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Simon HL, Reif de Paula T, Spigel ZA, Keller DS. Factors Associated With Adjuvant Chemotherapy Noncompliance and Survival in Older Adults With Stage III Colon Cancer. Dis Colon Rectum 2023; 66:1254-1262. [PMID: 36574320 DOI: 10.1097/dcr.0000000000002656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Standard management of stage III colon cancer includes surgical resection and adjuvant chemotherapy. Despite improved overall survival with adjuvant chemotherapy in stage III colon cancer, it is reportedly underused in older adults. To date, no contemporary national analysis of adjuvant chemotherapy use and its impact on older adults with stage III colon cancer exists. OBJECTIVE This study aimed to assess the current use of adjuvant chemotherapy in older adults with stage III colon cancer and determine factors associated with noncompliance. DESIGN Retrospective cohort study. SETTINGS Conducted using the National Cancer Database. PATIENTS This study included patients aged 65 years and older undergoing curative resection for stage III colon adenocarcinomas, 2010-2017. MAIN OUTCOME MEASURES Adjuvant chemotherapy use, factors associated with adjuvant chemotherapy use, and overall survival with and without adjuvant chemotherapy in older adults with pathologic stage III disease. RESULTS Of 64,608 patients included, 64.3% received adjuvant chemotherapy. Adjuvant chemotherapy was significantly independently associated with improved 1-, 3-, and 5-year overall survival vs no adjuvant chemotherapy (92.8%, 75.3%, 62.4% vs 70.8%, 46.6%, 32.7%; HR 0.475; 95% CI, 0.459-0.492; p <0.001). Compared with the no adjuvant chemotherapy cohort, patients who received adjuvant chemotherapy were younger, female, and less comorbid ( p < 0.001). Factors associated with adjuvant chemotherapy noncompliance included advancing age, lower annual income, open approach, longer length of stay, pathologic stage IIIA, and fewer than 12 lymph nodes. LIMITATIONS Administrative data source with inherent risks of bias, coding errors, and limitations in the fields available for analysis. CONCLUSIONS Adjuvant chemotherapy significantly improved overall survival but was only used in 64.3% of older adults with stage III colon cancer. Adjuvant chemotherapy noncompliance was seen in the most vulnerable and highest-risk patients, including those with greater comorbidity, lower income, and patients who received open surgery. See Video Abstract at http://links.lww.com/DCR/C125 . FACTORES ASOCIADOS CON EL INCUMPLIMIENTO DE LA QUIMIOTERAPIA ADYUVANTE Y LA SUPERVIVENCIA EN ADULTOS MAYORES CON CNCER DE COLON EN ESTADIO III ANTECEDENTES: El tratamiento estándar de oro del cáncer de colon en estadio III incluye la resección quirúrgica y la quimioterapia adyuvante. A pesar de la mejora de la supervivencia general con la quimioterapia adyuvante en el cáncer de colon en estadio III, se reporta que se utiliza poco en los adultos mayores. Hasta la fecha, no existe ningún análisis nacional actual, sobre el uso de quimioterapia adyuvante y su impacto en adultos mayores con cáncer de colon en etapa III.OBJETIVO: Evaluar el uso actual de quimioterapia adyuvante en adultos mayores con cáncer de colon en estadio III y determinar los factores asociados con el incumplimiento.DISEÑO: Estudio de cohorte retrospectivo.AJUSTES: Realizado y utilizando la Base de Datos Nacional de Cáncer.PACIENTES: Pacientes de 65 años o más sometidos a resección curativa por adenocarcinomas de colon en estadio III de 2010-2017.PRINCIPALES MEDIDAS DE RESULTADO: Uso de quimioterapia adyuvante, factores asociados con el uso de quimioterapia adyuvante y supervivencia general con y sin quimioterapia adyuvante en adultos mayores con enfermedad en estadio patológico III.RESULTADOS: De 64.608 pacientes incluidos, el 64,3% recibió quimioterapia adyuvante. La quimioterapia adyuvante se asoció de forma significativa e independiente con una mejor supervivencia general a 1, 3 y 5 años frente a ninguna quimioterapia adyuvante (92,8 %, 75,3 %, 62,4 % frente a 70,8 %, 46,6 %, 32,7 %; respectivamente, HR 0,475, 95 % IC 0,459-0,492, p < 0,001). En comparación con la cohorte sin quimioterapia adyuvante, los pacientes que recibieron quimioterapia adyuvante eran más jóvenes, mujeres y con menos comorbilidad. (p < 0,001). Los factores asociados con el incumplimiento de la quimioterapia adyuvante incluyeron edad avanzada (OR 0,857, IC del 95 % 0,854-0,861), ingresos anuales más bajos (OR 0,891, IC del 95 % 0,844-0,940), abordaje abierto (0,730, IC del 95 % 0,633-0,842), mayor duración de la estancia (OR 0,949, IC 95% 0,949-0,954) y estadio patológico IIIA (0,547, IC 95% 0,458-0,652) y <12.LIMITACIONES: Fuente de datos administrativos con riesgos inherentes de sesgo, errores de codificación y limitaciones en los campos disponibles para el análisis.CONCLUSIONES: La quimioterapia adyuvante mejoró significativamente la supervivencia general, pero solo se utilizó en el 64,3 % de los adultos mayores con cáncer de colon en estadio III. El incumplimiento de la quimioterapia adyuvante se observó en los pacientes más vulnerables y de mayor riesgo, incluidos aquellos con mayor comorbilidad, menores ingresos y pacientes que recibieron cirugía abierta. Consulte Video Resumen en http://links.lww.com/DCR/C125 . (Traducción-Dr. Fidel Ruiz Healy ).
