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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.
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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
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Steer C, Rasekaba T, Owen K, Jayasuriya D, Kapur M, Young K, Webb N, Blackberry I. Geriatric Oncology in the Instagram Era: Feasibility and Acceptability Randomised Controlled Trial on Adopting PhotoVoice to Enable Empowerment, Patient-Centred Care, and Shared Decision Making-Study Protocol. Methods Protoc 2023; 6:68. [PMID: 37623919 PMCID: PMC10458883 DOI: 10.3390/mps6040068] [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: 06/29/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023] Open
Abstract
Geriatric assessment (GA) is fundamental to optimising cancer care in older adults, yet implementing comprehensive GA tools in real-world clinical settings remains a challenge. This study aims to assess the feasibility and acceptability of integrating information from patient-derived photographs (PhotoVoice) into enhanced supportive care (ESC) for older adults with cancer. A feasibility randomised controlled trial will be conducted at a regional cancer care centre in Australia. Participants aged 70 and above will be randomised into two groups: PhotoVoice plus ESC or usual care (ESC) alone. In the PhotoVoice group, participants will provide four photographs for deduction of representations of different aspects of their lives using photo-elicitation techniques. ESC will be conducted for both groups, incorporating PhotoVoice analysis in the intervention group. PhotoVoice may improve patient-centred care outcomes, including enhanced communication, shared decision making, and identification of patient priorities and barriers. Findings will provide insights into implementing PhotoVoice in geriatric assessment and guide future trials in cancer among older adults.
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Affiliation(s)
- Christopher Steer
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, VIC 3690, Australia; (C.S.); (K.Y.); (I.B.)
- Border Medical Oncology and Haematology, Albury-Wodonga, NSW 2640, Australia;
- School of Clinical Medicine, Rural Clinical Campus, University of New South Wales, Albury, NSW 2640, Australia; (D.J.); (M.K.)
| | - Tshepo Rasekaba
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, VIC 3690, Australia; (C.S.); (K.Y.); (I.B.)
| | - Kylie Owen
- Department of Community and Clinical Allied Health, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, VIC 3690, Australia;
| | - Darren Jayasuriya
- School of Clinical Medicine, Rural Clinical Campus, University of New South Wales, Albury, NSW 2640, Australia; (D.J.); (M.K.)
| | - Mira Kapur
- School of Clinical Medicine, Rural Clinical Campus, University of New South Wales, Albury, NSW 2640, Australia; (D.J.); (M.K.)
| | - Kim Young
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, VIC 3690, Australia; (C.S.); (K.Y.); (I.B.)
| | - Nicole Webb
- Border Medical Oncology and Haematology, Albury-Wodonga, NSW 2640, Australia;
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, VIC 3690, Australia; (C.S.); (K.Y.); (I.B.)
- Care Economy Research Institute, La Trobe University, Albury-Wodonga, VIC 3690, Australia
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Thibaud V, Billy C, Prud’homm J, Garin J, Hue B, Cattenoz C, Somme D, Corvol A. Inside the Black Box: A Narrative Review on Comprehensive Geriatric Assessment-Driven Interventions in Older Adults with Cancer. Cancers (Basel) 2022; 14:cancers14071642. [PMID: 35406414 PMCID: PMC8996864 DOI: 10.3390/cancers14071642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Comprehensive geriatric assessment is defined as a multi-dimensional, multi-disciplinary diagnostic and therapeutic process that is conducted to determine the medical, mental, and functional problems that older people with frailty have so that a coordinated and integrated plan for treatment and follow-up can be developed. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients. This review highlights the scarcity of published studies on this topic. Comprehensive geriatric assessment-based interventions have not yet demonstrated their specific impact. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. Abstract There is a consensus that the use of comprehensive geriatric assessment (CGA) is good clinical practice for older patients with solid tumors or hematological malignancies. To be complete, a CGA must include a geriatric assessment and an intervention plan. According to the SIOG consensus, a CGA should assess several domains: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and the presence of geriatric syndromes. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients in each domain mentioned in the SIOG consensus. An online search of the PubMed database was performed using predefined search algorithms specific for each domain of the CGA. Eligible articles had to have well-defined interventions targeting specific domains of the CGA. We screened 1864 articles, but only a few trials on single-domain interventions were found, and often, these studies involved small groups of patients. This review highlights the scarcity of published studies on this topic. The specific impacts of CGA-based interventions have not yet been demonstrated. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. New studies are necessary in multiple care contexts, and innovative designs must be used to balance internal and external validity. An accurate description of the intervention and what “usual care” means will improve the external validity of such studies.
