperative morbidity and 1-year mortality. Chronological age is not sufficient to assess the risk of postoperative complications. The CGA has been developed to better identify frail patients. Geriatric co-management have been developed to optimize the post-operative outcomes. We analyzed the real-life of geriatric co-management within an ERAS program on surgical outcomes at 90 days and oncologic outcomes at 1 year in patients aged 70 years or older after surgery for CRC. This was a retrospective study based on a prospective cohort. Fifty-one patients with a G8 score ≤ 14 were referred to geriatricians for preoperative CGA (Frail Group). They were compared with 151 patients with a G8 score ≥ 15 (Robust Group). In the Frail Group, patients were significantly older with more comorbidities than the patients in the Robust Group. Oncologic characteristics, treatments and global post-operative outcomes were comparable between the two groups. One year after surgery mortality and recurrence rates were similar between the two groups. Our study suggests that geriatric co-management is feasible and contributes to the reduction of postoperative morbimortality. Moreover, performing the CGA after G8 score screening and completion of geriatric interventions resulted in similar 90-day postoperative outcomes, in frail patients than in robust patients. Our results confirmed the benefit of geriatric co-management, involving G8 screening, CGA, and ERAS, for frail older patients undergoing surgery for CRC.
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Affiliation(s)
- A Pille
- Service d'Oncologie médicale, Institut Paoli-Calmettes, 232 bd Sainte Marguerite, Marseille, 13009, France.
| | - H Meillat
- Service de chirurgie oncologique digestive, Institut Paoli-Calmettes, Marseille, France
| | - C Braticevic
- Service d'Oncologie médicale, Institut Paoli-Calmettes, 232 bd Sainte Marguerite, Marseille, 13009, France
| | - B Lelong
- Service de chirurgie oncologique digestive, Institut Paoli-Calmettes, Marseille, France
| | - F Rousseau
- Service d'Oncologie médicale, Institut Paoli-Calmettes, 232 bd Sainte Marguerite, Marseille, 13009, France
| | - M Cecile
- Service d'Oncologie médicale, Institut Paoli-Calmettes, 232 bd Sainte Marguerite, Marseille, 13009, France
| | - L Tassy
- Service d'Oncologie médicale, Institut Paoli-Calmettes, 232 bd Sainte Marguerite, Marseille, 13009, France.
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Skorus-Zadęcka U, Miążek A, Zmysłowska N, Kupniewski K, Kenig J. Comorbidity assessment methods and their significance in predicting the results of treatment of older patients undergoing elective abdominal surgeries for cancer - A scoping review. Cancer Epidemiol 2024; 91:102597. [PMID: 38865796 DOI: 10.1016/j.canep.2024.102597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION The scoping review was performed to identify methods of comorbidity assessment and to evaluate their significance in predicting the results of treatment of older patients undergoing elective abdominal surgeries for cancer. MATERIALS AND METHODS Ovid MEDLINE, Embase, CENTRAL, Web of Science, ClinicalTrials.gov and European Trials Register were searched for eligible studies investigating the impact of comorbidity on various postoperative outcomes of patients aged ≥65. Findings were narratively reported. RESULTS The review identified 40 studies with a total population of 59,612 patients, using eight different methods of comorbidity assessment. The most used was Charlson Comorbidity Index (60 % of studies) and presence of specific comorbid conditions (38 %). No study provided rationale for the choice of specific comorbidity measure. Most of the included studies reported short-term results (75 %), such as postoperative complications (43 %) and mortality (18 %) as main clinical endpoint. The results were inconsistent across the studies. DISCUSSION There is still no consensus regarding the choice of comorbidity measures and their role in postoperative outcome prediction. Further efforts are needed to develop new, well-designed, more effective comorbidity assessments tools.
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Affiliation(s)
- Urszula Skorus-Zadęcka
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, Cracow 30-688, Poland.
| | - Apolonia Miążek
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, Cracow 30-688, Poland
| | - Natalia Zmysłowska
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, Cracow 30-688, Poland
| | - Kuba Kupniewski
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, Cracow 30-688, Poland
| | - Jakub Kenig
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, Cracow 30-688, Poland
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Winters AM, Bakker J, Ten Hoor J, Bilo HJG, Roodbol PF, Edens MA, Finnema EJ. Prognostic value of Geriatric-8 for adverse outcomes within 30 days of surgery in older adults with colorectal cancer: A retrospective cohort study. Eur J Oncol Nurs 2024; 70:102591. [PMID: 38652933 DOI: 10.1016/j.ejon.2024.102591] [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: 12/15/2023] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE It is unclear whether the Geriatric-8 (G8) has the accuracy to preselect patients for complete geriatric assessment, and has the ability to predict adverse outcomes in patients with colorectal cancer (CRC). We therefore aimed to determine whether the G8, or other variables present in the medical record, are applicable in predicting 30-day adverse outcomes in older patients undergoing surgery for CRC. METHODS We performed a retrospective cohort study involving patients ≥70 years who had surgery for CRC between 2018 and 2020 in a general hospital in the Netherlands. The primary outcome was adverse outcome(s), which is a composite of surgical and non-surgical complications, readmission and mortality, all within 30 days of surgery. The secondary endpoints were the individual components, such as delirium, infection and ileus. We explored potential prognostic factors using multivariable logistic regression analysis. Data were collected from the Dutch ColoRectal Audit (DRCA) and medical records. RESULTS The study included 200 patients (mean age 78.9 years: 50% female), with 36.5% having adverse outcomes in the first 30 days of surgery. In neither univariate nor multivariable analysis were G8 scores associated with adverse outcomes. Factors with higher odds of adverse outcomes were male gender, and having cognitive decline or previous delirium. CONCLUSION This study confirms that G8 scores have no prognostic value for adverse outcomes, complications and mortality within 30 days of surgery among older adults with CRC. Therefore, the G8 should not be the tool for short-term risk prediction of adverse outcomes in these patients.
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Affiliation(s)
- A M Winters
- Department of Internal Medicine/Geriatrics, Isala Hospital, Zwolle, the Netherland; Nursing Science, Department of Health Sciences, University Medical Center Groningen and University of Groningen, Groningen, the Netherland.
| | - J Bakker
- Department of Oncology, Isala Hospital, Zwolle, the Netherland
| | - J Ten Hoor
- Department of Pediatric Medicine, Zaans Medical Center, Zaandam, the Netherland
| | - H J G Bilo
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherland; Stichting Onderzoekcentrum Chronische Ziekten, Zwolle, the Netherland
| | - P F Roodbol
- Nursing Science, Department of Health Sciences, University Medical Center Groningen and University of Groningen, Groningen, the Netherland
| | - M A Edens
- Stichting Onderzoekcentrum Chronische Ziekten, Zwolle, the Netherland; Department of Innovation and Science, Epidemiology Unit, Isala Hospital, Zwolle, the Netherland
| | - E J Finnema
- Nursing Science, Department of Health Sciences, University Medical Center Groningen and University of Groningen, Groningen, the Netherland; Hanze University of Applied Sciences, Groningen, the Netherland; NHL Stenden University of Applied Sciences, Leeuwarden, the Netherland
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Yanagisawa T, Tatematsu N, Horiuchi M, Migitaka S, Yasuda S, Itatsu K, Kubota T, Sugiura H. Responsiveness and minimal clinically important difference of the 6-minute walk distance in patients undergoing colorectal cancer surgery. Support Care Cancer 2024; 32:382. [PMID: 38789578 DOI: 10.1007/s00520-024-08596-y] [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: 12/21/2023] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE This study aimed to clarify the responsiveness and minimal clinically important difference (MCID) of the 6-minute walk distance (6MWD) from before and 1 week after surgery in patients with colorectal cancer (CRC). METHODS This retrospective cohort study enrolled 97 patients with primary CRC scheduled for surgery. An anchor-based approach estimated the MCID of the 6MWD, with postoperative physical recovery and EuroQol 5-dimension 5L questionnaire assessments serving as anchors. Effect size (ES) and standardized response mean (SRM) of the 6MWD were calculated to evaluate responsiveness, and the receiver operating characteristic (ROC) curve was used to estimate the MCID of the 6MWD. RESULTS Of the 97 patients, 72 were included in the analysis. The absolute value of ES and SRM of the 6MWD were 0.69 and 0.91, respectively. The ROC curve indicated that the optimal cut-off values for estimating the MCID of the 6MWD were -60 m (area under the curve [AUC] = 0.753 [95% CI: 0.640-0.866]) and -75 m (AUC = 0.870 [95% CI: 0.779-0.961]) at each anchor. CONCLUSION From before to 1 week after surgery, the responsiveness of the 6MWD was favorable, and the MCID of the 6MWD was -75 to -60 m in patients with CRC.
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Affiliation(s)
- Takuya Yanagisawa
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan
| | - Noriatsu Tatematsu
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan.
| | - Mioko Horiuchi
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan
| | - Saki Migitaka
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan
| | - Shotaro Yasuda
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan
| | - Keita Itatsu
- Department of Surgery, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan
| | - Tomoyuki Kubota
- Department of Breast Surgery, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
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Xia SF, Liu Y, Chen Y, Li ZY, Cheng L, He JY, Hang L, Maitiniyazi G, Cheng XX, Sun SR, Gu DF. Association between dietary inflammatory potential and frailty is mediated by inflammation among patients with colorectal cancer: A cross-sectional study. Nutr Res 2024; 125:79-90. [PMID: 38552503 DOI: 10.1016/j.nutres.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 06/01/2024]
Abstract
Patients with colorectal cancer (CRC) are at high risk of frailty, leading to reduced quality of life and survival. Diet is associated with frailty in the elderly through regulating inflammation. Thus, we hypothesized that dietary inflammatory potential (as assessed by dietary inflammatory index [DII]) might be associated with frailty in patients with CRC through regulating inflammatory biomarkers. A total of 231 patients with CRC were included in this cross-sectional study. Dietary intake was evaluated by 3-day, 24-hour dietary recalls, and frailty status was assessed in accordance with the Fried frailty criteria. Plasma inflammatory cytokines were determined in 126 blood samples. A total of 67 patients (29.0%) were frail, with significantly higher DII scores than nonfrail patients, accompanied with significantly increased interleukin-6 (IL-6) and decreased interleukin-10 (IL-10) concentrations. Each 1-point increase of DII was related to a 25.0% increased risk of frailty. IL-6 was positively correlated with frailty and DII, whereas IL-10 was negatively correlated. After adjusting for age, sex, body mass index, education level, smoking status, and energy, mediation analysis revealed that the association between DII and frailty was significantly mediated by IL-6 (average causal mediation effect [ACME], 0.052; 95% confidence interval, 0.020-0.087; P = .002) and IL-10 (ACME, 0.025; 95% confidence interval, 0.004-0.063; P = .016). The ρ values for the sensitivity measure at which estimated ACMEs were zero were 0.3 and -0.2 for IL-6 and IL-10, respectively. Therefore, a pro-inflammatory diet was associated with frailty in patients with CRC possibly in part by affecting circulating IL-6 and IL-10 concentrations.
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Affiliation(s)
- Shu-Fang Xia
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Yuan Liu
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Yue Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Zi-Yuan Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Lan Cheng
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Jian-Yun He
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Ling Hang
- Department of Nursing, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | | | - Xin-Xin Cheng
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Shi-Ru Sun
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Dan-Feng Gu
- Department of Nursing, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China.
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Cauley CE, Samost-Williams A, Philpotts L, Brindle M, Cooper Z, Ritchie CS. Geriatric Assessment in Colorectal Surgery: A Systematic Review. J Surg Res 2024; 296:720-734. [PMID: 38367523 DOI: 10.1016/j.jss.2023.12.055] [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: 07/19/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The prevalence of colorectal surgery among older adults is expected to rise due to the aging population. Geriatric conditions (e.g., frailty) are risk factors for poor surgical outcomes. The goal of this systematic review is to examine how current literature describes geriatric assessment interventions in colorectal surgery and associated outcomes. METHODS Systematic searches of Ovid MEDLINE, Cochrane Library, CINAHL, Embase, and Web of Science were completed. Review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered in PROSPERO, the international prospective register of systematic reviews in health and social care. All cohort studies and randomized trials of adult colorectal surgery patients where geriatric assessment was performed were included. Geriatric assessment with/without management interventions were identified and described. RESULTS Seven-hundred ninety-three studies were identified. Duplicates (197) were removed. An additional 525 were excluded after title/abstract review. After full-text review, 20 studies met the criteria. Reference list review increased final total to 25 studies. All 25 studies were cohort studies. No randomized clinical trials were identified. Heterogeneous assessments were organized into geriatrics domains (mind, mobility, medications, matters most, and multi-complexity). Incomplete evaluations across geriatric domains were performed with few studies describing the use of assessments to impact management decisions. CONCLUSIONS There are no randomized trials assessing the impact of geriatric assessment to tailor management strategies and improve outcomes in colorectal surgery. Few studies performed assessments to evaluate the geriatric domain matters most. These findings represent a gap in evidence for the efficacy of geriatric assessment and management strategies in colorectal surgical care.
