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Başoğlu S, Polat Ü. The Effect of Education and Monitoring via Tele-Nursing to Elderly Cancer Patients Using Oral Anticancer Agents on Self-efficacy and Medication Adherence: A Randomized Controlled Trial. Semin Oncol Nurs 2024:151692. [PMID: 39030135 DOI: 10.1016/j.soncn.2024.151692] [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: 02/07/2024] [Revised: 05/24/2024] [Accepted: 06/19/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVES This study was conducted as a randomized controlled trial to determine the effect of the education and monitoring provided via tele-nursing to elderly cancer patients using oral anticancer agents on their medication treatment adherence self-efficacy and medication adherence. METHODS The sample of the study consisted of 60 elderly cancer patients who presented to the oncology outpatient clinics of a medical faculty hospital in Turkey. An Elderly Information Form, the Oral Chemotherapy Adherence Scale, the Medication Adherence Self-Efficacy Scale, a Tele-nursing Evaluation Form, and a Telephone Monitoring Form were used to collect data. Patients in the intervention group were sent text messages and educational videos via WhatsApp® for the first four weeks, and after the fifth week, they were monitored by phone for eight weeks. Data collection tools were applied to the control and intervention groups at weeks 1, 8, and 12. Independent samples t-test, Repeated measurements analysis of variance chi-square test, and Pearson correlation test were used to analyze the data. RESULTS In the study, while there was no significant difference between the mean scores of the intervention and control groups on the pretest application of the Oral Chemotherapy Adherence Scale and the Medication Adherence Self-Efficacy Scale (p > .05), a significant difference was found between the mean posttest scores of the groups (p < .05). CONCLUSIONS In this study, it was determined that the education and monitoring provided to elderly cancer patients via tele-nursing positively affected their self-efficacy and medication adherence. IMPLICATIONS FOR NURSING PRACTICE In line with the research results, it is recommended that nurses use tele-nursing applications in the care of elderly cancer patients using oral anticancer agents.
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Affiliation(s)
| | - Ülkü Polat
- Faculty of Nursing, Gazi University, Ankara, Turkey
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Karihtala P, Schiza A, Fountzilas E, Geisler J, Meattini I, Risi E, Biganzoli L, Valachis A. Clinical trials in older patients with cancer - typical challenges, possible solutions, and a paradigm of study design in breast cancer. Acta Oncol 2024; 63:441-447. [PMID: 38881342 PMCID: PMC11332548 DOI: 10.2340/1651-226x.2023.40365] [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: 03/18/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND PURPOSE While the prevalence of older breast cancer patients is rapidly increasing, these patients are greatly underrepresented in clinical trials. We discuss barriers to recruitment of older patients to clinical trials and propose solutions on how to mitigate these challenges and design optimal clinical trials through the paradigm of IMPORTANT trial. PATIENTS AND METHODS This is a narrative review of the current literature evaluating barriers to including older breast cancer patients in clinical trials and how mitigating strategies can be implemented in a pragmatic clinical trial. RESULTS The recognized barriers can be roughly divided into trial design-related (e.g. the adoption of strict inclusion criteria, the lack of pre-specified age-specific analysis), patient-related (e.g. lack of knowledge, valuation of the quality-of-life instead of survival, transportation issues), or physician-related (e.g. concern for toxicity). Several strategies to mitigate barriers have been identified and should be considered when designing a clinical trial dedicated to older patients with cancer. The pragmatic, de-centralized IMPORTANT trial focusing on dose optimization of CDK4/6 -inhibitors in older breast cancer patients is a paradigm of a study design where different mitigating strategies have been adopted. INTERPRETATION Because of the existing barriers, older adults in clinical trials are considerably healthier than the average older patients treated in clinical practice. Thus, the study results cannot be generalized to the older population seen in daily clinical practice. Broader inclusion/exclusion criteria, offering telehealth visits, and inclusion of patient-reported, instead of physician-reported outcomes may increase older patient participation in clinical trials.
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Affiliation(s)
- Peeter Karihtala
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland.
| | - Aglaia Schiza
- Department of Oncology, Uppsala University Hospital and department of Immunology, Genetics and Pathology Uppsala University, Uppsala, Sweden
| | - Elena Fountzilas
- Department of Medical Oncology, St. Luke's Clinic, Thessaloniki, Greece
| | - Jürgen Geisler
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway & Akershus University Hospital, Department of Oncology, Lørenskog, Norway
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology and Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
| | - Emanuela Risi
- Department of Oncology, Hospital of Prato, Azienda USL Toscana Centro, Italy
| | - Laura Biganzoli
- Department of Oncology, Hospital of Prato, Azienda USL Toscana Centro, Italy
| | - Antonios Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Tripathi N, Gebrael G, Chigarira B, Sahu KK, Balasubramanian I, Caparas C, Mathew Thomas V, Cohan JN, Pelletier K, Maughan BL, Agarwal N, Swami U, Gupta S. Treatment Patterns and Outcomes by Age in Metastatic Urinary Tract Cancer: A Retrospective Tertiary Cancer Center Analysis. Cancers (Basel) 2024; 16:2143. [PMID: 38893262 PMCID: PMC11172373 DOI: 10.3390/cancers16112143] [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: 04/07/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Metastatic urinary tract cancer (mUTC) is challenging to treat in older adults due to comorbidities. We compared the clinical courses of younger and older (≥70 years) adults with mUTC receiving first-line (1L) systemic therapy in a tertiary cancer center. Baseline clinical characteristics, treatments received, tolerability, and survival outcomes were analyzed. Among 212 patients (103 older vs. 109 younger), the older patients had lower hemoglobin at baseline (84% vs. 71%, p = 0.03), the majority were cisplatin-ineligible (74% vs. 45%, p < 0.001), received more immunotherapy-based treatments in the 1L (52% vs. 36%, p = 0.01), received fewer subsequent lines of treatment (median 0 vs. 1, p = 0.003), and had lower clinical trial participation (30% vs. 18%, p = 0.05) compared to the younger patients. When treated with 1L chemotherapy, older patients required more dose adjustments (53.4% vs. 23%, p = 0.001) and received fewer cycles of chemotherapy (median 4 vs. 5, p= 0.01). Older patients had similar OS (11.2 months vs. 14 months, p = 0.06) and similar rates of treatment-related severe toxicity and healthcare visits, independent of the type of systemic treatment received, compared to younger patients. We conclude that select older adults with mUTC can be safely treated with immunotherapy and risk-adjusted regimens of chemotherapy with tangible survival benefits.