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Affiliation(s)
- Hillary L Simon
- Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Thais Reif de Paula
- Department of Biomedical Sciences, University of Houston College of Medicine, Houston, Texas
| | - Zachary A Spigel
- Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, University of California, Davis Medical Center, Sacramento, California
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Extermann M, Al-Jumayli M, Sam C, Kish JA. Oncogeriatric Developments. Gerontology 2023; 69:1045-1055. [PMID: 37321185 DOI: 10.1159/000531559] [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: 01/02/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Cancer is a disease of aging and is rapidly becoming the number one cause of mortality in older people. Over their lifetime, one in two men and one in three women will develop a cancer, with half of the risk being beyond the age of seventy. Therefore, cancer is a problem frequently encountered by geriatricians. In this article, we review a few recent progresses that will be of interest to the geriatric community. First, we now have robust evidence that a comprehensive geriatric assessment and management change outcomes in older cancer patients, notably allowing decreased treatment toxicity, better treatment completion, and increased functional outcomes. In gastrointestinal cancers and breast cancer, several recent studies have addressed when treatment intensity can be decreased, and when it cannot. New treatments for acute myeloid leukemia are finally beginning to improve outcomes for older patients and such patients should be referred to oncologists for management. In prostate cancer, new imaging techniques (e.g., PSMA scan) and treatment options can allow better treatment targeting and spare some hormonal and chemotherapy toxicity. Finally, we review recent public policy efforts to address the epidemiologic wave of cancer in older patients on a global scale.
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Affiliation(s)
- Martine Extermann
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Christine Sam
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
| | - Julie A Kish
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
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3
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Jones E, Duan Z, Nguyen TT, Giordano SH, Zhao H. Adjuvant 5-Fluorouracil/leucovorin, capecitabine, and oxaliplatin-related regimens for stage II/III colon cancer patients 66 years or older. Cancer Med 2022; 12:2389-2406. [PMID: 36229957 PMCID: PMC9939133 DOI: 10.1002/cam4.5078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 11/11/2022] Open
Abstract
Adjuvant chemotherapy of leucovorin-modulated 5-fluorouracil (5-FU/LV), capecitabine, and adding oxaliplatin to 5-FU/LV or capecitabine (FLOX/OX) have been standard regimens for high-risk stage II or III colon cancer (CC). We aimed to evaluate their patterns of use, association with survival, and rate of emergency room visit (ER) or hospitalization during the treatment period. High-risk stage II or III patients aged >65 years diagnosed between 2007 and 2015, underwent colectomy, and received any of these three regimens were selected from SEER and Texas Cancer Registry (TC) linked with Medicare data. Chi-square test, Kaplan-Meier survival curves, Cox regression, and logistic regression were used in data analysis. A total of 5621 (1080 stage II and 4541 stage III) patients with median age of 72 years were included in this study. For stage II, 24.4% used 5-FU/LV, 31.2% used capecitabine, and 44.4% used FLOX/OX; the respective numbers for stage III were 13.8%, 17.9%, and 68.3%. Patients aged <70 years, not in the West region, not in Medicare state-buy-in program, and with no comorbidity were more likely to use FLOX/OX. FLOX/OX was associated with improved overall survival (OS) in stage II and III patients and improved cancer-specific survival in stage III patients compared with 5-FU/LV. The survival benefit of FLOX/OX was sustained in stage III patients aged ≥70 years. Capecitabine had the lowest ER/hospitalization rate with 19.2% in stage II and 28.9% in III. The use of FLOX/OX was associated with improved survival compared with 5-FU/LV among CC patients. Capecitabine was associated with the lowest ER/hospitalization rate.