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Affiliation(s)
- Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts; Ariadne Labs, Brigham and Women's Hospital, Harvard. T.H. School of Public Health, Boston, Massachusetts.
| | - Aubrey Samost-Williams
- Ariadne Labs, Brigham and Women's Hospital, Harvard. T.H. School of Public Health, Boston, Massachusetts; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary Brindle
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Ariadne Labs, Brigham and Women's Hospital, Harvard. T.H. School of Public Health, Boston, Massachusetts
| | - Zara Cooper
- The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Marcus Institute for Aging Research, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine S Ritchie
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts; Division of Palliative Care & Geriatrics, Massachusetts General Hospital, Boston, Massachusetts
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Horiuchi K, Kuno T, Takagi H, Egorova NN, Afezolli D. Predictive value of the G8 screening tool for postoperative complications in older adults undergoing cancer surgery: A systematic review and meta-analysis. J Geriatr Oncol 2024; 15:101656. [PMID: 37940482 DOI: 10.1016/j.jgo.2023.101656] [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: 03/19/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Older adults with cancer who are being considered for cancer surgery are heterogenous, with variation in their physical, mental, and social baselines and risk of postoperative complications. Due in part to the complex nature of this population, the optimal preoperative evaluation method is not clearly defined. In this study we investigated whether geriatric-8 (G8), a screening tool for older patients with cancer that determines the need for a full geriatric assessment, is suitable for assessing the risk of postoperative complications in this population being considered for surgery. MATERIALS AND METHODS Studies that enrolled older patients undergoing cancer surgery and compared prevalence of postoperative complications in G8 "high" (≥15) patients and G8 "low" (<15) patients were identified using PubMed and EMBASE. A meta-analysis was conducted to calculate the risk ratio of postoperative complication rate. Postoperative mortality was systematically reviewed. RESULTS Eleven studies published between 2017 and 2022 were included in our analysis with a total of 2,691 older patients who underwent various types of cancer surgery and were characterized by their G8 scores: 1,255 G8 high (≥15) patients and 1,436 G8 low (<15) patients. G8 low patients had a significantly higher prevalence of postoperative complications than G8 high patients (risk ratio [95% confidence interval]: 1.56 [1.18-2.07], p = 0.002, I2 = 79%). DISCUSSION G8 can be an effective and efficient preoperative tool to assess risk of postoperative complications in older adults undergoing cancer surgery and identify potential need for further evaluation of an individual's risk with a comprehensive geriatric assessment.
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Affiliation(s)
- Kohei Horiuchi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizouka, Japan
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Debora Afezolli
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ju Y, Lin X, Zhang K, Yang D, Cao M, Jin H, Leng J. The role of comprehensive geriatric assessment in the identification of different nutritional status in geriatric patients: a real-world, cross-sectional study. Front Nutr 2024; 10:1166361. [PMID: 38260073 PMCID: PMC10800699 DOI: 10.3389/fnut.2023.1166361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Background Malnutrition is an often unrecognized problem, but it is common in older patients and leads to adverse outcomes. Aims The purpose of this study is to analyze the prevalence of the risk of undernutrition in elderly patients and the correlation between CGA and nutritional status, and to determine the nutritional status of elderly patients. Methods This is a real-world cross-sectional study of continuously enrolled elderly patients aged 65 years or older with a complete CGA database. CGA inventory was prepared by compiling and screening general information, body composition and blood biochemical results. MNA was also conducted for each elderly patient to screen for malnutrition. A multivariable logistic regression analysis was used to determine the association between the CGA and nutritional assessment. Result The average age of the 211 selected elderly patients (160 men and 51 women) was 79.60 ± 9.24 years, and their ages ranged from 65 to 96 years. After controlling for confounders, patients with a history of PUD (OR = 2.353, p = 0.044), increased ADLs & IADLs scores (OR = 1.051, p = 0.042) or GDS scores (OR = 6.078, p < 0.001) may increase the incidence of the risk of undernutrition respectively, while an increase in BMI (OR = 0.858, p = 0.032) may lower the incidence of malnutrition risk. In addition, increased ADLs & IADLs scores (OR = 1.096, p = 0.002) or GDS scores (OR = 11.228, p < 0.001) may increase the incidence of undernutrition. However, increased MMSE (OR = 0.705, p < 0.001), BMI (OR = 0.762, p = 0.034), UAC (OR = 0.765, p = 0.048) and CC (OR = 0.721, p = 0.003) may decrease the incidence of undernutrition, respectively. Conclusion The study found that the prevalence of risk of undernutrition in elderly patients was the highest. Risk of undernutrition was independently associated with peptic ulcer disease, ADLs & IADLs, GDS and BMI. However, we found that when the nutritional status reached the level of undernutrition, it was related to more factors, including ADLs & IADLs, MMSE, GDS, BMI, UAC and CC. Determining the level of malnutrition through CGA may help to prevent and intervene malnutrition as early as possible.
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Affiliation(s)
| | | | | | | | | | | | - Jiyan Leng
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, Jilin, China
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Ketelaers SHJ, Jacobs A, van der Linden CMJ, Nieuwenhuijzen GAP, Tolenaar JL, Rutten HJT, Burger JWA, Bloemen JG. An evaluation of postoperative outcomes and treatment changes after frailty screening and geriatric assessment and management in a cohort of older patients with colorectal cancer. J Geriatr Oncol 2023; 14:101647. [PMID: 37862736 DOI: 10.1016/j.jgo.2023.101647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 07/23/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Adequate patient selection is crucial within the treatment of older patients with colorectal cancer (CRC). While previous studies report increased morbidity and mortality in older patients screened positive for frailty, improvements in the perioperative care and postoperative outcomes have raised the question of whether older patients screened positive for frailty still face worse outcomes. This study aimed to investigate the postoperative outcomes of older patients with CRC screened positive for frailty, and to evaluate changes in treatment after frailty screening and geriatric assessment. MATERIALS AND METHODS Patients ≥70 years with primary CRC who underwent frailty screening between 1 January 2019 and 31 October 2021 were included. Frailty screening was performed by the Geriatric-8 (G8) screening tool. If the G8 indicated frailty (G8 ≤ 14), patients were referred for a comprehensive geriatric assessment (CGA). Postoperative outcomes and changes in treatment based on frailty screening and CGA were evaluated. RESULTS A total of 170 patients were included, of whom 74 (43.5%) screened positive for frailty (G8 ≤ 14). Based on the CGA, the initially proposed treatment plan was altered to a less intensive regimen in five (8.9%) patients, and to a more intensive regimen in one (1.8%) patient. Surgery was performed in 87.8% of patients with G8 ≤ 14 and 96.9% of patients with G8 > 14 (p = 0.03). Overall postoperative complications were similar between patients with G8 ≤ 14 and G8 > 14 (46.2% vs. 47.3%, p = 0.89). Postoperative delirium was observed in 7.7% of patients with G8 ≤ 14 and 1.1% of patients with G8 > 14 (p = 0.08). No differences in 30-day mortality (1.1% vs. 1.5%, p > 0.99) or one-year and two-year survival rates were observed (log rank, p = 0.26). DISCUSSION Although patients screened positive for frailty underwent CRC surgery less often, those considered eligible for surgery can safely undergo CRC resection within current clinical care pathways, without increased morbidity and mortality. Efforts to optimise perioperative care and minimise the risk of postoperative complications, in particular delirium, seem warranted. A multidisciplinary onco-geriatric pathway may support tailored decision-making in patients at risk of frailty.
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Affiliation(s)
- Stijn H J Ketelaers
- Department of Surgery, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands.
| | - Anne Jacobs
- Department of Gerontology and Geriatrics, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands
| | - Carolien M J van der Linden
- Department of Gerontology and Geriatrics, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands
| | | | - Jip L Tolenaar
- Department of Surgery, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands; Department of GROW, School for Oncology & Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Jacobus W A Burger
- Department of Surgery, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands
| | - Johanne G Bloemen
- Department of Surgery, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands
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Chen A, An E, Yan E, He D, Saripella A, Butris N, Tsang J, Englesakis M, Wong J, Alibhai S, Chung F. Incidence of preoperative instrumental activities of daily living (IADL) dependence and adverse outcomes in older surgical patients: A systematic review and meta-analysis. J Clin Anesth 2023; 89:111151. [PMID: 37210810 DOI: 10.1016/j.jclinane.2023.111151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
STUDY OBJECTIVE Instrumental activities of daily living (IADLs) are essential to patient function and quality of life after surgery. In older surgical patients, the incidence of preoperative IADL dependence has not been well characterized in the literature. This systematic review and meta-analysis aimed to determine the pooled incidence of preoperative IADL dependence and the associated adverse outcomes in the older surgical population. DESIGN Systematic review and meta-analysis. SETTING MEDLINE, MEDLINE Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations, Embase/Embase Classic, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews, ClinicalTrials.Gov, the WHO ICTRP (International Clinical Trials Registry Platform) were searched for relevant articles from 1969 to April 2022. PATIENTS Patients aged ≥60 years old undergoing surgery with preoperative IADL assessed by the Lawton IADL Scale. INTERVENTIONS Preoperative assessment. MEASUREMENT The primary outcome was the pooled incidence of preoperative IADL dependency. Additional outcomes included post-operative mortality, postoperative delirium [POD], functional status improvement, and discharge disposition. MAIN RESULTS Twenty-one studies (n = 5690) were included. In non-cardiac surgeries, the pooled incidence of preoperative IADL dependence was 37% (95% CI: 26.0%, 48.0%) among 2909 patients. Within cardiac surgeries, the pooled incidence of preoperative IADL dependence was 53% (95% CI: 24.0%, 82.0%) among 1074 patients. Preoperative IADL dependence was associated with an increased risk of postoperative delirium than those without IADL dependence (44.9% vs 24.4, OR 2.26; 95% CI: 1.42, 3.59; I2: 0%; P = 0.0005). CONCLUSIONS There is a high incidence of IADL dependence in older surgical patients undergoing non-cardiac and cardiac surgery. Preoperative IADL dependence was associated with a two-fold risk of postoperative delirium. Further work is needed to determine the feasibility of using the IADL scale preoperatively as a predictive tool for postoperative adverse outcomes.
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Affiliation(s)
- Alisia Chen
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ekaterina An
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ellene Yan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David He
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nina Butris
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jinny Tsang
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Shabbir Alibhai
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network and University of Toronto, Toronto, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Tokura Y, Kawai T, Takei K, Ujiie T, Kanatani A, Yamada Y, Kaneko T, Kamai T, Nakagawa T. Geriatric 8 and Vulnerable Elders Survey-13 predict length of hospital stay and postoperative complications in Japanese patients undergoing urological surgery. J Geriatr Oncol 2023; 14:101558. [PMID: 37327760 DOI: 10.1016/j.jgo.2023.101558] [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: 02/11/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The Geriatric 8 (G8) and Vulnerable Elders Survey-13 (VES-13) are established screening tools for assessing vulnerability in older patients. Here we investigated their usefulness as predictors of length of hospital stay and postoperative complications in Japanese patients undergoing urological surgery. MATERIALS AND METHODS This study included 643 patients who underwent urological surgery (74% were for malignancy) at our institute from 2017 to 2020. G8 and VES-13 scores were routinely recorded upon admission. These indices and other clinical data were obtained through chart review. The correlation between G8 group (high, >14; intermediate, 11-14; low, <11) or VES-13 group (normal, <3; high, ≥3) and length of total hospital stay (LOS), postoperative hospital stay (pLOS), and postoperative complications including delirium were analyzed. RESULTS The median patient age was 69 years. A total of 44%, 45%, and 11% of patients were classified into high, intermediate, and low G8 groups, respectively, while 77% and 23% were classified into normal and high VES-13 groups, respectively. Univariate analyses revealed that low G8 scores were associated with prolonged LOS (vs. intermediate, odds ratio [OR] 2.87, P < 0.001; vs. high, OR 3.87, P < 0.001), prolonged pLOS (vs. intermediate, OR 2.37, P = 0.005; vs. high, OR 3.06, P < 0.001), and delirium (vs. intermediate, OR 3.23, P = 0.007; vs. high, OR 5.38, P < 0.001), and high VES-13 scores were associated with prolonged LOS (OR 2.85, P < 0.001), prolonged pLOS (OR 2.97, P < 0.001), and Clavien-Dindo grade ≥ 2 complications (OR 1.74, P = 0.044), and delirium (OR 3.18, P = 0.001). Furthermore, multivariate analyses revealed that low G8 and high VES-13 scores were independent factors which predicted prolonged LOS (low G8; vs. intermediate, OR 2.96, P < 0.001; vs. high, OR 3.94, P < 0.001; high VES-13; OR 2.98, P < 0.001) and prolonged pLOS (low G8; vs. intermediate, OR 2.41, P = 0.008; vs. high, OR 3.18, P = 0.002; high VES-13; OR 3.47, P < 0.001), respectively. DISCUSSION The G8 and VES-13 may be effective tools for predicting prolonged LOS/pLOS and postoperative complications in Japanese patients who undergo urological surgery.
