1
|
Giger AKW, Ditzel HM, Ewertz M, Ditzel H, Jørgensen TL, Pfeiffer P, Lund C, Ryg J. Effect of comprehensive geriatric assessment on hospitalizations in older adults with frailty initiating curatively intended oncologic treatment: The PROGNOSIS-RCT study. J Geriatr Oncol 2024:101821. [PMID: 39034167 DOI: 10.1016/j.jgo.2024.101821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/09/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Frailty constitutes a risk for unplanned hospitalizations in older adults with cancer. This study examines whether comprehensive geriatric assessment (CGA) as an add-on to standard oncologic care can prevent unplanned hospitalizations in older adults with frailty and cancer who initiate curative oncological treatment. MATERIALS AND METHODS This randomized controlled trial included older adults aged ≥70 with frailty (Geriatric 8 [G8] ≤14), and solid cancers who initiated curative oncological treatment. Participants were randomized 1:1 to either standard oncologic care (control) or standard oncologic care supplemented with CGA-guided interventions (intervention). Baseline characteristics were retrieved prior to randomization. The primary endpoint, the between-group rate ratio of unplanned hospitalizations within six months of treatment initiation, was analyzed using negative binominal regression. Analyses were performed using an intention-to-treat approach, followed by per-protocol analysis, including participants receiving CGA within 30 days of randomization, and preplanned subgroup analyses based on treatment modality and Geriatric 8 screening. Secondary endpoints included acute hospital contacts, treatment adherence, and toxicity. RESULTS From November 1, 2020 to May 31, 2023, 173 participants were enrolled. Median age was 75 (interquartile range 72-79), 51.5% were female, 58% had a G8 score > 12, and 84% had Eastern Cooperative Oncology Group performance status 0-1. The most common cancer sites were lung (23%), upper gastrointestinal (15%), and breast (13%). The rate (per person-years) of unplanned hospitalization was 1.32 in the intervention group and 1.81 in the control group, with a between-group rate ratio of 0.74 (95% confidence interval [CI] 0.45-1.23, P = 0.25) favoring the intervention. The between-group rate ratio increased in the per-protocol analysis (0.64 [95% CI 0.37-1.10, P = 0.10]). Similarly, no significant between group differences were found in treatment adherence, rate of acute hospital contacts, or toxicity. DISCUSSION In this study, CGA did not significantly reduce the rate of unplanned hospitalizations. Furthermore, no between-group differences were found in treatment adherence, toxicity lead hospitalizations, or treatment completion in older adults with cancer and frailty. However, per-protocol analysis suggests that increasing adherence to CGA may improve the outcome. Larger studies ensuring higher CGA adherence are warranted to confirm our findings.
Collapse
Affiliation(s)
- Ann-Kristine Weber Giger
- Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, J.B. Winsløws vej 9A, 5000 Odense, Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark.
| | - Helena Møgelbjerg Ditzel
- Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, J.B. Winsløws vej 9A, 5000 Odense, Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Oncology, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| | - Marianne Ewertz
- Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| | - Henrik Ditzel
- Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Oncology, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| | - Trine Lembrecht Jørgensen
- Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Oncology, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| | - Per Pfeiffer
- Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Oncology, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| | - Cecilia Lund
- Department of Medicine, Copenhagen University Hospital, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark; CopenAge, Copenhagen Center for Clinical Age research, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Fionavej 36, 5230 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, J.B. Winsløws vej 4, 5000 Odense, Denmark
| |
Collapse
|
2
|
Lund CM, Nielsen DL, Schultz M, Dolin TG. Physical decline, falls, and hospitalization among vulnerable older patients in the trajectory of colorectal cancer treatment. J Geriatr Oncol 2024:101820. [PMID: 38955634 DOI: 10.1016/j.jgo.2024.101820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/02/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Resilience to anticancer treatment for colorectal cancer (CRC) among older patients varies. Many experience weight loss, physical decline, falls, and hospitalization during treatment, often leading to early discontinuation of otherwise effective chemotherapy. Screening for vulnerability might help to identify patients at risk of these adverse outcomes in older adults. MATERIALS AND METHODS This is a secondary analysis from the GERICO trial. Patients aged ≥70 years assessed for chemotherapy for CRC were screened for eligibility for the GERICO trial with the geriatric-8 (G8) frailty screening tool. The present study population comprised patients who were (1) screened with G8 but for reasons not included in the GERICO study and (2) patients who were randomized to the GERICO control group. We evaluated whether patients identified as vulnerable with G8 (≤14/17) or retrospectively constructed mG8 (≥6/35) had higher risk of experiencing decline in performance status (PS), falls, and unplanned hospitalization during treatment. The association between frailty status and the adverse outcomes was analyzed with univariate and multivariate logistic regression. The discriminative ability of G8/mG8 to predict outcomes was analyzed using the area under the curve for receiver operating characteristics curves. RESULTS In total, 238 patients (median age 74 years [range 70-91]) were included in this analysis. More vulnerable than fit patients experienced decline in PS (G8: 41% vs. 14%, p = 0.006 and mG8: 28% vs. 17%, p = 0.04) during treatment. Furthermore, more vulnerable than fit patients experienced falls (G8 14% vs. 6% p = 0.04) and unplanned hospitalization (G8: 31% vs. 14%, p = 0.009 and mG8: 34% vs. 13%, p < 0.001). Multivariate analyses showed an association between G8 vulnerability and decline in PS, falls, and hospitalization. DISCUSSION Patients with G8 or mG8 vulnerability were more likely to experience decline in PS and unplanned hospitalization during chemotherapy for CRC than fit patients. More G8 vulnerable patients experienced falls compared with fit patients. Appropriate interventions should be offered to older patients with CRC assessed as vulnerable with G8 or mG8 to maintain PS during chemotherapy.
Collapse
Affiliation(s)
- Cecilia M Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark.
| | - Dorte L Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark; Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark
| | - Martin Schultz
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Troels G Dolin
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark
| |
Collapse
|
3
|
Meerkerk CDA, Bruijnen CP, van den Bos F, Emmelot-Vonk MH, de Bree R. The geriatric assessment and sarcopenia to assess frailty in older patients with cancer. J Geriatr Oncol 2024; 15:101776. [PMID: 38677936 DOI: 10.1016/j.jgo.2024.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/23/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Christiaan D A Meerkerk
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Cheryl P Bruijnen
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Frederiek van den Bos
- Department of Geriatrics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Marielle H Emmelot-Vonk
- Department of Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| |
Collapse
|
4
|
Maumus M, Roussin F, Daulange A, Ouerk Y, Larnaudie R, Vayre L, Streicher C. [Older patients and injectable anticancer drug: Feasibility study of the implementation of pharmaceutical interviews in oncogeriatrics in a hospital center]. Bull Cancer 2024:S0007-4551(24)00125-5. [PMID: 38866628 DOI: 10.1016/j.bulcan.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION In our establishment, pharmaceutical interviews in oncogeriatrics have been developed to reduce drug iatrogenesis. The target patients were older patients (≥65years) with polypharmacy and/or identified at risk of frailty (G8≤14), starting an injectable cancer protocol. METHODS The aim of this study is to evaluate the feasibility of implementing pharmaceutical interviews in oncogeriatrics over a period of six months. RESULTS In total, 30 patients benefited from a pharmaceutical interview in oncogeriatrics (median age 76 years; 21 patients with G8≤14). Two-thirds of the patients met other interveners during patient care, 4 of whom after referral by the pharmacist. As for medication reviews: 93% of patients required pharmaceutical intervention (average of 3.5 per patient). The majority proposed therapeutic follow-ups and discontinuations of treatment. According to their evaluation by a pharmacist/oncologist pair, 97% of pharmaceutical interventions would have a positive clinical impact, of which 13 % a major clinical impact. The main drug classes concerned by the pharmaceutical interventions were analgesics, drugs used in diabetes and psycholeptics. Among the four pharmaceutical interventions with major clinical impact, nine proposed the optimization of analgesic treatment. DISCUSSION The implementation of these interviews allowed us to initiate the creation of a care pathway dedicated to older patients identified as fragile. The pharmaceutical care offered appear to provide added value in the care of these patients. Organizational changes are necessary to promote multidisciplinarity and improve our practices in oncogeriatrics.
Collapse
Affiliation(s)
- Manon Maumus
- Pharmacie à usage intérieur, centre hospitalier de Brive La Gaillarde, 1, boulevard du Dr Verlhac, 19100 Brive La Gaillarde, France.
| | - Fanny Roussin
- Pharmacie à usage intérieur, centre hospitalier de Brive La Gaillarde, 1, boulevard du Dr Verlhac, 19100 Brive La Gaillarde, France
| | - Annick Daulange
- Pharmacie à usage intérieur, centre hospitalier de Brive La Gaillarde, 1, boulevard du Dr Verlhac, 19100 Brive La Gaillarde, France
| | - Yanis Ouerk
- Pôle de cancérologie, centre hospitalier de Brive La Gaillarde, 1, boulevard du Dr Verlhac, 19100 Brive La Gaillarde, France
| | - Régine Larnaudie
- Pharmacie à usage intérieur, centre hospitalier de Brive La Gaillarde, 1, boulevard du Dr Verlhac, 19100 Brive La Gaillarde, France
| | - Laure Vayre
- Pôle de cancérologie, centre hospitalier de Brive La Gaillarde, 1, boulevard du Dr Verlhac, 19100 Brive La Gaillarde, France
| | - Caroline Streicher
- Pharmacie à usage intérieur, centre hospitalier de Brive La Gaillarde, 1, boulevard du Dr Verlhac, 19100 Brive La Gaillarde, France
| |
Collapse
|
5
|
Yajima S, Masuda H. The significance of G8 and other geriatric assessments in urologic cancer management: A comprehensive review. Int J Urol 2024; 31:607-615. [PMID: 38402450 DOI: 10.1111/iju.15432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
In urologic oncology, which often involves older patients, it is important to consider how to manage their care appropriately. Geriatric assessment (GA) is a method that can address the specific needs of older cancer patients. The GA encompasses various assessment domains, but these domains exhibit variations across the literature. Some of the common items include functional ability, nutrition, comorbidities, cognitive ability, psychosocial disorders, polypharmacy, social and financial support, falls/imbalance, and vision/hearing. Despite the diversity of domains, there is limited consensus on reliable measurement methods. This review discusses the role of GA in managing urologic cancer in unique scenarios, such as those necessitating temporary or permanent urinary catheters or stomas due to urinary diversion. A comprehensive GA is time and human-resource-intensive in real-world clinical practice. Hence, simpler tools such as the Geriatric-8 (G8), capable of identifying high-risk patients requiring a detailed GA, are also under investigation in various contexts. Therefore, we conducted a systematic literature review on the G8. Our findings indicate that patients with low G8 scores encounter difficulties with stoma self-care after urinary diversion and have higher risks of urinary tract infections and ileus after radical cystectomy. The utilization of G8 as a screening tool for urologic cancer patients may facilitate the delivery of appropriate and personalized treatment and care.
Collapse
Affiliation(s)
- Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Guven DC, Martinez-Cannon BA, Testa GD, Martins JC, Velasco RN, Kalsi T, Gomes F. Immunotherapy use in older adults with cancer with frailty: A young SIOG review paper. J Geriatr Oncol 2024; 15:101742. [PMID: 38472009 DOI: 10.1016/j.jgo.2024.101742] [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: 09/30/2023] [Revised: 02/04/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
Immune checkpoint inhibitors (ICIs) became a treatment option in most tumor types and improved survival in patients with cancer in the last decade. Older patients with cancer are underrepresented in the pivotal clinical trials with ICIs. Older patients with cancer often have significant comorbidities and geriatric syndromes like frailty, which can complicate cancer care and treatment decisions. Frailty is among the most prevalent geriatric syndromes in patients with cancer and could lead to inferior survival and a higher risk of complications in patients treated with chemotherapy. However, the effect of frailty on the efficacy and safety of ICIs is understudied. This review focuses on the available evidence regarding the association between frailty and ICI efficacy and safety. Although the survival benefits of ICIs have generally been shown to be independent of age, the available real-world data has generally suggested higher rates of immune-related adverse events (irAEs) and treatment discontinuation in older patients. While international organizations recommend conducting a comprehensive geriatric assessment CGA to assess and address frailty before the start of anti-cancer therapies, an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or higher is frequently used in clinical practice as synonymous with frailty, albeit with significant limitations. The available data has generally demonstrated diminished ICI efficacy in patients with an ECOG 2 or higher compared to patients with better performance status, while the incidence of high-grade irAEs were similar. Whilst evidence regarding outcomes with ICI in older patients and in those with sub-optimal performance status is growing, there is very limited data specifically evaluating the role of frailty with ICIs. These studies found a shortened overall survival, yet no evidence of a lower response rate to ICIs. These patients experienced more AEs, but they did not necessarily have a higher incidence of irAEs.