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Affiliation(s)
- Emily Jones
- Department of BiostatisticsThe University of Texas School of Public Health at HoustonHoustonTexasUSA
| | - Zhigang Duan
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Thinh T. Nguyen
- Institute for Clinical and Translational Research, Baylor College of MedicineHoustonTexasUSA
| | - Sharon H. Giordano
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA,Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Hui Zhao
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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O'Sullivan DE, Cheung WY, Boyne DJ, Jarada TN, Tang PA, Gill S, Hilsden RJ, Brenner DR. Treatment patterns and survival outcomes of early-onset colorectal cancer patients in Alberta, Canada: a population-based study. Cancer Treat Res Commun 2022; 32:100585. [PMID: 35679754 DOI: 10.1016/j.ctarc.2022.100585] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The incidence of early-onset (<50) colorectal cancer (eoCRC) has been increasing in Canada. Little is known about treatment patterns and outcomes among this patient population in Canada. PATIENTS AND METHODS We conducted a retrospective population-based cohort study of CRC patients in Alberta (2010-2018) using electronic medical records and administrative claims data. Treatment patterns and CRC-specific mortality were compared between early-onset age groups (<40 and 40-49) and average age-at-onset (60-70) (aoCRC) patients with multivariable logistic regression and cox proportional hazard models. RESULTS There were 334 and 935 patients in the early-onset groups and 4606 in the aoCRC group. Compared with aoCRC, patients <40 were more likely to receive chemotherapy in stage II colon (OR 3.41, CI 1.75-6.47) and stage III rectal (OR 3.01, CI 1.18-10.21), and to receive systemic therapy (OR 2.40, CI 1.46-4.12) and radiation in stage IV CRC (OR 2.70, CI 1.48-4.92). The 40-49 age group was more likely to receive chemotherapy in stage II colon (OR 2.13, CI 1.25-3.56), and chemoradiation in stage II rectal (OR 2.16, CI 1.25-3.80) and stage III rectal (OR 1.63, CI 1.13-2.40), as well as systemic therapy in stage IV CRC (OR 2.46, CI 1.75-3.52). Survival did not differ between <40 and 60-70 age groups. Survival was significantly higher for the 40-49 age group, but only in stage IV (HR 0.79, CI 0.67-0.94). CONCLUSIONS EoCRC patients tended to receive more therapy than average age CRC patients with minimal survival gains. Additional research to identify optimal treatment strategies for eoCRC patients is required.
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Affiliation(s)
- Dylan E O'Sullivan
- Department of Community Health Sciences, University of Calgary, Calgary, AB; Department of Oncology, University of Calgary, Calgary, AB; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB
| | - Winson Y Cheung
- Department of Community Health Sciences, University of Calgary, Calgary, AB; Department of Oncology, University of Calgary, Calgary, AB
| | - Devon J Boyne
- Department of Community Health Sciences, University of Calgary, Calgary, AB; Department of Oncology, University of Calgary, Calgary, AB
| | - Tamer N Jarada
- Department of Community Health Sciences, University of Calgary, Calgary, AB
| | - Patricia A Tang
- Department of Oncology, University of Calgary, Calgary, AB; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Sharlene Gill
- Division of Medical Oncology, BC Cancer/University of British Columbia, Vancouver, BC
| | - Robert J Hilsden
- Department of Community Health Sciences, University of Calgary, Calgary, AB; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Darren R Brenner
- Department of Community Health Sciences, University of Calgary, Calgary, AB; Department of Oncology, University of Calgary, Calgary, AB; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB.