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Affiliation(s)
- Nishita Tripathi
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
- Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
| | - Georges Gebrael
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Beverly Chigarira
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Kamal Kant Sahu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Ishwarya Balasubramanian
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Constance Caparas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Vinay Mathew Thomas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Jessica N. Cohan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Kaitlyn Pelletier
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Benjamin L. Maughan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Sumati Gupta
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA
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Paredero-Pérez I, Jimenez-Fonseca P, Cano JM, Arrazubi V, Carmona-Bayonas A, Covela-Rúa M, Fernández-Montes A, Martín-Richard M, Gironés-Sarrió R. State of the scientific evidence and recommendations for the management of older patients with gastric cancer. J Geriatr Oncol 2024; 15:101657. [PMID: 37957106 DOI: 10.1016/j.jgo.2023.101657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
Gastric cancer is one of the most frequent and deadly tumours worldwide. However, the evidence that currently exists for the treatment of older adults is limited and is derived mainly from clinical trials in which older patients are poorly represented. In this article, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Group for the Treatment of Digestive Tumours (TTD), and the Spanish Multidisciplinary Group on Digestive Cancer (GEMCAD) reviews the existing scientific evidence for older patients (≥65 years old) with gastric cancer and establishes a series of recommendations that allow optimization of management during all phases of the disease. Geriatric assessment (GA) and a multidisciplinary approach should be fundamental parts of the process. In early stages, endoscopic submucosal resection or laparoscopic gastrectomy is recommended depending on the stage. In locally advanced stage, the tolerability of triplet regimens has been established; however, as in the metastatic stage, platinum- and fluoropyrimidine-based regimens with the possibility of lower dose intensity are recommended resulting in similar efficacy. Likewise, the administration of trastuzumab, ramucirumab and immunotherapy for unresectable metastatic or locally advanced disease is safe. Supportive treatment acquires special importance in a population with different life expectancies than at a younger age. It is essential to consider the general state of the patient and the psychosocial dimension.
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Affiliation(s)
- Irene Paredero-Pérez
- Lluís Alcanyís de Játiva Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Valencia, Spain
| | - Paula Jimenez-Fonseca
- Asturias Central University Hospital (HUCA), Health Research Institute of the Principality of Asturias (ISPA), Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD), Oviedo, Spain
| | - Juana María Cano
- Ciudad Real University Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Ciudad Real, Spain.
| | - Virginia Arrazubi
- Navarra University Hospital, Navarra Institute for Health Research (IdiSNA), Spanish Society of Medical Oncology (SEOM), Pamplona, Spain
| | - Alberto Carmona-Bayonas
- IMIB Morales Meseguer University Hospital, Murcia University (UMU), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Murcia, Spain
| | - Marta Covela-Rúa
- Lucus Agusti University Hospital (HULA), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Lugo, Spain
| | - Ana Fernández-Montes
- Ourense University Hospital Complex (CHUO), Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Orense, Spain
| | - Marta Martín-Richard
- Institut Català d'Oncologia (ICO) - Duran i Reynals University Hospital, Multidisciplinary Spanish Group of Digestive Cancer (GEMCAD), Barcelona, Spain.
| | - Regina Gironés-Sarrió
- Polytechnic la Fe University Hospital, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Valencia, Spain
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Stueger A, Joerger M, De Nys K. Geriatric evaluation methods in oncology and their use in clinical studies: A systematic literature review. J Geriatr Oncol 2024; 15:101684. [PMID: 38072709 DOI: 10.1016/j.jgo.2023.101684] [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: 01/21/2023] [Revised: 06/04/2023] [Accepted: 12/01/2023] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Therapeutic options in oncology keep on expanding. Nonetheless, older adults are underrepresented in clinical trials and those enrolled often have a better health status than their average peers, resulting in a lack of representative evidence for this heterogenous population. The inclusion of older patients and a uniform categorization of "frailty" is becoming increasingly urgent. Standardized tools could contribute to the quality and comparability of clinical trials and facilitate clinical decisions. The aim of this literature review was to elaborate an overview of the use of geriatric evaluation (GE) methods in clinical cancer research. MATERIALS AND METHODS We performed a literature review of the PubMed database. Clinical pharmacotherapy studies that applied or evaluated a clearly defined system for the GE of oncological patients were included. Data retrieved encompassed the applied GE method(s), cancer type(s), and pharmacotherapy investigated, the number of included patients, study type, year of publication, as well as the primary purpose of the GE. The GEs used most frequently were depicted in more depth. RESULTS In this literature review, 103 publications were selected for inclusion. The biggest proportion of studies (36%, n = 34) used clearly defined, but not previously validated, GE methods (study-specific GE). Standardized GE methods encountered in at least five publications were the G8 screening test (applied in 18% of included studies, n = 17), the Balducci score (7%, n = 7), and a geriatric assessment based on Hurria (5%, n = 5). The primary purpose of GE was predominantly an appraisal of its potential role in pharmacotherapy optimization. The GE also served as baseline and outcome measure, inclusion/exclusion criterion, factor for stratified randomization, and to determine treatment allocation. DISCUSSION The wide range of GE methods used across studies make direct comparisons difficult, and many methods are poorly characterized and/or not previously validated. The further inclusion of representative older patients in clinical trials combined with the use of a standardized GE could help clinicians in the decision-making process.