Collapse
Affiliation(s)
- Deniz Can Guven
- Medical Oncology Clinic, Health Sciences University, Elazig City Hospital, Elazig, Turkey.
| | | | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | | | - Rogelio N Velasco
- Clinical Trial and Research Division, Philippine Heart Center, Quezon City, Philippines
| | - Tania Kalsi
- Department of Ageing and Health, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Fabio Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK
| |
Collapse
|
8
|
Rottenberg Y, Cooper L, Rose AJ. Geriatric assessment tools for older patients with cancer: Are they screening tools, or something else? J Geriatr Oncol 2024; 15:101752. [PMID: 38561311 DOI: 10.1016/j.jgo.2024.101752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/04/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Yakir Rottenberg
- The Department of Oncology, Hadassah-Hebrew University Medical Center, Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel.
| | - Lisa Cooper
- Geriatric Medicine, Rabin Medical Center, Petach Tikva, and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Adam J Rose
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem.
| |
Collapse
|
9
|
Yajima S, Nakanishi Y, Ogasawara RA, Imasato N, Hirose K, Katsumura S, Kataoka M, Masuda H. Comparing Preoperative Screening Tools for Elective Urologic Cancer Surgery: Insights from a Cluster Analysis. Gerontology 2024; 70:741-754. [PMID: 38583416 DOI: 10.1159/000538733] [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: 08/28/2023] [Accepted: 03/31/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the features and benefits of different geriatric screening tools for enhancing the perioperative care of patients who undergo elective cancer surgery using cluster analysis. METHODS This study was a retrospective, observational analysis of 1,019 consecutive patients who had elective major cancer surgery in the urology department of our hospital from October 2019 to January 2023. Before the surgery, a trained nurse screened the patients using six tools: Eastern Clinical Oncology Group performance status (ECOG-PS), flemish version of the triage risk screening tool (fTRST), geriatric-8 (G8), instrumental activities of daily living, patient health questionnaire-2 (PHQ-2), and simple questionnaire to rapidly diagnose sarcopenia (SARC-F). The study grouped the patients into four clusters based on their scores on these tools and compared their outcomes after the surgery. The outcomes included overall survival, ambulation failure, delirium, and severe complications. The study also examined how each screening tool was associated with the outcomes. RESULTS Based on their clinical data and screening results, we classified the patients into four groups: Healthy (73%), Depressive (11%), Intermediate (11%), and Unhealthy (5%). The Unhealthy group had the worst outcomes in overall survival (OS), ambulation failure, and delirium, followed by the Intermediate group. In addition, fTRST and SARC-F emerged as significant predictors of OS; ECOG-PS, fTRST, G8, and SARC-F of ambulation failure; ECOG-PS, fTRST, and G8 of delirium; and G8 of severe complications. CONCLUSION Various geriatric screening tools were found to have the potential to forecast diverse postoperative outcomes.
Collapse
Affiliation(s)
- Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yasukazu Nakanishi
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ryo Andy Ogasawara
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naoki Imasato
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kohei Hirose
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Sao Katsumura
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Madoka Kataoka
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
10
|
Yajima S, Nakanishi Y, Ogasawara RA, Imasato N, Hirose K, Katsumura S, Kataoka M, Masuda H. An exploratory study on the heterogeneity of postoperative delirium: Preoperative cognitive screening does not detect hallucinatory delirium risk. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108243. [PMID: 38460247 DOI: 10.1016/j.ejso.2024.108243] [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: 12/19/2023] [Revised: 02/06/2024] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION This study compared the clinical characteristics of patients who had hallucinations and those who did not during delirium after elective cancer surgery. MATERIALS AND METHODS This study retrospectively observed 1137 consecutive patients who had preoperative screening by a trained nurse before elective major urologic cancer surgery in our department. We compared the patient characteristics, including mini-cognitive assessment instrument (Mini-Cog) and Geriatric-8 (G8) scores, between those who developed postoperative delirium and those who did not, and also between those who had hallucinations and those who did not during delirium. RESULTS Out of 1137 patients, 68 developed postoperative delirium, and 12 of them had hallucinations. A hierarchical cluster analysis based on the G8 and Mini-Cog scores divided the patients into two groups: one with high G8 and cognitive function (36 patients) and one with low G8 and cognitive function (32 patients). Hallucinations during delirium were more frequent in the high G8 and cognitive function group (11 out of 36 patients) than in the low G8 and cognitive function group (one out of 32 patients). Patients who had hallucinations during delirium also had higher preoperative Mini-Cog scores (P = 0.002) and G8 scores (P = 0.03) than those who did not, indicating better cognitive function and less frailty. DISCUSSIONS We identified a patient population that is prone to hallucinations that preoperative screening tools cannot detect. This suggests the heterogeneity of postoperative delirium and the need for further research.
Collapse
Affiliation(s)
- Shugo Yajima
- National Cancer Center Hospital East, Department of Urology, Chiba, Japan.
| | - Yasukazu Nakanishi
- National Cancer Center Hospital East, Department of Urology, Chiba, Japan
| | - Ryo Andy Ogasawara
- National Cancer Center Hospital East, Department of Urology, Chiba, Japan
| | - Naoki Imasato
- National Cancer Center Hospital East, Department of Urology, Chiba, Japan
| | - Kohei Hirose
- National Cancer Center Hospital East, Department of Urology, Chiba, Japan
| | - Sao Katsumura
- National Cancer Center Hospital East, Department of Urology, Chiba, Japan
| | - Madoka Kataoka
- National Cancer Center Hospital East, Department of Urology, Chiba, Japan
| | - Hitoshi Masuda
- National Cancer Center Hospital East, Department of Urology, Chiba, Japan
| |
Collapse
|
11
|
Rao AR, Noronha V, Ramaswamy A, Kumar A, Pillai A, Gattani S, Sehgal A, Kumar S, Castelino R, Pearce J, Dhekale R, Jagtap P, Tripathi V, Satamkar S, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Chitre A, Kapoor A, Gota V, Banavali S, Badwe RA, Prabhash K. Assessing frailty in older Indian patients before cancer treatment: Comparative analysis of three scales and their implications for overall survival. J Geriatr Oncol 2024; 15:101736. [PMID: 38428186 DOI: 10.1016/j.jgo.2024.101736] [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: 12/07/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Frailty, characterized by ageing-related vulnerability, influences outcomes in older adults. Our study aimed to investigate the relationship between frailty and clinical outcomes in older Indian patients with cancer. MATERIALS AND METHODS Our observational single-centre study, conducted at Tata Memorial Hospital from February 2020 to July 2022, enrolled participants aged 60 years and above with cancer. Frailty was assessed using the Clinical Frailty Scale (CFS), G8, and Vulnerable Elders Survey (VES)-13. The primary objective was to explore the correlation between baseline frailty and overall survival. Statistical analyses include Kaplan-Meier, Cox proportional hazards, and Harrell's C test. RESULTS A total of 1,177 patients (median age 68, 76.9% male) were evaluated in the geriatric oncology clinic. Common malignancies included lung (40.0%), gastrointestinal (35.8%), urological (11.9%), and head and neck (9.0%), with 56.5% having metastatic disease. Using CFS, G8, and VES-13 scales, 28.5%, 86.4%, and 38.0% were identified as frail, respectively. Median follow-up was 11.6 months, with 43.3% deaths. Patients fit on CFS (CFS 1-2) had a median survival of 28.02 months, pre-frail (CFS 3-4) 13.24 months, and frail (CFS ≥5) 7.79 months (p < 0.001). Abnormal G8 (≤14) and VES-13 (≥3) were associated with significantly lower median survival (p < 0.001). Multivariate analysis confirmed CFS's predictive power for mortality (p < 0.001), with hazard ratios [HRs] for pre-frail at 1.61(95% confidence interval [CI] 1.25 to 2.06) and frail at 2.31 (95%CI 1.74 to 3.05). G8 ≤ 14 had HR 2.00 (95%CI 1.42 to 2.83), and abnormal VES-13 had HR 1.36 (95%CI 1.11-1.67). In the likelihood ratio test, CFS significantly improved the model fit (p < 0.001). Harrell's C index for survival prediction was 0.62 for CFS, 0.54 for G8, and 0.58 for VES-13. DISCUSSION In conclusion, our study highlights varying frailty prevalence and prognostic implications in older Indian patients with cancer, emphasizing the need for personalized care in oncology for this aging population. We would recommend using CFS as a tool to screen for frailty for older Indian patients with cancer.
Collapse
Affiliation(s)
- Abhijith R Rao
- Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Arshiya Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Jessica Pearce
- NIHR Acaemic Clinical Fellow in Medical Oncology, Leeds Institute of Medical Research at St James', University of Leeds, United Kingdom
| | - Ratan Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Pravin Jagtap
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vinod Tripathi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sunita Satamkar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jyoti Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Lekhika Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jayita Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nabila Ansari
- Department of Occupational therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjusha Vagal
- Department of Occupational therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Purabi Mahajan
- Department of Digestive diseases and Clinical nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shivshankar Timmanpyati
- Department of Digestive diseases and Clinical nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjunath Nookala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ankita Chitre
- Department of physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Akhil Kapoor
- Department of Medical oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajendra A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| |
Collapse
|
12
|
de Barros LPL, de Oliveira Muniz Koch L, de Oliveira Lima JT, Apolinario TL, Dettino ALA, Petrarca CR, Martins JC, de Souza PMR, Rodrigues M, de Souza E Silva JT, Karnakis T, Junior LAG, Junior MGA, Honorato M, Abalos VR, Alvarado OC, Navarrete G, Rebelatto TF, Soto-Perez-de-Celis E. Development of geriatric oncology in Latin America: A report from the Latin American Cooperative Oncology Group. J Geriatr Oncol 2024; 15:101642. [PMID: 37977899 DOI: 10.1016/j.jgo.2023.101642] [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: 09/01/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
Population aging represents a critical issue for global cancer care, notably in low- and middle-income countries (LMIC). Latin America is a large region composed of 21 countries with notable diversity in both human development and access to quality healthcare. Thus, it is necessary to understand how care for older individuals is being delivered in such large and diverse regions of the world. This review describes the recent advances made in Mexico, Brazil, and Chile, focusing on the creation and implementation of educational, research, and clinical activities in geriatric oncology. These initiatives intend to change healthcare professionals' perceptions about the care for older adults and to improve the way older patients are being treated.
Collapse
Affiliation(s)
- Luciola Pontes Leite de Barros
- Oncology and Hematology Department, HCor, São Paulo, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Ludmila de Oliveira Muniz Koch
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Oncology and Hematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Theodora Karnakis
- Cancer Institute of São Paulo, University of São Paulo, São Paulo, Brazil
| | | | | | - Macarena Honorato
- Department of Geriatrics, Clínica Alemana de Santiago, Santiago, Chile
| | | | - Oscar Calderón Alvarado
- Department of Geriatrics, Clínica Alemana de Santiago, Santiago, Chile; Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Gonzalo Navarrete
- Hospital Clínico Universidad de Chile, Santiago, Chile; Fundación Arturo Lopez Perez, Santiago, Chile
| | | | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México City, Mexico
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Sattar S, Haase KR, Lee K, Campbell KL. Exercise interventions for frail older adults with cancer. Curr Opin Support Palliat Care 2024; 18:22-26. [PMID: 38126248 DOI: 10.1097/spc.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW Frailty is prevalent in older adults with cancer and can lead to complications during cancer treatment and poor health outcomes. Exercise has been shown to be a promising strategy to mitigate frailty and slow the accumulation of functional impairment in the general geriatric population. In this review, we present a discussion on the state of the science of exercise interventions for frail older adults with cancer. This review is timely and relevant given the aging of the population and corresponding increase in proportion of older adults living with cancer. RECENT FINDINGS Existing research related to exercise interventions for frail older adults with cancer appear to show some promise in feasibility and efficacy in both surgical and systemic treatment settings. SUMMARY More research on this topic and testing rigorously structured exercise interventions for older adults with cancer may help inform cancer-specific guidelines and create a foundation of evidence to enable implementation of exercise interventions. These interventions can support cancer care to attenuate frailty-related outcomes while extending its benefit to overall health of this population.
Collapse
Affiliation(s)
- Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia
- BC Cancer Research Institute, Cancer Control
| | - Kayoung Lee
- Faculty of Applied Science, School of Nursing, University of British Columbia
| | - Kristin L Campbell
- BC Cancer Research Institute, Cancer Control
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
15
|
Yajima S, Nakanishi Y, Ogasawara RA, Imasato N, Hirose K, Katsumura S, Kataoka M, Masuda H. Housework participation and mortality in Japanese male patients undergoing cancer surgery: A propensity score-matched study. Prev Med 2024; 180:107896. [PMID: 38360151 DOI: 10.1016/j.ypmed.2024.107896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Participation in housework and meal preparation are instrumental activity of daily living (IADL) evaluation items that is known to predict prognosis and complications in cancer care. However, these items are often assessed only for females, not for males, in IADL. METHODS We examined the impact of habit of housework and meal preparation on overall survival (OS) in 1025 Japanese male patients who underwent elective urologic cancer surgery at our institution. The study also used a cohort that was matched by propensity score. RESULTS We found that patients who did not prepare meals or do housework had significantly shorter OS (hazard ratio [HR] = 3.34, P = 0.005; HR = 5.01, P < 0.001, respectively). Even in the cohort of 448 patients matched by propensity score and adjusted for age, body mass index, comorbidities, performance status, living status, cancer type, stage groups of cancer, and surgical approach, lack of participation in housework was associated with shorter OS (HR = 2.92, P = 0.04) and was an independent predictor of worse OS in multivariable analysis (HR = 5.13, P = 0.008). CONCLUSIONS Males who did not regularly do household chores before elective cancer surgery had worse life outcomes. Doing more daily physical activities, such as household chores like making the bed and cleaning the room, might have a positive impact on survival when fighting cancer.
