1
|
Nguyen DH, Garcia D, Mirghani H, Giraud P, Laccourreye O. A STROBE analysis of conservative laryngeal treatment in France for cT1-2N0M0 glottic squamous cell carcinoma in octogenarians. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00136-4. [PMID: 39443220 DOI: 10.1016/j.anorl.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
OBJECTIVES To document conservative laryngeal treatment for cT12N0M0 glottic squamous cell carcinoma (SCC) in octogenarians in France in the 21st century. MATERIAL AND METHODS Retrospective observational study comparing a cohort of 38 octogenarians (Group A) to a control cohort of 107 septuagenarians (Group B), with isolated cT12N0M0 glottic SCC, consecutively managed between 2000 and 2018 at a single French university hospital center. The main endpoints were 5-year actuarial overall and disease-free survival and causes of death, compared between groups. Accessory endpoints were 5-year actuarial local control and laryngeal preservation. 93% of patients were followed until death or for a minimum 5years. The STROBE guideline was used. The significance threshold was set at P<0.005. RESULTS The only significant difference in demographic, oncologic and treatment variables between groups was a higher mean Charlson index in Group A (P=0.004). Five-year actuarial survival, at 79% overall, did not significantly differ between groups A and B (80% and 79%, respectively; P=0.30). Five-year actuarial disease-free survival, at 74% overall, did not significantly differ between groups (77% and 73%; P=0.42). Intercurrent disease accounted for 44% of causes of death, with cardiovascular etiology in 71% of cases. Five-year actuarial local control, at 76% overall, did not significantly differ between groups (80% and 75%; P=0.41). Salvage treatment for local recurrence yielded a 94% overall local control rate: 98% in Group A and 93% in Group B. Five-year actuarial laryngeal preservation rate, at 92%, did not significantly differ between groups (90% and 98%; P=0.20). CONCLUSION Conservative laryngeal treatment for cT12N0M0 SCC in octogenarians yielded the same results as in septuagenarians. Improvement in survival will depend on management and monitoring of comorbidity, and particularly cardiovascular comorbidity.
Collapse
Affiliation(s)
- D H Nguyen
- Service d'Oto-rhino-laryngologie et de Chirurgie Cervico-Faciale, HEGP, AP-HP, Université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France.
| | - D Garcia
- Service d'Oto-rhino-laryngologie et de Chirurgie Cervico-Faciale, HEGP, AP-HP, Université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France
| | - H Mirghani
- Service d'Oto-rhino-laryngologie et de Chirurgie Cervico-Faciale, HEGP, AP-HP, Université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France
| | - P Giraud
- Service d'Oncologie-Radiothérapie, HEGP, AP-HP, Université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France
| | - O Laccourreye
- Service d'Oto-rhino-laryngologie et de Chirurgie Cervico-Faciale, HEGP, AP-HP, Université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France
| |
Collapse
|
2
|
Reid-Agboola C, Klukowska A, Malcolm FL, Harrison C, Parks RM, Cheung KL. Comprehensive Geriatric Assessment for Older Women with Early-Stage (Non-Metastatic) Breast Cancer-An Updated Systematic Review of the Literature. Curr Oncol 2023; 30:8294-8309. [PMID: 37754517 PMCID: PMC10528736 DOI: 10.3390/curroncol30090602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/24/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND A previous systematic review by our team (2012) undertook comprehensive geriatric assessment (CGA) in breast cancer and concluded there was not sufficient evidence to instate CGA as mandatory practice. SIOG/EUSOMA guidelines published in 2021 advocate the use of CGA in breast cancer patients. The aim is to perform an updated systematic review of the literature. METHODS A systematic review of studies published between 2012 and 2022 that assessed the use of CGA in breast cancer was performed on Cochrane, PubMed and Embase. RESULTS A total of 18 articles including 4734 patients with breast cancer were identified. The studies covered four themes for use of CGA in breast cancer: (1) to determine factors influencing survival (2) as an adjunct to treatment decision-making (3) to measure quality of life, and (4) to determine which tools should be included. There was evidence to support the use of CGA in themes 1-3; however, it is uncertain which assessment tools are best to use (theme 4). CONCLUSIONS CGA can be used to determine factors affecting survival and quality of life in breast cancer patients and can therefore be used to aid treatment decision-making. Further work is required to determine gold standard CGA.