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Affiliation(s)
- Amelie Stueger
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland.
| | - Markus Joerger
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland; Department of Oncology and Hematology, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9000 St. Gallen, Switzerland.
| | - Katelijne De Nys
- Palliativzentrum, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9000 St. Gallen, Switzerland; KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, ON2 Herestraat 49 - box 424, BE-3000 Leuven, Belgium.
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Ioffe D, Bhatia-Patel SC, Gandhi S, Hamad EA, Dotan E. Cardiovascular Concerns, Cancer Treatment, and Biological and Chronological Aging in Cancer: JACC Family Series. JACC CardioOncol 2024; 6:143-158. [PMID: 38774000 PMCID: PMC11103051 DOI: 10.1016/j.jaccao.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of death globally, particularly among the rapidly growing population of older adults (OAs). CVD is a leading cause of mortality among cancer survivors, often accelerated by cancer treatments associated with short- or long-term cardiotoxicity. Moreover, there is a dynamic relationship among CVD, cancer, and aging, characterized by shared risk factors and biological hallmarks, that plays an important role in caring for OAs, optimizing treatment approaches, and developing preventive strategies. Assessment of geriatric domains (eg, functional status, comorbidities, cognition, polypharmacy, nutritional status, social support, psychological well-being) is critical to individualizing treatment of OAs with cancer. The authors discuss considerations in caring for an aging population with cancer, including methods for the assessment of OAs with CVD and/or cardiovascular risk factors planned for cancer therapy. Multidisciplinary care is critical in optimizing patient outcomes and maintaining quality of life in this growing vulnerable population.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Sakshi Gandhi
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Eman A. Hamad
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Mac Eochagain C, Barrell A, Slavova-Boneva V, Murphy J, Pattwell M, Cumming J, Edmondson A, McGinn M, Kipps E, Milton M, Jethwa J, Ring A, Battisti NML. Implementation of a geriatric oncology service at the Royal Marsden Hospital. J Geriatr Oncol 2024; 15:101698. [PMID: 38219333 DOI: 10.1016/j.jgo.2023.101698] [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: 08/20/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Despite significant evidence supporting the benefits of comprehensive oncogeriatric assessment in the management of older patients with cancer, the adoption of specialised geriatric oncology programs in the United Kingdom remains limited. Descriptions of clinic structure and models, patient demographics and baseline characteristics, resource utilisation, and predictors of resource utilisation are lacking in this population, which may complicate or impede the planning, resourcing, and development of further services in this subspecialty on a national and regional basis. MATERIALS AND METHODS Between November 2021 and April 2023, 244 patients commencing systemic anticancer treatment at the Royal Marsden Hospital, London underwent geriatric screening using the Senior Adult Oncology Programme-3 (SAOP3) screening tool. Baseline clinical factors (sex, age, Charlson Comorbidity Index score, Cumulative Illness Rating Scale-Geriatric [CIRS-G] score, Katz Index score, Barthel Index score, treatment intent, and Eastern Cooperative Oncology Group Performance Status [ECOG-PS]) were assessed as predictors of geriatric impairments and need for multidisciplinary referral and intervention using a negative binomial regression analysis. Referral rates to multidisciplinary teams were assessed against ECOG-PS score using point-biserial correlation, as well as against a historical control using descriptive statistics. RESULTS The median age of participants was 77; 75.8% were female. Breast cancer was the most prevalent diagnosis (61.9%). Most patients (67.6%) were undergoing treatment in the palliative setting. Two hundred eleven (86.5%) patients were identified as having at least one geriatric impairment. Six hundred forty-nine multidisciplinary referrals were made, of which 583 (86.7%) were accepted by the referred patient. Higher ECOG PS was positively associated with geriatric impairments in physiotherapy, occupational therapy, dietetics, pharmacy, and welfare rights domains, as well as with the overall number of geriatric impairments. DISCUSSION The Royal Marsden Senior Adult Oncology Programme represents the first geriatric oncology service in a tertiary cancer centre in the United Kingdom. Following implementation of SAOP3 screening, we observed a substantial increase in referrals to all multidisciplinary teams, suggestive of previously underrecognized needs among this population. The need for multidisciplinary intervention was strongly correlated with baseline ECOG-PS score, but not with other measured clinical variables, including comorbidity or functional indices.