Collapse
Affiliation(s)
- Shugo Yajima
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan.
| | - Yasukazu Nakanishi
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Ryo Andy Ogasawara
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Naoki Imasato
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Kohei Hirose
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Sao Katsumura
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Madoka Kataoka
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Hitoshi Masuda
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| |
Collapse
|
16
|
Vinod SK, Merie R, Harden S. Quality of Decision Making in Radiation Oncology. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00067-0. [PMID: 38342658 DOI: 10.1016/j.clon.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/04/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
High-quality decision making in radiation oncology requires the careful consideration of multiple factors. In addition to the evidence-based indications for curative or palliative radiotherapy, this article explores how, in routine clinical practice, we also need to account for many other factors when making high-quality decisions. Foremost are patient-related factors, including preference, and the complex interplay between age, frailty and comorbidities, especially with an ageing cancer population. Whilst clinical practice guidelines inform our decisions, we need to account for their applicability in different patient groups and different resource settings. With particular reference to curative-intent radiotherapy, we explore decisions regarding dose fractionation schedules, use of newer radiotherapy technologies and multimodality treatment considerations that contribute to personalised patient-centred care.
Collapse
Affiliation(s)
- S K Vinod
- Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia; South West Sydney Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
| | - R Merie
- Icon Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - S Harden
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
17
|
AlSendi M, Flynn CR, Khan MR, Selvadurai P, Crown J, McDermott RS, Walshe JM, Fennelly DW, Hanrahan EO, Doherty M, Higgins MJ. Pilot study of the implementation of G8 screening tool, Cognitive screening assessment and Chemotherapy Toxicity assessment in older adults with cancer in a Tertiary University Hospital in Ireland. Ir J Med Sci 2024; 193:45-50. [PMID: 37450258 DOI: 10.1007/s11845-023-03446-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: 01/19/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) is recommended by international guidelines prior to initiation of systemic anti-cancer treatment (SACT). In practice, CGA is limited by time constraints, lack of resources and expert interpretation. AIMS The primary objective of this pilot study was to establish the prevalence of frailty (assessed by G8), cognitive impairment (assessed by Mini-Cog), and risk of chemotherapy toxicity (assessed by CARG Chemo-Toxicity Calculator) among patients (pts) ≥65 years commencing SACT. We selected these three screening tools due to the ease of conducting them in a busy outpatient setting. In addition, they have been validated to predict frailty and risk of toxicity from SACT among older adults with cancer. METHODS Eligible participants were identified from medical oncology clinics. Assessments were conducted in an outpatient setting by treating physicians. Pt records were reviewed to gather demographic and cancer details. Statistical analyses were conducted using SPSS statistical software. RESULTS Sixty-three participants were enrolled. The mean age of participants was 73yrs (range=65-88). Thirty-three (52.4%) were female and 30 (47.6%) were male. The majority (n=38, 60.3%) had metastatic cancer. The mean G8 score was 11.9 (range=6-19). Eighty-three percent had a G8 score ≤14. Mini-Cog was positive in 13 pts (21%). The mean CARG score was 7.5 (range=0-16), and 80% had a risk of at least 50% grade ≥3 toxicity. Of these, 48 (76.2%) received chemotherapy and 15 (23.8%) received non-cytotoxic SACT. In multi-variate analyses, age, cancer type, treatment type, and disease stage did not impact G8, Mini-Cog, or CARG scores. CONCLUSIONS Our study has several limitations but suggests that the majority of older adults with cancer would qualify for formal CGA assessment. The risk of high-grade toxicity from SACT is substantial in this cohort. Chronological age was not found to negatively impact pts' frailty, cognition, or risk of toxicity.
Collapse
Affiliation(s)
- Maha AlSendi
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Calvin R Flynn
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Muhammad R Khan
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Paul Selvadurai
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - John Crown
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Raymond S McDermott
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Janice M Walshe
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - David W Fennelly
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Emer O Hanrahan
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Mark Doherty
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Michaela J Higgins
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| |
Collapse
|
18
|
Dardaine V, Cancel M, Inyambo K, Biogeau J, Sauger C, Lecomte T, Dorval E. Geriatric factors associated with overall survival in older patients with metastatic colorectal cancer. Clin Res Hepatol Gastroenterol 2024; 48:102280. [PMID: 38182006 DOI: 10.1016/j.clinre.2024.102280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 01/07/2024]
Abstract
Advanced age in patients with colorectal cancer is a factor of poor prognosis, but little is known about geriatric factors associated with survival and chemotherapy prescription in frail elderly patients. Our research sought to investigate these factors in older patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS patients aged ≥75 years, who were treated for mCRC and have had a Comprehensive Geriatric Assessment (CGA) due to their frailty, were included in this multicenter practice study in the Loire Valley region (France). With initial patient care for mCRC as the starting point, demographic, oncological, geriatric and survival data were collected from the regional cancer database and the medical record of each patient. We analyzed overall survival and chemotherapy prescription, according to the geriatric factors of the CGA. RESULTS 108 patients were enrolled (mean age 84.0 +/- 4.5 years; 57.4 % men), among whom 53 (49 %) received at least one line of chemotherapy. The median overall survival [95 %CI] was 8.05 [5.6-12.0] months. In univariate analysis, prescription of chemotherapy was associated with the number of severe co-morbidities, number of co-medications, G8 score, BMI, MMSE score, IADL and ADL scores, Lee index and Balducci criteria. Survival was significantly associated with chemotherapy, ADL and IADL scores, G8 score, repeated falls, number of severe co-morbidities, MMSE score, Lee index and Balducci criteria. In multivariate analysis, only the ADL score (HR [95 %CI]: 0.74 [0.55-0.99], p = 0.04), number of severe co-morbidities (HR [95 %CI]: 1.62 [1.06-2.47], p = 0.03) and repeated falls (HR [95 %CI]: 3.54 [1.70-7.39], p < 0.001) were significantly associated with survival. CONCLUSION in frail elderly patients with mCRC, dependency, co-morbidities and repeated falls are independent factors associated with survival. As such, there could be merit in taking these into consideration before the choice of oncological treatment is made.
Collapse
Affiliation(s)
- Véronique Dardaine
- Department of Gerontology, Tours Regional University Hospital Center (CHRU), France
| | | | - Kaggwa Inyambo
- Department of Gerontology, Tours Regional University Hospital Center (CHRU), France
| | - Julie Biogeau
- Department of Gerontology, Tours Regional University Hospital Center (CHRU), France
| | - Carine Sauger
- Regional Cancer Network, Geriatric Oncology Unit (Antenne d'Oncogériatrie/Oncocentre), Tours, France
| | - Thierry Lecomte
- Department of Gastroenterology and Cancer, CHRU, Tours, France
| | - Etienne Dorval
- Regional Cancer Network, Geriatric Oncology Unit (Antenne d'Oncogériatrie/Oncocentre), Tours, France.
| |
Collapse
|
19
|
Swartz K, Chapman A, Zhan T, Wen KY. Process evaluation of a G8 screening tool implementation in an outpatient oncology center. J Geriatr Oncol 2024; 15:101605. [PMID: 37633778 PMCID: PMC10843632 DOI: 10.1016/j.jgo.2023.101605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/18/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Affiliation(s)
| | - Andrew Chapman
- Sidney Kimmel Cancer Center, Thomas Jefferson University, USA
| | - Tingting Zhan
- Sidney Kimmel Cancer Center, Thomas Jefferson University, USA
| | - Kuang-Yi Wen
- Sidney Kimmel Cancer Center, Thomas Jefferson University, USA
| |
Collapse
|
20
|
Benzinger P, Eidam A, Bauer JM. [Frailty: Concept and Diagnosis]. Dtsch Med Wochenschr 2024; 149:30-37. [PMID: 38158204 DOI: 10.1055/a-2033-4957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Frailty increases the older adult's vulnerability to suffer adverse health outcomes. To date, no gold standard for the diagnosis of frailty exists. This article provides an overview of the most relevant frailty instruments and their scope of application.
Collapse
|
21
|
Giger AKW, Ditzel HM, Ditzel HJ, Ewertz M, Jørgensen TL, Pfeiffer P, Lund CM, Ryg J. Effects of comprehensive geriatric assessment-guided interventions on physical performance and quality of life in older patients with advanced cancer: A randomized controlled trial (PROGNOSIS-RCT). J Geriatr Oncol 2024; 15:101658. [PMID: 37939628 DOI: 10.1016/j.jgo.2023.101658] [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: 08/25/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Older patients with frailty starting oncological treatment are at higher risk of experiencing declining physical performance, loss of independence, and quality of life (QoL). This study examines whether comprehensive geriatric assessment (CGA)-guided interventions added to standard oncological care can prevent declining physical performance and QoL in older patients with frailty initiating palliative treatment. MATERIALS AND METHODS Patients aged ≥70 years, with a Geriatric-8 score of ≤14, initiating palliative oncological treatment were enrolled in an open label randomized controlled trial and randomized 1:1 to receive either CGA-guided interventions in addition to oncological standard care or oncological care alone. Baseline characteristics, physical performance measures, and QoL questionnaires were retrieved before group allocation. CGA was performed using a fixed set of domains and validated tests by a geriatrician-led team. The primary endpoint, physical performance, was measured by the 30-s chair stand test (30s-CST) at three months. Additional outcomes included 30s-CST at six months, handgrip strength test, and QoL. Outcomes were analyzed using linear mixed regression models. The trial was registered at clinicaltrials.org (NCT04686851). RESULTS From November 1, 2020 to May 31, 2022, 181 patients were included; 88 in the interventional arm and 93 in the control arm. Median age was 77 (interquartile range [IQR] 73-81) years, 69% were male, median Geriatric-8 score was 12 (IQR 10-13), 69% had a Performance Status of 0-1, and the median 30s-CST was 9 (IQR 5-11) repetitions. The between-group difference in 30s-CST at three months was 0.67 (95%CI: -0.94 - 2.29) and 1.57 (95%CI: -0.20 - 3.34) at six months, which were not statistically significant. Subgroup analysis including participants with a baseline Geriatric-8 of 12-14 found borderline significant between-group differences in 30s-CST scores at three and six months of 2.04 (95% confidence interval [CI]: -0.07 - 4.2, P = 0.06) and 2.25 (95%CI: 0.01-4.5, P = 0.05), respectively. No within-group or between-group differences in the summary score or the Elderly Functional Index score (measuring QoL) were found. DISCUSSION This study did not find significant between-group differences in the 30s-CST in older patients receiving palliative care. However, a tendency towards improved physical performance was seen in the least frail. These patients may represent a target group wherein CGA interventions provide particular benefit.
Collapse
Affiliation(s)
- Ann-Kristine W Giger
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark.
| | - Helena M Ditzel
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Henrik J Ditzel
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Marianne Ewertz
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Trine Lembrecht Jørgensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Per Pfeiffer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Cecilia M Lund
- Department of Medicine, Copenhagen University Hospital, Herlev, Gentofte, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; CopenAge, Copenhagen Center for Clinical Age research, University of Copenhagen, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| |
Collapse
|
22
|
Vinod S, Khoo A, Berry M, Bell K, Ahmed E, Campisi J, Gollon C, Pal A, Seto SK, Tcharkhedian E, Tran T, Bray V. Implementation and evaluation of a geriatric-oncology model of care for older adults with lung cancer. J Geriatr Oncol 2023; 14:101578. [PMID: 37422350 DOI: 10.1016/j.jgo.2023.101578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Shalini Vinod
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical Campuses, University of NSW, Liverpool, NSW, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Liverpool, NSW, Australia.
| | - Angela Khoo
- South Western Sydney Clinical Campuses, University of NSW, Liverpool, NSW, Australia; Department of Geriatrics, Liverpool Hospital, Liverpool, NSW, Australia
| | - Megan Berry
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical Campuses, University of NSW, Liverpool, NSW, Australia
| | - Katherine Bell
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Department of Dietetics, Liverpool Hospital, Liverpool, NSW, Australia
| | - Elhassan Ahmed
- Department of Physiotherapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Josephine Campisi
- Department of Occupational Therapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Cara Gollon
- Department of Occupational Therapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Abhijit Pal
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; University of Sydney, Camperdown, NSW, Australia
| | - Sau Kwan Seto
- Department of Occupational Therapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Elise Tcharkhedian
- Department of Physiotherapy, Liverpool Hospital, Liverpool, NSW, Australia
| | - Thomas Tran
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
| | - Victoria Bray
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Western Sydney University, Liverpool, NSW, Australia
| |
Collapse
|
23
|
Güzelöz Z, Gök Balcı U. The Impact of Radiotherapy on Frailty in Patients Aged 65 and Over. Cureus 2023; 15:e46351. [PMID: 37790869 PMCID: PMC10544825 DOI: 10.7759/cureus.46351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction and objective Frailty is characterized by the body's increased susceptibility to stressors due to aging and a concurrent decline in its resilience. A dominant hypothesis suggests that oncological interventions may amplify this vulnerability. Consequently, elderly individuals with cancer may pose challenges for conventional treatments. This research sought to assess the effects of radiotherapy (RT) on the frailty of elderly cancer patients by utilizing the Edmonton Frail Scale (EFS). Methods This research was designed as a prospective observational study. Patients aged 65 and older, receiving treatment at the radiation oncology clinic, were asked to complete the EFS form both before and at the end of their RT course. The scores achieved before and after the RT were obtained, and the medical histories of the patients were recorded. The difference between the pre- and post-RT scores was calculated by subtracting the post-RT score from the pre-RT score to determine any increase or decrease in the score. For the statistical evaluations, a suite of tests (including the Shapiro-Wilk test, Kolmogorov-Smirnov test, paired sample t-test, independent t-tests, analysis of variance {ANOVA}, and Pearson correlation) were implemented. All analyses were conducted using the Statistical Package for Social Sciences (SPSS) software (version 29.0) (IBM SPSS Statistics, Armonk, NY). Results From April 2021 to August 2023, a total of 121 patients participated in the study. Out of these, 81 underwent assessments both pre- and post-RT. The median age was 73; the median follow-up period was five months. The predominant diagnoses included prostate cancer, breast cancer, and gynecological malignancies. A significant proportion of patients was diagnosed with stage IV cancer and underwent palliative RT. Post-RT evaluations revealed a decline in scores for some patients, while an increase was observed for others. Certain score variations were statistically significant. Moreover, an inverse correlation was discerned between the RT dose and fraction number and the post-RT EFS score. Conclusion Our research confirmed that a substantial number of patients either experienced a decrease or maintained stability in their EFS scores after RT. This observation suggests that RT might not exacerbate frailty in the elderly in the short term. Nevertheless, to elucidate the long-term impact of RT on frailty, there is a pressing need for a comprehensive assessment correlating EFS scores with survival rates.