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Affiliation(s)
- Yuumi Tokura
- Department of Urology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan; Department of Urology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
| | - Taketo Kawai
- Department of Urology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Kazuki Takei
- Department of Urology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Takashi Ujiie
- Department of Urology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Atsushi Kanatani
- Department of Urology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan; Department of Urology, Tsujinaka Hospital Kashiwanoha, 148-6 Kashiwanoha Campus, 178-2 Wakashiba Kashiwa-city, Chiba 277-0871, Japan
| | - Yukio Yamada
- Department of Urology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan; Department of Urology, Musashino Red Cross Hospital, 1-26-1 Sakaiminami-cho, Musashino-shi, Tokyo 180-8610, Japan
| | - Tomoyuki Kaneko
- Department of Urology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Takao Kamai
- Department of Urology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
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12
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Taffurelli G, Montroni I, Ghignone F, Zattoni D, Garutti A, Di Candido F, Mazzotti F, Frascaroli G, Tamberi S, Ugolini G. Frailty assessment can predict textbook outcomes in senior adults after minimally invasive colorectal cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:626-632. [PMID: 36396488 DOI: 10.1016/j.ejso.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/21/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
AIM Colorectal cancer (CRC) surgery can be associated with suboptimal outcomes in older patients. The aim was to identify the correlation between frailty and surgical variables with the achievement of Textbook Outcome (TO), a composite measure of the ideal postoperative course, by older patients with CRC. METHOD All consecutive patients ≥70years who underwent elective CRC-surgery between January 2017 and November 2021 were analyzed from a prospective database. To obtain a TO, all the following must be achieved: 90-day survival, Clavien-Dindo (CD) < 3, no reintervention, no readmission, no discharge to rehabilitation facility, no changes in the living situation and length of stay (LOS) ≤5days/≤14days for colon and rectal surgery respectively. Frailty and surgical variables were related to the achievement of TO. RESULTS Four-hundred-twenty-one consecutive patients had surgery (97.7% minimally invasive), 24.9% for rectal cancer, median age 80 years (range 70-92), median LOS of 4 days (range 1-96). Overall, 288/421 patients (68.4%) achieved a TO. CD 3-4 complications rate was 6.4%, 90-day mortality rate was 2.9%. At univariate analysis, frailty and surgical variables (ileostomy creation, p = 0.045) were related to. However, multivariate analysis showed that only frailty measures such as flemish Triage Risk Screening Tool≥2 (OR 1.97, 95%CI: 1.23-3.16; p = 0.005); Charlson Index>6 (OR 1.61, 95%CI: 1.03-2.51; p = 0.036) or Timed-Up-and-Go>20 s (OR 2.06, 95%CI: 1.01-4.19; p = 0.048) independently predicted an increased risk of not achieving a TO. CONCLUSION The association between frailty and comprehensive surgical outcomes offers objective data for guiding family counseling, managing expectations and discussing the possible loss of independence with patients and caregivers.
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Affiliation(s)
- Giovanni Taffurelli
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy.
| | - Isacco Montroni
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Federico Ghignone
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Davide Zattoni
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Anna Garutti
- Department of Medical Oncology, Ospedale per gli Infermi, Faenza, AUSL Romagna, Italy
| | - Francesca Di Candido
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Federico Mazzotti
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Giacomo Frascaroli
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy
| | - Stefano Tamberi
- Department of Medical Oncology, Ospedale per gli Infermi, Faenza, AUSL Romagna, Italy
| | - Giampaolo Ugolini
- Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy; University of Bologna, Italy
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13
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Ju Y, Liu T, Zhang K, Lin X, Zheng E, Leng J. The relationship between Comprehensive Geriatric Assessment parameters and depression in elderly patients. Front Aging Neurosci 2022; 14:936024. [PMID: 35959294 PMCID: PMC9360413 DOI: 10.3389/fnagi.2022.936024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background Depression is common and serious among elderly patients. The treatment of elderly depression is often delayed owing to insufficient diagnosis, which eventually leads to adverse consequences. Aims To explore the association between the parameters of the Comprehensive Geriatric Assessment and depression in elderly patients. Methods A cross-sectional study of 211 outpatients and inpatients aged ≥ 65 years from the Comprehensive Geriatric Assessment database was conducted. A Comprehensive Geriatric Assessment inventory was prepared by compiling and screening general characteristics, chronic diseases (cardiovascular disease, diabetes, and peptic ulcer disease), nutritional status, daily living ability, anthropometric measurements (body mass index (BMI), upper arm circumference, and calf circumference), and blood biochemical indicators (hemoglobin, albumin, prealbumin, triglycerides, and low-density lipoprotein cholesterol). The Geriatric Depression Scale was also conducted for each elderly patient to screen for depression. A multivariable logistic regression analysis was used to determine the association between the parameters of the Comprehensive Geriatric Assessment and geriatric depression. Results There were 63 patients in the depression group with a median age of 84.00 years, and 148 patients in the non-depression group with a median age of 78.50 years. After controlling for confounders, the risk of depression in elderly patients with cardiovascular diseases was 6.011 times higher than that in those without cardiovascular diseases (p < 0.001); and the risk of depression in elderly patients with peptic ulcer diseases was 4.352 times higher than that in those without peptic ulcer diseases (p < 0.001); the risk of depression in elderly patients decreased by 22.6% for each 1-point increase in the Mini Nutritional Assessment (p < 0.001). The risk of depression in elderly patients decreased by 19.9% for each 1-point increase in calf circumference (p = 0.002), and by 13.0% for each 1-point increase in albumin (p = 0.014). Conclusion Our findings suggest that Comprehensive Geriatric Assessment parameters, such as cardiovascular disease, peptic ulcer disease, Mini Nutritional Assessment score, calf circumference, and albumin, were associated with depression. The Comprehensive Geriatric Assessment can assist in the early identification of depression in the elderly population.
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14
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Mima K, Nakagawa S, Miyata T, Yamashita Y, Baba H. Frailty and surgical outcomes in gastrointestinal cancer: Integration of geriatric assessment and prehabilitation into surgical practice for vulnerable patients. Ann Gastroenterol Surg 2022; 7:27-41. [PMID: 36643358 PMCID: PMC9831909 DOI: 10.1002/ags3.12601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/27/2022] [Indexed: 01/18/2023] Open
Abstract
As life expectancy increases, the older population continues to grow rapidly, resulting in increased requirement for surgery for older patients with gastrointestinal cancer. Older individuals represent a heterogeneous group in terms of physiological reserves, co-morbidity, cognitive impairment, and disability. Owing to the lack of treatment guidelines for vulnerable patients with gastrointestinal cancer, these patients are more likely to be at risk of undertreatment or overtreatment. Hence, the identification of frail patients with gastrointestinal cancer would improve cancer treatment outcomes. Although there is no standardized geriatric assessment tool, a growing body of research has shown associations of frailty with adverse postoperative outcomes and poor prognosis after resection of gastrointestinal tract and hepatobiliary-pancreatic cancers. Emerging evidence suggests that prehabilitation, which includes exercise and nutritional support, can improve preoperative functional capacity, postoperative recovery, and surgical outcomes, particularly in frail patients with gastrointestinal cancer. We reviewed major geriatric assessment tools for identification of frail patients and summarized clinical studies on frailty and surgical outcomes, as well as prehabilitation or rehabilitation in gastrointestinal tract and hepatobiliary-pancreatic cancers. The integration of preoperative geriatric assessment and prehabilitation of frail patients in clinical practice may improve surgical outcomes. In addition, improving preoperative vulnerability and preventing functional decline after surgery is important in providing favorable long-term survival in patients with gastrointestinal cancer. Further clinical trials are needed to examine the effects of minimally invasive surgery, and chemotherapy in frail patients with gastrointestinal cancer.
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Affiliation(s)
- Kosuke Mima
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Tatsunori Miyata
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yo‐ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
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15
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Tamura K, Matsuda K, Fujita Y, Sakaguchi S, Kinoshita H, Yamade N, Hotta T, Iwamoto H, Mizumoto Y, Yamaue H. What is related to postoperative outcome of frail status in elective colorectal cancer surgery? Surg Open Sci 2022; 8:69-74. [PMID: 35463847 PMCID: PMC9027309 DOI: 10.1016/j.sopen.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 11/27/2022] Open
Abstract
Background The population affected by colorectal cancer is growing, and there is an increasing need for prevention of functional decline following treatment. We proposed that the Kihon Checklist published by the Japanese Ministry of Health, Labor, and Welfare would be an appropriate means of frailty assessment for prediction of postoperative complications in older patients with colorectal cancer. This prospective cohort study aims to identify the factors influencing postoperative frailty. Methods We prospectively enrolled consecutive patients with colorectal cancer and aged ≥ 65 year (N = 500) between May 2017 and December 2018. Eligible patients were assessed with the Kihon Checklist prior to surgery and 30 days after surgery. The main measures were variables related to postoperative change in view of frail status. Results According to the Kihon Checklist questionnaire, 164 patients were frail preoperatively and 172 patients were frail postoperatively, whereas 38 patients changed from "nonfrail" before surgery to postoperative "frail." Overall complications were counted in 97 patients (19.4%), and 5 patients died. Performance status ≥ 2, history of laparotomy, open surgery, complication, ostomy creation, and delirium were significantly associated with changing postoperative "frail" (P = .014, P = .023, P = .006, P < .001, P = .023, and P = .024, respectively). In multivariate analysis, independent related factors of changing postoperative "frail" were complication (odds ratio 2.69, 95% confidence interval 1.19–6.09, P = .018) and ostomy creation (odds ratio 2.32, 95% confidence interval 1.01–5.33, P = .047). Conclusion The Kihon Checklist questionnaire could identify the factors related to postoperative change of frailty status in older patients with colorectal cancer. This cohort concluded that whether postoperative complication occurred or not was closely associated with perioperative change of frailty status. Our prospective cohort study examined the factor influencing postoperative frailty in older patients with colorectal cancer by Kihon Checklist questionnaire. The importance of this study is that postoperative complication and ostomy creation were significantly associated with postoperative change of frailty status.
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16
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Penning Y, El Asmar A, Moreau M, Raspé J, Dal Lago L, Pepersack T, Donckier V, Liberale G. Evaluation of the Comprehensive Geriatric Assessment (CGA) tool as a predictor of postoperative complications following major oncological abdominal surgery in geriatric patients. PLoS One 2022; 17:e0264790. [PMID: 35239731 PMCID: PMC8893608 DOI: 10.1371/journal.pone.0264790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction The concept of frailty extends beyond chronological age. Identifying frailty using a two-step approach, starting with the use of a screening tool (G8) followed by comprehensive geriatric assessment (CGA), may be useful in guiding treatment decisions and follow-up. This study evaluated the association between G8 and CGA, and the risk of 90-day postoperative complications risk, in oncogeriatric patients. Methods Data on geriatric patients with major oncological abdominal surgery was retrospectively collected from our hospital records between 2016 and 2019. Patients with an impaired G8 screening score, who subsequently underwent CGA geriatric screening, were included. Postoperative complications were classified using the Clavien-Dindo classification (CD), and the Comprehensive Complication Index (CCI). The association between the individual components of the geriatric assessment tools and the 90-day postoperative complications risk was analyzed. Results One hundred and twelve patients, aged ≥ 70 years, operated for an intra-abdominal tumor with curative intent, were included. Seventy-six patients (67.9%) presented with an impaired G8, out of whom sixty-six (58.9%) had a CGA performed. On univariate analysis, altered nutritional status assessed by the Mini-Nutritional Assessment-Short Form was the only variable associated with higher postoperative total complication rate (p = 0.01). Patients with an impaired G8 had significantly more postoperative complications and higher 1-year mortality rates than patients with normal G8. Fifteen patients (13.4%) had grade III-IVb complications. A CCI > 50 was recorded in 16 patients (14.3%). All-cause 90-day postoperative mortality was 10.7%. Conclusion Identifying an altered preoperative nutritional status, as part of the CGA, in patients screening positive for frailty, is a potentially modifiable risk factor that can enhance preoperative management and optimize treatment decision making. G8 may be a predictive factor for postoperative complications in oncogeriatric patients.