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Bang HJ, Shim HJ, Kim GR, Hwang JE, Bae WK, Chung IJ, Cho SH. Geriatric functional assessment for decision-making on adjuvant chemotherapy in older colon cancer patients. Korean J Intern Med 2022; 37:660-672. [PMID: 35421912 PMCID: PMC9082429 DOI: 10.3904/kjim.2021.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/14/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Despite the increasing need for geriatric assessment prior to chemotherapy, the method for this assessment remains inadequate for older cancer patients. We aimed to propose a simple assessment method to predict the performance of adjuvant chemotherapy in older patients after colon cancer surgery. METHODS This prospective study included patients over 65 years of age who were scheduled for adjuvant chemotherapy after colon cancer surgery. Before initiating chemotherapy, their functional status was assessed on the basis of activities of daily living (ADL)/instrumental activities of daily living (IADL). These parameters were analyzed with clinical characteristics and the patterns of adjuvant chemotherapy. The focus was on the completion rate of adjuvant chemotherapy. RESULTS A total of 89 patients with a median age of 72 years were analyzed. Among them, 54 (61%) were non-impaired and 35 (39%) were impaired regarding their ADL/IADL classification. Low body mass index and impairment of ADL/IADLs were significantly associated with chemotherapy interruption. Among toxicities, fatigue and hand-foot syndrome were independent prognostic factors for chemotherapy interruption. Impairments of ADL/IADL were significantly associated with fatigue regardless of age. Based on age and ADL/IADL stratification, younger patients (≤ 72 years) and/or those who were ADL/IADL non-impaired were significantly more likely to complete adjuvant chemotherapy than older patients (> 72 years) and ADL/IADL impaired patients (p = 0.038). This was regardless of the chemotherapy regimen. CONCLUSION Functional assessment using ADL/IADL is a convenient method to predict chemotherapy toxicity and performance. These results suggested that routine screening for ADL/IADLs could guide appropriate patient selection for the completion of adjuvant chemotherapy and predict expected outcomes.
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Affiliation(s)
- Hyun Jin Bang
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Jeong Shim
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Ga Ram Kim
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Eul Hwang
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Woo Kyun Bae
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Ik Joo Chung
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Hee Cho
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
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Optimal Allocation of Chemotherapy Schemes for Metastatic Colon Cancer in Colombia. Value Health Reg Issues 2021; 26:105-112. [PMID: 34166882 DOI: 10.1016/j.vhri.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/10/2020] [Accepted: 01/16/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aims to determine the optimal proportion for different chemotherapy schemes in patients with metastatic colorectal cancer who have undergone surgical resection in Colombia. METHODS A linear programming model was used to quantify the optimal proportion of the chemotherapy schemes that maximize quality-adjusted life-years (QALYs). The model was evaluated in 6 different scenarios using parametric and dynamic optimization with different budget restriction constraints. The results were compared to the current mixture of schemes used in our country. RESULTS The results show that 63%, 37%, and 0.8% of the population should receive the FOLFOXIRI scheme (fluorouracil + leucovorin + oxaliplatin + irinotecan), FOLFIRI (irinotecan + leucovorin + fluorouracil), and FOLFIRI plus cetuximab, respectively. With these proportions, 8734 QALYs and universal coverage of the population are obtained. In an optimistic scenario (high QALYs, low costs, and budget of $40 million), the entire population should receive the FOLFIRI scheme. A pessimistic scenario (low QALYs, high costs, and budget of $15 million) would benefit only 46% of the population with the fluorouracil plus leucovorin scheme. In the other 3 scenarios with higher budget constraints, 52%, 69%, and 86% of the population should receive FOLFIRI, respectively. Dynamic optimization revealed that FOLFIRI and FOLFOX (oxaliplatin + leucovorin + fluorouracil) schemes are more likely to generate higher QALYs with lower costs and a limited budget. CONCLUSIONS The current use of chemotherapy schemes is not optimal. An increasing proportion of FOLFIRI, FOLFOX, and FOLFOXIRI should be used more often as schemes to treat metastatic colorectal cancer in Colombia.