Collapse
Affiliation(s)
- Zeliha Güzelöz
- Radiation Oncology Department, University of Health Sciences, Tepecik Training and Research Hospital, İzmir, TUR
| | - Umut Gök Balcı
- Palliative Care Clinic, University of Health Sciences, Tepecik Training and Research Hospital, İzmir, TUR
| |
Collapse
|
24
|
Spencer KL, Absolom KL, Allsop MJ, Relton SD, Pearce J, Liao K, Naseer S, Salako O, Howdon D, Hewison J, Velikova G, Faivre-Finn C, Bekker HL, van der Veer SN. Fixing the Leaky Pipe: How to Improve the Uptake of Patient-Reported Outcomes-Based Prognostic and Predictive Models in Cancer Clinical Practice. JCO Clin Cancer Inform 2023; 7:e2300070. [PMID: 37976441 PMCID: PMC10681558 DOI: 10.1200/cci.23.00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/08/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE This discussion paper outlines challenges and proposes solutions for successfully implementing prediction models that incorporate patient-reported outcomes (PROs) in cancer practice. METHODS We organized a full-day multidisciplinary meeting of people with expertise in cancer care delivery, PRO collection, PRO use in prediction modeling, computing, implementation, and decision science. The discussions presented here focused on identifying challenges to the development, implementation and use of prediction models incorporating PROs, and suggesting possible solutions. RESULTS Specific challenges and solutions were identified across three broad areas. (1) Understanding decision making and implementation: necessitating multidisciplinary collaboration in the early stages and throughout; early stakeholder engagement to define the decision problem and ensure acceptability of PROs in prediction; understanding patient/clinician interpretation of PRO predictions and uncertainty to optimize prediction impact; striving for model integration into existing electronic health records; and early regulatory alignment. (2) Recognizing the limitations to PRO collection and their impact on prediction: incorporating validated, clinically important PROs to maximize model generalizability and clinical engagement; and minimizing missing PRO data (resulting from both structural digital exclusion and time-varying factors) to avoid exacerbating existing inequalities. (3) Statistical and modeling challenges: incorporating statistical methods to address missing data; ensuring predictive modeling recognizes complex causal relationships; and considering temporal and geographic recalibration so that model predictions reflect the relevant population. CONCLUSION Developing and implementing PRO-based prediction models in cancer care requires extensive multidisciplinary working from the earliest stages, recognition of implementation challenges because of PRO collection and model presentation, and robust statistical methods to manage missing data, causality, and calibration. Prediction models incorporating PROs should be viewed as complex interventions, with their development and impact assessment carried out to reflect this.
Collapse
Affiliation(s)
- Katie L. Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kate L. Absolom
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Matthew J. Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Samuel D. Relton
- Leeds Institute of Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Jessica Pearce
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Kuan Liao
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Centre for Health Informatics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sairah Naseer
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Omolola Salako
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Daniel Howdon
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Corinne Faivre-Finn
- Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Hilary L. Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sabine N. van der Veer
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Centre for Health Informatics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
25
|
Chon J, Timilshina N, AlMugbel F, Jin R, Monginot S, Tejero I, Breunis H, Alibhai SMH. Validity of a self-administered G8 screening test for older patients with cancer. J Geriatr Oncol 2023; 14:101553. [PMID: 37379768 DOI: 10.1016/j.jgo.2023.101553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/03/2023] [Accepted: 06/02/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION The Geriatric 8 (G8) is a brief cancer-specific tool which screens for patients who require a comprehensive geriatric assessment (CGA). The G8 test assesses patients on eight domains such as mobility, polypharmacy, age, and self-rated health. However, the current G8 requires a healthcare professional (nurse or physician) present to conduct the test, which limits its usefulness. The Self-G8 questionnaire (S-G8) is an adaptation of the original G8 test, assessing all the same domains, with questions modified to be appropriate for patients to self-complete. Our objective was to evaluate the performance of S-G8 compared to the G8 and CGA. MATERIALS AND METHODS The initial S-G8 was designed by our team through review of the literature and questionnaire design principles, and was optimized through feedback from patients over the age of 70. The questionnaire subsequently underwent further refinement after undergoing pilot testing (N = 14). The diagnostic accuracy of the final iteration of the S-G8 was evaluated along with the standard G8 in a prospective cohort study (N = 52) in an academic geriatric oncology clinic at the Princess Margaret Cancer Centre, Toronto, Canada. Psychometric characteristics were evaluated including internal consistency, sensitivity, and specificity compared to the G8 and to the CGA. RESULTS There was strong correlation between the G8 and S-G8 scores, with a Spearman correlation co-efficient of 0.76 (p < 0.001). Internal consistency was acceptable at 0.60. The frequency of abnormality (<14 score) for the G8 and S-G8 was 82.7% and 61.5%, respectively. The mean score for the original G8 and S-G8 was 11.9 and 13.5, respectively. The cut-off of 14 for the S-G8 yielded the best combination of sensitivity of 0.70 ± 0.07 and specificity of 0.78 ± 0.14 when compared to the G8. When compared to two or more abnormal domains on the CGA, the S-G8 performed at least as well as the G8 with a sensitivity of 0.77, specificity of 0.85, and a Youden's index of 0.62. DISCUSSION The S-G8 questionnaire appears to be an acceptable alternative to the original G8 in identifying older adults with cancer who will benefit from a CGA. Large scale testing is warranted.
Collapse
Affiliation(s)
- Joseph Chon
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Fahad AlMugbel
- Department of Medicine, University Health Network, Toronto, Canada
| | - Rana Jin
- Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Susie Monginot
- Nursing, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Isabel Tejero
- Department of Medicine, University Health Network, Toronto, Canada
| | | | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Canada.
| |
Collapse
|
26
|
Carroll C, Ruder L, Miklosovic C, Bauhof RM, Chiec L, Owusu C, Curseen KA, Gupta M. Early Palliative Care for the Geriatric Patient with Cancer. Clin Geriatr Med 2023; 39:437-448. [PMID: 37385695 DOI: 10.1016/j.cger.2023.04.005] [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] [Indexed: 07/01/2023]
Abstract
Older adults with cancer present with complex multidimensional problems. Therefore, early integration of palliative care for the older adult with cancer is important, and a multidisciplinary team approach is critical for optimum care. The importance of incorporating geriatric and palliative concerns in assessment, as well as early involvement of the multidisciplinary team, is discussed as a manner of addressing the needs of older adults with cancer. Concerns related to metabolic changes that can occur with aging, as well as risk for polypharmacy and inappropriate prescribing for older adults, are also reviewed.
Collapse
Affiliation(s)
- Colleen Carroll
- Division of Solid Tumor Oncology, Supportive and Palliative Oncology, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside Suite 1200, Mailstop LKS 5079, Cleveland, OH 44106, USA
| | - Lori Ruder
- Division of Solid Tumor Oncology, Supportive and Palliative Oncology, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside Suite 1200, Mailstop LKS 5079, Cleveland, OH 44106, USA
| | - Christine Miklosovic
- Division of Solid Tumor Oncology, Supportive and Palliative Oncology, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside Suite 1200, Mailstop LKS 5079, Cleveland, OH 44106, USA
| | - Rev Matthew Bauhof
- Division of Solid Tumor Oncology, Supportive and Palliative Oncology, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside Suite 1200, Mailstop LKS 5079, Cleveland, OH 44106, USA
| | - Lauren Chiec
- Division of Solid Tumor Oncology, Case Western Reserve University School of Medicine, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside Suite 1200, Mailstop LKS 5079, Cleveland, OH 44106, USA
| | - Cynthia Owusu
- Division of Solid Tumor Oncology, Case Western Reserve University School of Medicine, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside Suite 1200, Mailstop LKS 5079, Cleveland, OH 44106, USA
| | - Kimberly A Curseen
- Division of Palliative Care, Department of Family Preventative Medicine, Emory School of Medicine, 1365 Clifton NE, Atlanta, GA 30322, USA
| | - Mona Gupta
- Division of Solid Tumor Oncology, Supportive and Palliative Oncology, Case Western Reserve University School of Medicine, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside Suite 1200, Mailstop LKS 5079, Cleveland, OH 44106, USA.
| |
Collapse
|
27
|
Strang P, Schultz T. The Impact of Frailty on Palliative Care Receipt, Emergency Room Visits and Hospital Deaths in Cancer Patients: A Registry-Based Study. Curr Oncol 2023; 30:6623-6633. [PMID: 37504346 PMCID: PMC10378432 DOI: 10.3390/curroncol30070486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on end-of-life healthcare utilization in deceased cancer patients. METHOD Hospital Frailty Risk Scores (HFRS) were calculated based on 109 weighted International Classification of Diseases 10th revision (ICD-10) diagnoses, and HFRS was related to (a) receipt of specialized palliative care, (b) unplanned emergency room (ER) visits during the last month of life, and (c) acute hospital deaths. RESULTS A total of 20,431 deceased cancer patients in ordinary accommodations were studied (nursing home residents were excluded). Frailty, as defined by the HFRS, was more common in men than in women (42% vs. 38%, p < 0.001) and in people residing in less affluent residential areas (42% vs. 39%, p < 0.001). Patients with frailty were older (74.1 years vs. 70.4 years, p < 0.001). They received specialized palliative care (SPC) less often (76% vs. 81%, p < 0.001) but had more unplanned ER visits (50% vs. 35%, p < 0.001), and died more often in acute hospital settings (22% vs. 15%, p < 0.001). In multiple logistic regression models, the odds ratio (OR) was higher for frail people concerning ER visits (OR 1.81 (1.71-1.92), p < 0.001) and hospital deaths (OR 1.66 (1.51-1.81), p < 0.001), also in adjusted models, when controlled for age, sex, socioeconomic status at the area level, and for receipt of SPC. CONCLUSION Frailty, as measured by the HFRS, significantly affects end-of-life cancer patients and should be considered in oncologic decision-making.
Collapse
Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholms Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
- Research and Development Department, Stockholm's Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
| | - Torbjörn Schultz
- Research and Development Department, Stockholm's Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
| |
Collapse
|
28
|
Ishii N, Hatakeyama S, Miura H, Tanaka R, Oishi T, Horiguchi H, Hosogoe S, Fujita N, Iwamura H, Okamoto T, Yamamoto H, Yoneyama T, Hashimoto Y, Ohyama C. Trends in the age of hospitalized patients with urological cancers: A 17-year experience. Int J Urol 2023; 30:572-578. [PMID: 36941076 DOI: 10.1111/iju.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/28/2023] [Indexed: 03/22/2023]
Abstract
OBJECTIVES To investigate the impact of global aging on the trends in the age of hospitalized patients with a urological cancer diagnosis. METHODS We retrospectively evaluated a cumulative total of 10 652 cases of referred patients (n = 6637) with a urological disease who were hospitalized in our institution between January 2005 and December 2021. We compared age and the proportion of patients aged ≥80 years among patients who were hospitalized in the urological ward between the period of 2005-2013 and that of 2014-2021. RESULTS We identified 8168 hospitalized patients with urological cancer. The median age was significantly increased in patients with urological cancer between the periods of 2005-2013 and 2014-2021. The proportion of hospitalized patients with urological cancer aged ≥80 years was significantly increased between the periods of 2005-2013 (9.3%) and 2014-2021 (13.8%). The median ages of the patients with urothelial cancer (UC) and renal cell carcinoma (RCC), but not the median age of those with prostate cancer (PC), were significantly increased between the study periods. The proportion of hospitalized patients with UC, but not the proportions of those with PC and RCC, aged ≥80 years was significantly increased between the study periods. CONCLUSIONS The age of patients with urological cancer who were hospitalized in the urological ward and the proportion of patients with UC aged ≥80 years significantly increased over the entire study period.