Collapse
Affiliation(s)
- Chantae Reid-Agboola
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham NG7 2UH, UK; (C.R.-A.); (A.K.); (F.L.M.); (C.H.); (R.M.P.)
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK
| | - Anita Klukowska
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham NG7 2UH, UK; (C.R.-A.); (A.K.); (F.L.M.); (C.H.); (R.M.P.)
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK
| | - Francesca L. Malcolm
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham NG7 2UH, UK; (C.R.-A.); (A.K.); (F.L.M.); (C.H.); (R.M.P.)
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK
| | - Cora Harrison
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham NG7 2UH, UK; (C.R.-A.); (A.K.); (F.L.M.); (C.H.); (R.M.P.)
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Ruth M. Parks
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham NG7 2UH, UK; (C.R.-A.); (A.K.); (F.L.M.); (C.H.); (R.M.P.)
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK
| | - Kwok-Leung Cheung
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham NG7 2UH, UK; (C.R.-A.); (A.K.); (F.L.M.); (C.H.); (R.M.P.)
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK
| |
Collapse
|
3
|
Messaoud M, Vercherin P, Chanelière AF, Mottet N. [Geriatric assessment and treatment of nonmetastatic muscle-invasive bladder cancer in patients over 75 years of age. Retrospective and multicentric study of 121 cases]. Prog Urol 2022; 32:419-425. [PMID: 34998681 DOI: 10.1016/j.purol.2021.12.003] [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: 02/01/2021] [Revised: 11/04/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of our study was to assess prevalence of geriatric assessment (GA) in patients over 75years with nonmetastatic invasive bladder cancer (MIBC). MATERIAL AND METHODS We performed a retrospective study between 2000 and 2015. We assessed comobidity by Charlson score and ASA score, geriatric assessement (GA) and treatments. RESULTS One hundred and twenty one patients were inclued. Median age was 81 (73-95) at diagnosis. Thirty nine patients (32%) were evaluated by GA, G8 screening tool was performed in 16% of patients. Patients without GA were older (82 vs. 81years) and had less comorbidities (Charlson≥2 à 61% vs. 69%). Seventy-four percent of patients received a curarive therapy: 60% were treated by RC, 9% by chemoradiotherapy, 26% received palliative therapy and 15% were only in observation. CONCLUSION Patients with MIBC over 75years were less evaluated and less treated. Patients in pallative care received mostly observation. Although practices have improved, GA was underused. Care of these patients needs standardization in order to adapt therapeutic to their comorbidities and to treat them with curative intent. LEVEL OF PROOF 4.
Collapse
Affiliation(s)
- M Messaoud
- Service d'urologie, hôpital Nord, Centre hospitalo-universitaire de Saint-Étienne, Hôpital Nord, Saint-Priest en Jarez, France.