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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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Eligibility of Real-World Patients With Stage II and III Colon Cancer for Adjuvant Chemotherapy Trials. Clin Colorectal Cancer 2020; 19:e226-e234. [DOI: 10.1016/j.clcc.2020.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022]
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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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Batra A, Rigo R, Sheka D, Cheung WY. Real-world evidence on adjuvant chemotherapy in older adults with stage II/III colon cancer. World J Gastrointest Oncol 2020; 12:604-618. [PMID: 32699576 PMCID: PMC7340998 DOI: 10.4251/wjgo.v12.i6.604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/08/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
Colon cancer represents one of the most common cancers diagnosed in older adults worldwide. The standard of care in resected stage II and stage III colon cancer continues to evolve. While there is unequivocal evidence to suggest both disease free and overall survival benefits with the use of combination chemotherapy in patients with stage III colon cancer, data regarding its use in patients with stage II colon cancer are less clear. Further, although colon cancer is a disease that affects older adults, there is considerable debate on the value of adjuvant chemotherapy in the aging population. In particular, many older patients are undertreated when compared to their younger counterparts. In this review, we will describe the clinical trials that contributed to the current adjuvant chemotherapy approach in colon cancer, discuss representation of older adults in trials and the specific challenges associated with the management of this sub-population, and highlight the role of comprehensive geriatric assessments. We will also review how real-world evidence complements the data gaps from clinical trials of early stage colon cancer.
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Affiliation(s)
- Atul Batra
- Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta T2N 1N4, Canada
| | - Rodrigo Rigo
- Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta T2N 1N4, Canada
| | - Dropen Sheka
- Department of Medicine, Tom Baker Cancer Centre, Calgary, Alberta T2N 1N4, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta T2N 4N2, Canada
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Minicozzi P, Vicentini M, Innos K, Castro C, Guevara M, Stracci F, Carmona-Garcia M, Rodriguez-Barranco M, Vanschoenbeek K, Rapiti E, Katalinic A, Marcos-Gragera R, Van Eycken L, Sánchez MJ, Bielska-Lasota M, Rossi PG, Sant M. Comorbidities, timing of treatments, and chemotherapy use influence outcomes in stage III colon cancer: A population-based European study. Eur J Surg Oncol 2020; 46:1151-1159. [PMID: 32147427 DOI: 10.1016/j.ejso.2020.02.023] [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: 11/13/2019] [Revised: 01/21/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION For stage III colon cancer (CC), surgery followed by chemotherapy is the main curative approach, although optimum times between diagnosis and surgery, and surgery and chemotherapy, have not been established. MATERIALS AND METHODS We analysed a population-based sample of 1912 stage III CC cases diagnosed in eight European countries in 2009-2013 aiming to estimate: (i) odds of receiving postoperative chemotherapy, overall and within eight weeks of surgery; (ii) risks of death/relapse, according to treatment, Charlson Comorbidity Index, time from diagnosis to surgery for emergency and elective cases, and time from surgery to chemotherapy; and (iii) time-trends in chemotherapy use. RESULTS Overall, 97% of cases received surgery and 65% postoperative chemotherapy, with 71% of these receiving chemotherapy within eight weeks of surgery. Risks of death and relapse were higher for cases starting chemotherapy with delay, but better than for cases not given chemotherapy. Fewer patients with high comorbidities received chemotherapy than those with low (P < 0.001). Chemotherapy timing did not vary (P = 0.250) between high and low comorbidity cases. Electively-operated cases with low comorbidities received surgery more promptly than high comorbidity cases. Risks of death and relapse were lower for elective cases given surgery after four weeks than cases given surgery within a week. High comorbidities were always independently associated with poorer outcomes. Chemotherapy use increased over time. CONCLUSIONS Our data indicate that promptly-administered postoperative chemotherapy maximizes its benefit, and that careful assessment of comorbidities is important before treatment. The survival benefit associated with slightly delayed elective surgery deserves further investigation.
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Affiliation(s)
- Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Clara Castro
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal; EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Marcela Guevara
- Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fabrizio Stracci
- Department of Experimental Medicine, Section of Public Health, University of Perugia, Perugia, Italy; Umbria Cancer Registry, Perugia, Italy
| | - MaCarmen Carmona-Garcia
- Medical Oncology Department, Catalan Institute of Oncology, Universitary Hospital Dr Josep Trueta, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Miguel Rodriguez-Barranco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | | | - Elisabetta Rapiti
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Switzerland
| | | | - Rafael Marcos-Gragera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain; School of Medicine, University of Girona (UdG), Girona, Spain; Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | | | - Maria José Sánchez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Universidad de Granada (UGR), Granada, Spain
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Batra A, Cheung WY. Role of real-world evidence in informing cancer care: lessons from colorectal cancer. ACTA ACUST UNITED AC 2019; 26:S53-S56. [PMID: 31819710 DOI: 10.3747/co.26.5625] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The term "real-world evidence" (rwe) describes the analysis of data that are collected beyond the context of clinical trials. The use and application of rwe have become increasingly common and relevant, especially in oncology, because there is growing recognition that randomized controlled trials (rcts) might not be sufficiently representative of the entire patient population that is affected by cancer, and that specific clinical research questions might be best addressed by real-world data. In this brief review, our main aim is to highlight the role of rwe in informing cancer care, particularly focusing on specific examples from colorectal cancer. Our hope is to illustrate the ways in which rwe can complement rcts in improving the understanding of cancer management and how rwe can facilitate cancer treatment decisions for real-world patients encountered in routine clinical care.