Collapse
Affiliation(s)
- Noritaka Ishii
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hikari Miura
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Ryuma Tanaka
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Takuya Oishi
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hirotaka Horiguchi
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Shogo Hosogoe
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hiromichi Iwamura
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Regenerative Medicine, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
- Department of Advanced Blood Purification Therapy, Hirosaki University School of Medicine, Hirosaki, Japan
- Department of Advanced Regenerative Medicine, Hirosaki University School of Medicine, Hirosaki, Japan
| |
Collapse
|
29
|
Bouzan J, Horstmann M. G8 screening and health-care use in patients with cancer. THE LANCET. HEALTHY LONGEVITY 2023; 4:e297-e298. [PMID: 37327805 DOI: 10.1016/s2666-7568(23)00101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Affiliation(s)
- Jobar Bouzan
- Department of Urology, Oncologic Urology and Pediatric Urology, Hospital Düren, Düren, Germany; Faculty of Medicine, University of Duisburg-Essen, Essen 45147, Germany
| | - Marcus Horstmann
- Faculty of Medicine, University of Duisburg-Essen, Essen 45147, Germany; Department of Urology, Urooncology, and Minimal Invasive and Robotic Surgery, Klinikum Guetersloh, Guetersloh, Germany.
| |
Collapse
|
30
|
Depoorter V, Vanschoenbeek K, Decoster L, Silversmit G, Debruyne PR, De Groof I, Bron D, Cornélis F, Luce S, Focan C, Verschaeve V, Debugne G, Langenaeken C, Van Den Bulck H, Goeminne JC, Teurfs W, Jerusalem G, Schrijvers D, Petit B, Rasschaert M, Praet JP, Vandenborre K, Milisen K, Flamaing J, Kenis C, Verdoodt F, Wildiers H. Long-term health-care utilisation in older patients with cancer and the association with the Geriatric 8 screening tool: a retrospective analysis using linked clinical and population-based data in Belgium. THE LANCET. HEALTHY LONGEVITY 2023; 4:e326-e336. [PMID: 37327806 DOI: 10.1016/s2666-7568(23)00081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Little evidence is available on the long-term health-care utilisation of older patients with cancer and whether this is associated with geriatric screening results. We aimed to evaluate long-term health-care utilisation among older patients after cancer diagnosis and the association with baseline Geriatric 8 (G8) screening results. METHODS For this retrospective analysis, we included data from three cohort studies for patients (aged ≥70 years) with a new cancer diagnosis who underwent G8 screening between Oct 19, 2009 and Feb 27, 2015, and who survived more than 3 months after G8 screening. The clinical data were linked to cancer registry and health-care reimbursement data for long-term follow-up. The occurrence of outcomes (inpatient hospital admissions, emergency department visits, use of intensive care, contacts with general practitioner [GP], contacts with a specialist, use of home care, and nursing home admissions) was assessed in the 3 years after G8 screening. We assessed the association between outcomes and baseline G8 score (normal score [>14] or abnormal [≤14]) using adjusted rate ratios (aRRs) calculated from Poisson regression and using cumulative incidence calculated as a time-to-event analysis with the Kaplan-Meier method. FINDINGS 7556 patients had a new cancer diagnosis, of whom 6391 patients (median age 77 years [IQR 74-82]) met inclusion criteria and were included. 4110 (64·3%) of 6391 patients had an abnormal baseline G8 score (≤14 of 17 points). In the first 3 months after G8 screening, health-care utilisation peaked and then decreased over time, with the exception of GP contacts and home care days, which remained high throughout the 3-year follow-up period. Compared with patients with a normal baseline G8 score, patients with an abnormal baseline G8 score had more hospital admissions (aRR 1·20 [95% CI 1·15-1·25]; p<0·0001), hospital days (1·66 [1·64-1·68]; p<0·0001), emergency department visits (1·42 [1·34-1·52]; p<0·0001), intensive care days (1·49 [1·39-1·60]; p<0·0001), general practitioner contacts (1·19 [1·17-1·20]; p<0·0001), home care days (1·59 [1·58-1·60]; p<0·0001), and nursing home admissions (16·7% vs 3·1%; p<0·0001) in the 3-year follow-up period. At 3 years, of the 2281 patients with a normal baseline G8 score, 1421 (62·3%) continued to live at home independently and 503 (22·0%) had died. Of the 4110 patients with an abnormal baseline G8 score, 1057 (25·7%) continued to live at home independently and 2191 (53·3%) had died. INTERPRETATION An abnormal G8 score at cancer diagnosis was associated with increased health-care utilisation in the subsequent 3 years among patients who survived longer than 3 months. FUNDING Stand up to Cancer, the Flemish Cancer Society.
Collapse
Affiliation(s)
| | | | - Lore Decoster
- Department of Medical Oncology, Vrije Universiteit Brussel, University Hospitals Brussels, Brussels, Belgium
| | | | - Philip R Debruyne
- Division of Medical Oncology, Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; Medical Technology Research Centre, School of Life Sciences, Anglia Ruskin University, Cambridge, UK; School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Inge De Groof
- Department of Geriatric Medicine, Iridium Network Antwerp, Sint-Augustinus Cancer Center, Wilrijk, Belgium
| | - Dominique Bron
- Department of Hematology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Frank Cornélis
- Department of Medical Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sylvie Luce
- Department of Medical Oncology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Christian Focan
- Department of Oncology, Clinique CHC MontLégia, Liège, Belgium
| | - Vincent Verschaeve
- Department of Medical Oncology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Gwenaëlle Debugne
- Department of Geriatric Medicine, Centre Hospitalier de Mouscron, Mouscron, Belgium
| | | | | | - Jean-Charles Goeminne
- Department of Medical Oncology, Centre Hospitalier Universitaire UCL-Namur, Namur, Belgium
| | - Wesley Teurfs
- Department of Medical Oncology, ZNA Stuivenberg, Antwerp, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, Centre Hospitalier Universitaire Sart Tilman, Liège University, Liège, Belgium
| | - Dirk Schrijvers
- Department of Medical Oncology, ZNA Middelheim, Antwerp, Belgium
| | - Bénédicte Petit
- Department of Medical Oncology, Centre Hospitalier Jolimont, La Louvière, Belgium
| | - Marika Rasschaert
- Department of Medical Oncology, University Hospital Antwerp, Edegem, Belgium
| | - Jean-Philippe Praet
- Department of Geriatric Medicine, Centre Hospitalier Universitaire St-Pierre, Free Universities Brussels, Brussels, Belgium
| | | | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Cindy Kenis
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Freija Verdoodt
- Research Department, Belgian Cancer Registry, Brussels, Belgium
| | - Hans Wildiers
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
| |
Collapse
|
31
|
Morimoto K, Yamada T, Takeda T, Shiotsu S, Date K, Harada T, Tamiya N, Chihara Y, Takemura Y, Yamada T, Kanda H, Ishida M, Yoshimura A, Iwasaku M, Tokuda S, Kim YH, Takayama K. Prospective Observational Study Evaluating the Prognostic Value of the G8 Screening Tool for Extensive-Stage Small Cell Lung Cancer Patients Who Received Programmed Death-Ligand 1 Inhibitor plus Platinum-Etoposide Chemotherapy. Drugs Aging 2023; 40:563-571. [PMID: 37145245 DOI: 10.1007/s40266-023-01034-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Programmed death-ligand 1 (PD-L1) inhibitor plus platinum-etoposide chemotherapy is used as a first-line treatment for extensive-stage small cell lung cancer (ES-SCLC), regardless of age. OBJECTIVE We examined the role of the Geriatric 8 (G8) screening tool for evaluating treatment outcomes in patients with ES-SCLC treated with PD-L1 inhibitor plus platinum-etoposide chemotherapy as first-line therapy. PATIENTS AND METHODS Between September 2019 and October 2021, we prospectively evaluated patients with ES-SCLC treated with immunochemotherapy at ten institutions in Japan. The G8 score was assessed before treatment initiation. RESULTS We evaluated 44 patients with ES-SCLC. Patients with G8 score > 11 had longer overall survival (OS) than those with G8 score ≤ 11 (not reached versus 8.3 months; log-rank test, p = 0.005). In univariate and multivariate analyses, G8 score > 11 [hazard ratio (HR) 0.34; 95% confidence interval (CI) 0.15-0.75; p = 0.008 and HR 0.34; 95% CI 0.14-0.82; p = 0.02, respectively) and performance status (PS) of 2 (HR 5.42; 95% CI 2.08-14.2; p < 0.001 and HR 6.94; 95% CI 2.25-21.4; p < 0.001, respectively) were independent prognostic factors for OS. Among patients with good PS (0 or 1), the OS in patients with G8 score > 11 was significantly longer than that in patients with G8 score ≤ 11 (not reached versus 12.3 months; log-rank test, p = 0.02). CONCLUSIONS G8 score evaluation before treatment initiation was useful as a prognostic factor for ES-SCLC patients who received PD-L1 inhibitors and platinum-etoposide chemotherapy, even with good PS.
Collapse
Affiliation(s)
- Kenji Morimoto
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Takayuki Takeda
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Shinsuke Shiotsu
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koji Date
- Department of Pulmonary Medicine, Kyoto Chubu Medical Center, Kyoto, Japan
| | - Taishi Harada
- Department of Medical Oncology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Nobuyo Tamiya
- Department of Pulmonary Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Yusuke Chihara
- Department of Respiratory Medicine, Uji-Tokushukai Medical Center, Kyoto, Japan
| | | | - Takahiro Yamada
- Department of Pulmonary Medicine, Matsushita Memorial Hospital, Osaka, Japan
| | - Hibiki Kanda
- Department of Respiratory Medicine, Omi Medical Center, Shiga, Japan
| | - Masaki Ishida
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Akihiro Yoshimura
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masahiro Iwasaku
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shinsaku Tokuda
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Young Hak Kim
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
32
|
Sharon CE, Strohl C, Saur NM. Frailty Assessment and Prehabilitation as Part of a PeRioperative Evaluation and Planning (PREP) Program for Patients Undergoing Colorectal Surgery. Clin Colon Rectal Surg 2023; 36:184-191. [PMID: 37113278 PMCID: PMC10125297 DOI: 10.1055/s-0043-1761151] [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: 04/29/2023]
Abstract
Frailty assessment and prehabilitation can be incrementally implemented in a multidisciplinary, multiphase pathway to improve patient care. To start, modifications can be made to a surgeon's practice with existing resources while adapting standard pathways for frail patients. Frailty screening can identify patients in need of additional assessment and optimization. Personalized utilization of frailty data for optimization through prehabilitation can improve postoperative outcomes and identify patients who would benefit from adapted care. Additional utilization of the multidisciplinary team can lead to improved outcomes and a strong business case to add additional members of the team.
Collapse
Affiliation(s)
- Cimarron E. Sharon
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Strohl
- Department of Geriatrics, University of Pennsylvania, Philadelphia, Pennsylvania
- Geriatric Surgery Program, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Nicole M. Saur
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Geriatric Surgery Program, Pennsylvania Hospital, Philadelphia, Pennsylvania
- Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
33
|
Graham LS, Lin JK, Lage DE, Kessler ER, Parikh RB, Morgans AK. Management of Prostate Cancer in Older Adults. Am Soc Clin Oncol Educ Book 2023; 43:e390396. [PMID: 37207299 DOI: 10.1200/edbk_390396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The majority of men with prostate cancer are diagnosed when they are older than 65 years; however, clinical trial participants are disproportionately younger and more fit than the real-world population treated in typical clinical practices. It is, therefore, unknown whether the optimal approach to prostate cancer treatment is the same for older men as it is for younger and/or more fit men. Short screening tools can be used to efficiently assess frailty, functional status, life expectancy, and treatment toxicity risk. These risk assessment tools allow for targeted interventions to increase a patient's reserve and improve treatment tolerance, potentially allowing more men to experience the benefit of the significant recent treatment advances in prostate cancer. Treatment plans should also take into consideration each patient's individual goals and values considered within their overall health and social context to reduce barriers to care. In this review, we will discuss evidence-based risk assessment and decision tools for older men with prostate cancer, highlight intervention strategies to improve treatment tolerance, and contextualize these tools within the current treatment landscape for prostate cancer.
Collapse
Affiliation(s)
- Laura S Graham
- Division of Medical Oncology, University of Colorado, Aurora, CO
| | - John K Lin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ravi B Parikh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Coporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | | |
Collapse
|
34
|
Bouzan J, Nellas S, Stoilkov B, Willschrei P, Horstmann M. Item analysis of G8 screening in uro-oncologic geriatric patients. Int Urol Nephrol 2023; 55:1441-1446. [PMID: 37067702 DOI: 10.1007/s11255-023-03594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION/BACKGROUND The G8 score is a widespread screening tool for geriatric frailty in oncology. The aim of this study was to evaluate the scores and relevance of G8 items in a standard screening of geriatric patients with uro-oncologic diseases to better understand the results of the assessment. METHODS Eighty-two consecutive uro-oncologic geriatric patients aged 75 years and older were evaluated. All patients underwent a G8 screening that consisted of 8 items. Patients with a G8 score above 14 were considered geriatric "fit", while others were considered to be "frail". Overall results and single item scores were evaluated. Clinical data were gathered from patients' charts. RESULTS The mean age of the patients was 82 years (min. 75-max. 102). In 36 of the patients, the G8 score indicated "no-frailty", and in 46 patients, the G8 score indicated "frailty". The mean G8 score was 12.9 (min 4-max 17 pts). Item analysis revealed that points were most often lost in items H (polypharmacy), P (comparison of health status to peers) and Age. Fifty-nine, 56 and 52 patients lost points on item Age, item H and item P, respectively. In contrast, the majority of patients reached the maximum score for nutritional items [i.e., items A (food intake), B (weight loss) and F (body mass index (BMI))]. For item A, 73 patients reached the maximum score; for item B, 62 patients reached the maximum score; and for item F, 72 patients reached the maximum score. There were no differences in this distribution pattern when comparing tumour entities, sex, and patients with local vs. metastatic disease. CONCLUSION The present study revealed a high percentage of suspicious test results. Potential reasons for these findings include the low threshold of the G8 overall score and the fact that in some items, points were easily lost. Modifications of the test should be considered.