| | - P Vercherin
- Service de santé publique et information médicale, Hôpital Nord, centre hospitalo-universitaire de Saint-Étienne, hôpital Nord, Saint-Priest en Jarez, France
| | - A-F Chanelière
- Service de gériatrie et gérontologie clinique, Hôpital de la Charité, Centre hospitalo-universitaire de Saint-Étienne, Saint-Étienne, France
| | - N Mottet
- Service d'urologie, hôpital Nord, Centre hospitalo-universitaire de Saint-Étienne, Hôpital Nord, Saint-Priest en Jarez, France
| |
Collapse
|
4
|
Obesity survival paradox in cancer patients: Results from the Physical Frailty in older adult cancer patients (PF-EC) study. Clin Nutr 2019; 38:2806-2812. [DOI: 10.1016/j.clnu.2018.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 11/28/2018] [Accepted: 12/07/2018] [Indexed: 11/21/2022]
|
5
|
Mongiat-Artus P, Paillaud E, Albrand G, Caillet P, Neuzillet Y. [Evaluation of the elderly patient with cancer]. Prog Urol 2019; 29:807-827. [PMID: 31771766 DOI: 10.1016/j.purol.2019.08.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To explain the notion of frailty, then to explain how crucial is the detection of frailty detection in the elderly patient, and, in cases of suspected frailty, how crucial is the need for geriatric assessment. To describe (i) how this assessment of the elderly cancer patient is performed, (ii) how the results of this geriatric assessment must drive the decision making, and (iii) the role of the geriatrician in the care pathway. METHOD Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific geriatric societies, from the National Cancer Institute using the following keywords: elderly, geriatrics, cancer, frailty, assessment, decision making. RESULTS The goal of frailty detection is to optimize care, to maintain the independence and the survival of the patient. The prevalence of frailty increases with the age and the diagnosis of cancer. Detection of frailty in the elderly patient with cancer is performed using the G8 questionnaire recommended by the INCa. In case of anomaly or clinical justification, the patient receives a geriatric assessment, which is a multidimensional and multidisciplinary procedure. The clinician can call on the UCOG of the region in which he practices. The relevance of medical decisions will be based on the results of this geriatric assessment. The geriatrician plays a crucial role and will be involved throughout the care. CONCLUSION The detection of frailty in the elderly patient with cancer is obligatory. Consecutive geriatric assessment can be performed by the UCOG of the region. The results of the geriatric assessment must serve as a basis for any therapeutic decision making and the preservation of the independence of the patient must remain the priority.
Collapse
Affiliation(s)
- P Mongiat-Artus
- Inserm UMR_S1165, service d'urologie, unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université Paris Diderot, université de Paris, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
| | - E Paillaud
- EA 7376 épidémiologie clinique et vieillissement, service de gériatrie, unité d'onco-gériatrie et UCOG - Paris-Ouest, hôpital européen Georges-Pompidou, université René-Descartes, université de Paris, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - G Albrand
- Service de gériatrie et UCOG - IR, AuRA Ouest-Guyane, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - P Caillet
- Service de gériatrie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94000 Créteil, France
| | - Y Neuzillet
- Service d'urologie, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| |
Collapse
|
6
|
Yamada SI, Hasegawa T, Okuyama K, Yamakawa N, Okura M, Hashidume M, Yanamoto S, Akashi M, Kirita T, Umeda M, Kurita H. Clinical significance of the G8 screening tool in elderly patients with oral squamous cell carcinoma. Clin Oral Investig 2019; 24:1953-1961. [PMID: 31410674 DOI: 10.1007/s00784-019-03056-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The present study investigated the clinical significance of the G8 screening tool in elderly oral squamous cell carcinoma (OSCC) patients using a multicenter analysis. MATERIALS AND METHODS The medical records of 438 primary OSCC patients aged 75 years and older were retrospectively reviewed. To examine the clinical significance of the G8 screening tool in elderly OSCC patients, self-reliance (SR) rates and prognostic factors were statistically analyzed. RESULTS The mean score of the G8 screening tool was 10.9 ± 2.93. The SR cut-off value of the G8 score was 9.5 in a receiver operating characteristic curve analysis. Five-year overall survival rates were 40.1% in patients with a G8 score < 9.5 and 58.4% in those with a G8 score ≥ 9.5 (p < 0.01). Five-year cancer-specific rates were 34.3% in patients with a G8 score < 9.5 and 55.7% in those with a G8 score ≥ 9.5 (p < 0.01). Five-year SR rates were 40.7% in patients with a G8 score < 9.5 and 55.3% in those with a G8 score ≥ 9.5 (p < 0.05). A multivariate analysis identified an advanced age (≥ 80 vs < 80; HR, 1.437; 95%CI, 1.181-1.843; p < 0.01), poorer ECOG-PS (2-4 vs 0-1; HR, 1.560; 95%CI, 1.14-2.106; p < 0.01), and standard treatment (non-standard therapy vs standard therapy; HR, 0.598; 95%CI, 0.405-0.910; p < 0.05) as significant independent prognostic factors for SR. A lower G8 score was associated with poorer SR (≥ 9.5 vs < 9.5; HR, 0.765; 95%CI, 0.575-1.034; p = 0.081). CONCLUSION The clinical significance of the G8 score for elderly OSCC patients was demonstrated and its combination with ECOG-PS may be useful for assessing their prognoses.