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Affiliation(s)
- Yoon Penning
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Antoine El Asmar
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
- * E-mail:
| | - Michel Moreau
- Data Centre and Statistics Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Julie Raspé
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lissandra Dal Lago
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Pepersack
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Vincent Donckier
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Cooper L, Dezube AR, De León LE, Fox S, Bravo-Iñiguez CE, Mazzola E, Tarascio J, Cardin K, DuMontier C, Jaklitsch MT, Frain LN. Polypharmacy and frailty in older adults evaluated at a multidisciplinary geriatric-thoracic clinic prior to surgery. J Geriatr Oncol 2022; 13:249-252. [PMID: 34366275 PMCID: PMC9169667 DOI: 10.1016/j.jgo.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Lisa Cooper
- Division of Aging, Brigham and Women's Hospital, Boston, MA, United States of America.
| | - Aaron R. Dezube
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Luis E. De León
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Sam Fox
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Carlos E. Bravo-Iñiguez
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Jeffrey Tarascio
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Kristin Cardin
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Clark DuMontier
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, United States of America,New England GRECC, VA Boston Healthcare System, Boston, MA, United States of America
| | - Michael T. Jaklitsch
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Laura N. Frain
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, United States of America
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18
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Inoue D, Yamamoto M, Arima H, Tamura K, Yoshida Y. A nationwide web-based survey of oncologic surgeons to clarify the current status of preoperative assessment for elderly cancer surgery patients in Japan. Sci Rep 2021; 11:22789. [PMID: 34815510 PMCID: PMC8611021 DOI: 10.1038/s41598-021-02319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022] Open
Abstract
Elderly cancer patients requiring surgical treatment are increasing, and the deterioration of quality of life and shortening of healthy life expectancy due to postoperative complications represent major problems. This study investigated the current status of medical treatment, including perioperative evaluations, for elderly cancer patients requiring surgical treatment at cancer treatment facilities nationwide. A total of 436 cancer care facilities around Japan were invited to participate in this web-based survey regarding management of cancer patients ≥ 65 years old who had undergone surgical treatment in 2018. A total of 919 department heads from 245 facilities agreed to participate. Although most respondents answered that performance status, preoperative examinations, and comorbidities were important when deciding on a treatment plan, age, Geriatric Assessment (GA), and guidelines were "not important" for > 10% of all respondents. GA was familiar to 195 department heads (21%), and awareness of GA was significantly lower among respondents from medical education institutions than the other types of hospitals (18.5% vs 26.3%; P = 0.006). This large survey revealed that the use of GA is not widespread, and its awareness in medical education institutions remains low. We believe that accumulating evidence of geriatric oncology surgery is an urgent issue in Japan.
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Affiliation(s)
- Daisuke Inoue
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Makoto Yamamoto
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, 7-45-1 Nanakuma, Jhonan-ku, Fukuoka, Fukuoka, Japan
| | - Kazuo Tamura
- Emeritus Professor, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jhonan-ku, Fukuoka, Fukuoka, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
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Chen LJ, Trares K, Laetsch DC, Nguyen TNM, Brenner H, Schöttker B. Systematic Review and Meta-Analysis on the Associations of Polypharmacy and Potentially Inappropriate Medication With Adverse Outcomes in Older Cancer Patients. J Gerontol A Biol Sci Med Sci 2021; 76:1044-1052. [PMID: 32459845 DOI: 10.1093/gerona/glaa128] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Both polypharmacy and potentially inappropriate medication (PIM) intake are highly prevailing in older cancer patients. However, only studies on the association of polypharmacy and postoperative complications have been meta-analyzed previously. METHODS A systematic review and a meta-analysis of prospective/retrospective observational studies reporting associations of polypharmacy or PIM with at least one out of five predefined adverse health outcomes in a population of older cancer patients (≥60 years) were carried out. PubMed and Web of Science were used to search for relevant studies published between January 1991 and March 2020. Data were pooled by adopting a random-effects model. RESULTS Overall, 42 publications were included in the systematic review. Meta-analyses could be performed on 39 studies about polypharmacy and 13 studies about PIM. Polypharmacy was found to be statistically significantly associated with all-cause mortality (risk ratio [95% confidence interval]: 1.37 [1.25-1.50]), hospitalization (1.53 [1.37-1.71]), treatment-related toxicity (1.22 [1.01-1.47]), and postoperative complications (1.73 [1.36-2.20]). The association of polypharmacy with prolongation of hospitalization was not statistically significant at the p < .05 significance level (1.62 [0.98-2.66]). With respect to PIM, a statistically significant association with all-cause mortality (1.43 [1.08-1.88]) was observed but not with other adverse outcomes. CONCLUSIONS Polypharmacy was found to be associated with several adverse outcomes and PIM use with all-cause mortality in older cancer patients. However, these results should be interpreted with caution because about three-quarters of the studies identified did not adjust for comorbidity and are prone to confounding by indication.
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Affiliation(s)
- Li-Ju Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Germany
| | - Kira Trares
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Germany
| | - Dana Clarissa Laetsch
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thi Ngoc Mai Nguyen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Germany
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20
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Chen LJ, Nguyen TNM, Chang-Claude J, Hoffmeister M, Brenner H, Schöttker B. Association of Polypharmacy with Colorectal Cancer Survival Among Older Patients. Oncologist 2021; 26:e2170-e2180. [PMID: 34476870 PMCID: PMC8649018 DOI: 10.1002/onco.13961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/10/2021] [Indexed: 12/31/2022] Open
Abstract
Background In geriatric oncology, polypharmacy is often assessed during a comprehensive geriatric assessment. Previous studies about its association with survival among patients with colorectal cancer (CRC) were inconclusive and had high risk for indication bias. Patients and Methods A cohort study was conducted with 3,239 patients with CRC, aged ≥65 years, who were recruited in Germany between 2003 and 2016, while being hospitalized for CRC surgery. We defined polypharmacy as the concurrent use of five or more drugs, and excessive polypharmacy (EPP) as concurrent use of eight or more drugs. Cox proportional hazards regression models were performed to assess the associations of polypharmacy with 5‐year overall (OS), CRC‐specific (CSS), and non‐cancer‐specific survival (NCS) with rigorous adjustment for morbidity to minimize indication bias (e.g., for cancer stage, functional status, and 13 common diseases/conditions). Results The prevalence of polypharmacy was 54.7% and that of EPP was 24.2%. During up to 5 years of follow‐up, 1,070 participants died, among whom 615 died of CRC and 296 died of other causes than cancer. EPP was statistically significantly associated with poorer up‐to‐5‐year OS (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.02–1.47) and CSS (HR, 1.31; 95% CI, 1.03–1.68). HR point estimate for NCS was higher than 1 (1.22) but not statistically significant. Conclusion Polypharmacy was very common and EPP was a weak risk factor for mortality in this large cohort of older patients with CRC. Clinical trials are needed to address the causality of this relationship because older patients with CRC might benefit from deprescribing drugs without an indication. Implications for Practice The results of this study support the hypothesis that excessive polypharmacy, defined as use of eight or more concurrently used active substances, has a negative impact on the prognosis of older patients with colorectal cancer (CRC). This study suggests to oncologists that performing a medication review for older patients with CRC with eight drugs or more is indicated (especially when a broader comprehensive geriatric assessment is being performed). Such a medication review should not only focus on reducing the number of medications (by deprescribing drugs without an indication) but also check the appropriateness of indicated drugs for older patients with cancer. Excessive polypharmacy, defined as the concurrent use of eight or more drugs, is becoming more common, especially in the older population. This article evaluates the association of polypharmacy with overall survival in large cohort patients with colorectal cancer.
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Affiliation(s)
- Li-Ju Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Thi Ngoc Mai Nguyen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.,Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
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21
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Couderc AL, Suchon P, Saliba-Serre B, Rey D, Nouguerede E, Arcani R, Farnault L, Daumas A, Courcier A, Duffaud F, Salas S, Barlesi F, Greillier L, Costello R, Venton G, Villani P. Functional status in older patients with cancer. J Geriatr Oncol 2021; 13:40-45. [PMID: 34330668 DOI: 10.1016/j.jgo.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/22/2021] [Accepted: 07/22/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Functional Status (FS) is an important domain in Comprehensive Geriatric Assessment (CGA) and is most often evaluated using the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales separately. METHOD AND OBJECTIVES This secondary analysis of a previous prospective cohort study was conducted between September 2015 and May 2018 at Marseille University Hospital, France, on 613 cancer outpatients aged ≥70 years. The first objective of this study was to determine the prevalence of FS impairment in older outpatients with cancer using a combination of the information collected with the ADL and short IADL scales. Our second objective was to describe the potential impact of this combined FS on three-month unplanned hospitalizations and three-month mortality in this population. RESULTS The median age was 81 years and 61.2% were men. The most common types of tumours were lung and thoracic (22.3%). Concerning FS, 255 patients (41.6%) had unimpaired ADL-IADL, 131 patients (21.4%) had IADL impairment, 38 patients (6.2%) had ADL impairment, and 189 patients (30.8%) had impaired ADL-IADL. In the multivariate Cox analysis, metastatic stage (adjusted Hazard Ratio (aHR) = 1.79; 95% CI [1.14-2.80]) and impaired ADL-IADL (aHR = 3.46; 95% CI [1.89-6.33]) were independently associated with three-month mortality. In the logistic regression model, impaired ADL-IADL (adjusted Odd ratio (aOR) = 3.64; 95% CI [1.84-7.20]) was the only factor independently associated with three-month unplanned hospitalizations. INTERPRETATION The combined use of the ADL and IADL scales to evaluate functional status in older patients with cancer is of significant prognostic value regarding the risks of three-month unplanned hospitalizations and mortality.
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Affiliation(s)
- Anne-Laure Couderc
- Division of Internal Medicine, Geriatrics and Therapeutics, Sainte Marguerite Hospital, AP-HM, Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France; Aix-Marseille University, CNRS, EFS, ADES, Marseille, France..
| | - Pierre Suchon
- Haematology Laboratory Unit, AP-HM, Marseille, France; Aix Marseille University, INSERM, INRAE, C2VN, Marseille, France
| | | | - Dominique Rey
- Division of Internal Medicine, Geriatrics and Therapeutics, Sainte Marguerite Hospital, AP-HM, Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France
| | - Emilie Nouguerede
- Division of Internal Medicine, Geriatrics and Therapeutics, Sainte Marguerite Hospital, AP-HM, Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France
| | - Robin Arcani
- Division of Internal Medicine, Geriatrics and Therapeutics, Sainte Marguerite Hospital, AP-HM, Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France
| | - Laure Farnault
- Haematology and Cellular Therapy Department, AP-HM, Marseille, France
| | - Aurélie Daumas
- Division of Internal Medicine, Geriatrics and Therapeutics, Sainte Marguerite Hospital, AP-HM, Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France; Aix-Marseille University, Marseille, France
| | - Anais Courcier
- Division of Internal Medicine, Geriatrics and Therapeutics, Sainte Marguerite Hospital, AP-HM, Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France
| | - Florence Duffaud
- Aix-Marseille University, Marseille, France; Oncology Unit, AP-HM, Marseille, France
| | - Sébastien Salas
- Aix-Marseille University, Marseille, France; Oncology Unit, AP-HM, Marseille, France
| | - Fabrice Barlesi
- Aix-Marseille University, Marseille, France; Gustave Roussy Cancer Campus, Villejuif, France
| | - Laurent Greillier
- Aix-Marseille University, Marseille, France; Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France
| | - Régis Costello
- Haematology and Cellular Therapy Department, AP-HM, Marseille, France; Aix-Marseille University, Marseille, France
| | - Geoffroy Venton
- Haematology and Cellular Therapy Department, AP-HM, Marseille, France; Aix-Marseille University, Marseille, France
| | - Patrick Villani
- Division of Internal Medicine, Geriatrics and Therapeutics, Sainte Marguerite Hospital, AP-HM, Coordination Unit for Geriatric Oncology (UCOG), PACA West, Marseille, France; Aix-Marseille University, CNRS, EFS, ADES, Marseille, France
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22
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What Should We Recommend for Colorectal Cancer Screening in Adults Aged 75 and Older? ACTA ACUST UNITED AC 2021; 28:2540-2547. [PMID: 34287279 PMCID: PMC8293045 DOI: 10.3390/curroncol28040231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
The current recommendation to stop colorectal cancer screening for older adults is based on a lack of evidence due to systematic exclusion of this population from trials. Older adults are a heterogenous population with many available strategies for patient-centered assessment and decision-making. Evolutions in management strategies for colorectal cancer have made safe and effective options available to older adults, and the rationale to screen for treatable disease more reasonably, especially given the aging Canadian population. In this commentary, we review the current screening guidelines and the evidence upon which they were built, the unique considerations for screening older adults, new treatment options, the risks and benefits of increased screening and potential considerations for the new guidelines.