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Affiliation(s)
- Vincent Thibaud
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
- Department of Hematology, CHU Rennes, Université Rennes 1, 35000 Rennes, France
- Department of Hematology, Hôpital Saint-Vincent, Université Catholique de Lille, 59000 Lille, France
- Correspondence:
| | - Claire Billy
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
| | - Joaquim Prud’homm
- Laboratoire Traitement du Signal et de l’Image (INSERM LTSI—UMR 1099), CHU Rennes, Université Rennes 1, 35000 Rennes, France;
| | - Jeanne Garin
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
| | - Benoit Hue
- Department of Pharmacy, CHU Rennes, Université Rennes 1, 35000 Rennes, France;
| | - Catherine Cattenoz
- Department of Geriatrics, CHU Rennes, Université Rennes 1, 35000 Rennes, France; (C.B.); (J.G.); (C.C.)
- Centre Eugène Marquis, Department of Medical Oncology, Université Rennes 1, 35000 Rennes, France
| | - Dominique Somme
- Laboratoire Arènes(CNRS UMR 6051), CHU Rennes, Université Rennes 1, 35000 Rennes, France; (D.S.); (A.C.)
| | - Aline Corvol
- Laboratoire Arènes(CNRS UMR 6051), CHU Rennes, Université Rennes 1, 35000 Rennes, France; (D.S.); (A.C.)
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O'Hanlon S, Baxter M, Hosie A. Postoperative delirium in older patients with cancer: the role of psychological distress and social support. Curr Opin Support Palliat Care 2022; 16:38-47. [PMID: 34939608 DOI: 10.1097/spc.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Delirium is a common and important adverse event in the perioperative period. Older people with cancer are at significant risk, and outcomes are poor. There is increasing awareness of the effect of psychological distress and social support on pathogenesis and outcomes of delirium in this setting. This review aimed to describe recent research in this evolving area. RECENT FINDINGS Across six recent studies of postoperative delirium in older people with cancer, delirium incidence ranged from 8 to 19.8%. Poor social support and high levels of distress are implicated in the development of postoperative delirium. Distress can be related to negative emotional reaction to diagnosis, preconception of cancer diagnosis and interactions with the healthcare system. Prevention of delirium is key, and multicomponent interventions show evidence of effectiveness. 'Emotional distress' has been included in a new core outcome set for studies of interventions to prevent and/or treat delirium. SUMMARY Postoperative delirium in older adults with cancer is common and is associated with increased morbidity and mortality. Psychological distress and social support play an important role, but there are many unmet research needs in this area.
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Affiliation(s)
- Shane O'Hanlon
- Department of Geriatric Medicine, St Vincent's University Hospital
- University College Dublin, Dublin, Ireland
| | - Mark Baxter
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee
- Tayside Cancer Centre, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Annmarie Hosie
- School of Nursing and Midwifery, Sydney, The University of Notre Dame Australia
- St Vincent's Health Network Sydney, Darlinghurst
- IMPACCT - Improving Palliative, Aged and Chronic Care through Research and Translation, University of Technology Sydney, Ultimo, New South Wales, Australia
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Tuch G, Soo WK, Luo KY, Frearson K, Oh EL, Phillips JL, Agar M, Lane H. Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review. Curr Oncol 2021; 28:3987-4003. [PMID: 34677257 PMCID: PMC8534877 DOI: 10.3390/curroncol28050339] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022] Open
Abstract
Cognitive assessment is a cornerstone of geriatric care. Cognitive impairment has the potential to significantly impact multiple phases of a person's cancer care experience. Accurately identifying this vulnerability is a challenge for many cancer care clinicians, thus the use of validated cognitive assessment tools are recommended. As international cancer guidelines for older adults recommend Geriatric Assessment (GA) which includes an evaluation of cognition, clinicians need to be familiar with the overall interpretation of the commonly used cognitive assessment tools. This rapid review investigated the cognitive assessment tools that were most frequently recommended by Geriatric Oncology guidelines: Blessed Orientation-Memory-Concentration test (BOMC), Clock Drawing Test (CDT), Mini-Cog, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Short Portable Mental Status Questionnaire (SPMSQ). A detailed appraisal of the strengths and limitations of each tool was conducted, with a focus on practical aspects of implementing cognitive assessment tools into real-world clinical settings. Finally, recommendations on choosing an assessment tool and the additional considerations beyond screening are discussed.