Collapse
Affiliation(s)
- Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Okuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuhiro Yamakawa
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Masaya Okura
- The 1st Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Masao Hashidume
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| |
Collapse
|
7
|
Chlorogenic Acid Inhibits BAFF Expression in Collagen-Induced Arthritis and Human Synoviocyte MH7A Cells by Modulating the Activation of the NF- κB Signaling Pathway. J Immunol Res 2019; 2019:8042097. [PMID: 31240234 PMCID: PMC6556285 DOI: 10.1155/2019/8042097] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/01/2019] [Accepted: 04/10/2019] [Indexed: 11/22/2022] Open
Abstract
B cell activating factor (BAFF), a member of the tumor necrosis factor (TNF) family, plays a critical role in the pathogenesis and progression of rheumatoid arthritis (RA). Chlorogenic acid (CGA) is a phenolic compound and exerts antiarthritic activities in arthritis. However, it is not clear whether the anti-inflammatory property of CGA is associated with the regulation of BAFF expression. In this study, we found that treatment of the collagen-induced arthritis (CIA) mice with CGA significantly attenuated arthritis progression and markedly inhibited BAFF production in serum as well as the production of serum TNF-α. Furthermore, CGA inhibits TNF-α-induced BAFF expression in a dose-dependent manner and apoptosis in MH7A cells. Mechanistically, we found the DNA-binding site for the transcription factor NF-κB in the BAFF promoter region is required for this regulation. Moreover, CGA reduces the DNA-binding activity of NF-κB to the BAFF promoter region and suppresses BAFF expression through the NF-κB pathway in TNF-α-stimulated MH7A cells. These results suggest that CGA may serve as a novel therapeutic agent for the treatment of RA by targeting BAFF.
Collapse
|
8
|
[Non-programmed hospitalization of elderly patients with cancer: Which care pathway?]. Bull Cancer 2019; 106:293-303. [PMID: 30827485 DOI: 10.1016/j.bulcan.2018.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/03/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Management of elderly patients with cancer is challenging worldwide. Improvement of their care pathway should focus on unplanned hospitalizations. This study aimed to compare the geriatric and oncologic profiles of elderly patients with cancer, hospitalized for an acute pathology either in medical oncology or acute geriatric medicine units. METHODS Epidemiological, analytical, monocentric, transversal study performed in the geriatric and oncological short-stay units of the university hospital of Poitiers (France) from 07/01/2014 to 06/30/2015. Only patients with diagnosed cancer prior to hospitalization were included. The geriatric, oncological and hospitalization data were collected and analyzed. RESULTS In total, 230 patients were included (156 in geriatrics, 74 in oncology). Alteration of the general condition was the most frequent reason for admission. In multivariate age-adjusted analyses, factors associated with admission to a geriatric unit were co-morbidities (OR=0.18 [95% CI: 0.07-0.46], P<0.01) and dependence (OR=0.07 [95% CI: 0.01-0.36], P<0.01). Ongoing antineoplastic treatment (OR=2.60 [95%CI: 1.14-5.89], P=0.02) and metastatic cancer (OR=2.63 [95%CI: 1.18-5.86], P=0.02) influenced hospitalization in the oncology unit. During the hospital stay there was more frequent psychological support in oncology (OR=45.59 [95%CI: 9.79-212.23], P<0.01) and social support in Geriatrics (OR=0.13 [95% CI: 0.04-0.40], P<0.01). CONCLUSION This first comparative study showed a significant difference in profiles of elderly patients with cancer hospitalized for an acute problem, depending on the hospital unit. This finding paves the way of improvement of care pathway by formalizing links between these two departments to optimize care and referrals to the most appropriate care unit, according to patients condition, in case of unscheduled hospitalization.
Collapse
|
9
|
|
10
|
Pamoukdjian F, Ferreira A. [Risk assessment in medical geriatric oncology]. SOINS. GERONTOLOGIE 2019; 24:19-21. [PMID: 30765081 DOI: 10.1016/j.sger.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The assessment of risks in medical geriatric oncology requires close collaboration between oncologists and geriatricians. Vulnerability, death and severe chemotoxicity during cancer treatment represent the main risks to be assessed before making a decision regarding treatment in elderly patients with cancer. A comprehensive geriatric assessment and predictive scores enable a multidimensional assessment of the elderly cancer patient to be carried out.
