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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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Inflammation-based prognostic scores in geriatric patients with rectal cancer. Tech Coloproctol 2022; 27:397-405. [PMID: 36197565 DOI: 10.1007/s10151-022-02710-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/27/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND Morbidity/mortality and oncologic outcomes can be worsened in geriatric rectal cancer patients due to comorbidities and frailty. The aim of this study was to compare surgical and oncological results of geriatric rectal cancer patients using inflammation-based prognostic scores. METHODS The prospectively maintained database of 991 rectal cancer patients treated at our center between 2007 and 2020 were analyzed. All conventional clinicopathologic features, and oncologic outcomes are compared between patients ≥ 65 years old (geriatric patients: Group I) and < 65 years old (non-geriatric patients: Group II). The modified Glasgow Prognostic Score (mGPS) and the C-reactive protein-albumin ratio (CAR), were determined. The prognostic value of mGPS and CAR as well as the well-known clinico-pathologic factors to predict surgical morbidity, mortality, local and/or distant recurrence, and overall survival was assessed. RESULTS There were 567 (57.2%) patients who were ≥ 65 years old (Group I; 349 males, median age 74 [range 65-9]) years) and 424 (42.8%) who were < 65 years old (Group II; 252 males, median age 58 [range 20-64] years). The high-grade [Clavien-Dindo III-IV] complications rates of Group I and Group II patients sere 20% (n = 113), and 9% (n = 37), respectively. High-grade complications were related to mGPS (p < 0.001) and CAR (p < 0.001) values. The high-grade complication rate was found to be higher in Group I than in Group II, and this was statistically significant (p < 0.001). High preoperative mGPS and CAR values were significantly associated with postoperative mortality (p < 0.001). In Cox multivariate analysis, mGPS (p = 0.003) and CAR (p = 0.001) were significantly in correlation with lowered overall survival. The mGPS and CAR were found to be independent prognostic factors for overall survival. CONCLUSIONS The mGPS and CAR can predict severe postoperative complications and early mortality. mGPS, and CAR have a powerful prognostic value and the potential clinical usefulness to predict decreased overall survival in both geriatric and non-geriatric rectal cancer patients.
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Cooper L, Siam B, Sagee A, Orgad R, Levi Y, Wasserberg N, Beloosesky Y, Kashtan H. Some Nursing Screening Tools Can Be Used to Assess High-Risk Older Adults Who Undergo Colorectal Surgery for Cancer. Clin Interv Aging 2020; 15:1505-1511. [PMID: 32921996 PMCID: PMC7458272 DOI: 10.2147/cia.s258992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Life expectancy and incidence of cancer among older adults are increasing. The aim of this study was to assess whether routinely used nursing screening tools can predict surgical outcomes in older adults with colorectal cancer. Methods Data of patients who underwent elective colorectal cancer surgery at Rabin Medical Center during the years 2014-2016 were collected retrospectively. Patients were divided into study group (age 80-89 y), and control group (age 60-69 y) for comparing surgical outcomes and six-month mortality. In the study group, screening tool scores were evaluated as potential predictors of surgical outcomes. These included Malnutrition Universal Screening Tool (MUST), Admission Norton Scale Scores (ANSS), Morse Fall Scale (MFS), and Charlson Co-morbidity Index (CCI). Results The study group consisted of 77 patients, and the control group consisted of 129 patients. Postoperative mortality and morbidity were similar in both groups. Nursing screening tools did not predict immediate postoperative outcomes in the study group. MUST and CCI were predictors for six-month mortality. CCI score was 9.43±2.44 in those who died within six months from surgery compared to 7.07 ±1.61 in those who were alive after six months (p<0.05). Post-operative complications were not associated with increased 30-day mortality. Advanced grade complications were associated with an increased six-month mortality (RR=1.37, 95% CI 0.95-1.98, p=0.013). Conclusion Different screening tools for high-risk older adults who are candidates for surgery have been developed, with the caveat of necessitating skilled physicians and resources such as time. Routinely used nursing screening tools may be helpful in better patient selection and informed decision making. These tools, specifically MUST and CCI who were found to predict six-month survival, can be used to additionally identify high-risk patients by the nursing staff and promote further evaluation. This can be a valuable tool in multidisciplinary and patient-centered care.