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Affiliation(s)
- Colm Mac Eochagain
- Trinity St James' Cancer Institute, Dublin, Ireland; Royal Marsden Hospital, London, United Kingdom.
| | | | | | - Jane Murphy
- Royal Marsden Hospital, London, United Kingdom
| | | | | | | | | | - Emma Kipps
- Royal Marsden Hospital, London, United Kingdom
| | | | - Jo Jethwa
- Royal Marsden Hospital, London, United Kingdom
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Eochagain CM, Battisti NML. Reporting of older subgroups in registration breast cancer trials 2012-2021. Breast Cancer Res Treat 2023; 202:411-421. [PMID: 37665474 DOI: 10.1007/s10549-023-07081-0] [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: 06/19/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Adequate reporting of data specific to older populations enrolled to breast cancer trials is critical, given the high incidence of the disease among this demographic. This study aimed to examine the completeness of reporting of older subgroups among patients recruited to registration clinical trials investigating systemic treatments for breast cancer. METHODS Clinical trials leading to a US food and drug administration (FDA) approval in breast cancer between 2012 and 2021 were included. Primary study reports and and all available secondary publications were systematically and objectively assessed with regard to the availability of data regarding efficacy, baseline characteristics, safety, and health-related quality of life (HRQOL) outcomes among older subgroups. RESULTS 27 trials and 216 publications were assessed. 20.3% of patients were aged ≥65. 70.0% of patients had an eastern cooperative oncology group (ECOG) performance status of 0. Although complete reporting of primary endpoints was adequate (72.7%), most protocol-defined primary endpoints were surrogate endpoints (84.8%). Overall survival data among older populations was unavailable in 50.0% of studies. Reporting was poor for secondary efficacy endpoints (81.8% unreported), baseline characteristics (70.4% unreported), toxicity (55.6% unreported), and health-related quality of life outcomes (87.5% unreported). CONCLUSION The findings underline significant deficits in the reporting of age-specific data in breast cancer registration trials. The underreporting of key efficacy, safety, and HRQOL outcomes highlights the need for mandatory reporting standards and a dedicated emphasis on older populations' priorities and needs in the reporting of registration clinical trials.
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Soon JJY, Zhao Y, Shannon NB, Tan JTH. Adherence to Multidisciplinary Tumor Board Recommendations in Patients With Curable Esophageal and Gastric Cancers. J Gastrointest Cancer 2023; 54:614-622. [PMID: 35759206 DOI: 10.1007/s12029-022-00847-7] [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] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Multidisciplinary tumor board (MDT) discussion is standard practice in the management of Upper Gastrointestinal (UGI) cancers. However, poor adherence to MDT recommendations may account for the lack of improved oncological outcomes with MDTs. We aim to quantify adherence rates and compare outcomes between adherent and non-adherent patients. METHODS We included all patients with potentially curable primary UGI carcinomas who were discussed at UGI MDT from 2017 to 2018. MDT recommendations were compared to actual treatment received. Oncological and survival outcomes were compared between both groups. RESULTS Amongst 153 patients, 64 (41.8%) were non-adherent to MDT recommendations. Reasons for non-adherence were patient refusal (50.0%), treatment-related complications (31.3%), disease factors (17.2%) and clinician decision (1.56%). Univariate analysis showed that non-adherent patients were older (71.6 vs 65.2 years, p < 0.001), with higher clinical stage at point of diagnosis (p = 0.028), pathological stage after resection (p < 0.001) and were more likely to be recommended for multimodal therapy. No significant factors were associated with non-adherence at multivariate analysis. Non-adherent patients had worse median overall survival (19.5 months) compared to adherent patients (not reached at follow-up) with both unmatched and propensity-score matched analysis. Patients who received only part of the intended adjuvant chemotherapy course had worse median overall survival and disease-free survival compared to patients who completed or did not initiate adjuvant chemotherapy. CONCLUSIONS Non-adherence to MDT recommendations was associated with advanced age and tumor stage, and potentially contributes to the worse oncological outcomes in a group of patients already predisposed to poor outcomes.
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Affiliation(s)
- Joel Jia Yi Soon
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.
| | - Yue Zhao
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
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10
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Pisegna JL, BrintzenhofeSzoc K, Shahrokni A, Canin B, Plotkin E, Boehmer LM, Chien L, Malone MV, MacKenzie AR, Krok-Schoen JL. Differences in urban and suburban/rural settings regarding care provision and barriers of cancer care for older adults during COVID-19. Support Care Cancer 2022; 31:78. [PMID: 36562819 PMCID: PMC9780617 DOI: 10.1007/s00520-022-07544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Care for older adults with cancer became more challenging during the COVID-19 pandemic, particularly in urban hotspots. This study examined the potential differences in healthcare providers' provision of as well as barriers to cancer care for older adults with cancer between urban and suburban/rural settings. METHODS Members of the Advocacy Committee of the Cancer and Aging Research Group, with the Association of Community Cancer Centers, surveyed multidisciplinary healthcare providers responsible for the direct care of patients with cancer. Respondents were recruited through organizational listservs, email blasts, and social media messages. Descriptive statistics and chi-square tests were used. RESULTS Complete data was available from 271 respondents (urban (n = 144), suburban/rural (n = 127)). Most respondents were social workers (42, 44%) or medical doctors/advanced practice providers (34, 13%) in urban and suburban/rural settings, respectively. Twenty-four percent and 32.4% of urban-based providers reported "strongly considering" treatment delays among adults aged 76-85 and > 85, respectively, compared to 13% and 15.4% of suburban/rural providers (Ps = 0.048, 0.013). More urban-based providers reported they were inclined to prioritize treatment for younger adults over older adults than suburban/rural providers (10.4% vs. 3.1%, p = 0.04) during the pandemic. The top concerns reported were similar between the groups and related to patient safety, treatment delays, personal safety, and healthcare provider mental health. CONCLUSION These findings demonstrate location-based differences in providers' attitudes regarding care provision for older adults with cancer during the COVID-19 pandemic.