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23
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Michaud Maturana M, English WJ, Nandakumar M, Li Chen J, Dvorkin L. The impact of frailty on clinical outcomes in colorectal cancer surgery: A systematic literature review. ANZ J Surg 2021; 91:2322-2329. [PMID: 34013571 DOI: 10.1111/ans.16941] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The majority of colorectal cancer is diagnosed in people aged >65 years, yet the elderly are less likely to undergo curative surgery. Chronological age is poorly correlated with post-operative outcomes and is not an acceptable measure of risk. Conversely, frailty is a strong predictor of poor post-operative outcomes and presents an opportunity for optimisation. This systematic review aims to assess the evidence between frailty and outcomes in patients of all ages undergoing colorectal cancer resections and to compare the predictive value of frailty status to that of age alone. METHODS The review was registered on Prospero, CRD42019150542. PubMed was searched for articles reporting outcomes for frail patients undergoing elective or emergency colorectal cancer resection up until August 2019. All studies reporting outcomes in frail patients were deemed eligible for inclusion and assessed according to the PRISMA guidelines. RESULTS Of the 143 identified studies, 17 were eligible for inclusion. Study type, frailty assessments and outcomes measured were highly variable. 'Frailty' was associated with significantly higher rates of post-operative complications (7/7 studies), post-operative mortality (5/7 studies), readmission (3/4 studies) and length of stay (3/3 studies). Seven of 11 studies reported no association between age and adverse outcomes. CONCLUSION Frailty is a predictor of poor clinical outcomes in patients undergoing surgery for colorectal cancer. Standardisation of frailty assessment and outcome measure is needed. Accurate risk stratification of patients will allow us to make informed treatment decisions, identify patients who may benefit from preoperative intervention and tailor post-operative care.
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Affiliation(s)
| | - William James English
- Department of Colorectal Surgery, North Middlesex Hospital NHS Trust, London, UK.,National Bowel Research Centre, Blizard Institute, QMUL, London, UK
| | - Madura Nandakumar
- Department of Colorectal Surgery, North Middlesex Hospital NHS Trust, London, UK
| | - John Li Chen
- Department of Colorectal Surgery, North Middlesex Hospital NHS Trust, London, UK
| | - Lee Dvorkin
- Department of Colorectal Surgery, North Middlesex Hospital NHS Trust, London, UK
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24
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Beukers K, Bessems SAM, van de Wouw AJ, van den Berkmortel FWPJ, Belgers HJ, Konsten JLM, Sipers WMWH, Janssen-Heijnen MLG. Associations between the Geriatric-8 and 4-meter gait speed test and subsequent delivery of adjuvant chemotherapy in older patients with colon cancer. J Geriatr Oncol 2021; 12:1166-1172. [PMID: 34006492 DOI: 10.1016/j.jgo.2021.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/27/2021] [Accepted: 05/04/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Feasible screening methods are important to identify older patients who might benefit from adjuvant chemotherapy. The aim of this study was to investigate the associations between the outcomes of screening for frailty with the Geriatric-8 questionnaire (G8) and the 4-meter gait speed test (4MGST) and subsequent delivery of adjuvant chemotherapy and treatment tolerance in older patients with colon cancer. MATERIAL AND METHODS This retrospective multicentre study included all patients aged ≥70 with primary colon carcinoma who underwent elective surgery between May 2016 and December 2018 and for whom adjuvant chemotherapy was indicated. Data were analysed using multivariate regression models. RESULTS 97 (73.5%) of 132 eligible patients were screened by the G8 and 85 (64.4%) by the 4MGST. In univariate analyses, patients who scored indicative for frailty on both the G8 (≤14) and the 4MGST (>4 s) significantly more often did not proceed with adjuvant chemotherapy than patients who scored fit on both instruments (OR = 5.10, p = 0.01). After adjustment for gender, stage, and postoperative complications, the OR decreased to 4.22 (p = 0.04). Tolerance of treatment was very high (93%) and did not differ between screening groups. CONCLUSION Although patients who scored indicative for frailty on both the G8 and the 4MGST significantly more often did not proceed with adjuvant chemotherapy, it is still unknown whether the G8 and the 4MGST are reliable tools for identifying patients who are at high risk for severe chemotoxicity. Nonetheless, this study shows that current selection for adjuvant chemotherapy among older patients with colon cancer is safe with low rates of severe chemotoxicity.
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Affiliation(s)
- K Beukers
- Department of Medical Oncology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands.
| | - S A M Bessems
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - A J van de Wouw
- Department of Medical Oncology, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - H J Belgers
- Department of Surgery, Zuyderland Medical Centre, Sittard-Heerlen, the Netherlands
| | - J L M Konsten
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - W M W H Sipers
- Department of Geriatric Medicine, Zuyderland Medical Centre, Sittard-Heerlen, the Netherlands
| | - M L G Janssen-Heijnen
- Department of Geriatric Medicine, Zuyderland Medical Centre, Sittard-Heerlen, the Netherlands; Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
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25
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Ono R, Makiura D, Nakamura T, Okumura M, Fukuta A, Saito T, Inoue J, Oshikiri T, Kakeji Y, Sakai Y. Impact of Preoperative Social Frailty on Overall Survival and Cancer-Specific Survival among Older Patients with Gastrointestinal Cancer. J Am Med Dir Assoc 2021; 22:1825-1830.e1. [PMID: 33932352 DOI: 10.1016/j.jamda.2021.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/24/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Frailty is a multidimensional syndrome. However, typical frailty scales used in oncology clinics assess physical impairment and/or malnutrition but do not consider the social domain. Our study aimed to clarify the relationship between preoperative social frailty and overall survival (OS) and cancer-specific survival (CSS) among older patients with gastrointestinal cancer. DESIGN This was a prospective cohort study. SETTING AND PARTICIPANTS This single-center study recruited 195 patients with gastrointestinal cancer scheduled for curative surgery and aged >60 years. METHODS The outcomes considered were the OS and CSS of surgery. Primary associated factors included frailty defined as a Geriatric 8 score ≤14; social frailty defined as 2 or more of the following-going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not talking with someone daily, and combinations therein [no frailty without social frailty (-/-), frailty without social frailty (+/-), no frailty with social frailty (-/+), and frailty with social frailty (+/+)]. We used the Cox proportional hazards model and the Fine and Gray proportional subdistribution hazard model adjusting for confounding factors. RESULTS Of the 195 patients, 181 (mean age, 72.0 years) were included for analysis. The median follow-up time was 994 days. Social frailty (hazard ratio 3.10) and their combinations [6.35; frailty with social frailty (+/+) vs no frailty without social frailty (-/-)] were significant predictors of OS. Social frailty (subdistribution hazard ratio 3.23) and their combinations (7.57) were significant predictors of CSS. CONCLUSIONS AND IMPLICATIONS Preoperative social frailty is a predictor of OS and CSS in older patients with gastrointestinal cancer. Screening for social frailty, frailty, and their combinations in older patients with cancer is important.
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Affiliation(s)
- Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.
| | - Daisuke Makiura
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Maho Okumura
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Akimasa Fukuta
- Division of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takashi Saito
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan; Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Junichiro Inoue
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation, Kobe University Hospital, Kobe, Japan; Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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26
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Nishijima TF, Esaki T, Morita M, Toh Y. Preoperative frailty assessment with the Robinson Frailty Score, Edmonton Frail Scale, and G8 and adverse postoperative outcomes in older surgical patients with cancer. Eur J Surg Oncol 2021; 47:896-901. [DOI: 10.1016/j.ejso.2020.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/16/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022] Open
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27
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Use of the Geriatric-8 screening tool to predict prognosis and complications in older adults with head and neck cancer: A prospective, observational study. J Geriatr Oncol 2021; 12:1039-1043. [PMID: 33757718 DOI: 10.1016/j.jgo.2021.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/12/2021] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To clarify the usefulness of geriatric assessment screening tools for predicting prognosis and complications in older adults with head and neck cancer (HNC). MATERIAL AND METHODS The geriatric-8 (G8) screening tool was administered to 78 older adults with HNC at their first visit to the hospital before any treatments. The ability of the G8 to predict survival was evaluated by receiver operating characteristic (ROC) curve analysis and determining the cut-off value using Youden's Index. The G8 and other factors related to prognosis (age, performance status (PS), Charlson comorbidity index, number of oral medicines (polypharmacy), the controlling nutritional status (CONUT) score for biological nutrition status, and treatment intent (curative or palliative)) were validated by Cox proportional hazards regression analysis. The survival analysis was validated in a propensity score-weighting cohort to correct for confounding factors. Correlations between these factors and complications were examined using Fishers exact test. RESULTS The G8 cut-off value for overall survival was 10.5 (area under the curve (AUC) 0.69; 95% confidence interval (CI) 0.56-0.82). In the propensity score-weighted cohort, on Cox proportional hazards regression analysis, the hazard ratio of an abnormal G8 (<11) was 3.70 [1.59-8.61 (p = 0.002)], and the hazard ratio of PS-abnormal (≥2) was 0.85 [0.09-7.60 (p = 0.88)]. Thirty-day mortality and all-complication rates were significantly higher in the G8-abnormal group. Neither major complications nor transfer to other institutions was correlated with an abnormal G8. CONCLUSION The G8 was a strong prognostic factor and a possible predictor of complications in older adults with HNC.
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28
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Tamura K, Matsuda K, Fujita Y, Iwahashi M, Mori K, Yamade N, Hotta T, Noguchi K, Sakata Y, Takifuji K, Iwamoto H, Mizumoto Y, Yamaue H. Optimal Assessment of Frailty Predicts Postoperative Complications in Older Patients with Colorectal Cancer Surgery. World J Surg 2021; 45:1202-1209. [PMID: 33392705 DOI: 10.1007/s00268-020-05886-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The increasingly elderly worldwide population has affected the incidence of colorectal cancer. Establishment of reliable assessment of frailty and proposals for multi-disciplinary interventions are urgently required in oncology practices. Kihon Checklist (KCL) was published by the Japanese Ministry of Health, Labor and Welfare originally to identify individuals ≥ 65 years old at probable risk for requiring care or social support. We investigate the validity of KCL for frailty assessment to predict postoperative complication in older patients with colorectal cancer. METHODS Consecutive colorectal cancer patients aged ≥ 65 (n = 500) were prospectively examined between May 2017 and December 2018. Preoperative frailty assessment was conducted by the G8 questionnaire and KCL. The main outcome measures were correlation between frailty, other clinical variables, and postoperative complications within 30 days after elective surgery. RESULTS Of the 500 patients, 278 (55.6%) and 164 (32.8%) patients were classified as 'frail' by G8 and KCL, respectively. Overall complications counted among 97 patients (19.4%), and they were significantly associated with KCL ≥ 8-frail (46/164, p = 0.001), as opposed to G8 ≤ 14-frail (56/278, p = 0.531). Multivariate analysis showed that KCL ≥ 8 (hazard ratio 1.88, 95% confidence interval 1.16-3.04, p = 0.011) was an independent risk factor for these complications. CONCLUSIONS KCL assessment can identify frail older patients likely to suffer from postoperative complications after colorectal cancer surgery. Preoperative screening of frailty, particularly by KCL, would help older patients prevent their worse outcomes in colorectal cancer. TRIAL REGISTRATION UMIN000026689.
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Affiliation(s)
- Koichi Tamura
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Kenji Matsuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Yoichi Fujita
- Department of Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
| | - Makoto Iwahashi
- Department of Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, Wakayama, Japan
| | - Kazunari Mori
- Department of Surgery, Naga Municipal Hospital, 1282 Uchida, Kinokawa, Wakayama, Japan
| | - Naohisa Yamade
- Department of Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu, Wakayama, Japan
| | - Tsukasa Hotta
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Center, 27-1 Takinaicho, Tanabe, Wakayama, Japan
| | - Kohei Noguchi
- Department of Surgery and Endoscopic Surgery, Izumiotsu Municipal Hospital, 16-1 Gejyocyo, Izumiotsu, Osaka, Japan
| | - Yoshifumi Sakata
- Department of Surgery, Hashimoto Municipal Hospital, 2-8-1 Kominedai, Hashimoto, Wakayama, Japan
| | - Katsunari Takifuji
- Department of Surgery, Saiseikai Arida Hospital, 52-6, Yuasacho, Arida, Wakayama, Japan
| | - Hiromitsu Iwamoto
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Yuki Mizumoto
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan.