Collapse
Affiliation(s)
- J Bouzan
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - S Nellas
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - B Stoilkov
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - P Willschrei
- Department of Geriatrics, Evang. Hospital Essen-Steele, Am Deimelsberg 34, 45276, Essen, Germany
| | - M Horstmann
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuerstenstr. 69, 47829, Krefeld, Germany.
- University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
- Department of Urology, Klinikum Guetersloh, Reckenberger Str. 19, 33332, Gütersloh, Germany.
| |
Collapse
|
35
|
Gagesch M, Rösler W, Bauernschmitt R, Wilhelm MJ, Freystätter G. [Benefit of a Geriatric Evaluation before Operations, Interventions and Oncological Therapies]. PRAXIS 2023; 112:340-347. [PMID: 37042406 DOI: 10.1024/1661-8157/a004050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Benefit of a Geriatric Evaluation before Operations, Interventions and Oncological Therapies Abstract: Older patients face an increased risk of complications and adverse outcomes during and after operations, interventions, and intense oncological therapies. At the same time, this patient group should not be excluded per se from potentially beneficial medical procedures based on chronological age alone. The timely identification of geriatric syndromes and increased vulnerability by means of comprehensive geriatric assessment is becoming increasingly important and is already recommended in the guidelines of professional societies of several medical disciplines. Nonetheless, the geriatric assessment should ideally be followed by proactive co-management in the sense of integrated care. The establishment of interdisciplinary and integrated care pathways for older hospital patients can contribute to significantly improved treatment outcomes. In addition to better patient-related outcomes and rising quality indicators, this approach may also offer positive health economic effects.
Collapse
Affiliation(s)
- Michael Gagesch
- Klinik für Altersmedizin, Universitätsspital Zürich, Zürich, Schweiz
- Zentrum Alter und Mobilität, Universitätsspital Zürich, Zürich, Schweiz
| | - Wiebke Rösler
- Klinik für Medizinische Onkologie und Hämatologie, Universitätsspital Zürich, Zürich, Schweiz
| | | | - Markus J Wilhelm
- Klinik für Herzchirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Gregor Freystätter
- Klinik für Altersmedizin, Universitätsspital Zürich, Zürich, Schweiz
- Zentrum Alter und Mobilität, Universitätsspital Zürich, Zürich, Schweiz
| |
Collapse
|
36
|
Deldycke A, Denys H, Decruyenaere A, Velghe A, Naert E. Clinical decision-making in older patients with cancer: a cross-sectional single-centre study to assess the impact of clinical judgement and patient preferences. Acta Clin Belg 2023; 78:103-111. [PMID: 36879530 DOI: 10.1080/17843286.2022.2074702] [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: 10/18/2022]
Abstract
OBJECTIVE The heterogeneity in the population of older patients with cancer makes clinical decision-making difficult. We investigated the agreement between the G8 score and clinical judgment in frailty assessments, determined the impact of a life-expectancy calculator, and explored patient and caregiver preferences towards the treatment goal. METHODS Patients aged ≥75 years in need of new oncological treatment were prospectively enrolled between June 2020 and February 2021. Frailty was estimated by the oncologist and caregiver and compared to the G8 estimation. We examined whether the oncologist changed the fit/frail estimation based on life expectancy calculated using the ePrognosis tool. The main treatment goals, either longevity or quality of life (QoL), from the patient's and caregiver's perspective were noted and compared. RESULTS Forty-nine patients were included in the analysis. Comparison of the oncologist's and the caregiver's frailty estimation with the G8 assessment showed agreement and a Kappa coefficient of 58.3% (0.231) and 60% (0.255), respectively. The ePrognosis score and the odds of change in the frailty estimation by the oncologist showed no correlation. Regarding preferences, 28 (57.1%) and 17 (34.7%) patients and eighteen (47.3%) and seventeen (44.7%) caregivers chose longevity and QoL, respectively. The observed agreement and Kappa coefficient were 78.8% and 0.578. CONCLUSION Compared to the G8 assessment, frailty was underestimated by both oncologists and caregivers. Most of the patients chose longevity over QoL, and the preferences between the patient and the caregiver matched in the majority of cases.
Collapse
Affiliation(s)
- Annelies Deldycke
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Hannelore Denys
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Anja Velghe
- Geriatrics Department, Ghent University Hospital, Ghent, Belgium
| | - Eline Naert
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
37
|
Yajima S, Nakanishi Y, Yasujima R, Hirose K, Umino Y, Okubo N, Kataoka M, Masuda H. Rapid geriatric screening tools predict inability to manage stoma by oneself after urinary diversion: G8 and IADL-modified G8. J Geriatr Oncol 2023; 14:101468. [PMID: 36870222 DOI: 10.1016/j.jgo.2023.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION This study aimed to evaluate whether functional screening, as assessed by the Geriatric-8 (G8) and the instrumental activities of daily living (IADL)-modified G8, are associated with the inability to manage a stoma by themselves in patients with bladder cancer who underwent robot-assisted radical cystectomy. MATERIALS AND METHODS We analyzed a total of 110 consecutive patients with bladder cancer who underwent robot-assisted radical cystectomy and were screened preoperatively using the G8 and the IADL-modified G8 at our institution between January 2020 and December 2022. Patients who could not undergo geriatric screening at the preoperative clinic before surgery and patients who underwent orthotopic neobladder construction were excluded. We evaluated the association between clinical factors, including scores of G8 and IADL-modified G8, and the inability to manage a stoma by oneself. For both G8 and IADL-modified G8, a cutoff value of ≤14 was set. RESULTS Of the 110 patients, the median age was 77 years, 92 (84%) patients were male and 47 (43%) patients were unable to manage a stoma by themselves. The geriatric assessment indicated that 64 patients (58%) were classified in the low G8 (≤14) group and 66 patients (60%) were classified in the low IADL-modified G8 (≤14) group. The values of area under the receiver operating characteristic curve for predicting inability to manage stoma by oneself were 0.725 for the G8 and 0.734 for the IADL-modified G8, respectively. Multivariate analysis including the G8 revealed that age ≥ 80, Charlson comorbidity index of ≥3, and G8 ≤ 14 (odds ratio [OR] = 4.9; 95% confidence interval [CI] = 1.8-13.0; P = 0.002) were independent risk factors for inability to manage a stoma by oneself. Likewise, multivariate analysis including the IADL-modified G8 revealed that age ≥ 80, Charlson comorbidity index of ≥3, and IADL-modified G8 ≤ 14 (OR = 5.4; 95% CI = 1.9-14.0; P = 0.001) were independent risk factors for inability to manage a stoma by oneself. DISCUSSION Screening using G8 and IADL-modified G8 may predict patients who have difficulty self-managing their stomas.
Collapse
Affiliation(s)
- Shugo Yajima
- National Cancer Center Hospital East, Chiba, Japan
| | | | | | - Kohei Hirose
- National Cancer Center Hospital East, Chiba, Japan
| | - Yosuke Umino
- National Cancer Center Hospital East, Chiba, Japan
| | - Naoya Okubo
- National Cancer Center Hospital East, Chiba, Japan
| | | | | |
Collapse
|
38
|
Depoorter V, Vanschoenbeek K, Decoster L, De Schutter H, Debruyne PR, De Groof I, Bron D, Cornélis F, Luce S, Focan C, Verschaeve V, Debugne G, Langenaeken C, Van Den Bulck H, Goeminne JC, Teurfs W, Jerusalem G, Schrijvers D, Petit B, Rasschaert M, Praet JP, Vandenborre K, Milisen K, Flamaing J, Kenis C, Verdoodt F, Wildiers H. Linking clinical and population-based data in older patients with cancer in Belgium: Feasibility and clinical outcomes. J Geriatr Oncol 2023; 14:101428. [PMID: 36804333 DOI: 10.1016/j.jgo.2023.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 11/04/2022] [Accepted: 01/11/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Geriatric screening and geriatric assessment (GS/GA) have proven their benefits in the care for older patients with cancer. However, less is known about the predictive value of GS/GA for outcomes. To research this, clinical data on GS/GA can be enriched with population-based data. In this article we describe the methods and feasibility of data linkage, and first clinical outcomes (GS/GA results and overall survival). MATERIALS AND METHODS A large cohort study consisting of patients aged ≥70 years with a new cancer diagnosis was established using linked data from clinical and population-based databases. Clinical data were derived from a previous prospective study where older patients with cancer were screened with G8, followed by GA in case of an abnormal result (GS/GA study; 2009-2015). These data were linked to cancer registration data from the Belgian Cancer Registry (BCR), reimbursement data of the health insurance companies (InterMutualistic Agency, IMA), and hospital discharge data (Technical Cell, TCT). Cox regression analyses were conducted to evaluate the prognostic value of the G8 geriatric screening tool. RESULTS Of the 8067 eligible patients with a new cancer diagnosis, linkage of data from the GS/GA study and data from the BCR was successful for 93.7%, resulting in a cohort of 7556 patients available for the current analysis. Further linkage with the IMA and TCT database resulted in a cohort of 7314 patients (96.8%). Based on G8 geriatric screening, 67.9% of the patients had a geriatric risk profile. Malnutrition and functional dependence were the most common GA-identified risk factors. An abnormal baseline G8 score (≤14/17) was associated with lower overall survival (adjusted HR [aHR] = 1.62 [1.50-1.75], p < 0.001). DISCUSSION Linking clinical and population-based databases for older patients with cancer has shown to be feasible. The GS/GA results at cancer diagnosis demonstrate the vulnerability of this population and the G8 score showed prognostic value for overall survival. The established cohort of almost 8000 patients with long-term follow-up will serve as a basis in the future for detailed analyses on long-term outcomes beyond survival.
Collapse
Affiliation(s)
| | | | - Lore Decoster
- Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Oncologisch Centrum - Department of Medical Oncology, Brussels, Belgium
| | | | - Philip R Debruyne
- General Hospital Groeninge, Kortrijk Cancer Centre, Kortrijk, Belgium; Anglia Ruskin University, Medical Technology Research Centre (MTRC), School of Life Sciences, Cambridge, UK; University of Plymouth, School of Nursing & Midwifery, Plymouth, UK
| | - Inge De Groof
- Iridium Cancer Network Antwerp - Sint-Augustinus, Department of Geriatric Medicine, Wilrijk, Belgium
| | - Dominique Bron
- ULB Institute Jules Bordet, Department of Hematology, Brussels, Belgium
| | - Frank Cornélis
- Cliniques Universitaires Saint-Luc - UCLouvain, Department of Medical Oncology, Brussels, Belgium
| | - Sylvie Luce
- University Hospital Erasme- Université Libre de Bruxelles ULB, Department Medical Oncology, Brussels, Belgium
| | - Christian Focan
- Clinique CHC-MontLégia, Groupe Santé CHC-Liège, Department of Oncology, Liège, Belgium
| | - Vincent Verschaeve
- GHDC Grand Hôpital de Charleroi, Department of Medical Oncology, Charleroi, Belgium
| | - Gwenaëlle Debugne
- Centre Hospitalier de Mouscron, Department of Geriatric Medicine, Mouscron, Belgium
| | | | | | | | - Wesley Teurfs
- ZNA Stuivenberg, Department Medical Oncology, Antwerp, Belgium
| | - Guy Jerusalem
- Centre Hospitalier Universitaire Sart Tilman - Liège University, Department of Medical Oncology, Liège, Belgium
| | - Dirk Schrijvers
- ZNA Middelheim, Department of Medical Oncology, Antwerp, Belgium
| | - Bénédicte Petit
- Centre Hospitalier Jolimont, Department of Medical Oncology, La Louvière, Belgium
| | - Marika Rasschaert
- University Hospital Antwerp, Department of Medical Oncology, Edegem, Belgium
| | - Jean-Philippe Praet
- CHU St-Pierre - Free Universities Brussels, Department of Geriatric Medicine, Brussels, Belgium
| | | | - Koen Milisen
- University Hospitals Leuven - KU Leuven, Department of Geriatric Medicine - Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Johan Flamaing
- University Hospitals Leuven - KU Leuven, Department of Geriatric Medicine - Department of Public Health and Primary Care, Gerontology and Geriatrics, Leuven, Belgium
| | - Cindy Kenis
- University Hospitals Leuven, Department of General Medical Oncology - Department of Geriatric Medicine, Leuven, Belgium
| | - Freija Verdoodt
- Belgian Cancer Registry, Research Department, Brussels, Belgium
| | - Hans Wildiers
- University Hospitals Leuven - KU Leuven, Department of General Medical Oncology - Department of Oncology, Leuven, Belgium.
| |
Collapse
|
39
|
Goede V. Frailty and Cancer: Current Perspectives on Assessment and Monitoring. Clin Interv Aging 2023; 18:505-521. [PMID: 37013130 PMCID: PMC10066705 DOI: 10.2147/cia.s365494] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/12/2023] [Indexed: 03/30/2023] Open
Abstract
Frailty, an age-related condition of increased vulnerability to acute endogenous or exogenous stressors, is a key barrier to successful treatment of cancer in older people. In this group of patients, assessment of frailty is required before starting a new treatment. According to guidelines, the gold standard to assess frailty in older adults with cancer is geriatric screening followed by geriatric assessment (GA) across essential GA-domains (social status, physical function, nutrition, cognition, emotion, co-morbidity, polypharmacy). GA enables tailoring of both oncological therapy and non-oncological interventions to the patient's vulnerabilities. Large clinical trials recently have demonstrated that the feasibility and tolerability of systemic cancer treatment in older patients are significantly improved by such GA-guided management. Indications and optimal tools for frailty monitoring during the course of cancer treatment have not yet been defined in greater detail. New technologies such as wearable sensors or apps offer promising new opportunities to further develop frailty monitoring. This review describes the current standards and perspectives for the assessment and monitoring of frailty in elderly patients with cancer.