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Affiliation(s)
- Janell L. Pisegna
- Physical Therapy Program, Geriatric Research Education and Clinical Center VA Eastern Colorado Healthcare System, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | | | - Armin Shahrokni
- Department of Medicine, Gastrointestinal Oncology and Geriatrics Services, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | | | - Elana Plotkin
- Provider Education Programs, Association of Community Cancer Centers, Rockville, Maryland USA
| | - Leigh M. Boehmer
- Provider Education Programs, Association of Community Cancer Centers, Rockville, Maryland USA
| | - Leana Chien
- City of Hope Comprehensive Cancer Center, Duarte, CA USA
| | - Mariuxi Viteri Malone
- Division of Hematology, Florida Cancer Specialists and Research Institute, Venice, FL USA
| | - Amy R. MacKenzie
- Division of Hematology, Thomas Jefferson University, Philadelphia, PA USA
| | - Jessica L. Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10Th Ave., Columbus, OH 43210 USA
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11
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BrintzenhofeSzoc K, Canin B, Casas-Silva E, Denicoff A, Braun-Inglis C, Okado I, Bakos A. Through the Lens of Patient Partners: Challenges in Accrual of Older Adults to NCI Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:125-134. [PMID: 36519817 PMCID: PMC9949584 DOI: 10.1093/jncimonographs/lgac022] [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] [Received: 05/27/2022] [Revised: 08/15/2022] [Accepted: 09/11/2022] [Indexed: 12/23/2022] Open
Abstract
The workshop "Engaging Older Adults in Cancer Clinical Trials Conducted in the NCI Clinical Trials Network: Challenges and Opportunities" included a Patient Stakeholder Workgroup that explored the needs and concerns of older adults with cancer regarding clinical trials. To accomplish this, the workgroup conducted patient focus groups in which participants were interviewed, recorded conversations were analyzed and coded, and salient themes were identified. The focus groups identified general barriers to accrual such as complex consent forms, general communication, restrictive eligibility, nonreferrals, patient costs, cultural insensitivity, limited accessibility in community settings, and transportation issues. They also identified the influence of knowledgeable information presenters, improved care, family or caregiver support, and the desire to help others as drivers or reasons to participate in clinical trials. The workshop concluded that multi-level interventions could be used to increase the accrual of older adults to National Cancer Institute clinical trials as well as others.
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Affiliation(s)
- Karlynn BrintzenhofeSzoc
- Correspondence to: Karlynn BrintzenhofeSzoc, PhD, MSW, FAOSW, University of Louisville, 2301 S. 3rd St, Louisville, KY 40292, USA (e-mail: )
| | - Beverly Canin
- SCOREboard Patient Advocate Board, The Cancer and Aging Research Group, USA
| | - Esmeralda Casas-Silva
- Center for Biomedical Informatics and Information Technology, Informatics and Data Science Program, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
| | - Andrea Denicoff
- Division of Cancer Treatment and Diagnosis, Cancer Therapy and Evaluation Program, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
| | - Christa Braun-Inglis
- Clinical Faculty, UH Nancy Atmospera-Walch School of Nursing, University of Hawaii Cancer Center/Hawaii M/U NCORP, Honolulu, HI, USA
| | - Izumi Okado
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Alexis Bakos
- Division of Cancer Prevention, Community Oncology and Prevention Trials Research Group, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
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12
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Management of Advanced Urothelial Carcinoma in Older and Frail Patients: Have Novel Treatment Approaches Improved Their Care? Drugs Aging 2022; 39:271-284. [PMID: 35344197 DOI: 10.1007/s40266-022-00933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/03/2022]
Abstract
Patients with urothelial carcinoma tend to be older and frailer with a large number of chronic medical conditions. This is particularly pronounced in those with unresectable locally advanced and metastatic urothelial carcinoma. Prior to 2016, treatment options in advanced urothelial carcinoma were limited to chemotherapy, and as a result, a large number of patients were not receiving disease-directed management. Over the last 6 years, multiple alternative modalities including immune checkpoint inhibitors and targeted therapies have been introduced. They are being utilized clinically in older and frail patients, but there are limited studies investigating outcomes in these specific populations. Based upon current evidence, age does not impact the efficacy and tolerance of immune checkpoint inhibitors if patients are fit enough to receive therapy. In frailer patients, immune checkpoint inhibitors appear to be safe, but outcomes from largely retrospective studies demonstrate mixed data regarding their efficacy. Although there are indications from clinical trials that enfortumab vedotin, sacituzumab govitecan, and erdafitinib are also efficacious irrespective of age, there is still not enough evidence to draw definitive conclusions about their use in older and frail patients. Regardless, in all older patients with advanced urothelial carcinoma, it is critical to evaluate for frailty through geriatric screening tools and comprehensive assessments. Combining these evaluations with consideration of an individual patient's goals should be the foundation upon which therapeutic decisions are made in this population of patients.