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Navarrete-Reyes AP, Animas-Mijangos K, Gómez-Camacho J, Juárez-Carrillo Y, Torres-Pérez AC, Cataneo-Piña DJ, Negrete-Najar JP, Soto-Perez-de-Celis E. Geriatric principles for patients with cancer. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cancer is primarily a disease of older persons. Given the heterogeneity of aging, physiological age, rather than chronological age, better expresses the cumulative effect of environmental, medical, and psychosocial stressors, which modifies life expectancy. Comprehensive geriatric assessment, a tool that helps ascertain the physiological age of older individuals, is the gold standard for assessing older adults with cancer. Several international organizations recommend using the geriatric assessment domains to identify unrecognized health problems that can interfere with treatment and predict adverse health-related outcomes, aiding complex treatment decision making. More recently, it has been shown that geriatric assessment-guided interventions improve quality of life and mitigate treatment toxicity without compromising survival. In this review, we discuss the role of comprehensive geriatric assessment in cancer care for older adults and provide the reader with useful information to assess potential treatment risks and benefits, anticipate complications, and plan interventions to better care for older people with cancer.
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Bruijnen CP, Heijmer A, van Harten-Krouwel DG, van den Bos F, de Bree R, Witteveen PO, Emmelot-Vonk MH. Validation of the G8 screening tool in older patients with cancer considered for surgical treatment. J Geriatr Oncol 2020; 12:793-798. [PMID: 33172806 DOI: 10.1016/j.jgo.2020.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 09/06/2020] [Accepted: 10/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Geriatric 8 (G8) has proven to be one of the most sensitive frailty-screening tools for older patients with cancer undergoing systemic treatment. In this study we validated whether the G8 is also suitable for identifying impairments in their comprehensive geriatric assessment (CGA) in older patients with cancer undergoing surgery. Thereby, we investigated the differences in postoperative outcomes between the fit and frail patients classified by the G8. METHODS Patients ≥70 years with a surgery indication because of a (suspected) malignant disease were prospectively enrolled. In all patients, a CGA was performed. The G8 results were assessed in parallel. The diagnostic value of the G8 was determined by comparing the result with the CGA as a reference test. Deficits in CGA was defined as ≥ two impairments of the CGA. Postoperative complications were retrospectively obtained from the medical record and compared between the fit and frail patients. RESULTS In total, 143 patients were enrolled. The sensitivity, specificity, and negative predictive value of the G8 were 82% (95% CI 70-91), 63% (95% CI 52-73), and 85% (95% CI 75-91). In the patients with an impaired G8, a significantly prolonged hospital stay, higher rate of delirium, and higher 1-year mortality rate were seen. CONCLUSION The G8 is a simple and useful screening tool for identifying deficits in CGA in older patients with cancer requiring surgery. Second, we concluded that patients with an impaired G8 are more at risk for a complicated recovery from surgery.
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Affiliation(s)
- Cheryl P Bruijnen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Anne Heijmer
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Frederiek van den Bos
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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Bessems SAM, Konsten JLM, Vogelaar JFJ, Csepán-Magyar R, Maas HAAM, van de Wouw YAJ, Janssen-Heijnen MLG. Frailty screening by Geriatric-8 and 4-meter gait speed test is feasible and predicts postoperative complications in elderly colorectal cancer patients. J Geriatr Oncol 2020; 12:592-598. [PMID: 33158771 DOI: 10.1016/j.jgo.2020.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/29/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Identification of frail older colorectal cancer patients might help to select those prone to adverse events and may lead to adjustment of treatment plans. However, the prognostic validity of screening for frailty is unknown. METHODS This retrospective study evaluates colorectal cancer patients ≥70 years who underwent elective surgery between May 2016 and December 2018. The Geriatric-8 (G8) and 4-m gait speed test (4MGST) were used as frailty screening tools. According to hospital guidelines, patients were referred to a geriatrician when screening was indicative for frailty (G8 ≤ 14 and/or 4MGST < 1 m/s). Patients were categorized as fit, vulnerable or frail by comprehensive geriatric assessment (CGA). The clinical implications and prognostic validity of frailty screening and CGA were evaluated. RESULTS 149 patients were included, of whom 132 (89%) were screened for frailty. Frailty was suspected in 40% of screened patients (n = 53) of whom 89% (n = 47) was referred for CGA. A higher complication rate was seen in patients with G8 ≤ 14 and/or 4MGST < 1 m/s compared to those with G8 > 14 and 4MGST ≥1 m/s (respectively 62% versus 28%,p < 0.001). Pneumonia (21% versus 6%, p = 0.013) and cardiac complications (11% versus 4%, p = 0.093) were more prevalent in patients with G8 ≤ 14 and/or 4MGST < 1 m/s. CGA identified frail patients as a group with a high complication rate of 68%. CONCLUSION Screening for frailty with subsequent referral for CGA is feasible in older colorectal cancer patients. Our study suggests that screening for frailty by G8 + 4MGST can identify patients with higher risk for postoperative complications.
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Affiliation(s)
- Stan A M Bessems
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands.
| | - Joop L M Konsten
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Reka Csepán-Magyar
- Department of Geriatric Medicine, VieCuri Medical Centre, Venlo, the Netherlands
| | - Huub A A M Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Yes A J van de Wouw
- Department of Medical Oncology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
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Liu WY, Jin J, Tang Y, Li N, Tang Y, Wang J, Cheng YJ, Yang L, Fang H, Lu NN, Qi SN, Chen B, Wang SL, Song YW, Liu YP, Li YX, Liu Z, Zhou HT, Liang JW, Pei W, Wang XS, Zhang HZ, Zhou ZX. Safety and efficacy of preoperative chemoradiotherapy in fit older patients with intermediate or locally advanced rectal cancer evaluated by comprehensive geriatric assessment: A planned interim analysis of a multicenter, phase II trial. J Geriatr Oncol 2020; 12:572-577. [PMID: 33160954 DOI: 10.1016/j.jgo.2020.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 08/31/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Comprehensive geriatric assessment (CGA) is a diagnostic method to assess the physical and mental health status of older patients. The purpose of this study was to assess the safety and efficacy of preoperative concurrent chemoradiotherapy (preCRT) for intermediate or locally advanced rectal cancer in older people who were classified as "fit" by CGA. The interim analysis focusing on safety was reported here as the first part of this trial. METHODS AND MATERIALS This is a single arm, multicenter, phase II trial. The eligible patients for this study were aged 70 years or above that fulfilled the standard of intermediate or locally advanced risk category, and met the standard of fit (SIOG1) evaluated by CGA. All patients received preCRT (50 Gy) with Raltitrexed (3 mg/m2 on d1 and d22). Qualitative and quantitative variables were described using descriptive statistics. The surgery adherence predicting was analyzed by multivariate logistic regression. RESULTS Thirty-nine fit patients were enrolled. All patients except one finished radiotherapy without dose reduction. Thirty-two patients finished the prescribed Raltitrexed therapy as scheduled. A serious toxicity was observed in 12 patients (30.8%), and only six patients (15.4%) experienced non-hematological side effects. CONCLUSION Overall, our results showed that preCRT was feasible and safe in older patients with rectal cancer who were evaluated as fit based on CGA, supporting the use of CGA to tailor oncological treatment and predict the tolerance of a specific therapy. Completing this trial as planned would provide further valuable insights.
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Affiliation(s)
- Wen-Yang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yun-Jie Cheng
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Tao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Wei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Pei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Shan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Zeng Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Xiang Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Cooper L, Siam B, Sagee A, Orgad R, Levi Y, Wasserberg N, Beloosesky Y, Kashtan H. Some Nursing Screening Tools Can Be Used to Assess High-Risk Older Adults Who Undergo Colorectal Surgery for Cancer. Clin Interv Aging 2020; 15:1505-1511. [PMID: 32921996 PMCID: PMC7458272 DOI: 10.2147/cia.s258992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Life expectancy and incidence of cancer among older adults are increasing. The aim of this study was to assess whether routinely used nursing screening tools can predict surgical outcomes in older adults with colorectal cancer. Methods Data of patients who underwent elective colorectal cancer surgery at Rabin Medical Center during the years 2014-2016 were collected retrospectively. Patients were divided into study group (age 80-89 y), and control group (age 60-69 y) for comparing surgical outcomes and six-month mortality. In the study group, screening tool scores were evaluated as potential predictors of surgical outcomes. These included Malnutrition Universal Screening Tool (MUST), Admission Norton Scale Scores (ANSS), Morse Fall Scale (MFS), and Charlson Co-morbidity Index (CCI). Results The study group consisted of 77 patients, and the control group consisted of 129 patients. Postoperative mortality and morbidity were similar in both groups. Nursing screening tools did not predict immediate postoperative outcomes in the study group. MUST and CCI were predictors for six-month mortality. CCI score was 9.43±2.44 in those who died within six months from surgery compared to 7.07 ±1.61 in those who were alive after six months (p<0.05). Post-operative complications were not associated with increased 30-day mortality. Advanced grade complications were associated with an increased six-month mortality (RR=1.37, 95% CI 0.95-1.98, p=0.013). Conclusion Different screening tools for high-risk older adults who are candidates for surgery have been developed, with the caveat of necessitating skilled physicians and resources such as time. Routinely used nursing screening tools may be helpful in better patient selection and informed decision making. These tools, specifically MUST and CCI who were found to predict six-month survival, can be used to additionally identify high-risk patients by the nursing staff and promote further evaluation. This can be a valuable tool in multidisciplinary and patient-centered care.
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Affiliation(s)
- Lisa Cooper
- Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Baha Siam
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Aviv Sagee
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Internal Medicine C, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Ran Orgad
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Yochai Levi
- Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nir Wasserberg
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Yichayaou Beloosesky
- Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
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Kenig J, Szabat K, Mituś J, Mituś-Kenig M, Krzeszowiak J. Usefulness of eight screening tools for predicting frailty and postoperative short- and long-term outcomes among older patients with cancer who qualify for abdominal surgery. Eur J Surg Oncol 2020; 46:2091-2098. [PMID: 32800399 DOI: 10.1016/j.ejso.2020.07.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The aim of this study was to compare the ability of eight frailty screening scores to predict short- (30-day major morbidity and mortality), long-term outcomes (12-month mortality) and to compare their accuracy for predicting frailty among older patients with cancer undergoing elective abdominal surgery with curative intent. MATERIALS AND METHODS Consecutive patients aged ≥70 years were enrolled prospectively. The diagnostic performance of eight screening tests were evaluated: The Vulnerable Elderly Survey (VES-13), Triage Risk Screening Tool (TRST), Geriatric 8 (G8), Groningen Frailty Index (GFI), abbreviated Comprehensive Geriatric Assessment (aCGA), Rockwood, Balducci and Fried score. Frailty was defined based on the Geriatric Assessment (GA) with two (2ID) or three impaired domains (3ID). RESULTS The study included 269 consecutive patients; median age 78 (range 70-94) years. The prevalence of frailty based on the reference GA was: 40.9% (2ID), 34.2% (3ID) and using screening tools 40-75.5%. The area under the curve (AUC) for predicting the postoperative outcome was: 0.58-0.75 (30-day morbidity), 0.54-0.71 (30-day mortality) and 0.59-0.74 (12-month mortality), respectively, being the highest for the G8. The AUC for the frailty screening tests was: 0.67-0.85 (at the 2ID) and 0.63-0.83 (at the 3ID), being the highest for the aCGA. CONCLUSION The G8 was the best predictor of 30-day major morbidity, 30-day and 12-month mortality. It also had the highest sensitivity and negative predictive value in frailty screening, in case of both frailty definitions. In turn, the aCGA had the highest discriminatory ability in terms of frailty screening.