Collapse
Affiliation(s)
- Valentin Goede
- Department of Oncogeriatrics, Center of Geriatric Medicine, St. Marien-Hospital, Cologne, Germany
- Correspondence: Valentin Goede, Department of Oncogeriatrics, Center of Geriatric Medicine, St. Marien-Hospital, Kunibertskloster 11-13, Cologne, 50668, Germany, Tel +49 221 1629 2311, Fax +49 221 1629 2306, Email
| |
Collapse
|
40
|
Frank MS, Bodtger U. An Individualized Approach to Comorbidities in Lung Cancer. J Thorac Oncol 2023; 18:254-256. [PMID: 36842806 DOI: 10.1016/j.jtho.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 02/28/2023]
Affiliation(s)
- Malene S Frank
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Internal Medicine, Zealand University Hospital, Næstved, Denmark.
| |
Collapse
|
41
|
Multidimensional Oncological Frailty Scale (MOFS): A New Quick-To-Use Tool for Detecting Frailty and Stratifying Risk in Older Patients with Cancer-Development and Validation Pilot Study. Cancers (Basel) 2023; 15:cancers15051553. [PMID: 36900343 PMCID: PMC10001199 DOI: 10.3390/cancers15051553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/18/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Frailty detection with comprehensive geriatric assessment (CGA) is of pivotal importance in older patients with cancer to avoid over- or under-treatment and to detect those at increased risk for poor outcomes. Several tools have been developed to capture the complexity of frailty, but only a few were explicitly conceived for older adults with cancer. The study aimed at developing and validating a multidimensional, easy-to-use diagnostic tool for early-risk stratification in patients with cancer, called the Multidimensional Oncological Frailty Scale (MOFS). METHODS In this single-center prospective study, we consecutively enrolled 163 older women (age ≥ 75 years) with breast cancer, screened with a G8 score ≤ 14 during the outpatient preoperative evaluation at our breast centre, as the development cohort. Seventy patients with different types of cancer admitted to our OncoGeriatric Clinic served as the validation cohort. Using stepwise linear regression analysis, we evaluated the relationship between Multidimensional Prognostic Index (MPI) and CGA items, and, finally, realized a screening tool based on the combination of the significant variables. RESULTS The mean age of the study population was 80.4 ± 5.8 years, while the mean age of the validation cohort was 78.6 ± 6.6 years [42 women (60%)]. A composite model of the Clinical Frailty Scale, G8, and hand grip strength test showed a strong correlation with MPI (R= -0.712, p < 0.001). The MOFS accuracy in the prediction of mortality was optimal in both the development and the validation cohorts (AUC 0.82 and 0.87; p < 0.001 and 0.003, respectively). CONCLUSION MOFS represents a new, accurate, quick-to-use frailty screening tool for stratifying the risk of mortality in geriatric cancer patients.
Collapse
|
42
|
Büttelmann M, Hofheinz RD, Kröcher A, Ubbelohde U, Stintzing S, Reinacher-Schick A, Bornhäuser M, Folprecht G. Geriatric assessment and the variance of treatment recommendations in geriatric patients with gastrointestinal cancer-a study in AIO oncologists. ESMO Open 2023; 8:100761. [PMID: 36638708 PMCID: PMC10024156 DOI: 10.1016/j.esmoop.2022.100761] [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: 06/17/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Geriatric assessment (GA) is recommended to detect vulnerabilities for elderly cancer patients. To assess whether results of GA actually influence the treatment recommendations, we conducted a case vignette-based study in medical oncologists. MATERIALS AND METHODS Seventy oncologists gave their medical treatment recommendations for a maximum of 4 out of 10 gastrointestinal cancer patients in three steps: (i) based on tumor findings alone to simulate the guideline recommendation for a '50-year-old standard patient without comorbidities'; (ii) for the same situation in elderly patients (median age 77.5 years) according to the comorbidities, laboratory values and a short video simulating the clinical consultation; and (iii) after the results of a full GA including interpretation aid [Barthel Index, Cumulative Illness Rating Scale (CIRS), Geriatric 8 (G8), Geriatric Depression Scale (GDS), Mini Mental Status Examination (MMSE), Mini-Nutritional Assessment (MNA), Timed Get Up and Go (TGUG), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ-C30), stair climb test]. RESULTS Data on 164 treatment recommendations were analyzed. The recommendations had a significantly higher variance for elderly patients than for 'standard' patients (944 versus 602, P < 0.0001) indicating a lower agreement between oncologists. Knowledge on GA had marginal influence on the treatment recommendation or its variance (944 versus 940, P = 0.92). There was no statistically significant influence of the working place or the years of experience in oncology on the variance of recommendations. The geriatric tools were rated approximately two times higher as being 'meaningful' (53%) and 'useful for the presented cases' (49%) than they were 'used in clinical practice' (19%). The most commonly used geriatric tool in patient care was the MNA (30%). CONCLUSIONS The higher variance of treatment recommendations indicates that it is less likely for elderly patients to get the optimal recommendation. Although the proposed therapeutic regimen varied higher in elderly patients and the oncologists rated the GA results as 'useful', the GA results did not influence the individual recommendations or its variance. Continuing education on GA and research on implementation into clinical practice are needed.
Collapse
Affiliation(s)
- M Büttelmann
- TU Dresden / University Hospital Carl Gustav Carus, National Center for Tumor Diseases (NCT/UCC), Medical Dept. I, Dresden, Germany
| | | | - A Kröcher
- TU Dresden / University Hospital Carl Gustav Carus, National Center for Tumor Diseases (NCT/UCC), Medical Dept. I, Dresden, Germany
| | - U Ubbelohde
- TU Dresden / University Hospital Carl Gustav Carus, National Center for Tumor Diseases (NCT/UCC), Medical Dept. I, Dresden, Germany
| | - S Stintzing
- Charité - Universitaetsmedizin Berlin, Department of Hematology, Oncology, and Cancer Immunology (CCM), Berlin, Germany
| | - A Reinacher-Schick
- Ruhr University Bochum, St. Josef Hospital, Department of Hematology, Oncology and Palliative Care, Bochum, Germany
| | - M Bornhäuser
- TU Dresden / University Hospital Carl Gustav Carus, National Center for Tumor Diseases (NCT/UCC), Medical Dept. I, Dresden, Germany
| | - G Folprecht
- TU Dresden / University Hospital Carl Gustav Carus, National Center for Tumor Diseases (NCT/UCC), Medical Dept. I, Dresden, Germany.
| |
Collapse
|
43
|
Yajima S, Nakanishi Y, Sugimoto M, Kobayashi S, Kudo M, Yasujima R, Hirose K, Sekiya K, Umino Y, Okubo N, Kataoka M, Gotohda N, Masuda H. A novel predictive model for postoperative delirium using multiple geriatric screening factors. J Surg Oncol 2023; 127:1071-1078. [PMID: 36695780 DOI: 10.1002/jso.27206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/14/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The purpose of this study was to develop a new composite score to accurately predict postoperative delirium (POD) after major urological cancer surgery. METHODS Our retrospective analysis included, in total, 449 consecutive patients who experienced major urological cancer surgery and a preoperative geriatric functional assessment at our institution (development cohort). Geriatric functional assessments included Geriatric 8, Instrumental Activities of Daily Living, and mini-cognitive assessment instrument (Mini-Cog). Multivariate analysis was used to identify factors related to POD and combined to create a predictive score. The composite score was externally validated using a cohort of 92 consecutive pancreatic cancer patients who underwent pancreaticoduodenectomy and a preoperative geriatric functional assessment (validation cohort). The predictive accuracy and performance of the composite score were evaluated using the area under the receiver operating characteristic curves (AUC) and calibration plots. RESULTS In multivariate analysis of a development cohort, the following factors were significantly associated with POD: a Mini-Cog score of <3 (odds ratio [OR] = 9.5; p < 0.001), disability in the responsibility for medication (OR = 4.1; p = 0.03), and the preoperative use of benzodiazepine (OR = 6.4; p < 0.001). The composite score of these three factors showed excellent discrimination in predicting POD, with AUC values of 0.819 and 0.804 in development and validation cohorts, respectively. Calibration plots showing predicted probability and actual observation in both cohorts showed good agreement. CONCLUSIONS A combined model of Mini-Cog, a disability in the responsibility for medication, and preoperative benzodiazepine use showed excellent discriminative power in predicting POD.
Collapse
Affiliation(s)
- Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Yasukazu Nakanishi
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Motokazu Sugimoto
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Shin Kobayashi
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Masashi Kudo
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Rikuto Yasujima
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Kohei Hirose
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Ken Sekiya
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Yosuke Umino
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Naoya Okubo
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Madoka Kataoka
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| |
Collapse
|
44
|
The preoperative G8 geriatric screening tool independently predicts survival in older patients with endometrial cancer: results of a retrospective single-institution cohort study. J Cancer Res Clin Oncol 2023; 149:851-863. [PMID: 35212815 PMCID: PMC9931812 DOI: 10.1007/s00432-022-03934-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the prognostic impact of global health status assessment tools in elderly patients with endometrial cancer (EC) on survival. METHODS Preoperative frailty status was assessed by the G8 geriatric screening tool (G8 Score), Lee Schonberg prognostic index, Charlson Comorbidity index and American Society of Anesthesiologists Physical Status System in women older than 60 years with EC. Univariable and multivariable Cox-regression analyses, as well as Kaplan-Meier survival analyses were performed to determine the prognostic impact. Statistical analyses were adjusted for cancer entity-specific risk factors such as conventional histopathological tumor characteristics and relevant anamnestic life style parameters. RESULTS 153 patients with all stages of EC who were operated at the University Medical Center Mainz between 2008 and 2019 were included. In multivariable analyses, only the G8 Score retained independent significance as a prognostic factor for disease-specific survival (DSS) (HR:4.58; 95% CI [1.35-15.51]) and overall survival (OS) (HR:2.89; 95% CI [1.31-6.39]. 92 patients (61.3%) were classified as G8-non-frail with a significantly increased DSS and OS rate compared to the 58 G8-frail patients (DSS:93.8% vs. 60.8%; p < 0.001 and OS:88.2% vs. 49.7%; p < 0.001; respectively). CONCLUSIONS This is the first study demonstrates the substantial clinical and prognostic impact of the G8 Score on survival in elderly women with EC. Assessing the frailty status to estimate the individual vulnerability of elderly cancer patients could be useful in preoperative decision-making to individualize treatment plans such as the surgical radicality and to improve pre- and postoperative morbidity.
Collapse
|
45
|
Honorato M, Calderón O, Rojas V, Fasce G, Bartolotti C, Caglevic C. Considerations and analysis of the implementation of oncogeriatrics in Chile and its importance: Review of current literature. FRONTIERS IN AGING 2023; 4:1141792. [PMID: 37033403 PMCID: PMC10077059 DOI: 10.3389/fragi.2023.1141792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/24/2023] [Indexed: 04/11/2023]
Abstract
The Chilean census of 2017 reported that 11.4% of the local population are 65 years or older, and according to the National Institute of Statistics (INE) the current expectancy of life in Chile is 76 years for men and 81 years for women respectively. Cancer in Chile is a major public health problem. Aging is a significant risk factor for cancer development which added to the improved life expectancy, it increases the incidence of cancer. In 2040, new cancer cases will increase from 19.3 to 30.2 million worldwide. Older people are a heterogeneous group requiring specialized and individualized management. Chronological age does not necessarily correlate with physiological age. More than half of the geriatric patients with cancer have at least one comorbidity which is relevant when defining a cancer treatment. Likewise, polypharmacy is frequent and is an important issue to consider in people with cancer due to the risk associated with drug interactions. Oncogeriatric assessment consists of a comprehensive multidimensional evaluation, including functional and biopsychosocial issues, addressing aspects of the neoplastic disease such as the risk of toxicities due to systemic therapy and life expectancy. This tool has proven to be helpful in the diagnosis of conditions that are not evident in a routine oncological evaluation, such as geriatric syndromes, frailty, functional dependence, and cognitive impairment among others, which have an impact when deciding on therapy, predicting risks of treatment toxicity and mortality. In this article we aim to describe the current situation of Oncogeriatrics and to provide epidemiological information about cancer in the elderly population in Chile attempting to highlight the importance of the Oncogeriatrics units, within cancer departments, for a better decision taking in the elderly cancer patient.