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Affiliation(s)
- Gina Tuch
- Department of Geriatric Medicine, Alfred Health, Melbourne, VIC 3004, Australia
| | - Wee Kheng Soo
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia;
- Cancer Services, Eastern Health, Box Hill, VIC 3128, Australia
- Aged Medicine Program, Eastern Health, Box Hill, VIC 3128, Australia
| | - Ki-Yung Luo
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
| | - Kinglsey Frearson
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
| | - Ek Leone Oh
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
| | - Jane L. Phillips
- Queensland University of Technology, Brisbane City, QLD 4000, Australia;
| | - Meera Agar
- University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Heather Lane
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
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Lee SY, Wang J, Chao CT, Chien KL, Huang JW. Frailty is associated with a higher risk of developing delirium and cognitive impairment among patients with diabetic kidney disease: A longitudinal population-based cohort study. Diabet Med 2021; 38:e14566. [PMID: 33772857 DOI: 10.1111/dme.14566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/09/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
AIMS Delirium, a form of acute brain failure, exhibits a high incidence among older adults. Recent studies have implicated frailty as an under-recognized complication of diabetes mellitus. Whether the presence of frailty increases the risk of delirium/cognitive impairment among patients with diabetic kidney disease (DKD) remains unclear. METHODS From the longitudinal cohort of diabetes patients (LCDP) (n = 840,000) in Taiwan, we identified adults with DKD, dividing them into those without and with different severities of frailty based on a modified FRAIL scale. Cox proportional hazard regression was utilized to examine the frailty-associated risk of delirium/cognitive impairment, identified using approaches validated by others. RESULTS Totally 149,145 patients with DKD (mean 61.0 years, 44.2% female) were identified, among whom 31.0%, 51.7%, 16.0% and 1.3% did not have or had 1, 2 and >2 FRAIL items at baseline. After 3.68 years, 6613 (4.4%) developed episodes of delirium/cognitive impairment. After accounting for demographic/lifestyle factors, co-morbidities, medications and interventions, patients with DKD and 1, 2 and >2 FRAIL items had a progressively higher risk of developing delirium/cognitive impairment than those without (for those with 1, 2 and >2 items, hazard ratio 1.18, 1.26 and 1.30, 95% confidence interval 1.08-1.28, 1.14-1.39 and 1.10-1.55, respectively). For every FRAIL item increase, the associated risk rose by 9%. CONCLUSIONS Frailty significantly increased the risk of delirium/cognitive impairment among patients with DKD. Frailty screening in these patients may assist in delirium risk stratification.
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Affiliation(s)
- Szu-Ying Lee
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chia-Ter Chao
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jenq-Wen Huang
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Caba Y, Dharmarajan K, Gillezeau C, Ornstein KA, Mazumdar M, Alpert N, Schwartz RM, Taioli E, Liu B. The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review. JNCI Cancer Spectr 2021; 5:pkab002. [PMID: 34056540 PMCID: PMC8152697 DOI: 10.1093/jncics/pkab002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/21/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022] Open
Abstract
Dementia and cancer occur commonly in older adults. Yet, little is known about the effect of dementia on cancer treatment and outcomes in patients diagnosed with cancer, and no guidelines exist. We performed a mixed studies review to assess the current knowledge and gaps on the impact of dementia on cancer treatment decision-making, cancer treatment, and mortality. A search in PubMed, Medline, and PsycINFO identified 55 studies on older adults with a dementia diagnosis before a cancer diagnosis and/or comorbid cancer and dementia published in English from January 2004 to February 2020. We described variability using range in quantitative estimates, ie, odds ratios (ORs), hazard ratios (HRs), and risk ratios (RR) when appropriate and performed narrative review of qualitative data. Patients with dementia were more likely to receive no curative treatment (including hospice or palliative care) (OR, HR, and RR range = 0.40-4.4, n = 8), while less likely to receive chemotherapy (OR and HR range = 0.11-0.68, n = 8), radiation (OR range = 0.24-0.56, n = 2), and surgery (OR range = 0.30-1.3, n = 4). Older adults with cancer and dementia had higher mortality than those with cancer alone (HR and OR range = 0.92-5.8, n = 33). Summarized findings from qualitative studies consistently revealed that clinicians, caregivers, and patients tended to prefer less aggressive care and gave higher priority to quality of life over life expectancy for those with dementia. Current practices in treatment-decision making for patients with both cancer and dementia are inconsistent. There is an urgent need for treatment guidelines for this growing patient population that considers patient and caregiver perspectives.
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Affiliation(s)
- Yaelin Caba
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kavita Dharmarajan
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Gillezeau
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Healthcare Delivery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rebecca M Schwartz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
PURPOSE OF REVIEW As the surgical population ages, preoperative diagnosis and optimization of frailty becomes increasingly important. Various concepts are used to define frailty, and several tools have been validated for use in the perioperative period. This article reviews current conceptual frameworks of frailty, references current literature and provides a practical approach to the preoperative frailty assessment with a focus on potential interventions. RECENT FINDINGS A multipronged approach toward preoperative optimization should be used in patients with frailty syndrome. Oral protein supplementation and immunonutrition therapy can reduce complications in patients with malnutrition. Initiating a preoperative physical exercise regimen may mitigate frailty. Nonpharmacologic interventions to reduce preoperative anxiety and improve mood are effective, low-cost adjuncts associated with improvement in postoperative outcomes. Engaging in shared decision making is a critical component of the preoperative evaluation of frail patients. SUMMARY Emerging evidence suggests that frailty may be mitigated with patient-specific, multidimensional preoperative interventions, thus potentially improving postoperative outcomes in this vulnerable patient population.