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Affiliation(s)
- A Batra
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB.,Section of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - W Y Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB.,Section of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB
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Sakin A, Yasar N, Sahin S, Arici S, Secmeler S, Can O, Geredeli C, Demir C, Cihan S. Efficacy and tolerability of adjuvant therapy in ≥70-year-old patients with T3N0M0 colorectal cancer: An observational study. J Oncol Pharm Pract 2019; 26:619-631. [PMID: 31366267 DOI: 10.1177/1078155219865008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to retrospectively investigate the efficacy and tolerability of adjuvant chemotherapy in ≥70-year-old patients with stage IIA (T3N0M0) colorectal cancer. METHODS Lymphovascular invasion, perineural invasion, margin positivity, dissected lymph node count of <12, and presence of perforation/obstruction were accepted as risk factors. Those patients with at least one risk factor were regarded as having high risk. RESULTS The study included 168 patients, among which 95 (56.5%) were male and 73 (43.5%) were female. The median age of patients was 73 years (range: 70-94). One hundred one (60.1%) patients were identified to have high risk. Eighty-one (87%) patients received 5-flourouracil+leucovorin and 12 (13%) patients received capecitabine regimens as adjuvant chemotherapy. The patients receiving capecitabine regimen had significantly higher rates of dose reduction at initiation and during the treatment. Among low-risk group, there was no statistically significant difference between patients with and without adjuvant chemotherapy in terms of disease-free survival or overall survival (p = 0.528 and p = 0.217, respectively). In high-risk group, patients receiving adjuvant chemotherapy significantly differed from those not receiving adjuvant chemotherapy in terms of median disease-free survival and overall survival (p = 0.009 and p < 0.001, respectively). While the grade, lymph node status, and adjuvant chemotherapy were identified as the most significant independent factors for disease-free survival, the most significant factors for overall survival were the age, Eastern Cooperative Oncology Group performance status, adjuvant chemotherapy, and recurrence. CONCLUSION The findings of our study showed improved disease-free survival and overall survival in high-risk ≥70-year-old patients who received adjuvant chemotherapy due to T3N0M0 colorectal cancer. We believe that 5-flourouracil+leucovorin or capecitabine regimens should be recommended for these older high-risk patients who could receive adjuvant chemotherapy regardless of age.
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Affiliation(s)
- Abdullah Sakin
- Department of Medical Oncology, Yuzuncu Yil University Medical School, Van, Turkey
| | - Nurgul Yasar
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Suleyman Sahin
- Department of Medical Oncology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Serdar Arici
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Saban Secmeler
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Orcun Can
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Caglayan Geredeli
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Cumhur Demir
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Sener Cihan
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Predicting Life Expectancy for Older Adults with Cancer in Clinical Practice: Implications for Shared Decision-making. Curr Oncol Rep 2019; 21:68. [PMID: 31240500 DOI: 10.1007/s11912-019-0821-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The calculation of noncancer-specific life expectancy can guide shared decision-making and avoid over- and undertreatment in older adults with cancer. Several factors determine life expectancy, including socio-demographic background, comorbidities, physical performance, and geriatric assessment variables. We present an overview of existing tools to estimate life expectancy, as well as practical examples of how to take into account the patient's noncancer-specific life expectancy when discussing screening decisions, initiation of treatment, and end-of-life care. RECENT FINDINGS Life expectancy prognostication has been recently recommended by international societies as part of the initial assessment of all older adults with cancer. Additionally, online resources have been created in order to make life expectancy calculation tools accessible for clinicians. Understanding available methods to estimate life expectancy, as well as how to utilize them, is a fundamental part of geriatric oncology that should be integrated into everyday clinical practice.
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