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Affiliation(s)
- Jakub Kenig
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Krakow, Poland.
| | - Kinga Szabat
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy Mituś
- Centre of Oncology Maria Sklodowska Curie Memorial Institute, Department of Surgical Oncology Krakow, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Mituś-Kenig
- Department of Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy Krzeszowiak
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Krakow, Poland
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Dogrul RT, Dogrul AB, Konan A, Caglar O, Sumer F, Caliskan H, Kizilarslanoglu MC, Kilic MK, Balci C, Arik G, Aycicek GS, Ozsurekci C, Halil M, Cankurtaran M, Yavuz BB. Does Preoperative Comprehensive Geriatric Assessment and Frailty Predict Postoperative Complications? World J Surg 2020; 44:3729-3736. [PMID: 32737555 DOI: 10.1007/s00268-020-05715-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The influence of preoperative comprehensive geriatric assessment and frailty on postoperative morbidity, mortality, delirium were examined. METHODS A total of 108 patients were evaluated. The Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Brody Instrumental Activities of Daily Living Scale (IADL), the Mini-Nutrition Assessment test (MNA), the Mini-Mental State Examination (MMSE), Yesavage Geriatric Depression Scale (GDS) were performed. Fried Criteria were used to assess physical frailty. We used the Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity score (POSSUM), the American Society of Anesthesiologists Score (ASA), and the Charlson Comorbidity Index (CCI) to determine the risk of postoperative morbidity and mortality. Assessment Test for Delirium (4AT) was applied for detection of delirium. RESULTS The median age was 71 years (min-max: 65-84). IADL (p = 0.032), MNA (p = 0.01), MMSE scores (p = 0.026) were found to be significantly lower in patients with morbidity. POSSUM physiology score (p = 0.005), operative score (p = 0.015) and CCI (p = 0.029) were significantly higher in the patients with morbidity. Patients developed morbidity were found to be more frail (p < 0.001). The patients with delirium were found to have lower IADL (p = 0.049) and MMSE scores (p = 0.004), higher POSSUM physiology score (p = 0.005) and all of them were frail. It was found that frailty (OR = 23.695 95% CI: 6.912-81.231 p < 0.001), POSSUM operative score (OR:1.118 95% CI: 1.021-1.224 p = 0.016) and preoperative systolic blood pressure (OR:0.937%95 CI: 0.879-0.999 p = 0.048) were independently related factors for postoperative morbidity. CONCLUSION In our study, CGA and frailty in preoperative period were found to be indicators for postoperative morbidity and delirium.
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Affiliation(s)
- Rana Tuna Dogrul
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey.
| | - Ahmet Bulent Dogrul
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Konan
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Omur Caglar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Sumer
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Hatice Caliskan
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Muhammet Cemal Kizilarslanoglu
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Mustafa Kemal Kilic
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Cafer Balci
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Gunes Arik
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Gozde Sengul Aycicek
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Cemile Ozsurekci
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Meltem Halil
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Burcu Balam Yavuz
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Sattar S, Haase K, Kuster S, Puts M, Spoelstra S, Bradley C, Wildes TM, Alibhai S. Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 2020; 29:21-33. [PMID: 32671565 DOI: 10.1007/s00520-020-05619-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE This update of our 2016 systematic review answers the following questions: (1) How often do older adults with cancer fall? (2) What are the predictors for falls? (3) What are the rates and predictors of injurious falls? (4) What are the circumstances and outcomes of falls? (5) How do falls in older patients affect subsequent cancer treatment? and a new research question, (6) Which fall reduction interventions are efficacious in this population? METHODS MEDLINE, PubMed, CINAHL, and Embase were searched (September 2015-January 25, 2019). Eligible studies included clinical trials and cohort, case-control, and cross-sectional studies published in English in which the sample (or subgroup) included adults aged ≥ 60, with cancer, in whom falls were examined as an outcome. RESULTS A total of 2521 titles were reviewed, 67 full-text articles were screened for eligibility, and 30 new studies were identified. The majority involved the outpatient setting (n = 19) utilizing cross-sectional method (n = 18). Sample size ranged from 21 to 17,958. Fall rates ranged from 1.52 to 3.41% per 1000 patient days (inpatient setting) and from 39%/24 months to 64%/12 months (outpatient setting). One out of the 6 research questions contributed to a new finding: one study reported that 1 in 20 older patients experienced impact on cancer treatment due to falls. No consistent predictors for falls/fall injuries and no studies on fall reduction interventions in the geriatric oncology setting were identified. CONCLUSION This updated review highlights a new gap in knowledge pertaining to interventions to prevent falls. Additionally, new knowledge also emerged in terms of impact of falls on cancer treatment; however, further research may increase generalizability. Falls and fall-related injuries are common in older adults with cancer and may affect subsequent cancer treatment. Further studies on predictors of falls, subsequent impacts, and fall reduction in the oncology setting are warranted.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, 4400 4th Avenue, Room 108, Regina, Saskatchewan, S4T 0H8, Canada.
| | - K Haase
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - S Kuster
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, Canada
| | - M Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - S Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA
| | - C Bradley
- Library, University of Regina, Regina, Canada
| | - T M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - S Alibhai
- Department of Medicine, Institute of Health Policy, Management, and Evaluations, University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
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Nutritional status and interventions for patients with cancer - A systematic review. J Geriatr Oncol 2020; 12:6-21. [PMID: 32616384 DOI: 10.1016/j.jgo.2020.06.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Malnourishment is commonly seen in ageing, cancer and many chronic conditions, and is associated with poorer prognosis. AIM We set out to collect all currently available evidence on the association between nutritional status assessed with a validated screening tool and prognosis or course of treatment in older patients with cancer, and on the benefit of nutritional interventions in improving these outcomes. METHODS A systematic search in MEDLINE and EMBASE. RESULTS We included 71 studies on the association between nutritional status and outcome in (older) patients with cancer and 17 studies on the benefit of nutritional interventions in improving outcomes in this patient population. There is a significant association between nutritional status and increased intermediate- and long-term mortality (hazard ratio 1.87 (95% confidence interval 1.62-2.17). Those with poorer nutritional status were less likely to complete oncologic treatment according to plan and had higher health care consumption. Benefit of dietary interventions was limited although dietary counselling may lead to improved quality of life while nutritional support may lead to a decrease in post-operative complication rates. CONCLUSION Nutritional status is associated with poorer survival, decreased treatment completion and higher health care consumption and nutritional interventions are only able to negate these negatives outcome to a very limited degree.
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Watanabe D, Miura K, Yamashita A, Minowa T, Uehara Y, Mizushima S, Yoshikawa S, Mizushima A. A Comparison of the Predictive Role of the Geriatric Nutritional Risk Index and Immunonutritional Parameters for Postoperative Complications in Elderly Patients with Renal Cell Carcinoma. J INVEST SURG 2020; 34:1072-1077. [PMID: 32397831 DOI: 10.1080/08941939.2020.1762808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The geriatric nutritional risk index (GNRI) is reportedly a useful factor for predicting postoperative complications in elderly patients with several cancers. The aim of this study was to investigate the relationship between postoperative complications and the GNRI in elderly patients with renal cell carcinoma (RCC). MATERIALS AND METHODS The clinical data of 62 patients who were ≥65 years old and underwent open surgery for RCC were analyzed retrospectively. The American Society of Anesthesiologists physical status, Charlson comorbidity index, surgical procedure, body mass index, GNRI, platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), psoas muscle index (PMI), visceral fat area, and subcutaneous fat area were examined. The association of the GNRI and immunonutritional parameters with postoperative complications was analyzed by the univariate and multivariate analyses. RESULTS Grade ≥ II postoperative complications evaluated by the Clavien-Dindo classification were seen in 11 out of 62 cases. In the Spearman's correlation test, the GNRI showed a significant negative correlation with the PLR and NLR and a significant positive correlation with the PMI. The group with postoperative complications showed a significantly lower GNRI, higher PLR, and higher NLR than those without complications. In the multivariate analysis, a GNRI ≤92 was independently associated with postoperative complications. CONCLUSION The GNRI might play an important role in evaluation of the risk of postoperative complications in open surgery for elderly RCC patients.
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Affiliation(s)
- Daisuke Watanabe
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Urology, Koto Hospital, Tokyo, Japan
| | - Kunihisa Miura
- Department of Anesthesiology and Pain Medicine, Koto Hospital, Tokyo, Japan
| | | | | | - Yuko Uehara
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinobu Mizushima
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Seiichiro Yoshikawa
- Cancer Therapeutic Center, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akio Mizushima
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Agasi-Idenburg SC, Punt CJA, Aaronson NK, Stuiver MM. The association between preoperative fatigue and instrumental activities in daily living with complications and length of hospital stay in patients undergoing colorectal surgery. Aging Clin Exp Res 2020; 32:257-264. [PMID: 30997661 DOI: 10.1007/s40520-019-01199-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) is highest among the elderly. An important treatment modality is surgery. After surgery, due to poor functional recovery, some elderly have an increased risk for complications and prolonged length of hospital stay (LOS). Preoperative elevated levels of fatigue and impaired functioning in instrumental activities of daily living (iADL) might be associated with these outcomes, and may, therefore, be helpful to recognize patients with elevated risk for complications or prolonged LOS, who should undergo more thorough functional assessment. AIMS This exploratory study aims to assess whether physical fatigue, reduced activity and/or iADL, assessed preoperatively, are associated with postoperative complications and prolonged LOS, in elderly patients undergoing surgery for CRC. METHODS We performed an exploratory prospective study in older (≥ 65 years) patients (n = 57) who were scheduled to undergo elective surgery for colorectal cancer. Fatigue and iADL functioning were assessed with questionnaires. Multivariable regression analyses were used to examine the relationship of fatigue and iADL with complications and LOS. RESULTS IADL was not associated with complications or LOS. Fatigue was not associated with complications. Patients with higher fatigue had increased LOS in the univariable analyses but not in the multivariable analyses after adjustment for nutritional status and neoadjuvant treatment. DISCUSSION We found that fatigue was associated with increased LOS in the univariable analysis. The results from the multivariable analysis and path analysis indicate, however, that this is likely not a causal relationship; the observed relationship between physical fatigue and LOS appears to be confounded by nutritional status and by having received neoadjuvant treatment. CONCLUSIONS Although fatigue is a predictor for increased LOS, assessment of fatigue and iADL has no additional value for identifying elderly at risk for poor functional outcome after CRC surgery.
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Affiliation(s)
- S C Agasi-Idenburg
- University of Applied Sciences Utrecht, Utrecht, The Netherlands.
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - C J A Punt
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M M Stuiver
- ACHIEVE Center for Applied Research, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Mohamed MR, Ramsdale E, Loh KP, Arastu A, Xu H, Obrecht S, Castillo D, Sharma M, Holmes HM, Nightingale G, Juba KM, Mohile SG. Associations of Polypharmacy and Inappropriate Medications with Adverse Outcomes in Older Adults with Cancer: A Systematic Review and Meta-Analysis. Oncologist 2020; 25:e94-e108. [PMID: 31570516 PMCID: PMC6964156 DOI: 10.1634/theoncologist.2019-0406] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Polypharmacy (PP) and potentially inappropriate medications (PIM) are highly prevalent in older adults with cancer. This study systematically reviews the associations of PP and/or PIM with outcomes and, through a meta-analysis, obtains estimates of postoperative outcomes associated with PP in this population. MATERIALS AND METHODS We searched PubMed, Embase, Web of Science, and Cochrane Register of Clinical Trials using standardized terms for concepts of PP, PIM, and cancer. Eligible studies included cohort studies, cross-sectional studies, meta-analyses, and clinical trials which examined outcomes associated with PP and/or PIM and included older adults with cancer. A random effects model included studies in which definitions of PP were consistent to examine the association of PP with postoperative complications. RESULTS Forty-seven articles met the inclusion criteria. PP was defined as five or more medications in 57% of the studies. Commonly examined outcomes included chemotherapy toxicities, postoperative complications, functional decline, hospitalization, and overall survival. PP was associated with chemotherapy toxicities (4/9 studies), falls (3/3 studies), functional decline (3/3 studies), and overall survival (2/11 studies). A meta-analysis of four studies indicated an association between PP (≥5 medications) and postoperative complications (overall odds ratio, 1.3; 95% confidence interval [1.3-2.8]). PIM was associated with adverse outcomes in 3 of 11 studies. CONCLUSION PP is associated with postoperative complications, chemotherapy toxicities, and physical and functional decline. Only three studies showed an association between PIM and outcomes. However, because of inconsistent definitions, heterogeneous populations, and variable study designs, these associations should be further investigated in prospective studies. IMPLICATIONS FOR PRACTICE Polypharmacy and potentially inappropriate medications (PIM) are prevalent in older adults with cancer. This systematic review summarizes the associations of polypharmacy and PIM with health outcomes in older patients with cancer. Polypharmacy and PIM have been associated with postoperative complications, frailty, falls, medication nonadherence, chemotherapy toxicity, and mortality. These findings emphasize the prognostic importance of careful medication review and identification of PIM by oncology teams. They also underscore the need to develop and test interventions to address polypharmacy and PIM in older patients with cancer, with the goal of improving outcomes in these patients.