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13
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Bumanlag IM, Jaoude JA, Rooney MK, Taniguchi CM, Ludmir EB. Exclusion of Older Adults from Cancer Clinical Trials: Review of the Literature and Future Recommendations. Semin Radiat Oncol 2022; 32:125-134. [PMID: 35307114 PMCID: PMC8944215 DOI: 10.1016/j.semradonc.2021.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this review, we present the context of older adult (OA) cancer patients within the broader cancer population, including cancer burdens and trial representation. We first describe the proportion of older adults in clinical trials, with studies showing strong evidence that the proportion of OA in cancer trials is much less than the proportion of OA in the overall cancer population. We highlight the lack of generalizability that can lead to challenges in treatment decisions for OA as well as concerns regarding health inequity. We then discuss barriers to OA enrollment related to trial structure and design, physician perspective, and patient and/or caregiver perspective. We expand on this further by outlining these barriers throughout the process of trial design, patient enrollment/trial implementation, and data analysis in post-market settings. We summarize guidelines from national societies, regulatory agencies, and other institutional bodies, then present a compilation of on-the-ground actionable recommendations to address the challenges of clinical trial design, focusing on geriatric assessments and OA-specific trials. We conclude by providing an outline for future directions, noting specifically the potential impact that radiotherapy and radiation oncology may have on clinical trials related to OA patients.
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Affiliation(s)
- Isabela M Bumanlag
- The University of Texas, Anderson Cancer Center, Houston, TX.; The University of Texas Health Science Center, McGovern Medical School, Houston, TX
| | | | | | | | - Ethan B Ludmir
- The University of Texas, Anderson Cancer Center, Houston, TX..
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14
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Chow R, Lage DE, Williams GR, Sedrak MS, Greer JA, Temel JS, Nipp RD. Representation and Outcomes of Older Adults in Practice-Changing Oncology Trials in the Era of Novel Therapies: A Guideline Appraisal. J Natl Compr Canc Netw 2022; 20:37-44. [PMID: 34991068 DOI: 10.6004/jnccn.2021.7055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Older adults account for 70% of cancer-related deaths, but previous studies have shown that they are underrepresented in cancer clinical trials. We sought to analyze the representation and outcomes of older adults in trials conducted in the era of novel targeted therapy and immunotherapy. METHODS We searched the 2020 NCCN Clinical Practice Guidelines in Oncology and retrieved trials from the past 10 years leading to category 1 recommendations in the first-line metastatic setting for the 5 most common causes of cancer death. We categorized trials by cancer type, single-agent versus multiagent approach, and therapeutic class. We described the percentage of older adults (according to each trial's definition) and used a Mantel-Haenszel random-effects meta-analysis model to compare overall and progression-free survival by age. RESULTS We identified 30 trials consisting of 24,416 patients. Across all trials, 44% of enrolled patients were older adults. Representation of older adults by cancer type within trials was 49% prostate cancer, 38% pancreatic cancer, 37% breast cancer, and 34% non-small cell lung cancer. Representation of older adults also varied by therapeutic class: 20% received immunotherapy, 44% received cytotoxic chemotherapy, 54% received targeted/hormonal therapy, and 34% received combination therapy (P<.001 for all comparisons). For each year since 2010, the percentage of older adults enrolled in trials increased by 1.9%, although this difference was not significant. We observed no difference in overall or progression-free survival between older and younger adults. In our analysis of practice-changing clinical trials, we found that 44% of clinical trial participants were older adults. Trials that included immunotherapy or a combination of therapeutic classes had a lower representation of older adults (<40%). CONCLUSIONS We found that >40% of patients in practice-changing trials are older adults. Although they remain underrepresented in clinical trials compared with the general population, older adults in practice-changing trials seem to be better represented than in previously reported analyses of cooperative group trials.
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Affiliation(s)
- Ronald Chow
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Daniel E Lage
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Grant R Williams
- 2Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Mina S Sedrak
- 3Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California; and
| | - Joseph A Greer
- 4Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Temel
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Ryan D Nipp
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
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15
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Mohile SG, Mohamed MR, Xu H, Culakova E, Loh KP, Magnuson A, Flannery MA, Obrecht S, Gilmore N, Ramsdale E, Dunne RF, Wildes T, Plumb S, Patil A, Wells M, Lowenstein L, Janelsins M, Mustian K, Hopkins JO, Berenberg J, Anthony N, Dale W. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet 2021; 398:1894-1904. [PMID: 34741815 PMCID: PMC8647163 DOI: 10.1016/s0140-6736(21)01789-x] [Citation(s) in RCA: 270] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Older adults with advanced cancer are at a high risk for treatment toxic effects. Geriatric assessment evaluates ageing-related domains and guides management. We examined whether a geriatric assessment intervention can reduce serious toxic effects in older patients with advanced cancer who are receiving high risk treatment (eg, chemotherapy). METHODS In this cluster-randomised trial, we enrolled patients aged 70 years and older with incurable solid tumours or lymphoma and at least one impaired geriatric assessment domain who were starting a new treatment regimen. 40 community oncology practice clusters across the USA were randomly assigned (1:1) to the intervention (oncologists received a tailored geriatric assessment summary and management recommendations) or usual care (no geriatric assessment summary or management recommendations were provided to oncologists) by means of a computer-generated randomisation table. The primary outcome was the proportion of patients who had any grade 3-5 toxic effect (based on National Cancer Institute Common Terminology Criteria for Adverse Events version 4) over 3 months. Practice staff prospectively captured toxic effects. Masked oncology clinicians reviewed medical records to verify. The study was registered with ClinicalTrials.gov, NCT02054741. FINDINGS Between July 29, 2014, and March 13, 2019, we enrolled 718 patients. Patients had a mean age of 77·2 years (SD 5·4) and 311 (43%) of 718 participants were female. The mean number of geriatric assessment domain impairments was 4·5 (SD 1·6) and was not significantly different between the study groups. More patients in intervention group compared with the usual care group were Black versus other races (40 [11%] of 349 patients vs 12 [3%] of 369 patients; p<0·0001) and had previous chemotherapy (104 [30%] of 349 patients vs 81 [22%] of 369 patients; p=0·016). A lower proportion of patients in the intervention group had grade 3-5 toxic effects (177 [51%] of 349 patients) compared with the usual care group (263 [71%] of 369 patients; relative risk [RR] 0·74 (95% CI 0·64-0·86; p=0·0001). Patients in the intervention group had fewer falls over 3 months (35 [12%] of 298 patients vs 68 [21%] of 329 patients; adjusted RR 0·58, 95% CI 0·40-0·84; p=0·0035) and had more medications discontinued (mean adjusted difference 0·14, 95% CI 0·03-0·25; p=0·015). INTERPRETATION A geriatric assessment intervention for older patients with advanced cancer reduced serious toxic effects from cancer treatment. Geriatric assessment with management should be integrated into the clinical care of older patients with advanced cancer and ageing-related conditions. FUNDING National Cancer Institute.