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Affiliation(s)
- Lisa Cooper
- Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Baha Siam
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Aviv Sagee
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Internal Medicine C, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Ran Orgad
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Yochai Levi
- Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nir Wasserberg
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Yichayaou Beloosesky
- Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
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Tamini N, Giani A, Famularo S, Montuori M, Giardini V, Gianotti L. Should radical surgery for rectal cancer be offered to elderly population? A propensity-matching analysis on short- and long-term outcomes. Updates Surg 2020; 72:801-809. [PMID: 32036561 DOI: 10.1007/s13304-020-00717-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/26/2020] [Indexed: 02/08/2023]
Abstract
Elderly patients with rectal tumor are often undertreated if compared to younger ones. The reasons for this attitude are not fully clear.The aim of this study was to determine the feasibility of radical treatments for rectal cancer in subjects with an age ≥ 75 years (group 1) and to compare short- and long-term outcomes of these patients with patients with an age of less that 75 years (group 2). 311 consecutive patients who underwent radical surgery for rectal cancer were evaluated. A propensity-matching analysis on short- and long-term outcomes was conducted to compare older and younger patients. Overall postoperative complication rate was 23.8% (19/80) in the group 2 and 33.8% (27/80) in group 1 (p = 0.162). OS at 1, 3 and 5 years was 96.2%, 88.4% and 75.9% in under 75 and 92.5%, 64.3% and 50.6% in over 75 group, respectively (p = 0.001). However, TSS was considered, no significant difference was found. Major complications were comparable within groups: 10 (12.5%) versus 11 (13.8%) in groups 2 and 1, respectively (p = 0.633). This study suggests that major rectal cancer surgery with curative intent should not be denied to an elderly population on the basis of age alone. Specific oncologic features and comorbidities are better long-term mortality predictors than aging.
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Affiliation(s)
- Nicolò Tamini
- Department of Surgery, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy.
| | - Alessandro Giani
- Department of Surgery, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy.,School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Simone Famularo
- Department of Surgery, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy.,School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Mauro Montuori
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Vittorio Giardini
- Department of Surgery, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy
| | - Luca Gianotti
- Department of Surgery, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy.,School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
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Tominaga T, Nagasaki T, Akiyoshi T, Fukunaga Y, Fujimoto Y, Yamaguchi T, Konishi T, Nagayama S, Ueno M. Feasibility of neoadjuvant therapy for elderly patients with locally advanced rectal cancer. Surg Today 2019; 49:694-703. [PMID: 30937632 DOI: 10.1007/s00595-019-01801-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/07/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The feasibility of neoadjuvant therapy (NAT) for elderly patients with rectal cancer has not been evaluated well. METHODS Between 2004 and 2014, 506 patients with locally advanced low rectal cancer underwent curative resection. Fifty-four were over 75 years old (elderly group), and 452 were under 75 years old (young group). The patients were divided into sub-groups according to whether they received NAT. RESULTS Nineteen (35.2%) patients from the elderly group and 348 (77.0%) from the young group received NAT. The proportion of patients who received NAT was significantly lower in the elderly group. In the elderly group, the median age and prevalence of co-morbidities were significantly lower in patients with than in those without NAT. The incidence of severe adverse events was similar in the two groups. On multivariate analysis, age was not related to postoperative complications in patients who received NAT. The 5-year local recurrence rate was significantly lower in the elderly patients who received NAT, and similar to that of the young patients who received NAT. CONCLUSIONS Neoadjuvant therapy was feasible and should be considered as a treatment option for carefully selected elderly patients with locally advanced low rectal cancer.
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Affiliation(s)
- Tetsuro Tominaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yoshiya Fujimoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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