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Affiliation(s)
- Mostafa R. Mohamed
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Erika Ramsdale
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Asad Arastu
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Huiwen Xu
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
- Department of Public Health, University of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Spencer Obrecht
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Daniel Castillo
- MLIS‐Miner Library, University of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Manvi Sharma
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, UniversityMississippiUSA
| | - Holly M. Holmes
- The University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Ginah Nightingale
- Department of Pharmacy Practice, Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Katherine M. Juba
- Department of Pharmacy, University of Rochester Medical CenterRochesterNew YorkUSA
- Department of Pharmacy Practice, Wegmans School of PharmacyRochesterNew YorkUSA
| | - Supriya G. Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical CenterRochesterNew YorkUSA
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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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Loh KP, Mohile SG, Epstein RM, McHugh C, Flannery M, Culakova E, Lei L, Wells M, Gilmore N, Babu D, Whitehead MI, Dale W, Hurria A, Wittink M, Magnuson A, Conlin A, Thomas M, Berenberg J, Duberstein PR. Willingness to bear adversity and beliefs about the curability of advanced cancer in older adults. Cancer 2019; 125:2506-2513. [PMID: 30920646 DOI: 10.1002/cncr.32074] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/07/2019] [Accepted: 02/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Older patients with advanced cancer who are 100% certain they will be cured pose unique challenges for clinical decision making, but to the authors' knowledge, the prevalence and correlates of absolute certainty about curability (ACC) are unknown. METHODS Cross-sectional data were collected in a geriatric assessment trial. ACC was assessed by asking patients, "What do you believe are the chances that your cancer will go away and never come back with treatment?" Response options were 100% (coded as ACC), >50%, 50/50, <50%, 0%, and uncertain. The willingness to bear adversity in exchange for longevity was assessed by asking patients to consider trade-offs between survival and 2 clinical outcomes that varied in abstractness: 1) maintaining quality of life (QOL; an abstract outcome); and 2) specific treatment-related toxicities (eg, nausea/vomiting, worsening memory). Logistic regression was used to assess the independent associations between willingness to bear adversity and ACC. RESULTS Of the 524 patients aged 70 to 96 years, approximately 5.3% reported that there was a 100% chance that their cancer would be cured (ACC). ACC was not found to be significantly associated with willingness to bear treatment-related toxicities, but was more common among patients who were willing to trade QOL for survival (adjusted odds ratio, 4.08; 95% CI, 1.17-14.26). CONCLUSIONS Patients who were more willing to bear adversity in the form of an abstract state, namely decreased QOL, were more likely to demonstrate ACC. Although conversations regarding prognosis should be conducted with all patients, those who are willing to trade QOL for survival may especially benefit from conversations that focus on values and emotions.
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Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ronald M Epstein
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Division of Palliative Care, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Colin McHugh
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Marie Flannery
- School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Eva Culakova
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lianlian Lei
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Megan Wells
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nikesha Gilmore
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Dilip Babu
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mary I Whitehead
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - William Dale
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Arti Hurria
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Marsha Wittink
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Alison Conlin
- Pacific Cancer Research Consortium National Cancer Institute Community Oncology Research Program (NCORP), Seattle, Washington
| | - Melanie Thomas
- Southeast Clinical Oncology Research Consortium (SCOR), Winston-Salem, North Carolina
| | - Jeffrey Berenberg
- Hawaii Minority Underserved National Cancer Institute Community Oncology Research Program (MU-NCORP), Honolulu, Hawaii
| | - Paul R Duberstein
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, New Brunswick, New Jersey
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Couderc AL, Boulahssass R, Nouguerède E, Gobin N, Guérin O, Villani P, Barlesi F, Paillaud E. Functional status in a geriatric oncology setting: A review. J Geriatr Oncol 2019; 10:884-894. [PMID: 30824222 DOI: 10.1016/j.jgo.2019.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 01/07/2019] [Accepted: 02/11/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Comprehensive Geriatric Assessment (CGA), is used in older patients with cancer to identify frailties, which can interfere with specialized treatment, and to help with therapeutic care. Functional Status (FS) is a domain of CGA in which Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) are evaluation tools. OBJECTIVE Our study reviewed the data available on the most frequently used tools to assess ADL and IADL in a geriatric oncology setting and their predictive values on overall survival (OS), toxicity, treatment feasibility or decision and postoperative complications. DESIGN This review was based on a systematic search of the MEDLINE® database for articles published in English and French between January 1, 2010, and December 31, 2017. In the final analysis, 40 out of 4061 studies were included. RESULTS The most common ADL and IADL scales used are the Katz ADL (KL-ADL) in 25 studies and the Lawton IADL (IADL8) in 22 studies. FS is predictive of OS in 11 out of 24 studies, chemotoxicity in 2 out of 7 studies, treatment feasibility in 2 out of 5 studies, treatment decisions in 2 out of 3 studies, and postoperative complications in 4 out of 6 studies. CONCLUSION FS is of prognostic value in a geriatric oncology setting despite heterogeneous methodology and inclusion criteria, in the studies included. Additional research is needed to explore more precisely the prognostic value of FS in overall survival, toxicity, treatment feasibility or decision and postoperative complications, in older cancer patients.
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Affiliation(s)
- Anne-Laure Couderc
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France; Coordination Unit for Geriatric Oncology (UCOG), PACA West, France.
| | - Rabia Boulahssass
- Geriatric Department, Coordination Unit for Geriatric Oncology (UCOG) PACA East, Cimiez Hospital, Nice, France
| | - Emilie Nouguerède
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France
| | - Nirvina Gobin
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France
| | - Olivier Guérin
- Geriatric Department, Coordination Unit for Geriatric Oncology (UCOG) PACA East, Cimiez Hospital, Nice, France; Nice Sophia-Antipolis University, Nice, France
| | - Patrick Villani
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France; Aix-Marseille University, Marseille, France
| | - Fabrice Barlesi
- Aix-Marseille University, Marseille, France; Division of Multidisciplinary Oncology and Therapeutic Innovations, North Hospital, AP-HM, Marseille, France
| | - Elena Paillaud
- Department of Geriatrics, Geriatric Oncology Unit, APHP, Hospital European Georges Pompidou, Paris, France; Clinical Epidemiology and Ageing Unit, EA, 7376, Universite' Paris-Est, Creteil, France
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Montroni I, Ugolini G, Saur NM, Spinelli A, Rostoft S, Millan M, Wolthuis A, Daniels IR, Hompes R, Penna M, Fürst A, Papamichael D, Desai AM, Cascinu S, Gèrard JP, Myint AS, Lemmens VE, Berho M, Lawler M, De Liguori Carino N, Potenti F, Nanni O, Altini M, Beets G, Rutten H, Winchester D, Wexner SD, Audisio RA. Personalized management of elderly patients with rectal cancer: Expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer. Eur J Surg Oncol 2018; 44:1685-1702. [DOI: 10.1016/j.ejso.2018.08.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/22/2018] [Accepted: 08/03/2018] [Indexed: 12/23/2022] Open
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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: 18] [Impact Index Per Article: 3.0] [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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Factors predicting intolerance to definitive conventional radiotherapy in geriatric patients. Strahlenther Onkol 2018; 194:894-903. [DOI: 10.1007/s00066-018-1318-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/08/2018] [Indexed: 12/22/2022]
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47
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Shahrokni A, Alexander K, Wildes TM, Puts MTE. Preventing Treatment-Related Functional Decline: Strategies to Maximize Resilience. Am Soc Clin Oncol Educ Book 2018; 38:415-431. [PMID: 30231361 DOI: 10.1200/edbk_200427] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The majority of patients with cancer are older adults. A comprehensive geriatric assessment (CGA) will help the clinical team identify underlying medical and functional status issues that can affect cancer treatment delivery, cancer prognosis, and treatment tolerability. The CGA, as well as more abbreviated assessments and geriatric screening tools, can aid in the treatment decision-making process through improved individualized prediction of mortality, toxicity of cancer therapy, and postoperative complications and can also help clinicians develop an integrated care plan for the older adult with cancer. In this article, we will review the latest evidence with regard to the use of CGA in oncology. In addition, we will describe the benefits of conducting a CGA and the types of interventions that can be taken by the interprofessional team to improve the treatment outcomes and well-being of older adults.
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Affiliation(s)
- Armin Shahrokni
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Koshy Alexander
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tanya M Wildes
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Martine T E Puts
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Schreckenbach T, Zeller MV, El Youzouri H, Bechstein WO, Woeste G. Identification of factors predictive of postoperative morbidity and short-term mortality in older patients after colorectal carcinoma resection: A single-center retrospective study. J Geriatr Oncol 2018; 9:649-658. [PMID: 29779798 DOI: 10.1016/j.jgo.2018.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/23/2018] [Accepted: 05/01/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study is to investigate the effect of age on patient outcome after colorectal carcinoma (CRC) resection in patients over 65 years of age. METHODS This study included patients aged 65 years and older who underwent CRC resection between 2003 and 2013 at a single-center institution. Patients were divided into two groups: Group A (65-74 years old) and Group B (≥75 years old). RESULTS Multivariable logistic analysis of 415 patients revealed serum albumin levels on the third postoperative day (POD) (Odds Ratio (OR), 0.44; 95% CI, 0.21-0.94; P = 0.03) and C-reactive protein (CRP) levels (OR, 1.05; 95% CI, 1.00-1.01; P = 0.04) in patients with colon cancer as predictive factors for morbidity. In addition, the multivariable logistic analysis revealed serum albumin levels (OR, 0.27; 95% CI, 0.08-0.87; P = 0.03) in patients with rectal cancer as predictive factors for morbidity. The multivariate Cox Proportional Hazards Model identified re-intervention for colon cancer (Hazard Ratio (HR), 4.57; 95% CI, 1.36-15.4 P = 0.01) and for rectal cancer (HR, 11.8; 95% CI, 1.08-129 P = 0.04) as a predictive factor for 30-day mortality. Serum albumin level on the third POD was predictive of 30-day mortality (HR, 0.30; 95% CI, 0.13-0.71; P = 0.01) and of 1-year mortality (HR, 0.34; 95% CI, 0.17-0.66; P < 0.01) in patients with colon cancer. CONCLUSION Age is not predictive of postoperative morbidity and mortality in patients with CRC. Serum albumin levels on the third POD can predict morbidity and mortality for colon and rectal carcinoma in older patients undergoing colorectal resections.
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Affiliation(s)
- Teresa Schreckenbach
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
| | - Matthias Valentin Zeller
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Hanan El Youzouri
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Wolf Otto Bechstein
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Guido Woeste
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
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Corrigan LR, Bracken-Clarke DM, Horgan AM. The challenge of treating older patients with pancreaticobiliary malignancies. Curr Probl Cancer 2018; 42:59-72. [PMID: 29459178 DOI: 10.1016/j.currproblcancer.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 02/06/2023]
Abstract
Pancreatic and biliary tract cancers are aggressive malignancies. They commonly present with metastatic or unresectable disease. Those that do present with resectable cancer have high rates of recurrence. Despite recent advances in surgical technique, chemotherapy, and radiotherapy regimens, they are associated with poor survival outcomes. These cancers represent an exception to the trend of improved overall survival evident in most malignancies in recent decades. Depending on the goal of treatment, active management of pancreatic and biliary cancers involves surgery, chemotherapy, and radiation therapy, either alone or in combination. Both pancreatic and biliary tract cancers have a preponderance in the older population. Older patients are a heterogeneous group; although tolerability of multimodality treatment may be a challenge for some, many fit older patients may be undertreated based on their age alone. The growing field of geriatric oncology has highlighted the importance of a comprehensive assessment of these patients, and not relying on age alone as a discriminating factor for treatment. Management of older patients with pancreaticobiliary cancers is particularly challenging owing to limited prospective data in this population. As such, there is uncertainty with regard to optimal treatment approaches for these patients. In this article, we outline the therapeutic options available to patients with localized or advanced pancreatic and biliary tract cancers, and the evidence for specified treatment options in the elderly. We examine the inclusion and outcomes of elderly patients in relevant clinical trials; the morbidity that may be encountered by elderly patients receiving specified treatments and the tools that may assist the physician in selecting elderly patients for particular treatments.
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Affiliation(s)
- Lynda R Corrigan
- Department of Medical Oncology, University Hospital Waterford, Ardkeen, Co Waterford, Ireland.
| | - Dara M Bracken-Clarke
- Department of Medical Oncology, University Hospital Waterford, Ardkeen, Co Waterford, Ireland
| | - Anne M Horgan
- Department of Medical Oncology, University Hospital Waterford, Ardkeen, Co Waterford, Ireland
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