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Affiliation(s)
- Supriya G Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA.
| | - Mostafa R Mohamed
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Huiwen Xu
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Eva Culakova
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Kah Poh Loh
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Marie A Flannery
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Spencer Obrecht
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Nikesha Gilmore
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Erika Ramsdale
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Richard F Dunne
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Tanya Wildes
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Sandy Plumb
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Amita Patil
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Megan Wells
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Lisa Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle Janelsins
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Karen Mustian
- Department of Surgery, University of Rochester Cancer Center National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base, Rochester, NY, USA
| | - Judith O Hopkins
- Southeast Clinical Oncology Research (SCOR) Consortium NCORP, Winston-Salem, NC, USA
| | | | - Navin Anthony
- Southeast Clinical Oncology Research (SCOR) Consortium NCORP, Winston-Salem, NC, USA
| | - William Dale
- Department of Supportive Care, City of Hope National Medical Center, Duarte, CA, USA
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16
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What Should We Recommend for Colorectal Cancer Screening in Adults Aged 75 and Older? ACTA ACUST UNITED AC 2021; 28:2540-2547. [PMID: 34287279 PMCID: PMC8293045 DOI: 10.3390/curroncol28040231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
The current recommendation to stop colorectal cancer screening for older adults is based on a lack of evidence due to systematic exclusion of this population from trials. Older adults are a heterogenous population with many available strategies for patient-centered assessment and decision-making. Evolutions in management strategies for colorectal cancer have made safe and effective options available to older adults, and the rationale to screen for treatable disease more reasonably, especially given the aging Canadian population. In this commentary, we review the current screening guidelines and the evidence upon which they were built, the unique considerations for screening older adults, new treatment options, the risks and benefits of increased screening and potential considerations for the new guidelines.
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17
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Flannery MA, Culakova E, Canin BE, Peppone L, Ramsdale E, Mohile SG. Understanding Treatment Tolerability in Older Adults With Cancer. J Clin Oncol 2021; 39:2150-2163. [PMID: 34043433 PMCID: PMC8238902 DOI: 10.1200/jco.21.00195] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Marie A. Flannery
- University of Rochester Medical Center, School of Nursing, Rochester, NY
| | - Eva Culakova
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Beverly E. Canin
- SCOREboard Stakeholder Advisory Group, University of Rochester Medical Center, Rochester, NY
| | - Luke Peppone
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Erika Ramsdale
- Department of Medicine, University of Rochester, Rochester, NY
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18
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Tucker-Seeley RD, Wallington SF, Canin B, Tang W, McKoy JM. Health Equity for Older Adults With Cancer. J Clin Oncol 2021; 39:2205-2216. [PMID: 34043411 DOI: 10.1200/jco.21.00207] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Reginald D Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA.,USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Sherrie F Wallington
- The George Washington University School of Nursing & Milken Institute School of Public Health, Washington, DC
| | - Beverly Canin
- Cancer and Aging Research Group, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Weizhou Tang
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
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19
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Kanesvaran R, Mohile S, Soto-Perez-de-Celis E, Singh H. The Globalization of Geriatric Oncology: From Data to Practice. Am Soc Clin Oncol Educ Book 2021; 40:1-9. [PMID: 32347757 DOI: 10.1200/edbk_279513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Older adults with cancer are a unique group of patients who require specialized care and treatment. The field of geriatric oncology (GO) was born more than 3 decades ago to address the needs of this growing group of patients. Some challenges in the GO field include establishing a GO clinical service, educating and training personnel, and conducting research in GO. These issues are addressed to varying extents with global initiatives in GO, which are largely dependent on the socioeconomic status of the countries involved. To overcome disparities seen globally, scientific journals that reach an international cancer audience should publish content related to improving care of older adults with cancer around the world, develop an organizational structure that encourages global dissemination of GO knowledge, and advance reporting policies that encourage higher-quality reporting of data relevant to older adults with cancer worldwide. A number of international scientific journals have risen to the occasion to address these disparities. A key battle in enabling access of this vulnerable group of patients to clinical trials is now being fought and won on the global front with numerous regulatory initiatives. The U.S. Food and Drug Administration (FDA) Oncology Center of Excellence (OCE) recently issued draft guidance on the inclusion of older adults in cancer clinical trials. This and other global initiatives led by the FDA have the potential to further improve the evidence base for older adults with cancer.