Collapse
Affiliation(s)
| | - Oscar Calderón
- Geriatrics Department, Clínica Alemana de Santiago, Santiago, Chile
- Geriatrics, Complejo Asistencial Dr Sótero del Río, Santiago, Chile
| | - Verónica Rojas
- Geriatrics Department, Clínica Alemana de Santiago, Santiago, Chile
| | - Gerardo Fasce
- Geriatrics Service, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
- Geriatrics Service, Department of Medicine, Clínica Las Condes, Santiago, Chile
| | - Constanza Bartolotti
- Geriatrics, Internal Medicine Department, Universidad de la Frontera, Temuco, Chile
- Geriatrics, Centro Comunitario Kiműnche, Temuco, Chile
| | - Christian Caglevic
- Cancer Research Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
- *Correspondence: Christian Caglevic,
| |
Collapse
|
46
|
Fokas E, Glynne-Jones R, Fleischmann M, Piso P, Tselis N, Ghadimi M, Hofheinz RD, Rödel C. Radiotherapy dose escalation using endorectal brachytherapy in elderly and frail patients with rectal cancer unsuitable for surgery: Lessons from studies in fit patients and future perspectives. Cancer Treat Rev 2023; 112:102490. [PMID: 36463667 DOI: 10.1016/j.ctrv.2022.102490] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Epidemiological data indicate that more than 50 % of patients with newly-diagnosed rectal cancer are older than 70 years, with rising numbers expected over the next decades. Treatment decision-making is challenging in elderly and frail patients with rectal cancer, whereas standardized treatment guidelines for this patient cohort are lacking. Elderly and frail rectal cancer patients are often considered by surgeons as unfit to undergo radical surgery as the risk of surgical complications and postoperative mortality rises with increasing age and comorbidity. Furthermore, these patients often receive no treatment at all, resulting in local and/or systemic disease progression with associated symptoms and impaired quality of life (QoL). Recent data from randomized trials in young fit patients with early stage rectal cancer indicate that RT dose escalation can be safely delivered using external beam (chemo)radiotherapy (EBRT) followed by endoluminal radiotherapeutic modalities, such as contact X-ray brachytherapy (CXB) or high-dose rate endorectal brachytherapy (HDR-BT). However, prospective studies testing this therapeutic concept in elderly and frail patients remain limited. Here, we review the current evidence in the epidemiology and the management of elderly and frail patients with rectal cancer. We summarize the potential of RT dose escalation to achieve long-term local control of the primary tumour, prevent disease-related morbidity, improve QoL and even organ preservation. Future perspectives and open questions will be discussed as well.
Collapse
Affiliation(s)
- Emmanouil Fokas
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany.
| | - Robert Glynne-Jones
- Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Northwood, Middlesex, UK
| | - Maximillian Fleischmann
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Barmherzige Brüder Hospital, 93049 Regensburg, Germany
| | - Nikolaos Tselis
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany
| | - Michael Ghadimi
- Department of General, Visceral, and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Ralf-Dieter Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, University Heidelberg, Heidelberg, Germany
| | - Claus Rödel
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany
| |
Collapse
|
47
|
Hopkins JO, Braun-Inglis C, Guidice S, Wells M, Moorthi K, Berenberg J, St. Germain D, Mohile S, Hudson MF. Enrolling Older Adults Onto National Cancer Institute-Funded Clinical Trials in Community Oncology Clinics: Barriers and Solutions. J Natl Cancer Inst Monogr 2022; 2022:117-124. [PMID: 36519815 PMCID: PMC9753219 DOI: 10.1093/jncimonographs/lgac019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 12/23/2022] Open
Abstract
In April 2021, the National Cancer Institute (NCI) Division of Cancer Prevention collaborated with the NCI Division of Cancer Treatment and Diagnosis to produce a virtual workshop that developed recommendations for enhancing NCI-sponsored clinical trial accrual of older adults. Prior to the workshop, a multidisciplinary group of stakeholders (eg, community oncologists, advanced practice practitioners, clinic and research staff, and patient advocates) gathered information related to accrual of older adults to clinical trials from the literature. Subsequently, a survey was conducted to detail NCI Community Oncology Research Program members' perspective on accrual barriers for this population; 305 individuals responded to the survey. Barriers to clinical trial accruals included comorbidity-attributed trial ineligibility, transportation and time issues, concern that the proposed regimen is too toxic for older adults, patient or family caregiver declined participation, and lack of trials relevant to older patients. Identified solutions included broadening clinical trial inclusion criteria, increasing the number of clinical trials specifically designed for older adults, simplifying consent forms, improving recruitment materials for older adults and their families, and facilitating transportation vouchers. At the workshop, participants, including stakeholders, used prior literature and survey results to develop recommendations, including interventions to address clinician bias, implement geriatric assessment, and promote clinician and staff engagement as mechanisms to improve accrual of older adults to clinical trials.
Collapse
Affiliation(s)
- Judith O Hopkins
- Novant Health Cancer Institute/SCOR National Cancer Institute Community Oncology Research Program (NCORP), Kernersville, NC, USA
| | - Christa Braun-Inglis
- University of Hawaii Cancer Center/Hawaii Minority/Underserved NCORP, Honolulu, HI, USA
| | - Sofia Guidice
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Meg Wells
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Kiran Moorthi
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Berenberg
- University of Hawaii Cancer Center/Hawaii Minority/Underserved NCORP, Honolulu, HI, USA
| | - Diane St. Germain
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Supriya Mohile
- Correspondence to: Supriya G. Mohile, MD, Departments of Medicine and Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box 704, Rochester, NY 14642, USA (e-mail: )
| | | |
Collapse
|
48
|
Magnuson A, Van der Walde N, McKoy JM, Wildes TM, Wong ML, Le-Rademacher J, Little RF, Klepin HD. Integrating Geriatric Assessment Measures into National Cancer Institute Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:142-150. [PMID: 36519816 PMCID: PMC9949568 DOI: 10.1093/jncimonographs/lgac021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022] Open
Abstract
To improve the care of older adults with cancer, the traditional approach to clinical trial design needs to be reconsidered. Older adults are underrepresented in clinical trials with limited or no information on geriatric-specific factors, such as cognition or comorbidities. To address this knowledge gap and increase relevance of therapeutic clinical trial results to the real-life population, integration of aspects relevant to older adults is needed in oncology clinical trials. Geriatric assessment (GA) is a multidimensional tool comprising validated measures assessing specific health domains that are more frequently affected in older adults, including aspects related to physical function, comorbidity, medication use (polypharmacy), cognitive and psychological status, social support, and nutritional status. There are several mechanisms for incorporating either the full GA or specific GA measures into oncology therapeutic clinical trials to contribute to the overarching goal of the trial. Mechanisms include utilizing GA measures to better characterize the trial population, define trial eligibility, allocate treatment receipt within the context of the trial, develop predictive models for treatment outcomes, guide supportive care strategies, personalize care delivery, and assess longitudinal changes in GA domains. The objective of this manuscript is to review how GA measures can contribute to the overall goal of a clinical trial, to provide a framework to guide the selection and integration of GA measures into clinical trial design, and ultimately enable accrual of older adults to clinical trials by facilitating the design of trials tailored to older adults treated in clinical practice.
Collapse
Affiliation(s)
- Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Noam Van der Walde
- Department of Radiation Oncology, West Cancer Center and Research Institute, University of Tennessee Health Science Center, Germantown, TN, USA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tanya M Wildes
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Nebraska Medicine, Omaha, NE, USA
| | - Melisa L Wong
- Divisions of Hematology and Oncology and Geriatrics, Department of Internal Medicine, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | | | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Heidi D Klepin
- Correspondence to: Heidi D. Klepin, MD, MS, Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA (e-mail: )
| |
Collapse
|
49
|
Norimatsu Y, Ito K, Takemura N, Inagaki F, Mihara F, Kokudo N. Estimation of Physiologic Ability and Surgical Stress (E-PASS) Predicts Postoperative Major Complications After Hepato-Pancreato Biliary Surgery in the Elderly. World J Surg 2022; 46:2788-2796. [PMID: 36066664 DOI: 10.1007/s00268-022-06716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND As society ages, an increasing number of elderly patients require hepato-pancreato-biliary (HPB) surgery. We investigated the risk factors for complications in elderly patients undergoing HPB surgery using surgical risk scoring models. METHODS We retrospectively investigated 184 elderly patients (≥ 65 years old) who underwent HPB surgery, including the liver, pancreas, bile duct, and/or gallbladder resection, with exemption to simple cholecystectomy between January 2017 and December 2019. The surgical risk scoring models used included the Estimation of Physiological Ability and Surgical Stress (E-PASS), Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), and Geriatric 8 (G8). We evaluated the correlations between the scores and severe complications. Complications were classified as severe (Clavien-Dindo classification [C-D] ≥ III) or non-severe (C-D ≤ II). RESULTS Complications occurred in 78 patients (24 C-D ≥ III, 54 C-D ≤ II). Preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) were significantly higher in patients with C-D ≥ IIIa than in those with C-D ≤ II. Multiple logistic regression analysis revealed that PRS (P = 0.01) and SSS (P = 0.04) were independent predictive factors for severe complications. However, the POSSUM and G8 models showed no significant correlations to severe complications. CONCLUSION E-PASS is a useful model for predicting complications in elderly patients undergoing HPB surgery.
Collapse
Affiliation(s)
- Yu Norimatsu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kyoji Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| |
Collapse
|
50
|
Meert G, Kenis C, Milisen K, Debruyne PR, De Groof I, Focan C, Cornélis F, Verschaeve V, Bachmann C, Bron D, Den Bulck HV, Schrijvers D, Langenaeken C, Specenier P, Jerusalem G, Praet JP, Lobelle JP, Flamaing J, Wildiers H, Decoster L. Functional status in older patients with cancer and a frailty risk profile: A multicenter observational study. J Geriatr Oncol 2022; 13:1162-1171. [PMID: 36085275 DOI: 10.1016/j.jgo.2022.08.019] [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: 02/02/2022] [Revised: 08/02/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Functional status (FS) and frailty are significant concerns for older adults, especially those with cancer. Data on FS (Activities of Daily Living [ADL]; Instrumental Activities of Daily Living [IADL]) and its evolution during cancer treatment in older patients and a frailty risk profile are scarce. Therefore, this study examines FS and its evolution in older patients with cancer and a frailty risk profile and investigates characteristics associated with functional decline. MATERIAL AND METHODS This secondary data-analysis, focusing on FS, uses data from a large prospective multicenter observational cohort study. Patients ≥70 years with a solid tumor and a frailty risk profile based on the G8 screening tool (score ≤ 14) were included. A geriatric assessment was performed including evaluation of FS based on ADL and IADL. At approximately three months of follow-up, FS was reassessed. Univariable and multivariable logistic regression analyses were used to identify predictive factors for functional decline in ADL and IADL. RESULTS Data on ADL and IADL were available at baseline and follow-up in 3388 patients. At baseline 1886 (55.7%) patients were dependent for ADL, whereas 2085 (61.5%) patients were dependent at follow-up. Functional decline was observed in 23.6% of patients. For IADL 2218 (65.5%) patients were dependent for IADL, whereas 2591 (76.5%) patients were dependent at follow-up. Functional decline in IADL was observed in 41.0% of patients. In multivariable analysis, disease stage III or IV, comorbidities, falls history in the past twelve months, and FS measured by IADL were predictive factors for functional decline in both ADL and IADL. Other predictive factors for functional decline in ADL were polypharmacy, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score 2-4, and cognitive impairment, and for functional decline in IADL were female sex, fatigue, and risk for depression. DISCUSSION Functional impairments are frequent in older persons with cancer and a frailty risk profile, and several characteristics are identified that are significantly associated with functional decline. Therefore, FS is an essential part of the geriatric assessment which should be standard of care for this patient population. Next step is to proceed with directed interventions with the aim to limit the risk of functional decline as much as possible.
Collapse
Affiliation(s)
- Glen Meert
- Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Cindy Kenis
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Philip R Debruyne
- Department of Medical Oncology, Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; Medical Technology Research Centre (MTRC), School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Inge De Groof
- Department of Geriatric Medicine, St. Augustinus, Wilrijk, Belgium
| | - Christian Focan
- Department of Oncology, Clinique CHC Montlégia, Liège, Belgium
| | - Frank Cornélis
- Department of Medical Oncology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Vincent Verschaeve
- Department of Medical Oncology, GHDC Grand Hôpital de Charleroi, Charleroi, Belgium
| | | | - Dominique Bron
- Department of Hematology, ULB Institut Jules Bordet, Brussels, Belgium
| | | | - Dirk Schrijvers
- Department of Medical Oncology, ZNA Middelheim, Antwerp, Belgium
| | - Christine Langenaeken
- Department Medical Oncology, Iridium Cancer Network Antwerp, AZ Klina, Brasschaat, Belgium
| | - Pol Specenier
- Department of Medical Oncology, University Hospital Antwerp, Antwerp, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, Centre Hospitalier Universitaire Sart Tilman and Liege University, Liege, Belgium
| | - Jean-Philippe Praet
- Department of Geriatric Medicine, CHU St-Pierre, Free Universities Brussels, Brussels, Belgium
| | - Jean-Pierre Lobelle
- Consultant in Statistics, Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven - University of Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Lore Decoster
- Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| |
Collapse
|