Collapse
Affiliation(s)
- Frédéric Pamoukdjian
- Service de médecine gériatrique, Hôpital Avicenne, Hôpitaux universitaires de Paris Seine-Saint-Denis (HUPSSD, AP-HP), 125 rue de Stalingrad, 93000 Bobigny, France; Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), 94000 Créteil, France.
| | - Alzira Ferreira
- Service de médecine gériatrique, Hôpital Avicenne, Hôpitaux universitaires de Paris Seine-Saint-Denis (HUPSSD, AP-HP), 125 rue de Stalingrad, 93000 Bobigny, France
| |
Collapse
|
11
|
[Geriatric assessment and prognostic scores in older cancer patient: Additional support to the therapeutic decision?]. Bull Cancer 2017; 104:946-955. [PMID: 29150094 DOI: 10.1016/j.bulcan.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/25/2017] [Accepted: 10/03/2017] [Indexed: 01/10/2023]
Abstract
Cancer is a disease of the elderly as demonstrated by the epidemiological evolution of Western countries. Indeed, two third of cancers newly diagnosed occur over 65 years. However, older cancer patients have been often excluded from clinical trials in oncology and the extrapolation of cancer treatments in this population remains difficult in practice. Scientific societies recommend that a comprehensive geriatric assessment (CGA) be performed in patients aged 70 and over and selected using screening tools for frailty such as the G8 index. The CGA allows to detect aging-related vulnerabilities in various domains (comorbidities, polypharmacy, autonomy, nutrition, mobility, cognition, mood, social) and associated with adverse outcomes during cancer treatment (reduced overall survival, perioperative complications, toxicity-related chemotherapy). The CGA is allow to elaborate a personalized treatment plan in geriatric oncology. However, to date, no algorithms based on CGA is validated to guide therapeutic decision in geriatric oncology. The collaboration between geriatrician and oncologist remains essential to elaborate an appropriate therapeutic strategy and limit the situations of over- and under-treatment. This article presents the set of tools and scores used in geriatric oncology to guide the therapeutic decision.
Collapse
|
12
|
Diagnostic performance of gait speed, G8 and G8 modified indices to screen for vulnerability in older cancer patients: the prospective PF-EC cohort study. Oncotarget 2017; 8:50393-50402. [PMID: 28881570 PMCID: PMC5584139 DOI: 10.18632/oncotarget.17361] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/03/2017] [Indexed: 02/03/2023] Open
Abstract
Background The diagnostic performance of tools used to screen vulnerability in older cancer patients varies widely. We assessed the diagnostic performance of gait speed (GS) for assessing vulnerability in such patients. Methods All consecutive outpatients 65 years and older were referred for geriatric oncology assessment (GA) before a therapeutic decision between November 2013 and April 2016 in a bicentric observational and prospective cohort study. Vulnerability was defined as impaired score on at least one of the 6 domains of the GA. GS and the G8 index and G8 modified index were assessed at the first geriatric oncology visit during the GA. Sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratio were estimated. The accuracy of the three tools was analysed by the area under the receiver operating characteristic curve (AUC). Results Among 269 included patients (mean [SD] age, 81.3 years [5.9]; 55% women, 94.4% solid tumors; 39.4% with metastasis), 252 (93.7%) had impaired GA. With the GS threshold of 1 m/s, sensitivity was 79.4% (95% CI, 73.8-84.2), specificity 64.7% (38.3-85.8), and AUC 82.0 (74.0-90.0). The corresponding values for the G8 index were 90.1% (85.7-93.5), 35.3% (14.2-61.7), and 79.0 (70.0-88.0) and G8 modified index were 89.3% (84.8-92.8), 64.7% (38.3-85.8), and 84.0 (74.0-92.0). Conclusions GS < 1 m/s with a single measure could be used as a new screening tool for detecting vulnerability in older cancer outpatients. This first external validation of the G8 modified index was very good.
Collapse
|