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Affiliation(s)
| | - Jeanna Blitz
- Duke University School of Medicine, Durham, North Carolina, USA
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9
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Morgans AK, Renzulli J, Olivier K, Shore ND. Risk of Cognitive Effects in Comorbid Patients With Prostate Cancer Treated With Androgen Receptor Inhibitors. Clin Genitourin Cancer 2021; 19:467.e1-467.e11. [PMID: 33893042 DOI: 10.1016/j.clgc.2021.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 12/18/2022]
Abstract
Prostate cancer (PC) is primarily a disease of older men. As the risk of neurocognitive decline increases as people age, cognitive dysfunction is a potential complication in men with PC, imposing detrimental effects on functional independence and quality of life. Importantly, risk of cognitive decline may increase with exposure to androgen deprivation therapy and other hormonal therapies. Particular consideration should be given to patients with castration-resistant PC (CRPC), many of whom require continuous, long-term androgen deprivation therapy combined with a second-generation androgen receptor inhibitor. Non-comparative evidence from interventional trials of androgen receptor inhibitors in men with non-metastatic CRPC suggests differential effects on cognitive function and central nervous system-related adverse events within this drug class. Drug-drug interactions with concomitant medications for chronic, non-malignant comorbidities differ among ARIs and thus may contribute further to cognitive impairment. Hence, establishing baseline cognitive function is a prerequisite to identifying subsequent clinical decline associated with androgen receptor-targeted therapies. Although brief, sensitive screening tools for cancer-related cognitive dysfunction are lacking, mental status can be ascertained from the initial medical history and neurocognitive examination, progressing to more in-depth evaluation when impairment is suspected. On-treatment neurocognitive monitoring should be integrated into regular clinical follow-up to preserve cognitive function and quality of life throughout disease management. This review summarizes the multiple factors that may contribute to cognitive decline in men with CRPC, awareness of which will assist clinicians to optimize individual treatment. Practical, clinic-based strategies for managing the risks for and symptoms of cognitive dysfunction are also discussed.
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Affiliation(s)
- Alicia K Morgans
- Department of Medicine (Hematology and Oncology), Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Joseph Renzulli
- Department of Urology, Yale School of Medicine, New Haven, CT
| | - Kara Olivier
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Neal D Shore
- Department of Urology, Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC
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Abstract
PURPOSE OF REVIEW Cognitive impairment is increasing in an ageing population and as people live longer, they are more likely to develop cancer therefore cognitive impairment and cancer are frequently co-occurring. We reviewed articles published since 2018 on cognitive impairment and cancer. RECENT FINDINGS The current review has focused on diagnosis, treatment and palliative and end of life care. A comprehensive systematic review reported joint cancer and cognitive impairment prevalence from 0.2 to 45.6%. The review reported there was reduced likelihood of patients with co-occurring cognitive and cancer receiving information regarding cancer stage, reduced cancer treatment with curative intent and limited pain and symptom management. Further studies emphasized the role of family carers in supporting patients with cognitive impairment through cancer treatment. SUMMARY Disappointingly in an area where the numbers of patients with cognitive impairment and cancer are increasing, there appears to be little recently published research in this area. We conclude that further research is required to determine how best to support patients with cognitive impairment and cancer and families during diagnosis of cancer, treatment and continuing care and most importantly the findings of all studies are implemented within clinical practice.
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Schmidt NE, Steffen A, Meuser TM. Impairment for Medication Management in Older Adults: Validity of a Family Report Measure. Clin Gerontol 2020; 43:350-362. [PMID: 31826718 DOI: 10.1080/07317115.2019.1703064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Medication nonadherence can have significant consequences for the health of older adults. Difficulty managing medications is often a sign of cognitive impairment, and monitoring is an early caregiving task for family members. This study examined a screening tool for independence in medication management.Methods: Reliability and validity of the screening tool were assessed in a sample of 152 female care partners for a relative aged 65+years.Results: The tool showed sound test-retest reliability, convergent and discriminant validity, and test utility, such that medication assistance was not better predicted by a global rating of cognitive impairment.Conclusions: In context of cognitive impairment, detection of medication mismanagement could be improved in both primary care and specialty health encounters through adoption of this single-item screening tool.Clinical Implications: This single-item report can be used to quickly facilitate discussions of medication management and cognitive impairment screening in office visits. The item also shows promise for efficient measurement of impairment in medication management than typical IADL assessment language.
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Affiliation(s)
- Nicholas E Schmidt
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Ann Steffen
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Thomas M Meuser
- Center for Excellence in Aging, University of New England, Biddeford, ME, USA
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