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Affiliation(s)
| | - Supriya Mohile
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | - Harpreet Singh
- Division of Oncology 2, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD
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20
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Kadambi S, Loh KP, Dunne R, Magnuson A, Maggiore R, Zittel J, Flannery M, Inglis J, Gilmore N, Mohamed M, Ramsdale E, Mohile S. Older adults with cancer and their caregivers - current landscape and future directions for clinical care. Nat Rev Clin Oncol 2020; 17:742-755. [PMID: 32879429 PMCID: PMC7851836 DOI: 10.1038/s41571-020-0421-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 12/13/2022]
Abstract
Despite substantial improvements in the outcomes of patients with cancer over the past two decades, older adults (aged ≥65 years) with cancer are a rapidly increasing population and continue to have worse outcomes than their younger counterparts. Managing cancer in this population can be challenging because of competing health and ageing-related conditions that can influence treatment decision-making and affect outcomes. Geriatric screening tools and comprehensive geriatric assessment can help to identify patients who are most at risk of poor outcomes from cancer treatment and to better allocate treatment for these patients. The use of evidence-based management strategies to optimize geriatric conditions can improve communication and satisfaction between physicians, patients and caregivers as well as clinical outcomes in this population. Clinical trials are currently underway to further determine the effect of geriatric assessment combined with management interventions on cancer outcomes as well as the predictive value of geriatric assessment in the context of treatment with contemporary systemic therapies such as immunotherapies and targeted therapies. In this Review, we summarize the unique challenges of treating older adults with cancer and describe the current guidelines as well as investigational studies underway to improve the outcomes of these patients.
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Affiliation(s)
- Sindhuja Kadambi
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
| | - Kah Poh Loh
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Richard Dunne
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Allison Magnuson
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Ronald Maggiore
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Jason Zittel
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Marie Flannery
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Julia Inglis
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Nikesha Gilmore
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Mostafa Mohamed
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Erika Ramsdale
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Wilmot Cancer Institute, Department of Haematology/Oncology, Rochester, NY, USA.
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21
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Shahrokni A, Loh KP, Wood WA. Toward Modernization of Geriatric Oncology by Digital Health Technologies. Am Soc Clin Oncol Educ Book 2020; 40:1-7. [PMID: 32243198 DOI: 10.1200/edbk_279505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The number of older adults with cancer is increasing. Over the past 3 decades, geriatric oncology research has focused on improving the assessment of frailty and fitness of older adults with cancer as well as methods of improving their outcomes. At the same time, advances in digital health technologies have opened new frontiers for reaching this goal. Digital health technologies encompass a variety of solutions, from electronic patient-reported outcomes (ePROs) to Big Data and wireless sensors. These solutions have the potential to further advance our understanding of patients' experiences during cancer treatment. Whereas the data on the feasibility and utility of such solutions in the care of older adults with cancer are limited, interest from digital health oncology researchers to further explore the benefits of these products is increasing. In this article, we describe the focus of geriatric oncology, the rationale behind the need to explore digital health technologies in this setting, and emerging data and ongoing studies, as well as provide guidelines for proper selection, implementation, and testing of digital health solutions in the context of geriatric oncology.
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Affiliation(s)
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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22
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Liu J, Gutierrez E, Tiwari A, Padam S, Li D, Dale W, Pal SK, Stewart D, Subbiah S, Bosserman LD, Presant C, Phillips T, Yap K, Hill A, Bhatt G, Yeon C, Cianfrocca M, Yuan Y, Mortimer J, Sedrak MS. Strategies to Improve Participation of Older Adults in Cancer Research. J Clin Med 2020; 9:jcm9051571. [PMID: 32455877 PMCID: PMC7291007 DOI: 10.3390/jcm9051571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 02/02/2023] Open
Abstract
Cancer is a disease associated with aging. As the US population ages, the number of older adults with cancer is projected to dramatically increase. Despite this, older adults remain vastly underrepresented in research that sets the standards for cancer treatments and, consequently, clinicians struggle with how to interpret data from clinical trials and apply them to older adults in practice. A combination of system, clinician, and patient barriers bar opportunities for trial participation for many older patients, and strategies are needed to address these barriers at multiple fronts, five of which are offered here. This review highlights the need to (1) broaden eligibility criteria, (2) measure relevant end points, (3) expand standard trial designs, (4) increase resources (e.g., institutional support, interdisciplinary care, and telehealth), and (5) develop targeted interventions (e.g., behavioral interventions to promote patient enrollment). Implementing these solutions requires a substantial investment in engaging and collaborating with community-based practices, where the majority of older patients with cancer receive their care. Multifaceted strategies are needed to ensure that older patients with cancer, across diverse healthcare settings, receive the highest-quality, evidence-based care.
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Affiliation(s)
- Jennifer Liu
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Eutiquio Gutierrez
- Department of Internal Medicine, Harbor-UCLA Medical Center, Los Angeles, CA 90502, USA;
| | - Abhay Tiwari
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Simran Padam
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA 91010, USA;
| | - Sumanta K. Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Daphne Stewart
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Shanmugga Subbiah
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Linda D. Bosserman
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Cary Presant
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Kelly Yap
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Addie Hill
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Geetika Bhatt
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Christina Yeon
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Mary Cianfrocca
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Yuan Yuan
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Mina S. Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
- Correspondence:
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